Disinformation as a control method

How much do users of Piura, Peru's health post family Planning service kknow about emergency oral contraception?

By Marco Paulini.

 

LANCONÉS, Peru -- Huasimal de la Solana belongs to Lanconés District, Sullana Province  and it is located 50 km northeast its capital city. Lanconés District limits by the North to Tumbés Department and ecuador, by the South to Sullana and Querecotillo Districts (Sullana), by the East to Las Lomas (Piura) and Suyo (Ayabaca) Districts, and by the West to Marcavelica District (Sullana).

It's sunny along the year. Poechos Reservoir has created a mycroclimate in the zone, that estimulates fog in the winter. In the rainy season, the village leaves isolated because almost all Lanconés is divided by creeks.

We are talking about ways for cars or donkeys, using in some places the creeks courses. Most people move on animals, motorcycles, by walking, an few by car. Getting communicated by phone is complicated but there is actual access to mass-media, like local newspapers or radio stations, national and neighbor ecuador's as well.

Huasimal de la Solana is 1068 inhabitants, it has a I-1 cathegory health post without internment, working 6 hours per day, between 8 am. to 2 pm.  I got here to study the knowledge level on emergency oral contraception (EOC) in users of health post's family Planning service between October and November 2016. After the Peruvian Government announced the releasing of this contraceptive method's distribution, I wondered what happened there in the countryside, where access to everything seems to be limited.

 

Are the women informed?
Non-wanted pregnancies continue carrying death, poverty and unequity, all this inside the unnecesary taboo the sexuality is seen. Non-wanted pregnancy turns on a complete problem when we talk about public health, and the situation is agravated when it becomes provocated abortion. Regarding to World Health Organization report, in 2000-ending, there were 4.2 million of clandestine abortions, which 5000 ended in woman's death. In Peru, it was estimated in 1 million pregnancies per year, 56% were non-wanted.

All this leads us to suppose that women population actions don't know about emergency oral contraception. If we become to determine it, we can take decisions to allow actions for the people to be informed on issues forming part of their sexual and reproductive rights.

Then, I look for determine the knowledge level about emergency oral contraception in users of Family Planning service. Specifically, I want to describe what is the knowledge level on sexual and reproductive rights, also determining what is the knowledge level about action mechanism of emergency oral contraception.

 

Prior sightings
Around my research there are interesting results priorly published. So, internationally:

• LEYVA A. ET.AL (2010), on the thesis "Emergency Contraception in Mexican Students" evaluated the knowledge about this issue in 14-to-24-year-old teenagers . The objective was evaluating this topic and linked factors in students. Just 45% got correct knowledge , 3% of sexually active students had used it, concluding the knowledge was scarce and what is necessary giving clear messages about this issue to teenagers.
• IDROVO V., GÓMEZ E. (2010) makes the thesis "Knowledge and use of emergency contraception" in female students of University of Cuenca's School of Nursery and Technology (Ecuador). It was found that 80% of asked women unknew the consequences of undiscriminated use and 90.8% referred never used this contraceptive method. It concludes the fourth part of asked females ignored the issue.
• ZEPEDA E., DEL CASTILLO., (2011) makes the thesis "Knowledge and use of emergency contraceptive pill" in students of Minatitlán Public High-School (Veracruz, Mexico). It is concluded that they ignored its active principle and mostly of them had heard about this method from friends and relatives but they ignored the active principle of the pill. It determined its consumption is moderated and most had used by lover's suggestion.

Across Peru:

• CHOQUE F. (2015)on his thesis studies knowledge and attitude of emergency oral contraception in interns of Arzobispo Loayza National Hospital's Human Medicine. He determined 17% had a low knoledge as 58.7% had a indecision attitude, while 21.7% had a rejection attitude. So he concluded the lnowledge level is very low even in Health's students as indecision attitude predominates.
• CARMONA G. (2008)'s thesis investigates knowledge and attitude about contraceptive among Dora Mayer High school's 3rd-year teenagers in Bellavista, Callao from August to September. He foun the 79% had wrong information , concluding the teenagers had wrong knowledge and negative attitude on contraceptives, including emergency oral contraceptive. He recommends education on contraceptive methodology on the syllabus.
• INPPARES (2008) makes an investigation to study characteristics of female users using emergency oral contraceptive in INPPARES bureaus in Chimboté and Lima, whichh objetive was determining demographic characteristics, cause and type of emergency oral contraception. It is concluded that EOC is a method that only is accesible for complete basic education or high education people, less education people had a low access. It is used by long-term couples, 20 years old or older, who can use a safer method for good. However, it is not used by the very indeicated people what could be the eventual couples and teenagers. Social-demographic characteristics of female EOC users are: high-school or higher education, students, 20 to 30 years old, long-term relationships. The person and reference mean for EOC usage was the lover in Chimboté case and a friend in Lima case. The main cause ofor usage was having an unprotected intercourse.

