Doctor : Hello, what can I do for you?
Lady : I want to insert birth spacing device in my arm (Long -Acting Reversible Contraception , Implant).
Doctor : Why do you want this type of family planning or change this type ? Please tell me the birth spacing methods you have been used.
Lady : I used 3 month injectables DMPA( Depo Medroxy Progestrone). I want to change for weight gain and irregular periods. It makes me very distress.
Doctor : Do you know both injections DMPA and Implants contain the same hormone? That’ why the side effects and actions are same. You become fat and also menstrual irregularities. The difference between these methods is just only the effective duration.
Lady : I have no idea about family planning. The health care person of my village sa yar ma (may be nurse, midwife, auxillary midwife, traditional birth attendance or quack she didn’t mention) advised to change this method.
Doctor : Let me explain. You said whenever you are injected 3 months depo you suffered from irregular periods, aren’t you?
Lady : Sure
Doctor : You might have menstrual irregularities if you were inserted implant. You also gain body weight more and more. Her BMI is 35(Class II obesity). So, implant is not suitable method for you. You should choose another method of LARC, IUCD (Intrauterine Contraceptive Device) to insert in your womb. I can help you. IUCD is a barrier method and does not contain hormones. You will regain regular periods and maintain your body weight. You have to change this contraceptive device 5 years or 10 years later.
Lady : Ahhh, well. I want to take the advice of sayarma (health care person of their village) about the method you said.
Doctor : OK. I want to give this information that injection DMPA and Implant have the same actions (apart from route and duration) and similar side effects. Please relay this information to your sayarma (health care person) not to advise this method(implant) to the ladies who had suffered from the side effects of 3 months depo injection. If you change your mind, I will help you to choose the suitable contraceptive methods. Implant is not a suitable contraception for you.
Then, they left my clinic.
Nurses : They will consult the other clinics and ask to insert an implant. They believe their health care person than you. They don’t want to reject their health care person’s advice. They never go back their village without an implant.
Doctor : I think so. She can choose this method although it is not suitable for her. It’s her choice and her right. After taking informed consents and after she know she might suffer from similar side effects, medical person can insert her the implant. They have their rights, too. But in my own concern or opinion, I want to counsel the suitable contraception for her. I’m glad to give the information and her attendances received the health education more or less. As they had to consult another medical person, they got awareness about this massage. As I refused to insert an implant, they also got awareness about this important information.
And for me, I’m very satisfied that I did not break one of the medical ethics “Do No Harm”