How to avoid unwanted pregnancies

By Dr. V. Prasantha Gange

Family planning helps women protect themselves from unwanted pregnancies. There are many contraceptive methods and how effective they are will depend on how old you are, how often you have sexual intercourse and whether you follow the instructions that come with the contraceptive method well.
Although there are many myths around contraception, these are facts:

A woman can become pregnant the first time she has sex; She can become pregnant even without having an orgasm or the partner withdraws from her vagina before he ejaculates; she has sex when she has a period; she is not breast-feeding fully; she douches; or whatever position the couple uses during sexual intercourse.

Contraception can be reversible or permanent.

Oral contraceptive pill --

If taken according to instructions, it is 99% effective which means that only one in 100 women will get pregnant each year. If it is not taken as per the instructions, the chances of pregnancy are higher.

This pill contains the two hormones, oestrogen and progestegen, which stop a woman releasing an egg each month (ovulation). Often it reduces bleeding, period pain and pre-menstrual tension and protects the woman against ovarian and womb cancer and some pelvic infections.

This form of contraception is suitable for healthy non-smokers up to menopause. The rare but serious side-effects may include blood clots (thrombosis), breast cancer and cervical cancer.

Progesterone only pill --

This pill containing the hormone progestegen when taken at the same time each day makes it difficult for sperm to enter the womb or for the womb to accept a fertilized egg. In some women it prevents ovulation.

It is useful for older women who cannot take the combined pill and may also be used when breastfeeding.

Contraceptive injection –

Ninety-nine percent effective, this injection releases the hormone progestegen very slowly into the body and stops a woman from releasing an egg (ovulation). It also thickens cervical mucus to prevent the sperm meeting an egg.

The effects of the injection last for 12 weeks (Depo-Provera) and provides some protection against pelvic inflammatory disease. Often when taking the injection, a woman’s period becomes irregular or stops and to get back regular periods and fertility may take up to a year or more after stopping the injections. Some women also gain weight.

Implants --

More than 99% effective, under this method, under local anaesthesia a small flexible tube(s) is placed under the skin of the inner upper arm which steadily release the progestegen hormone into the bloodstream to stop ovulation and prevent a sperm-egg fusion.

A single tube works for three years and more up to five years and as soon as the implanted tubes are removed a woman’s fertility returns to normal. The woman’s period becomes irregular in the first year at least with some bleeding in between. The period may also stop and some women may gain weight. There may also be temporary side-effects such as headaches, mood changes and breast tenderness. As implants are fixed under local anaesthesia, no stitches are needed. The area may be tender for a day or two with bruising and some swelling.

Natural family planning –

If used properly, this method is 98% effective according to several fertility indicators. This means that two women in 100 will get pregnant in a year. However, if erratically carried out there will be a higher chance of pregnancy.

Under this method, the fertile and infertile times of the menstrual cycle are identified by noting the different fertility indicators and the couple advised to have sexual intercourse during the infertile times. During fertile times, sexual intercourse should be avoided or the woman should use a diaphragm or the man a condom.

As no hormones are used, there are no side-effects while the woman also has a greater awareness of her body. A pregnancy can also be planned or avoided.

Male condom –

If used according to instructions it is 98% effective. Made of very thin latex (rubber) or polyurethane, a condom is pulled over the erect penis before it touches the woman’s vagina. A condom stops sperm from entering the woman’s vagina. A new condom should be worn by the man every time there is sexual intercourse.

Condoms may be obtained free of charge from family planning clinics or bought over the counter from any store.They also protect both partners from sexually transmitted infections, including HIV.

Intrauterine device (IUD) -- It is 98% to over 99% effective depending on the type of IUD. This small plastic and copper device which is inserted into the womb can be kept in place three to 10 years depending on its type and can be removed at any time. It stops sperm meeting an egg or may stop a fertilized egg settling in the womb.

After insertion, some women may have a heavier, longer or more painful period and as such it may be unsuitable for those who already have heavy and painful periods.

An IUD can be fitted in a family planning clinic by a trained doctor or nurse. If fitted after the age of 40, it can be kept until menopause. Women are taught to check whether the IUD is in place by feeling the threads high in their vagina.

Permanent contraception

Female sterilization --

Over 99% effective, the lifetime failure rate is about I in 200, depending on the method used. A permanent method is for the fallopian tubes to be cut or blocked so the eggs cannot travel down to meet the sperm.

It is important to use another method of contraception up to the time of sterilization and until the first period after sterilization.

Male sterilisation (vasectomy) --

More than 99% effective, the lifetime failure rate is I in 2,000. Here the tubes carrying the sperm are cut, so that sperm are not present in the semen that is ejaculated.

Considered a minor operation, it takes 10-15 minutes and can be done at a special clinic. It usually takes a few months for all the sperm to disappear from the semen and as such contraception must be used during this time until there are two negative semen tests (no sperm seen).

Emergency contraception

If you have had sex without using contraception or if you think your method might have failed, there are two emergency methods you can use

  • Within 72 hrs of unprotected sex, two emergency pills can be used 12 hrs apart.
  • IUD (loop) can be fitted within five days.
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