Screening is a conversation, not an ordeal of tests
Across Nigeria, reproductive health specialists are calling attention to a quiet but consequential gap: women choosing contraceptives without the benefit of a physician's careful questions. The consequences—blood clots, strokes, preventable infections—are not the inevitable price of family planning, but the cost of mismatched methods and unasked questions. In a country where only one in six people uses contraception, and where myths about devices migrating to the brain persist, the path forward is not more technology but more conversation—a simple, structured exchange between a woman and a clinician who knows her history.
- Women in Nigeria are developing blood clots, strokes, and heart attacks after starting contraceptives that were never screened for compatibility with their health conditions.
- Only 17 percent of Nigerians use contraceptives, while millions more have an unmet need—held back by fear, misinformation, and inadequate counseling rather than lack of available methods.
- Gynecologists warn that certain women—those with hypertension, clotting histories, migraines with aura, or breast cancer—face serious danger from estrogen-containing pills, yet safer alternatives exist if the right questions are asked.
- The screening process itself is not the obstacle: a medical history, blood pressure check, and pregnancy test are all that most women need before safely starting a method.
- Specialists are pushing for proper counseling to become standard practice, arguing it would not only prevent harm but unlock contraception's lesser-known benefits—cancer risk reduction, fibroid management, and decreased abnormal bleeding.
Reproductive health specialists across Nigeria are sounding a clear alarm: before any woman begins a contraceptive method, she should first sit with a clinician who knows her medical history, checks her blood pressure, and asks careful questions about her health and her plans. This is not a bureaucratic hurdle—it is the difference between a method that protects and one that harms.
Gynecologists have documented women developing blood clots, suffering strokes, and experiencing heart attacks after starting contraceptives without proper assessment. These are not random misfortunes. They are preventable outcomes that occur when a woman with high blood pressure or a clotting history is given an estrogen-containing pill without anyone asking the right questions first. Professor Abubakar Panti of Usmanu Danfodiyo University in Sokoto outlines five purposes screening serves: identifying unsafe conditions, recommending suitable methods, reducing complication risk, explaining how methods work, and opening a dialogue about reproductive goals.
The process itself is modest—a medical history, blood pressure reading, weight assessment, and a pregnancy test. Additional investigations are ordered only when clinically warranted. Most women do not need extensive lab work. What they need is a conversation.
The stakes are highest for specific groups. Women with histories of hypertension, deep vein thrombosis, stroke, heart disease, migraine with aura, breast cancer, or severe liver disease should avoid estrogen-containing contraceptives. Smokers over 35 face elevated cardiovascular risk with hormonal pills. But this does not leave them without options—copper IUDs, hormonal IUDs, implants, and progesterone-only methods offer safer paths for those who cannot use combined hormonal contraception.
Professor Aniekan Abasiattai of the University of Uyo notes that a global eligibility framework exists precisely because no single method suits every person. Women with pelvic infections should not use intrauterine devices; those prone to abnormal bleeding face higher risks with IUCDs. Without proper assessment, documented side effects rise predictably.
Nigeria's contraceptive prevalence rate sits at just 17 percent, even as the 2023–24 National Demographic and Health Survey found that 21 percent of married women and 36 percent of sexually active unmarried women have an unmet need for family planning. Abasiattai attributes much of this gap to misinformation—including the persistent myth that contraceptive devices can travel to the brain. What many women do not realize is that modern contraceptives carry benefits beyond pregnancy prevention: reduced cancer risk, slower fibroid growth, lower rates of ectopic pregnancy, and decreased abnormal bleeding. The barrier is not the screening—it is the distance between what women fear and what is actually true.
Before a woman chooses a contraceptive method, she should sit down with a doctor who knows her medical history, checks her blood pressure, measures her weight, and asks careful questions about her health and her plans. This simple conversation—not an ordeal of tests and procedures—is what reproductive health specialists across Nigeria are now emphasizing as essential to preventing serious harm.
The warning comes from gynecologists who have watched women develop blood clots, suffer strokes, experience heart attacks, and face pelvic infections after starting contraceptives without proper assessment. These are not rare side effects in women who happen to be unsuitable for the method they chose. They are preventable complications that arise when a woman with, say, a history of blood clots or high blood pressure is prescribed an estrogen-containing pill without anyone asking the right questions first.
Abubakar Panti, a professor of obstetrics and gynecology at Usmanu Danfodiyo University in Sokoto, explains that medical screening serves five concrete purposes. It identifies any condition that would make a particular contraceptive unsafe for that individual. It helps a healthcare provider recommend the most suitable method based on her health and preferences. It reduces the risk of side effects and complications specific to her situation. It creates space to discuss how each method actually works, what benefits and risks come with it, and how to use it correctly. And it opens a conversation about reproductive goals—whether she wants to become pregnant soon, years from now, or not at all.
