Contraception literally means prevention of conception, in other words, prevention of occurrence of pregnancy. The aim of contraception is birth control, preventing unwanted pregnancy or family planning to limit family size.
Various reasons for individuals to choose contraception are:
- They do not want children yet, often the case in unmarried couples or newly weds.
- They want to have a gap of few years between two children.
- They want to control their family size and do not want any more children.
Practice of contraception has numerous benefits such as:
- It allows a couple to plan pregnancy when they are emotionally and economically comfortable.
- Benefits the women by allowing her to choose about herself resulting in better health and emotional outcomes.
- Benefits children as less number of children will have better quality of life.
- It also benefits the community and country as a whole as it helps in population control.
In India, however, contraception is still practiced only by 48% women and 75% of these undergo the surgical procedures of permanent sterilization after completion of desired family size. Hence, there is a huge population which is still not using any method of contraception. This is mostly because of lack of awareness, due to high illiteracy especially female illiteracy, social and religious norms that disallow use of contraception, even if couples are aware there is fear of side effects, fear of loss of sexual powers and often social stigma attached to talking about sex especially in young unmarried couples.
The choice of contraceptive method varies with age, marital status, future fertility desire, ease of availability and access to provider, ease of use, perceived risk and awareness or knowledge of various available methods. The commonly practiced methods of contraception are natural methods of contraception, barrier methods, oral contraceptive pills, injectable contraception, intrauterine contraceptive devices, and the permanent methods of sterilization.
Natural methods of contraception have been practiced for many decades as they are safe and devoid of any side effects. These methods basically mean that the couple avoids intercourse (practices abstinence) during the fertile period of female partner i.e. the period of maximum risk of occurrence of pregnancy.
Methods commonly practiced to recognize fertile period and avoid intercourse at these times are:
- Rhythm method: In this the fertile period is calculated according to length of menstrual cycle of the female partner. Beginning of fertile period is calculated as length of shortest cycle minus 20 and end of fertile period is length of longest cycle minus 11. Hence, safe period for intercourse is either before or after end of fertile period.
- Mucus method: There is secretion of clear liquid (mucus) after few days of cessation of menses. Intercourse is to be avoided from end of menses till about four days after this wetness appears.
- Basal body temperature: In this the female partner notes her temperature with help of thermometer every morning on getting up form bed. Normally, there is a 0.5°C rise in temperature after ovulation; intercourse is avoided from end of menses till about three days after this rise in temperature.
Other natural methods are coitus interruptus in which the male partner ejaculates outside the vagina and lactation amenorrhea method. It is seen that the chances of pregnancy are minimal in the first six months after delivery in women who exclusively breast feed their children and do not have menstruation (i.e. have amenorrhea) during that period.
Practice of natural methods requires a great degree of tolerance and compliance. There are also various faults in these methods for e.g., there will be difficulty in calculating fertile period of a women if she has irregular cycles, has vaginal infection or has fever. Hence, these methods often have high failure rates.
Barrier contraception is the use of methods in which a barrier is established preventing the entry of sperms into vagina. For all practical purposes, this means use of condom by male partner. Male condoms (often termed Nirodh) are easily available all over the country even in rural areas. Condoms are cheap, safe and easy to use. They also help prevent spread of sexually transmitted diseases. However, failure rate is high, as much as 20-40%, because compliance is difficult. In a male dominated society like India, it is not the first choice and practise of contraception is often responsibility of female partner.
Oral contraceptive pills are slowly gaining more and more acceptance amongst women. The pills contain hormones that prevent maturation of eggs and their release from ovaries (they prevent ovulation). They are very effective when taken correctly. They have added advantage of regularizing the cycles and decreasing pain during periods. However, pills have to be taken on daily basis and hence require high compliance and motivation. Pills are not suitable for use by obese women, women with migraine, diabetes, high blood pressure and those above 35 years age, smokers and women with history of clots in blood vessels.
Injectable contraceptive available in India is the depot provera injection. This injection is to be taken by female partner every 3 months to prevent pregnancy. Though cheap, it is not very popular because often women have irregular bleeding after injection and injection needs to be given by a health professional who may not be easily available or accessible to a the general population.
Intrauterine contraceptive devices, often termed as copper-T in day to day practise, are copper containing T-shaped plastic devices that are placed into the cavity of uterus. They are very effective, their insertion is a one time procedure and the device lasts for 3years, 5 years or ten years. However, in some women they cause irregular bleeding, heavy bleeding and back pain. Though their use is gradually increasing in India but fear of placement of foreign body and perception of risk for future pregnancy are often the reason is for poor acceptance in general population. Also, insertion of this device requires trained professionals which may not be available universally in our country.
Sterilization is the permanent method of contraception. It involves surgery and is termed as tubectomy in women and vasectomy in men.
References
- Cunningham G F et al (2001). Contraception, in Williams Obstetrics, 21st edition, publishers Mc Graw Hill, chapter 58:1517.
- Glacier A (2007). Contraception, in Dewhurst’s Textbook of Obstetrics and Gynaecology, Editor Edmonds DK, 7th edition, publishers Blackwell publishing, chaptetr32:299-317.
- Chaudhary SK (2007).Practice of fertility control 7th edition, publishers Elsevier India limited.