The Questions You Should Be Asking About Contraception (But Probably Aren't)

Twenty minutes into our World Contraception Day Twitter Space, someone asked: Can single women even use contraception?

Farida, a nurse from the National Medical Tower, almost lost it. "Everyone is entitled to family planning. Everyone!"

I wish that was obvious, but it's not. Not when walking into a clinic while single means facing "Why do you want this?" Not when asking about contraception gets you looks that make you feel wrong for asking.

But Farida said it anyway. And that set the tone for everything after.

Hannatu from The Sarah Project joined her, and for the next hour we talked about what actually matters: what it costs, where you can get it, what it feels like in your body, and what questions nobody's telling you to ask.

Here's what stuck with us.

How Soon Does It Work?

Injectable contraceptives need five to seven days before you can have unprotected sex. Hannatu mentioned women who didn't know this—got the shot, went home, had sex that week, ended up pregnant.

Some pills work immediately if started during your period. Others need days. IUDs and implants usually work right away, but as always, you should confirm with your provider.

The question you should ask: "When does this start working? Do I need backup?"

What Are The Side Effects, For Real?

Every contraceptive method has side effects. That's not a secret. What people don't always tell you is that side effects are wildly different for different people, and that makes it hard to know what's "normal" and what's a sign you should try something else.

Farida talked about spotting—bleeding between periods or after sex. It's one of the most common side effects, especially in the first few months. Your cycle might get lighter or shorter. It might stop entirely.

She mentioned knowing someone who had an implant for two years and didn't get a period the whole time. Not once. Her period only came back after she removed it. That freaked me out a little when I first heard it, but Farida explained it like it was the most normal thing in the world. Because for some people, it is.

Mood swings happen. Changes in sex drive happen—sometimes up, sometimes down. All the time, normal. When weight gain came up, both Farida and Hannatu wanted to address it head-on because it's one of those myths that won't die.

If weight gain occurs, it's usually fluid retention or increased appetite. Not particularly fat gain. Research shows the effect is small and usually stabilises once your body adjusts. Hannatu said, "Even when some contraception leads to weight gain, it's often fluid retention, and it's temporary. It reverses as your body gets used to the method."

Please remember: two people can use the exact same method and have completely different experiences. Farida was clear about this. Your body might react one way. Your friend's body might react another way. That's just how it works.

The questions you should ask: "What side effects should I expect? How long do they usually last? What side effects mean I need to come back and try something different?"

How Much Does This Actually Cost?

Injectables cost around ₦3,000 to ₦5,000 every three months. That's ₦12,000 to ₦20,000 a year. In this economy, all of that adds over time. IUDs and implants cost more upfront but can last for years—a copper IUD works for up to 10 years, which might actually be the cheaper option long-term if you can afford it at the start.

Hannatu kept emphasising this: ask about the yearly cost, not just what you're paying today. And ask if there are government programs or NGOs that subsidise the method you want. Sometimes you're paying full price at a private clinic when the exact same thing is available for free at a government hospital.

That sounds straightforward. But then we got into access, and Hannatu's tone shifted.

On paper, contraception exists in Nigeria. You can look up the options. You can read about where to get them. But in reality, fewer than one in five Nigerian women actually use modern contraception.

Why?

Sometimes it's money. 3k to 5k every three months sounds manageable until you're living on tight margins and that money needs to go towards something else.

Sometimes, the clinics run out. Women who need contraception most are often in areas where the supply is inconsistent.

Sometimes—and this is the part that made me angriest—the contraception is sitting right there in the clinic. The IUDs are there. The implants are there. But there's no one trained to insert them.

And other times, you have the money. You find a clinic with stock. You find trained staff. And you still get turned away because a healthcare worker tells you that you need your husband's permission.

Which—and I want to be very clear about this—you legally do not need.

The questions you should ask: "How much does this cost per month? Per year? Are there places where I can get this for free or at a subsidised rate?"

Does This Fit My Actual Life?

Nobody asks this question enough.

Do you travel a lot for work? Then daily pills that need to be taken at the same time every day might not work for you.

Are you living with family who ask too many questions? Then maybe a discreet method like an injectable (which you only need to renew every three months) makes more sense than pills you have to hide in your room.

One listener asked specifically about accessing contraception while still living with her parents. Hannatu's advice was practical: skip the daily pill. Go for something more discreet like injectables or implants. Go to a private clinic like MSI if you can afford it, or a public hospital if that's more realistic. And know that most places don't require parental consent—so don't let anyone tell you otherwise.

Do you have multiple sex partners? Then you still need condoms because most contraceptives only prevent pregnancy. They don't protect against STIs. Farida was very clear about this. If you want STI protection, your options are condoms, cervical caps, or diaphragms. That's it.

