After Mma left, I sat thinking. It all started coming back to me. It must have been like eighteen months ago or more that Mma and her children had come to register at the surgery having recently moved into the area from Africa.
She had told me then that they had come overseas due to her husband’s job. He worked with one of the oil companies, she said, and he had been posted abroad for four years.
She was a linguist with excellent command of Chinese and German and was hoping to get a job teaching these in one of the academies. A very pleasant woman, I recall thinking.
Her children were aged twenty-two, twenty and seventeen. The first had been due to get married in a few weeks.
Dike came to register almost six weeks after his family came. He had only come because his boss had insisted he needed to be registered with a surgery while in the UK. A complete waste of time, he told me.
He fidgeted while I went through my new patient’s routine. I was used to men feeling that coming to see the doctor was unnecessary.
Blood pressure check. Height check. Weight – a little overweight but nothing that a bit of exercise wouldn’t shift.
“Do you smoke?”
“Just when I am out in the rigs.”
“How many a day?”
“Ten sticks a day.”
“Have you ever considered stopping?”
“Maybe one day,” he glanced at his wristwatch. “Are we done now?'”
“Almost. I would like to offer you testing for blood borne viruses like HIV, Hepatitis B and C.”
“Why?” he asked surprised.
Would you have HIV and Hepatitis tests even if you believe you are not at risk??
Mma looked at me her eyes filled with tears. She was so overcome with emotion that she could hardly speak. I had to look down as I felt my own tears gathering behind my eyelids. I must remain professional. I must not get drawn in.
“Doctor, are you sure? Are you sure this is my result? Could there be a mistake?”
I swallowed the lump in my throat. I had seen this scenario many times and it never gets easier.
“I am sorry, Mma. This is the second time we’ve done it and it’s still positive.”
“But how could that be?” she burst out. “How could I be HIV positive? I am married! I don’t sleep around.”
She stopped again as the tears gathered, her shoulders shook as she cried, so broken, so devastated by the information I had just given her.
I had tried to be as gentle as I could. I’d given the usual warning shot and let her know that I had no good news for her. But still, no matter how we prepare patients to receive the news, it’s never easy to hear that you have HIV.
I swallowed back the words I was about to speak. Decided to allow her time to cry. After a while, she raised her head.
“Doctor, please tell me, how could I be HIV positive? I was brought up to be well behaved. I met my husband when I was a virgin. I never so much as showed any man my pants before then. And in twenty-four years of marriage, I have never slept with anyone else, apart from my husband. So how could this be?”
“There are several ways of contracting HIV. We would have to look and see how this might have happened. Sleeping with someone infected with HIV is one way of catching it. But there are other ways.”
“Well, for instance, if you’ve ever had a blood transfusion that was contaminated with HIV…”
“I’ve never had a blood transfusion.”
“Injected drugs before?”
“Okay, so those are out. Another way would be if you were accidentally pricked with a needle that had the virus on it…”
She paused as she gave it some thought.
“No, I haven’t ever had any injections. I had immunisations as a child but that wouldn’t have caused it, I don’t think.”
“Okay,” I replied. “Another way will be if for example…” I paused. It is never easy talking about sensitive issues like infidelity. I cleared my throat and continued: “if for example your partner has slept with someone who has HIV or if he ever received blood contaminated with HIV.”
She looked at me. Her eyes widened as realisation dawned on her. Then she asked in a quiet voice. “Do you think I may have got this from my husband?”
“I have no idea. You know best what may have happened.”
She looked away.
“I never imagined I would be HIV positive. I thought it only happens to people who are careless and have no morals. But not to me – I’ve never done anything wrong…”
She started crying again.
“Perhaps we could meet up in the next few days and talk about what you want to do.”
“Yes.” She shook her head, lost in grief.
Stay tuned as we follow Mma on her journey with HIV.
Do you know that, as current figures stand, an estimated 1 in 32 black women in the United States will be diagnosed with HIV in the course of their lives?
• How are our Black sisters getting HIV?
• What should we be doing to change the statistics?
Massive thanks to all who participated in our poll on contraception. Your involvement makes your feelings clear and once we know what our feelings are, we can change them in positive ways. Never forget that you have a voice and ‘We must be the change we wish to see in the world’ – Gandhi.