Across Piura Region:

• ULADECH CATÓLICA (2014)makes an article entitled "Knowledge on contraceptive methods in 3rd-year and 4th-year in Pedro Ruíz Gallo Military High-School's teenagers" in Castilla District between April and July, finding almost the half of the whole asked teenagers does not know about this issue. Unfolding such investigation, it's seen that 61% doesn't know how a hormonal contraceptive method works.
• Sullana (2015). An investigation called "Offered Levonorgestrel consumption" is made at a drugstore in Sullana District, Piura, between January and December. The main objective was evaluating the consumption, monthly and annual consumption of every commercial display as emergency oral contraceptive was determined, concluding the most consumed levonorgestrel commercial brand is Nogestrol 1,5 mg with 609 units, costing US$ 5.15 per box, amounting around US$ 3100. Annual total levonorgestrel consumption was 714 units and around US$ 3800*. It was paradoxically found that consumption of this contraceptive method is big in their different commercial displays , what realises us it's very accepted at least for who have a bold wallet, knowledge on its existence and maybe its action mechanism.

What I found
My study was quantitative, descriptive, non-experimental and transversal, which 35 women who used Huasimal de la Solana health post's family Planning Service between October and November 2016 participated.

I included women using family Planning service with at least one year of residence in the village, not matter age, civile status, number of sons and daughters (whether having tem or not), only if they agreed by writting to me. I excluded passenger women, with limited communication abilities, pertaining to any educational programme specialized on contraceptive methodology.

The majority were 20 to 29 years old, while minority were 40 years old or older. The most percentage of interviwed were non-married cohabitants.
80% doesn't recognize sexual rights as part of human rights, while almost a third part doesn't recognize the sexuality must be lived free.
Most think the parents must impose and choose who will marry their kids. More than a half believe only legal-aged guys must access to family planning methods. Most of interviewed think that teenagers can't decide about their sexuality.
Most than a half of interviewed opines it isn't necessary the teenager attends accompanied by parents or guardians to family planning service for receiving attention, and most than 80% opines teenagers don't have to be delivered with contraceptive methods.
Only 28% recognize having the right to choose how many kids she wants to have. It's close to the half the quantity of interviewed who ignore when pregnancy starts.
Most of interviewed ignore what the EOC action mechanism is, while only 17% know what it is. Asked about, the majority recognize EOC must be used when a contraceptive method was not used in the intercourse.
Paradoxically, 77% ignore EOC is a method that offers an alternative to raped women for preventing the pregnancy.
51.4% ignore that EOC must be used when contraceptive method which she is a user has failed or has been incorrectly used.
More than a half of Family Planning service users believe after-day pil use can be a routine.

Ignorance and friends
Ending the Analysis of gotten results onknowledge about emergency oral contraception in Huasimal de la Solana's Family Planning service users, We can conclude the following next:
- The results are similar to what happen abroad, nationally and regionally, about we can affirm it is few what is known regarding this issue.
- Concerning sexual and reproductive rights, the big majority doesn't know they have them neither, because it doesn't know the sexuality must be lived free, and that freedom implies to decide the number of kids they want to have. Also, they assume a vertical and rigid position about their kids' sexuality, considering the father and/or the mother are who must decide who must marry those kids. Add to this they opine under legal age teenagers mus not have access to family planning methods.
- Regarding EOC action mechanism, this study evidences it is almost ignored and negative attitude intensifies when makes sinergy when ignorance on the pregnancy's start. This gets up the woman assumes a reproductive role which it is not necessary to know about her body's physiology, and almost she waits for God's fate.
- When we talk about the situations in EOC can be used like an ally for preventing non-wanted pregnancy, the women don't take advantage this alternative because of simple ignorance.
It's evident the machismo culture (power of the strongest over the weakest) among they grew up wwwhen we talk about sexual and reproductive rights of teenagers. because the same mothers are who opine the teenager doesn't have decision on own sexuality. And if it's about attending to Family Planning service, they must go accompanied by their parents, and they don't have receive contraceptive methods. denying so the sexuality of the persons, not watching that many times those positions make the teenager not to be informed or do pregnant or get pregnant at early age.
We can affirm categorically there is a big ignorance in Huasimal de la Solana's women about emergency oral contraception, and this ignorance is just the lack of interest to rule about sexual and reproductive rights the Peruvian Government has been having. Add to this the Church's almost blaming position about sexual topics. No doubt, there is a lot of work to do.

(Based onan essay made during curriculum development at César Vallejo University's School of Medicine in Piura)
* Editors used a U.S. dollar per every three soles as an approximate currency for this story.

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