METHODS OF CONTRACEPTION: what you need to know

OVERVIEW

Men and women have used contraception in one form or the other for thousands of years and most individuals will at some point of time in their life need to use contraception especially with the current  world wide trend towards delayed childbearing and family planning advocacy. There is no one method of contraception that will suit everyone and so different individuals will use different methods at different stages of their lives. Contraceptive use in developing countries is estimated to have decreased the number of maternal deaths by up to 40% by reducing pregnancy in women at high risk and unsafe abortion.

Contraception, otherwise called birth control or family planning, is the prevention of conception or impregnation by methods apart from abstinence from coitus (sexual intercourse).

REASONS FOR CONTRACEPTION

  1. PERSONAL REASONS : People use contraception to avoid unwanted pregnancy and prevent the incidence of sexually transmitted infections.
  2. MEDICAL REASONS : Birth control lengthens the interval between pregnancies and this improves maternal health and delivery outcome as well as the survival of their children.
  3. POLITICAL REASONS : Contraception is used to control population explosion and improve socio-economic parameters. There will be fewer dependent children and more women can participate in the work force of the population.

WHY PEOPLE DO NOT USE CONTRACEPTION

  1. Certain cultural and religious beliefs stand against contraception except for the natural methods of birth control.
  2. Political reasons especially in regions where population need to be increased encourage more child births.
  3. Lack of awareness of the methods of contraception available.
  4. Poverty.

METHODS OF CONTRACEPTION

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NATURAL METHODS

Natural methods are based on the ability to predict the time of ovulation and so abstain from sex in that relatively short time when conception is most likely to occur. No drugs or devices are needed in this method of contraception. The available natural methods include

  • Rhythmic or safe period method: Relies on abstinence during the ovulation period which is believed to be 14 days before the next menstruation. The couple abstain from sex 5 days before and 5 days after ovulation.
  • Basal Body Temperature (BBT) method : The daily basal body temperature chart gives a prediction of the ovulation period and sex is avoided.
  • Cervical mucus method : It is also called Billing’s method. cervical mucus secretions increase during ovulation and the appearance and consistency of cervical mucus is noted and sex avoided.
  • Symptothermal method : This is the most effective natural contraception. It is a combination of rythymic and basal body temperature methods to give a more accurate prediction of ovulation and sex avoided.
  • Kitchen” method : This involves the use of dipstick to determine changes in urinary steroids production. Positive test indicate abstinence from sex.
  • Lactational Amenorrhea Method (LAM) : This is for post partum and breastfeeding women. It is effective in the first 6 months after delivery in the woman who is fully or near fully breastfeeding and amenorrhic (not menstruating).
  • Coitus interuptus : This is a male natural contraception where he withdraws his penis just before ejaculation during sex to avoid pregnancy.

ARTIFICIAL METHODS

Artificial methods involves the use of drugs and devices to prevent conception. Traditional artificial methods involves the use of mixtures of plant herbs, sponge soaked in vinegar, potassium salts and even supra pubic incisions rubbed with locally made medications. Modern artificial contraception make use of devices, hormones, sperm barriers and sterilization to avoid pregnancy. The available ones are

  1. Intrauterine contraceptive device (IUCD) : It is a small plastic carrier usually in the shape of “T” or similar design with copper wire wound around the vertical stem and inserted into the uterine cavity. It is the most widely used artificial method and has undergone a lot of changes in the shape and copper material used. 1st generation IUCD include Lipped loop, Saf T coil, and copper T while 2nd generation include Nova T and multi load 250. There is a 3rd generation; copper T 380A, 380S and copper safe 300. The mode of action of IUCD is to interfere with implantation by providing foreign body inflammatory effects in the endometrium and prevent sperm from reaching the upper genital tract.
  2. Hormonal contraception : This involves the use of hormones to interfere with ovulation, the endometrium and cervical mucus. They come in various forms such as oral contraceptive pills (OCP) which can be estrogen-only, progesterone-only or combined OCP taken for 21 days and pill free interval of 7 days. Post coital or emergency pills are also available and used to prevent pregnancy after unprotected sex by interfering with fertilisation and rendering endometrium unfavourable for implantation. There are also injectables like Depomedroxy progesterone acetate (DMPA) taken every 3 months, Norethisterone Enanthate (NET-EN) taken every 2 months and Cyclobutyl carboxylele taken once in 6 months. Subdermal implants are also available that last up to 3 years like Norplant and Implanon. There are progesterone releasing IUCDs which has better advantage over the normal IUCDs. 
  3. Barrier method: This works by preventing sperm from reaching the cervical canal. It is less effective than hormones and IUCDs. Available ones are male condoms, vaginal diaphragms and rings with vaginal spermicides.
  4. Sterilization : This is a surgical contraceptive method for both male and female which is the most effective of all the methods. Female surgical contraception involve tubal ligation or occlusion where the Fallopian tubes are tied with rings or clips to prevent conception. Male vasectomy is the surgical contraception for males in which the spermatic cord or vas deferense is ligated with rings. These surgical methods of contraception are hardly reversible.

FAILURE RATE

The failure rate of  contraceptives is expressed as the number of failures per 100 women after one year of use of a particular method. Factors affecting the failure rate of contraception include

  1. Inherent weakness of the method: The accuracy of natural methods cannot be compared with that of artificial methods.
  2. Age: Failure rate declines as age increases.
  3. Motivation: The success of any method depends on the determination of the woman to use it correctly. Pills can be forgotten, condoms and diaphragms could be neglected, displaced IUCDs can be ignored e.t.c which increases failure rate.
  4. Duration of use: Failure rate for occlusive methods and IUCDs declines with long duration of use. The longer they are used, the more effective they are.

WHICH METHOD TO USE?

There are many considerations when deciding the method of contraception to use.

  • Individual differences like cultural and religious beliefs.
  • Effectiveness of the method
  • Age of the woman
  • Whether the woman is single or married
  • The most available method
  • Easy to use

ADVERSE EFFECTS

  • Combined oral contraceptive pills increase the risk of thromboembolism and myocardial infarction.
  • Long use of progesterone oral contraceptive pills before age 25 has been shown to increase risk of subsequent breast cancer.
  • IUCDs increase risk of PID within the first year of use and increase menstrual bleeding therefore not suitable for young nulli parous women.
  • IUCDs can be expelled during menstruation and can translocate through the uterine wall into the peritoneal cavity if not properly inserted.
  • Reversal of male and female sterilization highly uncertain to succeed should the need arise.

 

REFERENCE

S. Campbell, A. Monga (2006), “Fertility control ” Gynaecology by Ten Teachers, 18th edition, (pg 59-70).

K. P. Hanretty (2003), “Contraception ” Obstetrics Illustrated, 6th edition (pg 404-419).

Wikipedia : Birth control (Retrieved 13/01/2018).

 

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