So please watch out for the next poll and take part in it. The result of the poll is given below in a bar chart -a picture speaks louder than many words!
The majority of the respondents, 64%, felt it was a woman’s duty, 32% felt it was a man’s duty and just 5% felt it was the doctors’ duty to sort out the issue of contraception. None of the respondents thought that a mother-in-law or father-in-law had any say in the matter, thankfully!
This is the traditional view and holds no surprises.
But I beg to differ!
With soaring abortion rates and unprecedented levels of sexually transmitted infections including HIV/AIDs, I lay the issue of contraception squarely at the Man’s door!!
Check out some statistics:
Of all the women living with AIDS, 64% are estimated to be Black women!!
AIDS continues to be the leading cause of death for black women aged 25-44(greater than death caused by heart disease, cancer and homicide!!)
Men, the time for ‘Bang, bang and bye’ has passed.
I challenge men who know they have a sexually transmitted infection to ‘PUT ON A CONDOM’ and protect their partners.
I challenge men who know they engage in risky sexual behaviour to ‘GET TESTED FOR HIV AND HEPATITIS ANUALLY’ at the barest minimum.
I challenge men who no longer want to have children to ‘GET STERILIZED’ and help beat down the soaring abortion rates and high levels of unplanned pregnancies.
I challenge men who are approached by young girls to ‘REFUSE SEXUAL INTERCOURSE’ with these vulnerable girls and encourage the girls to go back to their studies and make something of their lives.
I challenge men who no longer want children to stop and ask their partners ‘WHAT CONTRACEPTION ARE YOU ON?’ and if you don’t get a satisfactory answer, take time to find out why and if need be, come to the family planning clinic with the lady. Statistics show that women take the issue of contraception seriously if their partners are involved in the decision.
As usual, you can comment below. Feel free to share this with your network and help make a difference.
“No doctor, I really don’t want to go down the condom route. There is just no way I could rely on condoms again. So please, as he doesn’t want to be sterilised, just tell me what I need to do to get sterilised. I’m the one who has gone through the abortions and the child bearing. I think I am the one who will have to provide a solution to this since he is not willing,” she ended, gesturing at Baako.
“Eh..I didn’t say I am not willing. I’m just….”
“It’s okay, don’t worry. You can keep your manhood,” said Amina.
“Female sterilisation is getting your tubes tied and that means that when an egg is released from your ovaries, it cannot meet up with a sperm that has traveled up the vagina. If the egg cannot meet the sperm, no pregnancy can result.”
“How do you tie the tubes then?” asked Baako. “With a belt or what? Sorry, just asking,” he laughed when Amina threw him a scathing look.
I noted how relaxed he was now the pressure was off him.
“There are two ways of doing it. We could make tiny cuts on your tummy and, through them, find your tubes with special cameras and then cut and tie them or use clips to occlude them. That way you will only have very tiny scars. They’re barely visible. The other way is by passing special flexible tubes up your womb from your vagina. A tiny spring is inserted into each fallopian tube which then occludes the tubes. Both methods are very effective in preventing pregnancy. I must add that these are permanent methods of contraception.”
“So what if we want to have more children?” Baako asked.
“More children!? What are you saying? I thought we had agreed to stop?”
“Eh…but you never know…we may change our minds…”
“Then this method is not for you,” I replied.
“Doctor – please carry on,” said Amina.
“As I always say: ultimately the decision is yours and we are just here to help. Hopefully you can both decide on a method that is mutually acceptable. Sterilisation does carry a small risk of failure. If that happens and a woman falls pregnant, then it’s likely to be an ectopic pregnancy. That’s a pregnancy in the tubes rather than in the womb.”
“You hear that!” exclaimed Baako.
“It’s a very small risk. I must add that there are many women who have had ectopic pregnancies who have never been sterilised. One last thing – sterilisation can be reversed but it’s not always successful.”
“Doctor, I’ve thought about it and that’s what I’d like to do. What do I have to do next?”
“No!’ said Baako. “I don’t want you to get sterilised.”
“What!” Amina was annoyed.
“Yes doctor, what do you call a woman who is sterilised? A man?”
“What worries you about your wife going forward with this procedure?” I asked gently.
“It’s just so permanent eh! And also won’t it affect…”
“Affect what?” Amina asked.
