Contraceptive Use in Developing Countries: A Growing Concern


Today’s post is by “Obi,” a Nigerian doctor conducting his field experience at Planned Parenthood as part of his MPH program. He was a general practitioner in his home country with main interest and expertise in maternal and child health.

Health demonstration, Nigeria.The issue of contraception is a continuing concern around the globe. This concern is elevated among women of reproductive age who live in developing countries and can’t afford to sustain large families nor have access to adequate health care. Providing couples, especially women, in third world countries with access to effective contraceptives would improve the health status of individuals and the nation as a whole. There are numerous reasons and advantages to improving the availability, access, and use of contraceptive for women in third world countries.

More women are seeking effective contraception in order to prevent unwanted pregnancies. This number has risen from 716 million in 2003 to 867 million in 2012 and keeps rising. Most of this need for contraception was among women in the poorest countries, which also saw the highest population growth within this period (Guttmacher Institute, 2013). These nations also had the worst maternal and child health outcomes with very high rates of morbidity and mortality.

A report by the United Nations Population Fund (UNPF) in 2012 stated that greater access to family planning methods would save developing countries more than $11 billion a year. These savings would come from reduced costs of care for mothers and newborn babies. The report also states that about $2 billion a year would provide enough contraceptives to meet the needs of developing countries. This point is further buttressed by the fact that having fewer children has been very beneficial for developed countries both financially and with regards to health outcomes.

Using Nigeria as an example, the UNPF study revealed that if the fertility rate fell by one child per woman, the economy would grow by at least $30 billion!

In 2012, the United Nations declared access to contraception to be a ‘universal human right’. However, this human right isn’t being realized for millions of women around the world especially for women in developing countries. Sadly, these women are continually faced with difficult choices and serious consequences of unintended and unwanted pregnancies.

The agencies and organizations that are trying to empower women in these nations are faced with constant social, political, and religious oppositions. They are also faced with persisting negative cultural ideas about contraception. Real change requires community-wide, multifaceted interventions, life skills, access to youth-friendly services, women-friendly policies, and the support of the country’s leadership. Changing negative perceptions of modern contraceptive methods would go a long way in improving women’s health by preventing unwanted pregnancies and even reducing the burden of STIs.

Saving lives, improving the quality of life, and empowering women is a goal that can be achieved in developing nations with continuing effort and dedication. My firsthand experience of this issue has really made it a very important topic to me and I would love to hear about your experiences and comments with regards to women’s health in developing countries.

Your Three Holes: Urethra, Vagina, and Anus (Part II)

You may remember our very popular post Your Three Holes: Urethra, Vagina, and Anus, in which I briefly described what those parts do and how to find them. The popularity of that post leads me to believe that there are a lot of people out there who need more information about the three holes.

As a recap, let’s review the important terms:

  1. Vulva – all of the external parts (labia majora, labia minora, clitoris, urethral opening)
  2. Vagina – internal canal; place of penis/vagina intercourse, where period exits body, where tampon can be worn
  3. Perineum – skin between vaginal opening and anus
  4. Anus – end of large intestine; where feces exits body

See all the parts on this diagram:

Let’s add a few more important terms:

  1. Labia majora – soft, fleshy skin covered in pubic hair; protects labia minora, clitoris, and vagina
  2. Labia minora – widely varied in shape and color; two folds of skin that separate to reveal the urethra and vagina; provides physical and bacterial protection
  3. Clitoris – small round organ found where the labia minora meet (at top); home to 8,000 nerve endings; protected by clitoral hood
  4. Urethra – the tube that connects the bladder to the outside of the body; carries urine out of the body

Much of the reason why people don’t know there are three holes is because they are hidden. In order to see the urethra and vagina, you have to open up the skin of the labia minora, and even then, the urethra can be difficult to spot, even with a mirror.

clitorisThe clitoris is an amazing little organ. Evolutionary design really got it right with the clitoris. Did you know that the only function of the clitoris is sexual pleasure? But how does such a tiny organ pack such a punch? The glans portion (the part you can see) is about the size of a small pea but it is home to about 8,000 nerve endings. To put that into perspective, the penis, the clitoris’ equivalent, only has about 4,000. What you may not know is that the clitoris isn’t just the part you can see – it actually extends back into the body. When stimulated, the nerves in the clitoris respond. These nerves start ‘firing’ together in a rhythmic pattern, which is how an orgasm occurs. Basically, the nerves go berserk all at once, creating intense pleasure.

While we’re talking about orgasms, it is important to note that the vagina has far fewer nerve endings than the clitoris. This means that most women need stimulation of the clitoris to achieve orgasm.

There you have it, your second installment of Your Three Holes. Questions?

Fun Friday: What if condoms were more like the pill?

