The IUD or intrauterine device, more commonly referred to as the ‘coil’, tends to scare less-informed women as a birth-control technology. In a July 2013 study of 20 women from Karachi’s Shah Faisal Colony, the responses ranged from fear of the sight of it because it looked “dangerous” to fear it would hurt their husbands to the unfounded risk that it would ‘rust’ inside their body.
“People used to tell me that… when it rusts from inside it will produce fungus inside the uterus and obviously fungus will be converted into cancer,” said one woman, Shaista.
The study was based on in-depth interviews with the women, between 23 and 45 years of age, who were asked questions after they were shown the IUD, injectables and oral contraceptive pills. Only four said they used the IUD. “Many who commented were less familiar with IUDs, and several expressed hesitation about inserting a foreign object into the body,” states the study.
These women and others like them could be told that women around the world have been using the IUD for more than 30 years. Till 2006 it was known as the most commonly used reversible method with one in five (or 153 million) married women choosing it. The risk of infection is less than one percent. After it is removed, women have no trouble getting pregnant.
The study also found that the injectable contraceptive method was the most popular, as seven out of 20 women preferred it.
The women had certain perceptions about the pill. Some felt they were weak or less potent because they were so small. The belief was that the larger the pill, the greater its effect. They also felt that the lighter the colour of a pill, the “gentler” it was.
The researchers found that all the women associated contraceptives with a “heating” effect. “Obviously, they [contraceptive injections] are heat-generating,” said Nasreen. “They may be burning the blood.” It turns out that as the menstrual cycle can change, depending on what contraception is used, the women felt that if there was less blood, it was being “burnt” in the body.
The hot-cold concepts of medicines and the body or certain foods originates in the Hippocratic humoural medicine that spread via Arab influence. Western medicine is seen as ‘heating’ while Ayurvedic medicines are ‘neutral’, in reference to the speed with which they act and have an effect on the ‘blood’.
The researchers found that most women wanted family planning, but were not entirely comfortable with their experiences of contraceptive use. “Widespread concerns about adverse health consequences act as a barrier to the adoption and continued usage of contraceptives,” suggests the study.
The results of this study, conducted by Kamyla Marvi of the Leadership Development for Mobilising Reproductive Health and Natasha Howard of the London School of Hygiene and Tropical Medicine, suggest that a better understanding of women’s concerns and explanatory models could help health providers do a better job.
“The findings provide explanatory models from women themselves that could, with further research, inform health messages and family planning counseling, strengthening programmes in Karachi and potentially elsewhere in Pakistan,” concludes the study. T
*Names have been changed
Published in The Express Tribune, Sunday Magazine, August 18th, 2013.