Alex Kiwanuka says that emergency contraceptives, often referred to as morning-after pills, are the most commonly used contraceptive (as compared to non-emergency contraceptives). Kiwanuka works with the youth at Reproductive Health Uganda, and his observation could be representative of this demography. However, when he talks about the ways in which we abuse or misuse contraceptives, it isn't only the youth he talks about.
A number of contraceptive users are guilty of abuse or misuse and below, we sample some of the most misused contraceptives and the possible effects this could have:
These can prevent pregnancy when taken within 120 hours of unprotected sex or where a contraceptive has failed (say a condom breaks) or has been misused, according to the World Health Organisation.
Morning-after pills not for abortion:
The first mistake people make in using emergency contraceptive pills is thinking they are abortion pills. "Some pregnant girls come asking for them, hoping they will help them abort," Kiwanuka says, adding: "Emergency contraceptives prevent pregnancy; but they cannot be used to abort".
Some girls have expressed the fear that their babies could be aborted because they used emergency contraceptives unaware they were pregnant but according to the World Health Organisation, an abortion will not occur when one uses emergency contraceptives while pregnant.
Neither will their babies or the mothers be harmed, as far as available evidence shows. According to Kiwanuka, women who try to abort using emergency contraceptives, end up having psychological distress from the failed abortion and carrying an unwanted pregnancy, among other consequences.
"The recommended dose for emergency contraceptives is one dose per menstrual cycle," Kiwanuka says.
"However, you find people taking more than one".
He explains that a single dose of emergency contraceptive pills is equivalent to the 28 normal-use contraceptive pills. "If you take more than one dose [of emergency contraceptives] during one menstrual cycle, you are over-dosing," Kiwanuka says.
However, according to the UK's National Health Services, some emergency contraceptives, say Levonelle, may be used more than once in a single menstrual cycle.
The World Health Organisation, however, discourages regular use of emergency contraceptives - they are not as effective in preventing pregnancy as non-emergency contraceptive methods. Among the side effects of over-dosing on emergency contraceptives is an irregular menstrual cycle.
Waiting till late:
Kiwanuka says some girls wait a month before looking for emergency contraceptives. And yet these are effective only within 120 hours (five days) of unprotected sex. According to the WHO, emergency contraceptives are only effective if taken soon after having unprotected sex.
Non-emergency contraceptives pills:
Non-emergency contraceptives prevent pregnancy and they include combined-hormonal and progesterone-only pills. Even with these, Kiwanuka says, people make a number of mistakes, some of which are listed below.
Thinking any type can do:
"Women come in here and say, give me that one; it has worked for my neighbour yet they may not be suited to that particular type," Kiwanuka says, stressing,
"Anyone intending to use contraceptive pills needs to see a health-care provider to be guided on the best contraceptive for them. You cannot just go to the pharmacy and pick one".
He says high blood pressure patients may not be suited to a certain type of contraceptive pill and so may those on Anti-Retroviral treatment and certain medicines for epilepsies and those with liver problems, among others.
Individuals of certain body weights may also not be eligible for the Intra-Uterine Device (IUD). As such, it is recommended that one seeks guidance from medical personnel before choosing a non-emergency contraceptive pill.
These are supposed to use progesterone-only pills, according to Kiwanuka, because unlike the combined-hormonal type, they do not hinder milk production.
Using pills for more than 84 days:
If a woman uses combined-oral contraceptives, barring the usage of the iron pills (the maroon-ish/red-ish ones), she may stop her period. Research has shown that using this method to stop one's period is safe and Dr Dan Kaye, a gynaecologist at Mulago hospital agrees.
But if a woman chooses to stop her period this way, it is recommended that she uses her contraceptive pills for 84 days thereafter taking a break so as to prevent breakthrough bleeding -spotting or bleeding between periods- that may be experienced with continued usage of contraceptive pills.
Condoms should not be stored in wallets or in over-packed bags where they can be compressed and destroyed.