BY CHOICE, NOT BY CHANCE

8 March 2017
Gynaecologist at the Primary Healthcare Centre Lukavica, doctor Natasa Djeric-Rakita ©UNFPA/Vanja Cerimagic

According to the United Nations Population Fund’s reports, investments in family planning could have a helpful effect on developing countries. As a result, women would live longer and healthier lives and the number of new-born deaths in the first year of life would be drastically reduced. “Modern contraceptive methods, as well as counselling, including availability and accessibility of birth control methods, are integral components of the family planning concept. The family planning concept is among the largest development and health achievements in the second half of the 20th century. So far, it has saved lives of millions of women and children. All women, couples and adolescents have a right to information and the means they will use to decide on whether they will have children, how many children, and when. Family planning helps individuals and couples to avoid unwanted pregnancy and to decide on the timing of birth and number of children. The world has to understand that family planning is an important and proper investment. Not only does family planning improve health and save life, but it also makes savings for health systems and the economy in general”, said Doina Bologa, the UNFPA Representative in BiH.

In 2015, UNFPA supported the training of doctors from all over BiH, among them 10 gynaecologists and family medicine doctors, who became certified trainers. Last year, 20 of them trained 156 family medicine doctors in family planning.

During interactive training, all participants took an active part in different sessions on ethical and public health aspects of family planning, and health-related policies, strategies and regulations focusing on family planning in BiH (RS and FBiH) as well as on organisation of family medicine teams and their cooperation with other healthcare workers.

The training included also presentations on sexual and reproductive health in life, counselling and decision making in the context of consultations on family planning, medical eligibility and effectiveness criteria for contraceptive use, as well as the forms and methods of contraception and the selection of contraceptives. Among the doctors who were the first to complete successfully the training and later trained other doctors is our interlocutor, gynaecologist at the Primary Healthcare Centre Lukavica, Doctor Natasa Djeric-Rakita.

 

REPRODUCTIVE HEALTH THROUGH INFORMATION AND PREVENTION

Adequate information is a key prerequisite for the exercise of women’s right to sexual and reproductive health and thereby for the exercise of the right to family planning.

The only proper way to obtain the relevant information is to have consultations with a family medicine doctor or a gynaecologist. Such talks and regular visits are oftentimes avoided because gynaecology visits, not only in small but also in larger communities, implies negative connotations and a wrong assumption that the reason for a visits is unwanted pregnancy or a sexually transmitted disease. 

“In some communities, a gynaecology visit is still a taboo”, said Doctor Natasa Djeric-Rakita. She believes that the only way to overcome such a pattern is education since early childhood and raising awareness about gynaecology visits being as necessary as dental visits. “If you visit a gynaecologist regularly, it will be painless. Otherwise, it can be uncomfortable”, said Dr Djeric-Rakita, who, working as a gynaecologist at the Primary Healthcare Centre Lukavica, has an insight into the habits of all female patients oriented to her healthcare centre. “One half of them are seeing a gynaecologist on a regular basis, the other half of them visit once in ten, even twenty years. There is almost no happy medium”, she said, adding that there are no rules regardless of the distance of the places they come from.

“The women who are used to having regular medical exams do come. Those who are not used, do not come, even if they live next to the healthcare centre. It does not still mean that they will visit regularly. It’s a matter of custom, culture and education. When I say ‘education’, I don’t mean school education as some rural women are my regular patients and teach their children to visit regularly. On the other hand, some highly educated women visit a gynaecologist only when they have a problem. Gynaecology is a medical specialty in which many conditions can be prevented if patients are disciplined and visit regularly.”

 

IT IS NOT A SHAME TO SEE A GYNECOLOGIST

It is necessary to help change the perception of gynaecology visits. It is not a shame. It is particularly important that young women are aware of it. “Hardly any medical institution has an isolated gynaecology ward, particularly those located in smaller communities where the chances of seeing someone familiar are bigger. It has happened many times that a girl came in and, having encountered someone familiar, immediately said, ‘Woe is me! They’ll start gossiping now’. It is necessary to explain to some patients that what happens at a gynaecologist remains between the four walls, but, unfortunately, you cannot stop the people you encounter from gossiping and guessing. It’s a stumbling block”, doctor Djeric-Rakita said.

Over the past year, numerous activities have been undertaken to raise awareness about the importance of HPV testing. In this case, like in other medical interventions, some women come for a test, others think they are protected, and still others are panicking after internet search, believing they are infected. Here, we come to a particular problem – internet consultations and stronger belief in anonymous messages posted on internet forums than in doctors.

One important segment of family planning is the information and availability of modern contraceptive methods. Being informed about prevention of unwanted pregnancy and sexually transmitted diseases often depends on culture and economic circumstances.

On the basis of her own experience in communication with patients, Doctor Natasa Djeric-Rakita says that younger women are more interested, while grown-up women are really not. Despite all advantages of available contraceptive methods, the problem concerns inadequate contraceptive use without any consultations with a doctor, which may result in unwanted consequences.

“I am always in favour of contraception, but it would be good to have a conversation with a gynaecologist or a family medicine doctor after a decision is made. Many women are interested in hormonal contraception, and less in other contraceptive methods, but many women, as far as I can see, are not using any contraceptive method.”

FAMILY DOCTOR, THE PROPER ADDRESS FOR PROTECTION

Also the perception of the right to family planning varies from person to person. Grown up women are aware of it. But not all younger women are aware. Our interlocutor emphasizes that the largest number of unwanted pregnancies end in abortion. "This means that there is a failure somewhere in family planning. The entire concept of the training we undertook thanks to UNFPA implies that family medicine, or rather family medicine doctors, should be trained to provide all types of advice on reproductive health and family planning. We are at the beginning and we shall see how it will go", said Djeric-Rakita, identifying an economic factor, in addition to culture, as another obstacle to care for reproductive health.

"There are many women who do not have a job and many couples are unemployed and have no income. For them, a monthly expense on hormonal contraception is 'unnecessary'. Regarding availability, we don't have a problem, although it exists in smaller communities. If you live in a smaller community with only one pharmacy, in all likelihood you will not go there to buy contraceptives."

 

EXPERIENCE IN KNOWLEDGE TRANSFER

As we said above, Doctor Natasa Djeric-Rakita is among 20 doctors who successfully completed the UNFPA training in family planning and continues to transfer knowledge to her colleagues. Her impression is positive, regardless of the general resistance to overlaps between different specialties.

"I was fortunate enough to cooperate with the colleagues whom I personally know. Everything went pretty well, and they acquired the recommended content. Still, more work and cooperation will be needed. In principle, specialists are against overlaps between their specialties, in this case, between family medicine and gynaecology, but since I maintain close cooperation with my colleagues at the Centre, I think we managed quite well. If they need anything, I am always here to help, and vice versa. I have never heard that any of them has ever had a problem and I think that experiences from all training sessions are positive", Natasa Djeric-Rakita, a gynaecologist at the Primary Healthcare Centre Lukavica, concluded in the end.
It is important to recall a statement by the Executive Director of UNFPA, Babatunde Osotimehin, in which he said that any form of threat to the right to family planning leads to taking a step back and that “anything that reduces funding for family planning services would affect women around the world".