“I don’t know… please let’s go back to condoms. Doctor, you were going to tell us about condoms. Just tell us about that. Forget all these permanent methods. I don’t want to hear about them.”
“Okay, then, let’s talk about condoms.”
Baako and Amina had already decided that their family was complete, which was why he wanted Amina to have an abortion. What do you think about Baako’s attitude? Why does he oppose his wife’s sterilisation?
WHO figures for female sterilisation are as below:
Dominican Republic 47%
South Korean 24%
Just like male sterilisation, the concept of female sterilisation is yet to be established in Black communities.
Should we be promoting it??
Consider that the maternal mortality rate (i.e the number of women who die at childbirth) is 840 out of every 100,000 live births in Nigeria and 790 in Zimbabwe compared to 12 in U.K.
The issue of unplanned pregnancies must be tackled.
As usual, your thoughts are welcomed. Feel free to comment below. If you found this useful, please share with your network by clicking the relevant button below.
Thanks to those who have sent in comments 😀 We absolutely love to hear from you!
In the UK, the organisation that regulates doctors (called the General Medical Council or GMC for short) recognises that some doctors may have a conscientious objection to some procedures, such as abortion. The GMC’s guidance is clear: whatever a doctor’s beliefs may be, the doctor MUST signpost patients to where they can get the help they require. So even if the doctor has conscientious objections, they have to send you to someone who will help you. This must be done without delay and in a non-judgemental manner.
So I directed Amina to colleagues who ensured that she got what she wanted.
She was back with her husband, Baako, to see me the following week. This time, she was determined that the issue of contraception must be sorted.
“I’m never ever going to have another abortion. I think two is enough!”
“Okay. So what do you want to use?”
“Well…” She shuffled her feet as she thought it over.
“I’m not going to be sterilised,” her husband cut in, “so forget that.”
Amina looked at him angrily. “What’s the matter with you? What are you afraid of? We’ve got the number of children we want, why don’t you get sterilised?”
“Why should I be the one to be sterilised?” He shot back.
I decided it was time to make a suggestion. “Perhaps you can tell me what you are worried about and we can talk about it.”
“Look doctor, this is what makes a man a man! I cannot go and be castrated like a dog or a bull: I am a man!”
“Okay,” I said, trying not to smile. I saw Amina roll her eyes in exasperation.
“Any other concerns?”
“Besides, it’s just these Oyibo people that introduced all these things. How would a man open his mouth and tell his kinsmen that he is sterilised? How would that sound, doctor? How would that sound?”
“I see. Anything else?”
“Are these not enough reasons, doctor? And besides…”
“Yes, go on…”
“Yes!” Amina chipped in. “Tell the doctor, tell her!”
“He is afraid that the children and I may die.”
“I don’t mean it like that! Shut up woman! But doctor, you know what I mean… supposing something happens to my wife and children, what will happen to me then, eh? Does it mean I will not then have the capacity to impregnate a woman again?”
“I hear all your concerns and will take them one by one. Let’s start with the first one.’
“You said that this is what makes a man, a man… Well, I think there is more to a man than being able to impregnate a woman. I guess you are worried about your erection and being able to make love to your wife. I want to reassure you that sterilisation does not affect that ability at all. When you are sterilised, your tubes are tied but the penis is not affected and you should still have a strong erection and achieve penetration with your wife. Do you understand?”
“Are you sure, doctor? You know you people say one thing and then do another thing.”
“I assure you that your normal erection and sexual drive is not affected when you are sterilised. In fact some women enjoy sex more because they are not worrying about getting pregnant.”
“Okay, if you say so.”
“Your other concern was about what people will say. Yes, it’s still a foreign concept and not one that everyone understands or agrees with. So it might be best to keep it to yourself. You don’t have to tell anybody what goes on in your bedroom. It’s not their business, is it?”
“Besides, something foreign doesn’t have to be evil. Remember that Mary Slessor came and stopped the killing of twins in black communities. It was a foreign concept among our people who felt that twins were evil. But we know now that she was right. So sterilisation is foreign to our culture but that does not mean it is wrong.”
“Okay. What of my third concern?”
“Well, you wondered what may happen if your wife and children should die.”
