Rita Lama of Devichaur, Lalitpur started Depo-Provera, a birth control drug that is injected every three month, after the birth of her first child. Five years later her weight has doubled to 90kg. The staff at her neighbourhood clinic said the weight gain was caused by overeating and sent her off. The 32-year-old doesn’t want to use temporary contraceptives anymore because of the unpleasant side-effects.
For seven years Bishnu Kumari Tamang also from Devichaur had Norplant capsules implanted under the skin in her upper arm. But the mother of two switched to Depo-Provera because the capsules were causing irregular menstruation cycles and heavy bleeding. However, with the new birth control her periods completely stopped. When Tamang visited the district health centre, the staff laughed it off and told her that not having periods was the best form of contraceptive. “They didn’t even bother to find what was wrong and said it was not a big deal,” says Tamang.
Currently about 50 per cent of adult Nepalis use contraceptives. In its efforts to boost this number to 70 per cent in the next two years, the government set up the National Family Planning Policy Service in 2012. The goal is to make a wide range of birth control methods available to the general public as well as provide consultation and counseling services to couples and individuals. But most health centres only offer two types of drugs – injection or capsules – so women who experience severe side effects have no other option than to use what is available. And there are hundreds like Lama and Tamang who have no one to turn to for advice and are starting to abandon temporary contraceptives all together.
While irregular periods and sudden fluctuations in weight are the most common side effect of contraceptives, some women also experience nausea, headache, excruciating pain during menstruation, excessive vaginal discharge, and in extreme cases even amenorrhoea - the complete absence of periods. The misuse of contraceptives, however, is not only harmful to the body but results in unwanted pregnancies and further trauma caused by multiple abortions.
Senior gynecologist Bhola Rijal says the main problem in Nepal is that on the one hand a few pharmaceutical companies have a monopoly in the contraceptive market and on the other, women don’t have the resources to pick and choose birth control wisely. “Temporary contraceptives are being distributed in the same way as condoms. Women need to first check whether particular methods suit their bodies or not. Unfortunately there is a lack of qualified healthcare workers to help them,” he explains. “Family planning doesn’t only mean controlling the number of children, but also taking care of your family. But how can you do this when you are sick?”