The pain 27-year-old  Ramatu Adam* experienced during the insertion of her Intrauterine device (IUD) in 2023 was so overwhelming that she passed out. 

Not even the painkillers, including the local anaesthesia spray, helped. She still struggled months later.

An IUD is a T-shaped device placed inside the uterus in order to help prevent pregnancies. Even though they are reported to have a 99 per cent efficacy rate and need a specialist to put them in place, making them safer than some birth control methods, it sometimes comes with side effects such as cramps, clotting, headaches, anaemia, and ovarian cysts.

Ramatu lived her entire life in Kaduna, Northwest Nigeria, before she moved to the UK in 2021. 

“I was told to go [to the hospital] with someone, so I went with my husband. I experienced cramps, which they warned me about, and bled on and off for more than two months.” 

At first, Ramatu thought it was because she had an existing medical condition, uterine fibroid, which limited her options, but the experiences she later heard about IUD insertions from some women were similar, even though not all women go through that pain during the procedure. 

Gender bias in research and dismissal of female pain 

A 2013 study in Oxford Academic shows that 11 per cent of mothers and 17 per cent of women who had never given birth said they needed pain management. This is because they experienced a substantial amount of pain during insertion. Another survey by the Washington Post showed that 131 people experienced pain during or after insertion, with some becoming bedridden for days. Unfortunately, women tend to feel overlooked or ignored by their healthcare providers, who tend not to take this seriously. 

The hospital sent Ramatu a document with instructions and details on what to expect during and after the procedure, but even that was not enough to prepare her for the pain. “I know I gave my consent and all, but I didn’t expect the pain to be that intense,” she told HumAngle. 

A study published by The Journal of Pain shows that when patients exhibit the same amount of pain, that of the female is viewed as less intense, therefore creating a gender bias that leads to inequalities in treatments. According to Elizabeth Losin, a co-author in the research, “If the stereotype is to think that women are more expressive than men, perhaps ‘overly’ expressive, then the tendency will be to discount women’s pain behaviours.” 

Roger Filligam, the director of The Pain Research and Intervention Center of Excellence at the University of Florida, said that women are more sensitive to pain and are likely to express it more, making theirs viewed more as an over-exaggeration. 

In 2023, dozens of women sued Yale University due to their dismissal of pain during an egg harvesting procedure in their fertility clinic. It was later discovered that the painkiller, fentanyl, which was supposed to be used for the procedure, had been stolen and replaced with saline solution by a nurse in the clinic. Estimates of hundreds of women were believed to go through that painful procedure without the painkillers. 

The talk Ramatu was given before the procedure only told her it may be ‘a little uncomfortable.’  “They were also very focused on telling me about the cramps that may come after. But the cramps felt very much like period pain, and most of the struggle came from the insertion itself,” she said.

Before the IUD, Ramatu was on daily contraceptive pills. While that was pain-free, she experienced some side effects. “I had a series of side effects like mood swings, hunger, weight gain and so on.” She was glad when her body slowly adjusted to the IUD with time.  

Ramatu was also told she had to check the IUD thread once a month as, in some cases, “it may slip out or worse, injure your womb.” She recalled. 

However, when the World Health Organization commissioned a two-hormone injection to lower sperm count in men, the drug was not allowed to pass clinical trials by the independent review panel in 2016, even though it initially showed a 96 per cent effectiveness in preventing pregnancy. This was because some men were dropping out due to side effects such as acne, with few others showing up with other side effects such as mood swings and mood disorders. Despite these,  the men who stayed back on the study said they would use the product if it became available. 

This incident caused a stir because women have dealt with these side effects and more with hormonal birth control. Krystale Littlejohn, the author of ‘Just Get on The Pill: The Uneven Burden of Reproduction Politics,’ and  Assistant Professor at the University of Oregon, said: “Like many things in our society, there is a focus and emphasis on making sure that the experience is tolerable for [men] and women are just not given the same grace or consideration.” 