The screening itself is not burdensome. It requires a detailed medical history, a blood pressure check, assessment of weight and height, and a pregnancy test to rule out existing pregnancy before starting any method. Additional tests—pelvic exams, cervical cancer screening, blood work—are ordered only when the clinical picture suggests they are needed. Panti emphasizes that routine blood tests are not required for most women. The process is fundamentally a conversation, a careful gathering of information.
But the stakes are real for certain groups. Women with a history of hypertension, blood clots such as deep vein thrombosis or pulmonary embolism, stroke, heart disease, migraine with aura, current or recent breast cancer, severe liver disease, or diabetic complications affecting blood vessels should avoid estrogen-containing contraceptives. Women who smoke and those over 35 face increased cardiovascular risk with hormonal pills. This does not mean these women cannot use contraception at all. It means they need alternatives—a copper IUD, a hormonal IUD like Mirena, an implant, or a progesterone-only method—that are safer for their particular circumstances.
Aniekan Abasiattai, a professor at the University of Uyo, points out that there is a global eligibility framework for contraceptive use, and not every method suits every person. Women with pelvic infections or cancers of the female genital tract should not use intrauterine devices. Those with tendencies toward abnormal bleeding or blood clotting problems are not good candidates for IUCDs. Women who are overweight, have certain heart conditions, or tend to develop blood clots face higher risks with oral contraceptive pills. Without examination, counseling, and proper assessment, these women will develop documented side effects at higher rates.
Yet in Nigeria, only 17 percent of the population uses contraceptives, despite increased awareness of family planning methods. The National Demographic and Health Survey from 2023-24 found that 21 percent of currently married women and 36 percent of sexually active unmarried women have an unmet need for family planning. The World Health Organization estimates that 164 million women of reproductive age globally have an unmet need for contraception, driven by limited access, fear of side effects, cultural or religious opposition, poor service quality, and gender-based barriers. In Nigeria specifically, Abasiattai attributes low contraceptive prevalence to unfounded fears and persistent misinformation—including the belief that contraceptive devices can migrate to the brain.
What women often do not know is that modern contraceptives offer benefits beyond pregnancy prevention. They can reduce the risk of certain cancers, slow the growth of uterine fibroids, lower the risk of ectopic pregnancy, and decrease abnormal uterine bleeding. These non-contraceptive benefits represent real health gains that Nigerian women could access if misconceptions were cleared away and proper screening and counseling became standard practice. The barrier is not the screening itself—it is simple, focused, and quick. The barrier is the gap between what women fear and what is actually true.
Notable Quotes
Medical screening before starting contraception is not meant to create barriers for access. Rather, it helps match each woman with the safest, most effective, and most suitable contraceptive method based on her health, lifestyle and reproductive goals.— Abubakar Panti, Professor of Obstetrics and Gynecology, Usmanu Danfodiyo University, Sokoto
The fears are unfounded, and unfortunately, this has led to the low prevalence. A lot of our women do not use contraceptive agents because of these fears.— Aniekan Abasiattai, Professor of Obstetrics and Gynecology, University of Uyo
The Hearth Conversation Another angle on the story
Why does a woman need screening before choosing a contraceptive? Can't she just pick one and see if it works?
Because some contraceptives can cause serious harm in women with certain medical conditions. A woman with a history of blood clots who takes an estrogen-containing pill could have a stroke. Screening catches those risks before they become emergencies.
What does screening actually involve? Is it expensive? Does it take a long time?
It's straightforward. A doctor takes your medical history, checks your blood pressure, weighs you, and asks about your health and your plans. Most women don't need blood tests. It's a conversation, really. It takes time but not much money.
So if a woman has high blood pressure, she can't use any contraceptive?
No, she just can't use certain ones. Estrogen-based pills are risky for her. But she has other options—a copper IUD, a hormonal IUD, an implant, or a progesterone-only method. The screening helps match her with what's actually safe for her body.
Why is contraceptive use so low in Nigeria if these methods are safe and effective?
Fear and misinformation. Women hear that devices can migrate to the brain, or that hormonal contraceptives cause permanent infertility. These things aren't true. But without proper counseling, the fears win out.
What happens if a woman starts a contraceptive without screening?
She might develop blood clots, have a stroke, experience a heart attack, or face a pelvic infection. These aren't inevitable, but they're more likely if no one knew about her medical history before prescribing the method.
Beyond preventing pregnancy, do these contraceptives do anything else?
Yes. They can reduce the risk of certain cancers, slow fibroid growth, lower ectopic pregnancy risk, and decrease abnormal bleeding. These benefits matter, especially for women dealing with those specific health issues.