Do you want something you can stop on your own whenever you want? Pills and condoms are immediately reversible. IUDs and implants need a healthcare provider to remove them. That's not good or bad; it's just something to know before you choose.

The questions you should ask: "Does this method work with how I actually live? My travel schedule? My living situation? Can I stop it myself, or do I need a provider?"

What Happens When I Want To Get Pregnant Again?

I'm going to say this once, clearly, because it needs to be said:

Contraception does not cause permanent infertility.

Farida was so emphatic about this. Once you stop using contraception—whether it's pills, implants, IUDs, or injectables—your fertility comes back.

"Miss a birth control pill for just one day?" she said. "You can get pregnant the next day. It's that quick."

Implants are the same. Remove it, and your fertility returns almost immediately. Injectables might take a few months, but it's still temporary.

If someone's cycle doesn't return after stopping contraception, it's almost always because of an underlying condition like PCOS or endometriosis. Not because the contraception 'broke' something.

The questions you should ask: "How soon can I get pregnant after I stop using this? What should I expect when I come off it?"

How Do I Know If It's Not Working For Me?

Pregnancy isn't the only sign that a method isn't working for you.

If you're spotting heavily for weeks. If your blood pressure is spiking. If mood swings are making your life miserable. If you're in constant pain. Those are all signs.

Farida said that sometimes healthcare providers will give you a "correction pill"—a different formulation that you take for about seven days to stop spotting. But if the side effects are seriously messing with your life, it's time to switch.

"If the side effects outweigh the purpose of the contraceptive," she said, "Go back immediately and change methods."

You don't have to 'tough it out'. You don't have to suffer through something that isn't working for your body.

The questions you should ask: "What are the warning signs that this method isn't right for me? When should I come back to try something else?"

Emergency Contraception Is Not Regular Contraception

Farida wanted to clear this up because she'd seen confusion about it on Twitter recently.

The morning-after pill is for emergencies. You take it after unprotected sex or if a condom breaks. Ideally within 72 hours. It's a one-time thing.

"It's not something you should be taking consistently," she said. "The more you take it, the less effective it becomes."

If you're having sex regularly, you need a different method. Pills you take daily. Injectables every three months. Implants or IUDs that last for years. Condoms every time.

Emergency contraception is for when something goes wrong. Not for every time you have sex.

What About The Husband Conversation?

When Esther asked Hannatu how a married woman should talk to her husband about contraception, Hannatu was honest.

"I'm not married," she said. "But I've worked with enough women to know this conversation is delicate."

She suggested framing it around health. Not as "I don't want more kids, so I'm doing this." But as "This is what's healthiest for my body. This is what's best for me and for any future pregnancies."

"Contraception is ultimately a woman's right. Your health is not up for negotiation. Partner agreement is ideal—that's absolutely the ideal situation. But some situations call for you to make this choice for yourself."

There's tension there, and I don't think we talk about it enough. The tension between wanting your partner to agree and knowing that ultimately, it's your body and your decision. The tension between the relationship you want, where both people make decisions together, and the reality that sometimes, outsourcing decisions about your own health to someone else isn't safe.

Hannatu put it plainly: "You can't make choices about when to start or stop having kids when you have to outsource the final decision to the person you're married to."

I don't have a neat resolution for that tension. Neither did Hannatu. But I think naming it matters.

What About Men?

Men have two contraceptive options: condoms and vasectomy.

That's it.

Farida pointed this out, and honestly, it's wild when you think about it. Women have over ten methods to choose from. Men have two.

"A major misconception," Farida said, "is just the lack of awareness about male contraception. When people talk about contraception, they just think, females."

Vasectomy is permanent. "You have to be absolutely sure you don't want more kids," she said. There are reversal procedures, but they're not guaranteed to work.

So until someone invents a male birth control pill or something that actually works, contraception is mostly on women. Which sucks. But it also means you get to make informed choices about your own body.

One More Thing: You Can Change Your Mind

"There's no one best method."

What works for your friend might not work for you. What worked for you last year might not work now. And if you try something and it's not working—if you're spotting for weeks, if your blood pressure is going up, if this method is making your life harder instead of easier—you can switch.

Farida echoed this. "Always ask questions. If you're not comfortable with something, don't do it. Go for the safest choice for you."

That's the whole point of having options. Not just that they exist on paper somewhere, but that you actually get to choose. And you get to keep choosing until you find what works for your body, your life, and your goals.

Ask questions. Speak up when something doesn't feel right. And if a healthcare provider tries to shame you or deny you the care that you're legally entitled to, find another provider.