The New Nation - Internet Edition

Quamrun Nahar Ruma

Shahida Sultana, wife of an affluent bank official and mother of three, had been enjoying a good health until recently. Now she has started gaining weight abnormally. Reason: Taking of birth control pill for a long time.

"My man hardly uses condom. To him, it's nothing but a trouble. And I'm a woman. So, apart from performing many other responsibilities of the family, this is also my job to control birth," Shahida, in her late 30s, says.

A survey, conducted among 50 couples in Dhaka for this report, shows 17 of them have chosen pill as birth control measure, while eight used condom and 25 adopted none of them.

Among the 17 pill users, there is a couple where both the husband and the wife are doctors. The wife says, "In this male-dominated society, all the responsibilities fall on women's shoulders, even that of birth control. And there is nothing unique in my case. I'm also bearing the same burden."

According to Demographic Health Survey-2004 carried out by NIPORT, from 1991 to 2004, the use of condom was the least among the birth control methods.

The rate of its use was the same in 2004 as it was in 1991. During 1996-97, the condom use had marked a rise a bit, but it went down again. On the other side, the year 2004 had seen a larger use of oral pills compared to 1991. According to statistics of 2004, the use of oral pills was the highest among other contraceptive methods.

A global handbook for providers, jointly published by the Centre for Communication Programmes at John Hopkins Bloomberg Health and World Health Organization (WHO), shows that condom is the safest among all the birth control methods. This book has been published with research articles of doctors from different parts of the world.

According a WHO survey conducted in 1997, women become victims of health problems like high blood pressure, heart disease, liver complications, weight gain, ammonia, anemia, irregular period, headache, appetite loss and depression due to the use of the oral pills which are not suitable for health.

Samia Islam, a mother of two, is a college teacher. Her husband is also a teacher. Samia remains ill round the year for continuous use of pills.

She suffers problems like headache, vomiting and even irregular period. Doctors advised the couple to use condom. "Pill doesn't suit my body, but I can't make my husband understand the problem. He doesn't want to use condom for reasons unknown to me," she says. Not only Samia, most of the women using pills suffer from such side effects.

About the means to increase the use of condom, director of Family Planning Association of Bangladesh (FPAB) Halida Hanum says, "First of all, one-to-one communication needs to be increased. There should be a better understanding between husbands and wives.

A husband must have compassion for his wife. He should use condom considering that it has no side effect." She says the government should undertake various programmes to increase the use of condom among illiterate, less educated people and those living in rural areas, as surveys suggest the use of condom is very low among them.

Halida says women will have to be made aware about their rights. If so, a woman will understand that she too has the right to choose. Awareness will encourage women to discuss frankly about contraceptives and motivate their husbands to use condom.

Samina Chowdhury, a gynecologist of Dhaka Central Hospital, is critical of the mentality of men in this regard saying, "Due to domination of men, women have to take all the responsibilities that are hazardous. It's necessary to get men out of this mentality through counseling."

NIPORT research director Ahmed Al Sabir says there is a stereotype thinking among men. They think birth control is a woman-related issue. This attitude needs to be changed.

Referring to another important aspect, he says, "Most of the family planning workers are women. Naturally, they are approaching women more and talk about female methods. The number of male workers has to be increased. And, men will have to be informed that condom is the best among the birth control methods."

Dr Roushan Ara, head of gynecology department at Holy Family Hospital, emphasises the need for more and more campaign about condom through ads.

"The number of advertisements on condom is unusually fewer than that of pills. It needs to be increased on TV, radio, newspapers and magazines. Billboards will have to be used as much as possible," she says.

Dr Mahmuda Islam, assistant professor of Apollo Hospital's gynecology department, says there is a wrong perception among men that using condom one cannot have the complete sexual satisfaction. It has to go.

If this wrong perception can be corrected, men will be interested in using condom. Motivational activities are necessary to do that. And the government must play the leading role in this regard.

Halida Hanum says, "The use of condom is not a hormonal process. Since it is used externally, there is no side effect. And this is the safest birth control method. Many men think using condom they get less pleasure, as there is no skin-to-skin contact. Therefore, they don't want to use this method. This view has to be changed."