“What if you die, eh? Why must it be the children and I who die?” Amina interjected.
“Well, I understand your concern,” I answered Baako, “and again, this fear is rooted in our culture. In the past, we had many children because many of them died from diseases and poor living conditions. We had twelve, sixteen and even twenty children and in the end perhaps five survived. But now, things have improved. So if you follow that same mentality and have ten children, you may find that ten of them survive. So one shouldn’t have many children out of fear that some of them might not survive. It doesn’t work like that anymore. Does that answer your question?”
“Yes, okay. I will think about it but I still prefer condoms…”
“Eh… but condoms failed us,” said Amina.
“Whose fault is that?”
“Perhaps we should talk about condoms just to balance things up and see why they failed?” I asked.
My discussion with them concerning condoms and how to use them correctly and consistently will follow soon. Please stay tuned and dont forget to tell your friends (and foes!) about the blog 😉
So what are your own thoughts about sterilization? Have you or your husband been sterilized? How did it go? Do you regret your decision? Or is it the best thing that has happened to you? What will it take for you to be sterilized?
This time, I was pleased to see that she’d brought her husband with her. Studies show that if men are involved in making decisions about contraception, the women are more likely to continue with the method jointly chosen and are more tolerant of side effects. So ladies, take your husband along with you to the family planning clinic if you can.
After they both sat down and we finished with the pleasantries, the husband said: “I came so I can see this doctor who is suggesting adoption to my wife.” He was angry. “How could you even suggest such a thing?”
I gave Amina my best what-have-you-been-telling-your-husband look. I was taken aback.
“How would she carry the pregnancy? Everybody will see her pregnant and then what will we say to people when there is no baby in the end?”
‘I won’t let anyone know I am pregnant…’ Amina ventured timidly.
‘Indeed, when you start spitting all over the place, how won’t people know? And when the tummy starts showing, what would you say is inside there? Food?’
I stifled my laughter.
“We were just discussing possible options to abortion,” I explained. “I do the same with any woman who presents for an abortion; but of course the ultimate decision lies with you and we are here to help whatever your decision. I just try to make sure you’ve thought things through.’
I could see him visibly relax as I explained.
“Abortion is not like having your tooth taken out, you know.”
“Okay, I see,” he said, his voice quieter.
“All this wouldn’t have happened if she’d been more careful,” he continued gesturing at Amina.
“Me?!” Amina recoiled at the accusation. I could see tears forming.
“How do you mean?” I asked.
“’Doctor please tell her she needs to ensure she doesn’t keep getting pregnant. Even little girls of 16 years know how to not get pregnant.”
“What do you think you could do to help the situation?”
“Me?”’ He was thrown by my question. “But this is her responsibility. She is the one getting pregnant.”
“Have you ever considered getting sterilised?”
“What?! First you talked of adoption, now you are saying sterilisation! Surely you don’t understand our ways even though you are one of us. A man doesn’t get sterilised.”
“Okay, I look forward to discussing that at another time with you but, for now, let’s hear what you’ve decided to do about this pregnancy.”
“Abortion of course.”
I looked at Amina to get her consent. “Yes doctor, we will go for an abortion,” she said quietly.
“So what do we do next?” She asked.
I shall be discussing what happens on the next blog so be sure to click the follow button so you don’t miss out.
What do you think about male sterilization?
Consider these statistics from the World Health Organisation (WHO) 2013 on contraceptive use. The percentages using male sterilisation for different countries are as below:
South Africa 0.7%
It’s obvious that the concept of male sterilisation hasn’t taken root among black communities.
Should we be promoting male sterilisation? What do you think is the reason why black men do not go for sterilisation even when they are sure their families are complete?
A warm welcome to today’s post! I trust you have had a great time since the last blog and that you are already inspired to take positive measures towards better sexual well being.
Why not let other black sisters know what new steps you’ve taken. Drop a comment in the box below and you can also let me know if there are any burning sexual health issues you would like to discuss.
One of the commonest things ladies ask me about is contraception. Once I have been introduced to a woman and she learns that I am a doctor, the very next chance she has, she pulls me aside and say ‘Oh doctor, I have been meaning to see someone about this, please what contraception should I be using?’
People want answers to medical issues that they face daily and that is a good thing. The more informed we are, the more equipped we are to make positive choices.
