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Target for contraception: Male, female

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A long-standing debate or question has been ‘who is the most appropriate for contraception the male or the female? Supporters for the male to be the person to bear the brunt of contraception have argued that the female has borne the brunt for too long. It is the woman who gets pregnant, carries it for nine months, has labour and delivery sometimes at the expense of her life. Writes PROF JOSIAH MUTIHIR

AFTER that, she has sleepless nights meeting the demands of the new baby breastfeeding, changing nappies, bathing the baby sometimes many times;during the day and the night. The mother stays awake during the night until the baby falls asleep. The woman also does the home chores, takes care of the big baby (husband), and takes care of other children when they are there. The woman, yes, mother, well done Ma.

I have seen a powerful video clip in circulationwhichhas been viral.To quote the wordings of the video clip: “One man can impregnate 9 women every day for 9 months. That is 2,430 pregnancies in 9months. One woman can only get pregnant once within 9 months even if she sleeps with 9 men a day for 9 months. That is only one pregnancy. So clearly, the society is putting the birth control responsibility on the wrong gender. Science is so busy making pills and hormone altering devices on the wrong person, meanwhile the culprit is known and on the loose”. This implies that the culprit is the man, and that he should be be-labored with contraceptive methods and not the woman!The sentiment portrayed here is shared by this writer.

The statement appears to be by a woman, and a young woman for that matter. If she is married, may be for only a few months or years. Women married for longer periods think differently though. In a focus group discussion in Jos in the late 1980s among womenrequesting for female sterilization, the women preferred the methodon themselves rather thanon their husbands. They were so protective of their husbands that even the person conducting the focus group discussion was taken aback. They realized the man was the key player in sexual intercourse and therefore did not want, in a figment of their imagination, anything to happen to their husbands. If the man loses his sexual capacity (testes), the couple has had it, while the same is not the case if the woman ‘loses’ her ‘sexual capacity’ (ovaries).

In science, the man for now has 5 possible intervention points while the woman has 7 intervention points for fertility regulation. In addition, the woman has 2 hormones (estrogen and progesterone) which can be manipulated while the man has one (testosterone). The manipulation of 2 hormones appears easier than one hormone. To be specific, manipulation of the male hormone appears to be a delicate process to play around with. Increase in the male hormone level in the man could lead to a ‘super male’ with severe sexual urge that could tip the man into exaggerated male sexual behaviour. This can get the man into trouble difficult to dis-entangle. A decline in the male hormone (testosterone) could theoretically lead to inability to perform in the man or impotence. This I am sure will cause a nightmare to both the woman and the man. Thus, the male methods are few, namely abstinence, coitus interruptus, the use of male condom, both reversible, and the permanent or irreversible method, vasectomy. Research is ongoing for the expansion of male contraceptive methods that have no direct bearing on testosterone levels.

The woman has 7 intervention points including the manipulation of the female hormones (estrogen and progesterone). The manipulation of the female hormones either way has no severe consequences or adverse effects on her.

Another issue worth mention is the fact that it is the woman that has all the discomfort associated with pregnancy, from vomiting in early pregnancy through myriads of challenges during the pregnancy, labour and delivery and also in the puerperium and may be beyond. Maternal mortality is a possibility in as many as 512 women dying per 100,000 livebirths in Nigeria. The man has none of the above-mentioned problems. An anonymous saying has it that if the man were to get pregnant and deliver, all families would have at most 3 children. The man would cajole the woman to start. He would then have a go at it and keep the woes to himself. The woman would then have a go,the second round. When the woman is through and it comes to the man, the response by the man would be an emphatic ‘not at all’!!

The woman has the vagina, a receptacle for the man’s semen and spermatozoa. Fortunately, many methods can be used here like the spermicidal agents (medicaments that directly kill spermatozoa), the female condoms, the vaginal contraceptive rings and the vaginal diaphragms. The woman also has a cervix (mouth of the womb), for which devices can be placed to block spermatozoa from accessing the entrance into the uterus. The hormonal contraceptives also act directly on the cervix, altering its mucus, making it hostile to the passage of spermatozoa through it to the uterus.Another intervention site is the uterus where a baby usually grows. Devices, mainly the intrauterine contraceptives can be placed here. The copper bearing devices directly kill spermatozoa that get into the uterus. The hormonaldevices inhibit ovulation, interfere with sperm transport through the uterus, and the hormonal portion of the device also thins the endometrium altering support for the spermatozoa passing through the uterus. The fallopian tubes are also intervention sites. They allow transit of both the spermatozoa, ova and fertilized ova. This action can be blocked using various methods to preventtransport, fertilization, and pregnancy in the woman.The ovaries produce hormones and release mature ova (ovulation) andcan be prevented from ovulation through a feedback mechanism from the hypothalamus and anterior pituitary gland. However, endogenous production of estrogen and progesterone are maintained or sustained but at a lower level.

The hormonal contraceptive hormones and breastfeeding act on the hypothalamus and anterior pituitary gland to prevent the ovaries from ovulating through a negative feedback mechanism.

The female therefore has more intervention sites and methods used in these sites are inconsequential to her. Side effects are mild and transient. The woman also has numerous methods to choose from if she does not do well on one.

It is therefore obvious that the women folk ab-initio were favoured by nature for contraceptive methods. At creation, they were endowed with God’s birth control measures in addition to more intervention sites which science has capitalized on. The exigencies of pregnancy, labour and delivery have prompted the women to be willing partners in the contraceptive business. Surprisingly, women themselves have preferred to offer themselves for contraceptive methods instead of their partners, as if they knew that men have fewer options!!

The men however have to contend with their roles as men. They are heads of religious, political, traditional, cultural, community groups, etc,thus being gatekeepers at these points of engagement.Men can therefore be important influencers or supporters of women, advocate for family planning among their peers, act as role models, and use methods themselves (be clients),where applicable, or where theirpartner is unable to use a method. Men therefore require and should be provided with correct information about family planning by service providers to help them make better decisions about their health and that of their partners.

The women must be commended for their bravery in championing the use of contraception. They are already sacrificing and doing a lot for the survival of their homes! I personally doff my hat to them. Bravo our loving Women!!!!

Josiah Turi Mutihir is a Professor of Obstetrics and Gynaecology

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