There’s been a bit of talk lately about making birth control pills available over-the-counter. This could be great – fewer barriers and more access would mean a lot fewer headaches, so long as birth control is still treated like all other types of preventive medicine under Obamacare – covered free of charge.

But these conversations can get a bit heated, and a bit dry. So here’s a more lighthearted take on it all – what if we had to go through the same hassle to get condoms as we do to get birth control pills?

Busting IUD Myths: 4 Facts that May Surprise You

We’ve talked about IUDs here on the Feronia Project before, and we’ve had no shortage of love for them. I’ve personally used the Mirena and the ParaGard, and think that they’re both fabulous.

But whenever I end up talking about IUDs with people, I often run into folks who wince and ask me how I got over my fear. There are a lot of misperceptions out there about IUDs, and I’ve talked about 4 of the most common below (Including 2 that I had before I got mine!)

Childbirth: You don’t have to have had children in order to use an IUD.
The myth that IUDs are only for people who’ve given birth was one that I ran into when I was first looking to get my IUD, and it’s persisted, even though the WHO and the American College of Gynecologists both say that there’s no reason for this restriction.

One reason this myth keeps lingering is that Bayer, the company that makes the Mirena IUD, only recommends it for women who have had a child. But! That’s because when they were going through the process of FDA approval, they only included studies on women who had had children. Therefore, any use other than that is considered “off-label,” but it’s still perfectly safe.

Skyla, a newer, smaller hormonal IUD, went through FDA approval using studies that included women who hadn’t had a child. Since it can be marketed to everyone, it’s helping to put this myth to rest.

Ectopic Pregnancy: IUDs actually reduce your risk of an ectopic pregnancy.
Before getting an IUD, I’d heard about ectopic pregnancies, how dangerous they can be, and I’d often heard about them in the context of IUDs. However, because IUDs are very effective at preventing sperm from fertilizing an egg, the risk of an ectopic pregnancy is lower with an IUD than it is without birth control, or if you’re on a less effective method of birth control.

Abortion: IUDs don’t cause abortions, and won’t affect an existing pregnancy.
IUDs generally work by preventing fertilization. The copper ions in the ParaGard act as a spermicide, and the progestin in the Mirena and the Skyla IUDs thicken the cervical mucus, which prevents sperm from entering the uterus. Very rarely, sperm can make it through and fertilize an egg, in which case each of the IUDs prevents implantation. Even in these cases, the IUD is still a contraceptive, since a pregnancy doesn’t begin until a fertilized egg implants.

Infection: IUDs don’t increase your risk of STDs.
They don’t protect against getting them in the future, but they don’t put you at any greater risk for getting them, either. You will want to get tested for STIs as part of getting your IUD, though, because you’ll want to be sure to treat any existing infections so that the insertion doesn’t create new problems.

Now IUDs – like any form of birth control – aren’t for everyone. Some medical conditions, like fibroids, just won’t work with an IUD. Anyone with a copper allergy would need to avoid the ParaGard, and those who want to avoid hormonal methods wouldn’t be good candidates for the Mirena or the Skyla. So if you’re in the market, you’ll want to take some time to talk with a healthcare provider about the pros and cons of each option. I know that mine have worked really well, and I adore them – I hope you find a method you love just as much!

What is the Purpose of Testicles?

Many people think males store semen in their testicles, but this belief is incorrect. The testicles are the male version of the female’s ovaries. They produce sperm and make testosterone. Unlike females who are born with all the eggs they’ll ever have, males are not born with sperm. They start producing sperm (and a lot of it) during puberty around the age of 10-16 years old, and never stop! Males are sperm factories. They make around 3,000 sperm per second with an average of several hundred million every day. Sperm are produced in the testes, mature in the epidydimis, and when ejaculation occurs, they combine with fluid from the Cowper’s Gland and seminal vesicle and leave through the spermatic cord/vas deferens/urethra.

testicleBecause the testicles are covered in nerves and on the outside of the body rather than the inside (very little protection), it can be very painful when they are hit, kicked, pinched, or twisted. The reason they are outside the body is because they have to be kept 3 degrees cooler than the rest of the body. His “testicle thermostat” (scrotum) brings them closer to the body when it is cold and farther away from the body when it is hot. Essentially, the skin that makes up the scrotum either shrinks, drawing the testicles closer to the heat of the man’s body, or it relaxes allowing the testicles to move away from the heat of the body. The ability to make sperm would shut down if the testicles reached the body’s normal core temperature of 98.6 for an extended period of time. This is why doctors recommend wearing boxers instead of briefs and not frequenting hot tubs when males are trying to conceive.