According to an article by Nigerian newspaper The Punch, religious beliefs and fear of impotence, despite evidence that vasectomies are safe, reversible and do not affect sexual performance, are some of the key factors why Nigerian men are averse to trying this already existing male birth control method. Some of the interviewed men believe that family planning should be the woman’s responsibility. 

Olawale Ajia, a 61-year-old lawyer who is ‘a passionate advocate of family planning’ but draws a line at vasectomies, told Punch: “ I will not submit to that. If you ask men, they would say they are virtually dead [after a vasectomy]. No man will have self-esteem again after he is deprived of his manliness.”

Dr Rufaidah Sa’ad Baba, a gynaecologist at National Hospital Abuja, shed more light on the issue. “To accept birth control is strictly the patient’s decision. She also has to go through counselling about all available methods. So long as a patient requests for it to be removed due to side effects, it has to be removed.” The doctor also emphasised that birth control is offered free by the Ministry of Health, and any money charged is for the rendering of service, not the birth control itself. 

Navigating social limitations

Karimah Abdullahi* started to take birth control pills in 2015 after she gave birth to her first child. At first, there was no significant side effect that she could point to, but after a while, she started gaining a lot of weight. She had to keep taking them in secret because of her husband. 

“My husband doesn’t know I am taking birth control. So, I went for the pills because they are the safest option that he wouldn’t notice.” Karimah had been married for 10 years in Jalingo, Taraba State, North East Nigeria. 

Despite the fact that some women are forced to take responsibility for pregnancy and child spacing, there are many biases that make it harder for them to access birth control methods. One of such is the cultural and religious belief that children should come immediately after marriage. Sometimes, this required women to bring written consent from their spouses. 

There is no Nigerian law that regulates the use of contraceptives; however, the constitution provides for freedom to non-discrimination, the right to dignity, the right to privacy, and the right to liberty. 

According to a Nigerian study, a partner’s refusal is one of the main reasons women don’t use contraceptives. The study also states that 50 per cent of women using them tend not to be fully satisfied as a result of complexities, effects, decreased pleasure during sex, and unknown reliability. However, 52 per cent of married women have reported using contraceptives at least once in their lives. The commonest forms are natural planning methods and oral contraceptives. 

The maternal mortality rate as a result of childbirth in Nigeria is said to be a total of 1,047 cases per every 100,000 live births, and this risk can be reduced by using reliable contraceptive methods. 

“When I first went to the hospital, they asked if they should recommend a better-suited plan for me, but I told them to just give me the pills,” Karimah said. Her 29-year-old husband believes that it is ‘forbidden under Islam’ to deliberately stop or hinder pregnancies.

After the birth of her first son, Karimah brought up the topic with him, but he strictly refused to discuss the possibility, and that was when she decided to take matters into her own hands. 

Karimah never spoke to her doctors about the weight gain, as she knew she had no other options to try due to her situation. “I have gotten used to it, and it doesn’t affect me mentally as much anymore.” 

Halima Mason, a psychologist and holistic sex therapist in training, said, “Many women often learn about birth control after they start having children, aside from those who are reached by NGOs whose focus is in that area. I believe in the autonomy of women, especially pertaining to their bodies, and birth control is super important for that. Unplanned pregnancies can come with a lot of disadvantages, from the economic strain to the social and career impacts, health risks, relationship strain sometimes and just simply the possibility of impending on one’s freedom.”

Halima also believes in the importance of informing women about the risks of the methods they decide to try. “Unfortunately, the research when it comes to women’s health can often be lacking, and some of these side effects may be too much for some people to handle. But it is also important to note that not everyone experiences these drastic side effects, and sometimes they go away when the body adjusts,” she explained, adding that focusing the conversation of birth control as a family planning issue only erases others who are sexually active but don’t want children. This leads to the abuse of ‘Postinor 2’, an emergency contraceptive pill.

A study on  483 women in Lagos, aged 18 to 49, shows that 17 per cent of the women surveyed have used emergency contraceptive pills.  Availability of this over-the-counter pills has raised concerns for the risk of misuse. There is also concern that using this method may increase the risk of sexually transmitted diseases if switched with condoms. 

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Names in asterisks were changed to protect identities