Letters from TZ

Is it family planning or family culling?

Research has proven that the injectable contraceptive ‘Depo Provera’, has potentially fatal side effects. A study, which was published in the Lancet Infectious Diseases Journal, found a link between the contraceptive and HIV and Aids. The investigators established that women who used it doubled their risk of contracting HIV and passing it on to their partners.

The study found that the synthetic progestin (hormone that mimics progesterone) in ‘Depo Provera’ seems to cause changes in the vagina and cervix. It suggested that the progestin could increase the HIV’s ability to reproduce. In Tanzania, slightly more than six per cent of women who use contraceptives use ‘Depo Provera’.

In February this year, the World Health Organisation (WHO) concluded that women living with HIV or at high risk of HIV could safely continue to use hormonal contraceptives to prevent pregnancy. The recommendation followed what the organisation called a thorough review of evidence linking hormonal contraceptive use and HIV.

In a previous statement, WHO surmised that hormones “have other health effects for women, many of them beneficial, besides just preventing pregnancy.” They did admit that particular hormonal contraceptives, for example ‘Depo Provera’ may affect the health of women’s bones.

In 2004, Pfizer, Inc., the manufacturer of ‘Depo Provera’, submitted data to the Food and Drug Administration (FDA) in the US indicating that women using the contraceptive experience significant loss of bone mineral density (BMD). That same year, a study partly funded by the U.S. Agency for International Development (USAID) found that women using ‘Depo Provera’ have an increased risk of contracting Chlamydia and gonorrhoea. This notwithstanding, according to the Committee on Women, Population and the Environment (CWPE), USAID sends more units of ‘Depo Provera’ to Africa, than to any other part of the world.

The side effects of injectable hormonal contraception are numerous. They include breast cancer, osteoporosis and cervical cancer. ‘Depo Provera’ also prevents pregnancy for much longer than intended.

Other side effects can include severe allergic reactions, blood clots, chest pain, mental or mood changes, partial or complete loss of vision, severe dizziness or fainting, severe stomach pain, shortness of breath, slurred speech, sudden loss of coordination, sudden or severe headache or vomiting, swelling of fingers or ankles and weakness, numbness, or pain in the arms or legs.

Given that ridiculously long and potentially deadly list of side effects, injectable hormonal contraceptives may as well be the lethal injection. Unfortunately, the side effects of the other hormone based family planning methods are just as disturbing. Complications of long term use of hormonal birth control range from mild to severe and can include gallbladder disease, embolisms, resistance to insulin, immune system suppression, heart attack, stroke, breast tumours and liver cancers, ectopic pregnancies, blood clots and jaundice.

It was against this backdrop that the global Family Planning Summit took place in London on Wednesday last week. It was attended by President Jakaya Kikwete and co-hosted by the Bill and Melinda Gates Foundation and the UK Department for International Development (DFID). Technical support was provided by USAID and the United Nations Population Fund (UNFPA). Remember that USAID sends more units of ‘Depo Provera’ to Africa, than to any other part of the world. The aim of the Summit was to fund “family planning for an additional 120 million women in the world’s poorest countries” by 2020 and to “commit to sustaining coverage for the estimated 260 million women in these countries who are using contraceptives.” By the end of the day, rich countries had pledged 2.6 billion dollars to buy contraceptives for women in poor countries.

So. Was the Summit really about making women’s lives better by empowering them to take charge of their own sexuality? Are we really ‘treating’ maternal mortality by prescribing the same drugs that will eventually kill or injure millions of African women? Are contraceptives really one of the best investments a country can make in its future? The evidence would suggest not.

In early 2010, The Lancet published new research on maternal mortality and morbidity which showed that improvements in maternal health, a good indicator for women’s access to health services overall, depend on four key factors, only one of which has to do with contraception. They were: higher education levels for women and girls, rising per-capita income, access to skilled birth attendants and lower fertility (due to family planning).

All four of these factors have an impact on maternal death. Writing for the Huffington Post in an article titled, ‘The 2012 Global Family Planning Summit: Will Issues Be Adequately Addressed?’ Marianne Mollman offers an insightful perspective when she writes that, “All four drivers of healthy motherhood depend on women’s ability to exercise their rights to quality health care, non-discrimination in education and health, and economic empowerment through job creation and protections for equality in the workplace.”

It is not all about birth control; certainly not in the way the loudest voices would have us believe. In fact, it is more about big business and population control than anything else.

If more contraceptives are sold millions of lives will be saved. That’s the official position. But who benefits the most, given that maternal mortality is not linked to family planning alone? Is it the woman whose body has been battered by the side effects of long-term hormonal birth control use, or the pharmaceutical company that manufactures the drug? What is the endgame when it comes to man-made birth control methods? Is it to plan a family or cull a family of its members, starting with its unborn children and ending with the mother herself? I suppose a worse proposition would be to imagine that ‘family planning’ isn’t a pre-meditated agenda to forcibly control the population, but rather a reckless endangerment of the lives of millions purely for financial gain. Either way, women still have the right to choose natural alternatives to hormonal birth control methods. At the end of the day, the right to choose is all the empowerment we need.