Now that we cleared that up, what is up with guys having different sized testicles? When it comes to penis size, bigger is not always better, but for testicles, size definitely matters. If someone has bigger testicles, he produces more sperm and probably more testosterone. A normal sized testicle should be about the size of a walnut. If they are smaller (the size of an olive or a cherry), have unusual hardness or lumpiness they should be checked by a medical provider. Males should also seek medical attention if they notice any sores or bumps on their scrotum. For more information visit Planned Parenthood.

Fun Friday: Scroguard

I tried writing an introduction to The Scroguard for about 30 minutes. For the first time ever, I’m speechless. I’m caught between ‘no.way.ever’ and ‘this thing is GENIUS’! Go to and see for yourself. Seriously, go now. This is excellent fodder for your weekend conversations.



Still So Much to Learn About Sex!

bookAfter 22 years as a sexuality educator, I’m still excited when I learn something new. I recently started reading a book called Sexy Origins and Intimate Things that expanded my knowledge on a variety of subjects. I thought I’d share a few tidbits with our dear readers in the hope that you would learn something too!

Promiscuity can be deadly for a female bedbug. The penis of the bedbug is curved, sharply pointed and large like a lance. Since his penis cannot reach his partners vagina, he mounts her and thrusts it through her back to deposit the sperm. It there lies dormant until her belly becomes engorged after sucking blood from her next human host. The sperm them becomes mobile and finds its way into her ovaries. If she mates with more than 6 males she may die from multiple stab wounds.

bad ducks 4Humans are not the only animal to rape. Male ducks become sex crazed in the spring. Although many ducks remain mated and monogamous for life, some males remain unattached and will seek out a mated female and force himself on her. Some females will do their best to hide from an aggressive male, but may be attacked by several males who take turns forcing themselves on her.

Females are always “in heat.” Most female animals are only receptive to male advances when they are likely to conceive. They have a brief period of frantic searching for a mate, mad coupling, and then no interest until the next fertile time. She may attack or even kill an unwanted suitor. A current theory on why human females evolved differently goes back to when humans began to walk upright. This caused a narrowing of the pelvis and resulted in many deaths during childbirth. Women who gave birth prematurely were more likely to live. They began having longer periods of dependency on males for protection so found the more sex they provided for their mates, the more likely they were to stick around.

The first two hours after sex are the riskiest. You are most likely to die from a heart attack during this time whether you have a weak heart, strong heart, or have had a previous heart attack. The risk of a healthy person having a heart attack during sex is one in a million, for a person with heart disease it’s two in a million. Sex is still safer than driving a car. The best thing you can do to prevent a heart attack during sex is participate in regular moderate exercise.

Interesting, huh?


Sex Education and Your Preschooler

October is Let’s Talk Month so… let’s talk!

I am a mother of two daughters, ages 2 and 4, I have a Master’s degree in Public Health Education, and I have over ten years experience as a sex educator. Yes, I’m that mom who can’t wait until her kids ask where babies come from.

The term “sex education” is widely misunderstood. What most people don’t understand is that sex education is built upon a foundation of anatomical and emotional vocabulary, self-respect, self-exploration, body image, family values, communication and negotiation skills – and that’s just in the toddler/preschool years!

Sex education begins when you look into your baby’s eyes, meet their basic needs, and start to build a safe and secure attachment. The baby will cry, communicating the only way it knows how, and you’ll meet its needs, which is how your child starts to trust you.

woman-changing-diaper-photo-450x400-ts-75677441Diapering is another of those early opportunities you have to create positive experiences and foster brain development. Use gentle touches. Use positive language. Don’t use words like gross, disgusting, and stinky because remember that you are applying those words to their genital area and they need to have a positive relationship with their private parts. If they reach for their genitals while you’re changing them, don’t swat their hand away because that gives them the sense that there’s something wrong with them, that somehow touching their own body is wrong. Instead, gently move their hand to the side.

Before you know it, your 12-18 month old seems to be picking up a new word every day. By this time, you’re asking her where her nose, elbows, ears, and toes are so why not include the rest of the anatomical parts? Your son doesn’t have a “birdie” or a “ding dong,” he has a penis, scrotum and testicles. Your daughter doesn’t have a “vajajay” or a “potty maker,” she has a vulva and a vaginavagina. Your daughters can’t see their vaginas so it is best to use the correct term for the part they can see and touch (vulva). You may feel weird saying these words especially if your parents didn’t raise you using these words, but practice makes perfect. An elbow is an elbow, a back is a back, and a penis is a penis. Send the message that you are comfortable talking about their bodies because after words come sentences. And questions. Oh, the questions.

Seize questions and teachable moments like they are winning lotto tickets floating from the sky. If you aren’t sure how to answer their questions, follow these tips.

Using that technique, here’s a conversation I had with my almost-three year old:

Daughter: “How did the baby get out?”

Me: “How do you think it happened?”

Daughter: “It boomed out of her mouth.”

