A WAVE OF VERY YOUNG BABY-MAMAS /BABY-DADDIES IN SOCIETY

 

Jasmine* walks in , tears and confusion is evident from the look in her eyes . I take a quick history, she is in her early 20s , had a caesarean delivery 8 months ago and now is surprised that she has not seen her menses for 1 month and wants me to investigate for a hormonal imbalance . I ask her if she is sexually active currently and she bluntly denies; last sexual contact was before her baby was born . She is not on any family planning method . I  take more history , I ask her to allow me do a pregnancy test first and she refuses . She is in my office for investigation and treatment for hormonal imbalance and I should stop going round for baseless tests. I still proceed and do a serum pregnancy test as I ordered for other blood tests; she didn’t understand that the wording of the test still meant a pregnancy test but not the usual routine urine test . Surprise , surprise , the test was positive . So after all the missed menses were due to a an early pregnancy . Ultrasound doesn’t show much other than a bit of a thickened uterine lining . I break the news and diagnosis but she is annoyed that I didn’t respect her refusal for a pregnancy test . She breaks her own theory that the positive test could be from effects of the delivery 8 months ago ; there is no scientific plausibility to this unless we are dealing with a BHCG producing tumor which would have been picked on imaging anyway. She insists on this fact and wants medicine to ‘clean her up’ and get rid of this positive hormonal test and return her menses. I go into full Reproductive Health expert mode and enquire about any possible rape and she is confident that nothing of that nature happened. I call my secretary and ask her to hold the queue to enable me take time with my patient . I make a final diagnosis of an early pregnancy approx. 4 weeks gestational age . I refuse to issue any medications other than pregnancy supplements . She is not happy with me but finally blunts out ‘Doc wewe unajua vile baby-daddy ni stress half sasa niongeze baby-daddy mwingine kwanza mwenye hataki hiyo story?’.  To me this was in itself a confession of a recent unprotected intercourse . We start talking . I ask her why she is not on family planning and she tells me that she fears that family planning is not good for an unmarried woman and that she fears that it may affect her future fertility . I dismiss these as myths and explain to her on efficiency of family planning and go deeper on what may compromise fertility and family planning is definitely not one of the causes . She still denies the pregnancy and I warn her about dangers of abortion if she decides to take that illegal route. Fast forward , I gave her a return date after 4 weeks in which as expected we had a bouncing 8 week fetus on ultrasound . 

Then I remembered Rhodah, a tiny university student  . She came in with her boyfriend . Again had very irregular and missed menses mainly contributed by the very frequent use of emergency pills. They had been together for 2 years and in all this duration , has never been on a family planning method other than the abuse of the e-pills.  They told me that they normally pray before intercourse that they hopefully do not conceive ; Kwani Maombi is a F.P method ? Maajabu !!.  This time I also insisted on a pregnancy test which gladly came back  negative . I counselled them on the dangers of unprotected intercourse  , dangers of abuse of the e-pill and asked Rhoda if she was ready to be a baby-mama because this was  definitely loading . She still expressed fear over regular longterm family planning despite the counselling ; I really wanted her to leave the office with a method in-situ but sadly she refused . The emergency pill not only causes disturbed hormonal balance but can also fail and cause a pregnancy : studies have shown that a failed e-pill significantly increases the risk of ectopic pregnancies which unfortunately can lead to the loss of a fallopian tube or be life threatening if not caught early . 

Unfortunately women take the brunt of the burden and a lifelong irreversible consequences of unplanned pregnancies. Men don’t have much to lose especially in a country where child support is hardly enforced . They go on with their studies , jobs and even marry easily in the future. Can one sue a jobless student for child support ? 

Whenever I have teenage clients, I promptly kick their parents out . 70% open up on unprotected interrcourse and express discomfort in taking up reversible long term family planning  methods. ( this is very legal in Kenya without parental consent as long the teenager is sexually exposed). Of course at this age , abstinence is emphasized over and above any family planning method. 

Abstinence is best as always for all young women  ; no one ever died due to lack of intercourse . It protects against unplanned pregnancies , HIV/AIDS, STIs(which can cause permanent tubal blockage and infertility), HPV and in essence future cervical cancer  and mental stress/indignity . I’m very sure that no mother would proudly announce that their 20 year old is unmarried and sexually active . I recently cringed watching a national TV interview of a very young man openly discussing his sexual relations with the very young girlfriend who was in studio at the time; I wondered how her parents felt , how her future husband would take this ( I may need to style up and catch up with later generations 😀; niwache ushamba ).

The other alternative in a young couple ‘unable’ to abstain would be to to take up constant barrier method i.e condom use or reversible longterm family planning methods like the non-hormonal intrauterine device (coil) , implants , injections or the daily pill. These young-ins want methods that cannot be seen by their parents or their church elders so we get into this and settle on a favorable one for an individual . They must remember that contraceptives don’t protect against infections and HIV. 

Family planning methods do not cause future infertility; it is risky sexual behaviors that cause this. The IUCD doesn’t cause pelvic inflammatory disease or tubal blockage: it’s exposure to infections like Chlamydia and Gonorrhea that cause this leading to tubal factor infertility . It’s important to note that the return to fertility is immediate with family planning methods like the IUCD and the combine oral daily pill unlike the notion in the public domain that return to fertility may be affected. The depoprovera injection may have a longer return to fertility but this can be managed . See your gyanecologist for detailed F.P talk or watch my prior you-tube videos for more details . 

So we have a long way to go to remind our youths about abstinence and to demystify myths about F.P amongst young unmarried women : until we do that we will continue to encounter the scourge of unwanted pregnancies and complicated parenting called Baby-Mama/Baby-Daddy issue because our young ones are engaging in sexual relations at very young ages before they can be mature enough to marry/settle.  Pregnancy is just one of the side effects as I had discussed earlier . 

This remains a very controversial topic but an important one nonetheless. Let’s keep the talk going . ABSTAIN or RUBBER-UP or TAKE UP F.P. Young girls , how much sacrifice are we willing to make to please men who will only be in our lives very temporarily or for a season ? 

P:S* - Jasmine* and Rhoda* are hypothetical cases bases on so many true scenarios I encounter , this is not a true story of particular individuals