Yamah Kollie, 36, was shaken when a nurse at the Duport Health Center, in Liberia’s Montserrado County, delivered unexpected news: she was pregnant.
Upset and frustrated by this unplanned conception, Kollie questioned the reliability of the Microgynon contraceptive pill, her supposed protection against pregnancy. Did it fail, or was it simply used incorrectly?
Microgynon is a combined oral contraceptive containing synthetic oestrogen and progestogen – hormones that suppress ovulation and prevent pregnancy.
However, it is only effective when taken daily, at the same time of day, without skipping any pills.
The prescription drug should be taken after consultation with a doctor or nurse to ensure that the user is informed about side effects, understands how to use it properly, and is assessed for suitability.
Skipping this step can result in women using contraceptives that may not be ideal for their health conditions.
The World Health Organization recommends that healthcare workers assess women for pre-existing conditions such as heart disease or chronic kidney disease before recommending any contraceptive.
Yet Kollie, like many other Liberian women, bypassed medical consultation entirely. She purchased the pill from a local pharmacy without speaking to a health professional.
Nobody asked me anything,” she recalls.
“I just went in and said I wanted a family [planning] tablet, and they gave it to me.”
Microgynon should be taken for 21 consecutive days, starting on the first day of the menstrual cycle. This is followed by seven pill-free days before starting the next line of pills and continuing the cycle.
“I thought once you finished the first line, you didn’t need to take it again,” Kollie admits.
Deazee Saywon, an obstetrician and gynaecologist at the John F. Kennedy Medical Health Center, in Liberia, underscores the importance of consistency.
“Microgynon suppresses ovulation,” he tells SciDev.Net. “Missing doses will expose you to pregnancy.”
Saywon emphasises the need for professional support: “We have consistently advocated for direct consultation with healthcare providers.”
Misinformation, he says, often leads to misuse or abandonment of contraceptive methods.
Over-the-counter drugs
In Liberia, a wide range of contraceptives are sold over the counter, often without any medical advice. In many urban and rural communities, the idea of visiting a health facility for family planning services is still uncommon.
Barriers such as cost, stigma, and long distances to clinics also discourage women from seeking medical advice.
Jewel Tarpeh Kollie, Montserrado County Health Officer, says official data underrepresents contraceptive use.
“Our data only captures those who visit our centres,” she explains.
“People seek contraceptives without proper counseling, leading to dropouts and misinformation.”
Benetta Andrews, chair of the Liberia Medical and Dental Council, condemns the unregulated sale of contraceptives.
“These are specialised drugs,” she says.
“Selling them without proper medical examination is illegal.”
She attributes the problem to poor regulation but urges citizens to report violations.
“Communities need to be empowered to demand better health practices and hold providers accountable,” she told SciDev.Net.
Emergency contraception
Naomi Tulay-Solanke, founder of the Community Healthcare Initiative, particularly warns against the misuse of emergency contraceptives.
She says many adolescents frequently take misoprostol, a drug used to terminate a pregnancy, as a form of emergency contraception.
“They’re using it as a regular contraceptive, which is dangerous,” she says, explaining that doing so can disrupt a girl’s hormonal balance.
“They take it every month or every time they have unsafe sex,” she added.
Tulay-Solanke and other activists, through the Amplifying Rights Network, a sexual and reproductive health rights alliance, are pushing for the passage of the Public Health Law to monitor contraceptive access for proper use.
They believe education and policy reform must go hand in hand to address widespread misuse.
It comes amid fears that cuts to US global health aid could severely curtail family planning services in low- and middle-income countries, leading to an increase in unplanned pregnancies and unsafe abortions.
Liberia is one of the poorest countries in the world and its health system in heavily dependent on foreign aid.