Me: “Well, that’s interesting.”

And maybe you’re wondering why the sex educator mom didn’t tell her daughter the whole truth… well, I know my child best. I knew her body of knowledge and vocabulary about the topic and she was still 2 years old. I did not think it was age-appropriate to tell her the whole truth at that time. Lucky for me, she asked me again recently and I told her that a baby comes out either through the vagina or by surgery. Children ask more sexuality-related questions by 8 years old than they will the rest of their childhood and adolescence. Take advantage!

My two year old is starting to sit up on the changing table with legs spread apart to examine her vulva. I let her. I say, “that is your vulva.” She repeats after me. And just like that, a valuable teachable moment occurs.

When my oldest was three she had some questions about pregnancy. A well-intentioned friend told her that her baby was in the tummy, but she knew the tummy to be the stomach, where food goes. I clarified for her, “the baby actually grows inside of a very strong muscle called the uterus.” Teachable moment.

Messages about privacy and self-exploration are now working their way into conversations with my four year old. She has discovered that it “tickles” when she touches herself. I tell her it is ok as long as she does it in private. We also teach her that other people want privacy when they are in the bathroom and changing rooms.

My husband and I avoid using the f word. Not the swear word, the FAT word. We are both aware that early adoption of a healthy body image will directly influence her sexual decision making later in life. If she values and respects her body, she’ll hold her future partners to the same standard.

bodyimageA lot of the messaging about family values at this age is unspoken. Do you shower or get dressed in front of your little one? Do you show affection to your spouse and/or extended family members? Do you look at yourself in the mirror with appreciation or disdain? What role does your faith play? Do you and your spouse argue respectfully or not? And much of it is spoken, hopefully loud and clear. 

So the next time someone tells you that your child is too young to receive sex education, tell them they are wrong. In the beginning, sex education isn’t about sex at all. It’s about giving your child a solid foundation to stand on. Help them learn to love, respect, and trust during the early years because it’ll make a huge difference during their adolescence. Be open, be honest, and don’t fear THE BIG TALK. You know you’re doing it right if you’re having many little talks. You can do this!

Fun Friday: Cooking with Condoms

Just when we thought we’d seen it all, a Japanese cookbook called Condom Meals I Want to Make For You shows you how to cook with condoms! Japanese manga writer Kyosuke Kagami hopes to promote safer sex by showing the versatility and durability of condoms, which isn’t a bad idea since “Japanese men are the third worst condom users in the world.” So, if you’re tired of all those delicious latex-free cookie recipes on Pinterest, be sure to check out Condom Cookies, or if you’re really brave, how about Condom Meat Stuffing? Umm, no.


Domestic Violence 101

Today’s guest writer, “Deeds,” is a Masters of Public Health student (with a concentration in health education) and has BA in exercise science. Some of her areas of interest are body image, sexual health, and LGBT issues.

Domestic violence affects men and women alike. According to the National Coalition Against Domestic Violence (NCADV), nearly 1 in 3 women will experience domestic violence in her entire lifetime and 1 in 10 men will experience some form of abuse in his lifetime. Domestic abuse occurs in relationships when an intimate partner uses physical and verbal threats to gain power over the other. It’s a power game that represents the dissolution of trust and respect in a relationship in an intimate relationship. Victims are manipulated and convinced they are at fault and deserving of the violence; they feel trapped in their relationships for fear they will be judged, or worse, that their batterers will kill them. Perpetrators will repeatedly try to smooth over or even deny their behavior with apologies and promises of change. explains this phenomenon as “the cycle of violence” or “power wheel.”


It’s normal to have the occasional argument in a relationship, but what crosses the line? What is abuse? Below are the common types of abuse adapted from Centers for Disease Control (CDC).

  • Physical abuse: Has your partner ever hurt you? Have you been kicked, slapped, punched, or shoved?
  • Sexual abuse: Has your partner forcefully touched or tried to make you do sexual things? Do they refuse to practice safe sex with you?
  • Emotional or psychological abuse: Does your partner frequently insult, lie, blame, threaten you, or obsessively monitor your phone, computer, or other activities?

According to the NCADV, domestic violence is one of the most underreported crimes in the United States. Had security officers not arrived when Janay Palmer was knocked out cold, who knows what could have happened to her within the confines of their home?

Break the silence. If you or a friend may be experiencing domestic violence, check out the resources below:

  • If you are in immediate danger, dial 911. U.S. National Domestic Violence Hotline at 1-800-799-7233 and TTY 1-800-787-3224 TTY 1-866-331-8453
  • Text “loveis” to 22522 or live chat at
  • U.S. National Sexual Assault Hotline: 1-800-656-4673 (HOPE)
  • For more safety tips, such as how to stay safe online, please visit the National Resource on Domestic Violence.