Why the contraceptive failure rate is high

How effective is this method? Will I have weight gain? Will it interfere with my fertility? These are some of the questions posed to doctors before a woman chooses a contraception method. During the World Contraception Day last year, the Ministry of Health highlighted that contraceptive prevalence rate among married women had risen to 58 per cent, from 46 per cent, in the last decade. This increase in use of contraception is behind the reduced fertility rate — from 4.6 to 3.9 children per woman in the same period.

But still 30 percent to 50 percent of pregnancies are unplanned. A survey done by the Ministry of Health estimated that 41 percent of unintended pregnancies end up in abortion.

Some contraceptive options give 99 percent effectiveness if and only if they are correctly adhered to. That is, if a pill has to be taken every day, skipping days or weeks makes the method less effective.

A study conducted in Homa Bay County recorded a contraceptive failure rate of 18 per cent. The top four in the failure list were the natural rhythm method, with 38 per cent, followed by pills at 30 percent, injectables with 17 percent and withdrawal at 15 percent. The failure rate was mostly attributed to challenges with adherence to the contraception option and inappropriate use.

Depo Provera injectable

How common: 47.9 percent (most common)

How it works: You get an injection every three months. It contains progestin, a hormone that blocks ovulation. It also builds up mucus at the opening of the cervix to deter movement of sperm.

Best not used by: Women who have not yet had children. The injection may have a six to 12-month delay in return to fertility, as users continue to experience the effects of the hormone until it is cleared from the body.

It may fail... if more than 13 weeks pass between injections. You could become pregnant.

The implant

How common: Second most common.

How it works: Lasts for three to five years. The implant is inserted under the skin by a professional. It slowly releases progestin in the blood and the hormone prevents ovulation.

It may fail… if you have sex before it takes effect. It takes up to seven days for it to start working.

Pros: Fertility returns as soon as the period of effectiveness elapses or it is taken out.

The daily pill

The pill is available in two types, the combined pill (estrogen and progestin) and the progestin only pill.

How it works: The progestin only pill can work by hampering sperms’ movement or preventing ovulation, while combined pill prevents ovulation.

It may fail… if you do not comply with the rules. Some need to be taken at specific times every day, and if you skip a day, effectiveness goes down. It has 99 percent effectiveness with proper compliance.

Please note: “Generally, all estrogen-containing contraceptives are not suitable for hypertensive women since they have a small risk of blood clots,” says Clinician Lucy Luvuno.

Intrauterine Contraceptive Device (IUCD)

How it works: It can be effective for five to 10 years, with a cumulative likelihood of pregnancy at 1.7 percent.

How common: The copper bearing device is the most commonly used IUCD in Kenya, compared to the hormonal alternative.

How it works: The copper rod releases copper ions into the uterus, making the fluids in the uterus and Fallopian tubes inhospitable to sperm.

Pros: It is immediately reversible and lacks hormonal side effects. It does not interfere with ovulation and can be inserted immediately after childbirth.

Best not used by… “It is not recommended for women with uterine fibroids, as fibroids may continue to grow and dislodge the device,” says Ms Luvuno. Additionally, women with multiple sex partners may have an elevated risk for pelvic inflammatory disease with this method.” They may also affect a woman’s period flows within the few weeks post insertion.

Natural family planning methods

Includes: Abstinence, withdrawal, lactation amenorrhea method (LAM) and calendar methods.

Natural family planning can be up to 99 percent effective if all instructions are adhered to. However, one has to monitor fertility signals, which include body temperature and cervical fluids for at least six months to get a good grasp of it.

They may not work if… There is no discipline on the part of partners. The calendar method may be influenced by changes in diet, weather, and stress levels to cause a difference in the menstrual cycle.

Hormonal birth control and weight gain

Weight gain is one of the most common concern for people considering hormonal contraceptives. It could be a good enough reason to opt out for some. Research studies show that high levels of estrogen increase appetite and fluid retention. However, hormonal birth control methods have been modified to contain a hormone combination or estrogen levels low enough not to cause weight gain. What most women notice is not actually fat gain, but rather additional weight due to water retention. Age and metabolism are also a factor. Decreasing metabolism due to age could be the reason affecting the body’s ability to burn calories.

When hormonal contraceptives are not recommended

Hormonal contraceptives are not recommended for women who are battling breast cancer, smokers, women who suffer from migraines or those who have blood circulation problems. Intrauterine devices, abstinence and barrier methods can be the most suitable in such cases.

Data sourced from Family Planning 2020 and the Kenya Family Planning Policy document.