This blog looks at sexual health issues. Make sure you click the ‘follow’ button so you don’t miss out on any posts.
She found herself with an unplanned pregnancy and had come to the family planning clinic to request an abortion. This happens only too frequently.
We had established that Amina used condoms sometimes and nothing at other times. We will be focusing on condom use in a later post… so watch out!
“So how would you want to proceed from here?” I asked, gently.
“What else can I do, doctor? Abortion is my only option! We couldn’t possibly afford a fourth child,” her eyes brimmed over with tears again.
“How would you feel if I mentioned some option?”
“Like what, doctor?” “What are your thoughts about adoption?”
“What! Have the child and then give it away? God forbid!” She exclaimed. “Our culture does not support adoption…You should know that, doctor,” she ended reproachfully.
“Well, more and more black families are choosing to adopt children, especially those who can’t have their own kids,” I replied with a smile.
“I really don’t know about that. I don’t think I could go down that route, doctor. Any more options?” She asked hopefully.
“What about keeping the pregnancy?”
She shook her head slowly and gave a loud sigh. “We can’t afford another child, really. But I will discuss adoption with my husband and see what he thinks.”
“Ultimately the decision is yours and we are here to help. It’s only fair I highlight other options to you and you can let me know what you decide to do. Shall I see you back in two days or a week’s time?”
She booked an appointment for a week’s time.
When faced with an unplanned pregnancy, what do you do? Many black communities see adoption as something foreign and that means that option is not even considered in many cases. Should we encourage more adoption? What are your views?
What other options are there to abortion? What would you put in the fourth small circle on the left? Remember: the whole point of this blog is to prevent you from getting to the point where you face an unplanned pregnancy in the first place. Effective use of contraception will help this.
Amina came back to see me a week later. I am sure you would want to know what she decided to do so please stay tuned.
Its one of those issues that confront women at one time of their lives or another. It just wont go away! Atleast not while sex continues 😉
Many ignore it at their peril. Others barely tolerate it as a necessary evil.
Where do you stand?
Consider my discussion with Amina below (name changed to protect patient’s confidentiality).
Amina looked at me, her eyes filled with tears.
“I need your help, doctor, I’m pregnant again.” She paused as though the fact still amazed her, as if she was hearing the news for the first time.
I waited patiently as she fought with her emotions. When she started to speak again, the words tumbled out of her in a rush.
“It’s my fifth pregnancy, doctor… we had planned to stop… we really can’t afford another baby… I don’t have a job and my husband’s company is making people redundant so we are not sure of his job either…”
She grabbed the tissue I held out to her and dashed it to her eyes.
“I feel terrible. I had an abortion just four months ago.
“It’s… We… I just can’t have another baby.” The tears overflowed again.
When the storm had calmed, I gently enquired what contraception she was using.
“We use condoms… Sometimes.”
“At other times?”
And then: “Nothing,” she confessed.
“I just didn’t think it would happen again so soon, doctor.”
The statistics speak for themselves!
Consider the fact that in 2011, in England and Wales, 49% of black women having an abortion had a previous abortion. This is well above the national recurrent abortion average of 36%.
Black women are ignoring contraception with resulting serious consequences. Unplanned pregnancies, soaring abortion rates, HIV/AIDS, Hepatitis and other sexually transmitted infections continue to rule the day.
We must stop and take stock of where we are, Black sisters. Together let’s explore our issues and begin to make changes that will bear fruit.
My blog is committed to informing and equipping black women with the skill and knowledge they need to make positive decisions concerning their sexual health. I encourage black ladies to:
Make the right decision for themselves concerning Contraception and Reproductive Health care.
Knock down Unintended Pregnancy and Abortion rates
Avoid early teenage Sexual activity and Teenage Pregnancy prevention
Encourage testing for Human Immunodeficiency Virus (HIV), Hepatitis B and C
Ensuring that early diagnosis of the above infections result in effective treatment and therefore better health for the affected.
Join me as we take this journey. Stay tuned to the blog as I am sure you would love to know what Amina decided to do. Don’t forget to leave a comment as I would love to hear from you (Yes! Your opinion matters!). Like the page on facebook (Why not spread the news?). Follow the blog so you don’t miss any juicy bits.