Enab Baladi – Hassan Ibrahim

Hanaa al-Muhammed (a pseudonym for social reasons) suffered in the past months from adverse side effects of various contraceptives that she tried, despite her body’s rejection of them. She tried these methods to please her husband.

The 27-year-old woman underwent an IUD insertion at a free health center in Idlib due to the high cost of private clinics. However, she had to remove it after ten days due to severe pain and heavy bleeding caused by the displacement of the IUD.

The IUD is a small, flexible, T-shaped plastic device inserted into the uterus to prevent pregnancy and regulate childbirth.

“The IUD was embedded, and if left for a longer period, it would have required a dilation and curettage operation,” the gynecologist told al-Muhammed.

Afterward, the woman started taking birth control pills, which caused tremors and a significant increase in blood pressure. She stopped taking them according to the doctor’s instructions, who informed her that it could have endangered her life as the pills did not suit her body’s nature.

The doctor advised that birth control methods were not suitable for al-Muhammed due to her young age and the irregularity of her hormones after her repeated pregnancies without sufficient rest in the previous years. Therefore, the appropriate solution for her condition, as the doctor told her, was the condom. However, her husband refuses it “because it affects sexual pleasure,” as she quoted him.

Women in Idlib face pressure from society if they consider not having children. This pressure is not only imposed by males but also by fellow women themselves.

Some believe that a woman’s femininity is fulfilled through childbirth without defining the family’s structure and the number of its members. Meanwhile, women suffer negative symptoms from their repeated pregnancies and have difficulty raising their children in a disadvantaged living situation.

Some women seek ways to ensure their safety to stop or delay childbirth. However, these methods are not freely available, and their random use can harm their health.

Physical consequences

Al-Muhammed said she was no longer able to conceive and bear with her exhausted body. During her previous pregnancy, she suffered from high blood pressure and a herniated disc in her back. The doctor advised her to have a long rest period.

Widad resides in the city of Idlib, north of Syria, and is Hanan’s mother-in-law. She refuses her daughter-in-law’s use of any birth control methods, justifying it by saying, “The child comes with their sustenance.”

Widad informed Enab Baladi that she has never used any birth control methods in her life, and she has only given birth to seven children, which she considers natural and appropriate, and hopes her son will be blessed with more children.

Mona al-Sadeq, a gynecologist, told Enab Baladi that the physician following the woman’s condition determines the appropriate contraception method based on her health, social, and financial situation and that it is not advisable to use some birth control methods like injections and pills without a doctor’s prescription to avoid any complications that may affect women’s health.

Al-Sadeq explained that there is no ideal method for birth control, and each method has both positive and negative aspects.

The doctor emphasized the necessity of using birth control methods because short spacing between births leads to a shortage of vitamins and iron in the mother’s body, in addition to psychological and physical changes that affect the fetus’s growth. Furthermore, the close births lead to an increase in bleeding that the mother may experience due to uterus rupture.

Al-Sadeq pointed out that there is no risk in using birth control methods, but every woman should use what suits her situation, advising women to space their births so that the body has enough time and to focus on the newborn. Each birth should be at least two years apart.

Reproductive health

Several medical organizations work on providing reproductive health services through their clinics spread across Idlib province. The Syrian American Medical Society (SAMS) oversees a number of hospitals specializing in obstetrics and gynecological diseases. A reproductive health clinic offers contraception methods and advice for free, according to Ilham Nisif Ratl, the reproductive health supervisor at SAMS.

The supervisor told Enab Baladi that the clinic provides the contraceptives available to it, which are proportional to the woman’s situation, but the response is uneven among women, owing to the different social status, awareness, and culture affecting the way women deal with this issue.

According to the supervisor, the clinic provides available contraception methods, which vary according to the women’s response due to social situations, awareness, and culture that affect women’s approach to this matter.

She also explained that customs and traditions force women to choose the method regardless of its negative effects, or they refuse to use contraception methods completely.

Contraceptives minimize health risks

The United Nations Population Fund (UNFPA) warned of about 257 million women around the world who do not use safe contraception methods despite their desire to avoid pregnancy, according to a report in March 2022.

The Fund attributed this to various reasons, notably myths and misconceptions in society, fear of side effects, and the inability to secure the cost of safe contraception.

According to statistics in countries where data is available, 57% of women are able to make decisions about their health and their sexual and reproductive rights, while 23% of women cannot refuse sex.

The World Health Organization (WHO) considers using contraception methods to prevent health risks associated with pregnancy, especially for teenage girls. It states that children born less than two years apart have a 60% increased risk of death. Those born within two to three years have a 10% increased risk compared to those born after a gap of three years or more.

The number of women interested in using family planning methods has significantly increased over the past two decades, from 900 million in 2000 to nearly 1.1 billion in 2021, according to the World Health Organization.

In the period between 2000 and 2020, the number of women using modern contraception methods increased from 663 million to 851 million, with an expected addition of 70 million women by 2030.

In 2022, the prevalence rate of contraception methods was estimated at 65% worldwide, and for modern methods, it was 58.7% for married or cohabiting women.

What does Syrian law say?

In a previous report by Enab Baladi, lawyers stated that Syrian law does not prevent “family planning,” especially on the subject of pregnancy and the use of birth control methods.

Legally, men cannot force their wives to become pregnant if they do not desire it, and they can file for divorce or divorce them directly.

Pregnancy is an agreement between the husband and wife, and in case of disagreement, divorce is the only legal option in this case.

Preventing women from making decisions about childbirth is a violation of their rights, as stated in the Convention on the Elimination of All Forms of Discrimination Against Women, agreed upon in 1979 by the United Nations General Assembly.

Article 16 of the Convention states that women have the right to determine the spacing period between their children and to have access to all means to do so, besides receiving sufficient education on this matter.

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Enab Baladi’s correspondent in Idlib, Shams al-Din Matoun, contributed to this report.