For women in T&T, a new option for preventing pregnancy

After the birth of her third child, Savitri Singh-Jones decided she didn’t want to have any more children.

She turned to oral contraceptives, paying to refill her packet of pills monthly.

“You have to remember to take this pill every day, and sometimes I used to forget” says Savitri, now age 43.

She later tried injectable contraceptives, scheduling monthly visits to the health centre for a new dose. Being tied to the clock while taking the pill or compelled to make frequent visits to health centres for injections, Savitri was in search of a more convenient solution for her.

When a district nurse asked if she was interested in a form of contraception that would prevent pregnancy for five years, Savitri jumped at the opportunity.

“The best thing is, it’s in your arm. We went through a little talk and I decided to take it.”

Savitri was one of nearly 400 women who were the first in Trinidad and Tobago to receive the contraceptive implant.  It works by continuously releasing low doses of a synthetic hormone called levonorgestrel, preventing a woman’s eggs from maturing and thickening her cervical mucus so it’s harder for sperm to reach the egg.

The implant lasts for five years before it has to be removed. If a woman decides she wants to have a baby, she can opt to have the implant removed earlier. She’ll resume having normal periods within a few days, meaning her fertility returns almost instantly.

“It’s giving clients another choice,” explains midwife and family planning nurse, Chennel Davis-Gentle, who helped to administer the implant at a health centre in east Trinidad. “And because of the fact that it’s minimally invasive and it’s long acting yet reversible, they will find a lot of options for their reproductive life in this method. They find it interesting, and it’s something new. It’s something new to us.”

After a woman is successfully screened and pre-existing medical conditions that would contraindicate the insertion of the implant are ruled out, two small rods the size of a matchstick are inserted under the skin on the inside of the upper arm.

The process only requires local anesthesia and takes no more than three minutes.

“It was quick, it was not painful at all,” recalls Dalini Bhim, a 32-year-old mother of one. “It was a very happy thought that I don’t have to take any other contraceptives. And it’s very economical in terms of your pocket, instead of having to buy other types of contraceptives like the pill. Just this one procedure, and that’s it.”

Dalini says she wants to enjoy more time with her five-year-old son before having a second baby. She plans to expand her family after the implant is removed at the end of five years.

A First For Trinidad and Tobago

Contraceptive implants have been on the market since the 1990’s but were not available in Trinidad and Tobago.

UNFPA and the Ministry of Health’s Directorate of Women’s Health collaborated on a plan to introduce this contraceptive to the local population. PAHO/WHO and UNFPA trained a group of doctors and nurses from across the country.

The implants were offered free of charge during a year-long pilot project, which ran from July 2019 to June 2020 in two of the country’s regional health authorities.

In the year since she received her implant, Savitri has seen a secondary benefit of experiencing shorter, lighter periods. She’d always grappled with heavy bleeding that would last for weeks at a time.

“Mentally, it took a toll on me. Most of the time my blood count would be low, so I would have to see a doctor and try to take iron tablets,” she recalls. “Now, my period is very, very light which I really like. It’s a big relief.”

Dr. Jamila Belgrave, one of the physicians who helped coordinate the pilot project in Sangre Grande says even some women who could not use some other contraceptives benefitted from the implant.

“One thing that jumped out at me was that it had fewer contraindications,” she says. “So, we had a small set of patients who were hypertensive who could still get it, because they were limited in the contraceptives options they could use and this didn’t limit them.”

Dr. Belgrave said most of the women who received the implant already had at least one child and were trying to space out or prevent additional pregnancies.

“I hope that the project will continue because a lot of women are asking for it,” she says.

From Pilot Project to Full-Scale Programme

UNFPA is happy with the “very positive results” from the pilot project, according to UNFPA Assistant Representative to Trinidad and Tobago, Aurora Noguera-Ramkissoon.

Director of Women’s Health at the Ministry of Health, Dr. Adesh Sirjusingh, says the Ministry of Health plans to offer levonorgestrel implants nationally in 2021.

A 2011 government survey found that 40.3% of women ages 15 to 49 who are married or in a relationship use at least one method of contraception.

UNFPA’s mandate is to ensure universal access to sexual and reproductive health services, which includes offering contraceptives to people who want and need it.  Medical evidence shows that access to contraceptives helps reduce maternal mortality, one of the targets under the Sustainable Development Goals which Trinidad and Tobago achieved in 2018 through a number of interventions - including wider access to a variety of contraceptives.

In fact, the Ministry of Health created a dedicated Directorate of Women’s Health in 2015 as a national response to maternal and infant mortality rates. The office began operations in 2017 and reduced the mortality rates within a year, under Dr. Sirjusingh’s stewardship.

“Part of addressing issues with maternal mortality is being able to space out your births and addressing adolescent pregnancy, since adolescent pregnancies are high risk pregnancies as well. What UNFPA tries to do is ensure countries have a range of options for all women, so you can choose what is best for your own body and what works best for your lifestyle,” Noguera-Ramkissoon explains.

As UNFPA and the Ministry of Health continue collaborating to provide this contraceptive implant programme to the people of Trinidad and Tobago, its impacts are already being felt in the lives of hundreds of women like Savitri and Dalini.

“We have the choice over making the decision of when we want to conceive, so we are better able to plan conceiving a child,” Dalini says.

“For me, it’s just peace of mind,” Savitri adds. “I would encourage every woman to take this.”

Visit the UNFPA website:  https://caribbean.unfpa.org/en