Oluwatosin( Tosin) Onibokun, MD
Resident in OB/GYN BWH/MGH Combined Residency Program
With one of the nurses on
the labor and delivery ward
Being born and raised in Nigeria till the age of 17, going back for my research elective during my 3rd year as an OB/GYN resident was in line with part of my future goals to be involved and contribute in a positive way to the health care system in sub Saharan Africa. I chose to focus on studying the attitudes, knowledge and practice of health care providers towards providing reversible long -acting contraception- particularly intrauterine contraception devices (IUDs), to adolescents, young and unmarried women in one of the major teaching hospitals in Nigeria.
As an OB/GYN resident, I realize how challenging it can be to provide adequate contraception to women both in developed and developing countries. Nonetheless, I believe providing adequate contraception for women is a way to empower women to achieve their economic, educational, social and personal goals and potential, therefore this was a topic I was excited to explore within the Nigerian context.
With two of the senior residents at the morning review
On commencing my research experience at the University College Hospital( UCH), Ibadan, I was overwhelmed by how receptive and welcoming the study participants – OB/GYN residents, nurses and consultants (attendings) were. I was not sure of the kind of reception I would receive exploring a culturally and socially sensitive topic like providing contraception to sexually active teenagers in a relatively conservative culture like the Nigerian culture. However, my participants were very open and engaged with the study.
Without any proding whatsoever on my part, many of them discussed their own personal opinions with me about the use of reversible long acting contraception like (IUDs) in young women as they filled out the anonymous and confidential questionnaires. One of them shared an anecdote of a teenage woman that was a post partum patient in her ward and how her pregnancy may have been prevented with adequate contraception while another expressed concern about how the use of long-acting contraception could promote promiscuity among teenagers. Listening to the lively discussions that usually ensued among the participants served as encouragement to me on how important this topic is.
Those discussions also further confirmed to me that, although the topic of contraception for young women is usually “ the elephant in the room”, people are potentially open to a dialogue about it - dialogues that I think need to take place in order to improve access to effective contraception for young women.
Clinical experience at the University College Hospital (UCH):
Hall- way at the Family planning clinic at the University College Hospital
While at the University College Hospital (UCH), I had a chance to observe clinical work at the family planning clinic.
I was impressed by the major role the nurses played in the counseling and provision of contraception to women. Contrary to the norm in the United States, insertions of reversible long acting contraception were managed by the nurses at the family planning clinic (including placement and removal of contraceptive implants and intrauterine devices) with doctors available for back up as needed (which appeared to rarely happen).I think the training and empowerment of nurses in this area is very laudable and the right step towards expanding adequate contraception.
Of note, all reversible long-acting contraception ( IUDs and implants) provided at the family planning clinic at UCH are fully funded by the Nigerian Urban Reproductive Health Initiative (NURHI), which is a project funded by the Bill and Melinda Gates Foundation with the goal to eliminate the supply and demand barriers to contraceptive use in Nigeria, a very laudable and inspiring goal. The patients only pay a nominal fee to pay for the cost of syringes, needles and local anesthesia. This highlights to me the role of philanthropy in making an immense significant impact in the lives of people and nations.
I think the available funding explains why I saw more implantable contraception devices inserted into patients than I initially expected given their relatively high cost in the United States.
Posters in family planning clinic promoting contraception use as a form of child spacing
On the other hand, it was also interesting to note that the public awareness campaigns regarding contraception (with the exception of condoms) is skewed towards helping married women ensure adequate spacing between children and less as a way to prevent unwanted pregnancies in young unmarried women who are sexually active. This skew can be noted in the pictures that advertise contraception use. However, I think it is important to modify this rhetoric so that young women, married or not and parous or not, can have equitable access to effective contraception.
In summary, it was a great learning experience to observe the efforts at improving access to contraception in a Nigerian setting, a cause I hope to continue to be involved in as an OB/GYN.
Oluwatosin( Tosin) Onibokun,
OB/GYN Resident PGY 3
BWH/MGH Combine Residency Program