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Contraception – Need of the Hour

Keeping in view of exploding population in India as it is currently stands world no.2 and racing to achieve top position, the nation always debated the need of contraception in order to contain the population growth.  Since past few decades, government and health care professionals have been suggesting various contraception methods available from time to time in order to avoid unwanted pregnancies.

But still the usage is not that much happening as expected and it is said to be due to various social, religious factors.  The usage is also hindered by several myths surrounded by them due to lack of awareness.  In order to remove these misconception and also encourage effective usage of the same as per as the situation, World Health Organisation has decided to organize 26th September every year as World Contraception Day.

On this occasion, let us join together to understand about contraception, need and various options available.

What is Contraception & How it works:

Contraception is act or method used to prevent the pregnancy.  It can be achieved through various means i.e. with the help of a devise, medicines, procedure or changing the behavioral act during sexual activity.

Whatever may be the method or procedure, contraception prevents man’s sperm to reach and join women’s eggs(ova) thus leading to her becoming pregnant.  It tries to keep the egg and sperm apart and sometimes stopping the production of egg.  Some methods of contraception tries to stop the fertilized egg i.e combined sperm and egg getting attached to lining of womb for further development of the same.  Usage of methods like condoms, Copper T etc will stop the entry of the sperm with the help of thick mucous or shield.

Different types of Contraception:

Behavioural Methods –

  • Calendar Method – Normally it is assumed that during 30 day regular period calendar of female, the middle ten days are fertile days. It is advised to avoid sexual acts during this period by couples.  But this method requires regular tracking and understanding the changes in female’s period calendar.
  • Coitus Interuptus: Under this method, it is suggested to withdraw the penis just before ejection of semen from vagina of female thus avoiding releasing the semen by male.

Barrier Methods –

  • Barrier Method: Condome, Vaginal Diaphragm etc will prevents entry of sperms into uterus thus leaving no scope of male sperms joining female eggs.  It prevents sperm entry into uterine cavity.  But for single sexual act, a new condom or diaphragm has to be used.
  • Vaginal Ring (Nuva Ring): Hormone medicated rings prevents the entry of sperms into uterus and also delays or prevents egg releases from female. But ring has to be changed twice in a month.
  • Spermicides: Application of ointment kind of stuff over vagina is done in this method.  This ointment has a capacity to destroy or kill the sperms.  But for every single sexual act, the spermicide has to be applied as advised by medical professionals.
  • Contraceptive Sponge: It is a kind of sponge filled with Spermicides.

Implants or Intrauterine Devices –

  • Implants (Norplants): Medicated small rods implanted intradermally.  It protects one from pregnancy for a period of three years.  They produce a thick cervical mucous, which prevents sperm entry in to uterine cavity and prevents release of eggs.
  • Intradermal Patch: It is a harmone medicated patch sticked to skin.  This patch will prevents egg release with 99% efficacy.  But patch has to be changed on weekly basis.
  • Intrauterine Devices: Cuppor T is a intrauterine device placed in uterine cavity.  It damages the sperms with 99% efficiency.  The device can be used for a period of 3 or 5 or 10 years duration depending upon the variety.
  • Further a medicated hormone implant device can be also be placed in the uterine cavity in the place of Cuppor T. It lasts for a period of 8 years.  It also works with an efficacy of 99% by producing thick cervical mucous that prevents sperm entry into uterine cavity and also prevents release of eggs.

Oral & Injectable Contraceptives –

  • Oral Contraceptives: A combination of pills taken orally from 5th Day of menses to 21st  If the tablets are taken correctly without fail then it has a efficacy rate of 99% in preventing release of eggs.  But it is advised that those using these pills must visit a clinic for medical advice every three months.
  • Progesyeron Only Pills: A combination of pills taken orally from 5th day of menses to 21st  But it works by producing a thick cervical mucous thus preventing entry of sperm into uterine cavity and also simultaneously prevents release of eggs.
  • Injectable Contraceptives: Depo Provera Injections given every quarter for three times or monthly basis as advised by gynecologist.  It also works with an efficacy of 99% by producing a thick cervical mucous that prevents sperm entry into uterine cavity and also prevents release of eggs.

Contraception with the aid of surgery –

  • Open or Laparoscopic Tubectomy: By Performing Tubectomy, a surgical procedure either through open or Laproscopic methods on female’s sterilization is achieved.  In this surgical procedure tubes are blocked in a way that released sperms will not reach eggs of a female.
  • Vasectomy: It is a Sterilisation procedure performed on Males by twisting/tying the tubes that releases sperms so that they are not released.

Apart from above contraception methods, there are some more options available or used to prevent unwanted pregnancy.  Among the

  • Emergency Contraception Pills – They are taken within 3 days of unprotected sex. These pills prevent or delay the release of eggs thus stopping unwanted pregnancy.
  • Lactational Amenorrhea (LAM): It is a ecological contraception that is possible when a female is performing breast feeding on daily basis for every 4 to 6 hours.

Side Effects with Contraceptive Method:

With behavioral methods such as Calendar Method or Coitus Interruptus or LAM, there are no side effects observed.   But when using Barrier Methods, it is observed some allergic reactions, genital irritation, vaginal infections, urinary tract infections occurred among couple.

While using Intra Uterine Devices, irregular period for initial 3 to 6 months are observed.  Further it is also observed heavier periods, abdominal cramps in fewer people while using these devices.

Finally the oral contraception pills are said to be the cause for various side effects due to its systematic use.  Pills has to be taken under medical supervision.

Effectiveness of various methods:

Most of the implants will have failures rates of 0.5%.  In case of Intra Uterine Contraceptive Devices the failure rate is observed between 0.2% to 0.8%.  The Vasectomy may fail in 0.15% of individuals and Tubectomy is said to be having 0.5% of failure.  Thus all these options are putting their success rate at 99% of efficacy.

But male condoms are said to be failing at 18% and female condoms are asid to have failure rates at 21%.  Then other options such as coitus interuptus has failure rate of 22%, contraceptive sponge at 24%, spermicidal jelly at 28% and calendar method is at 24% failure rates thus presenting a success rate of 70 to 75 percent.

Finally the oral contraceptive pills or injectable contraceptive pills have a failure rate of 6% and 8% respectively.

In order to avoid unwanted pregnancy by couple, there are various contraceptive methods available for couples. But rather than adopting the method on their own, it is advised to consult a doctor in order to find a suitable method as per as their physical health condition and also requirements.  Further the proper usage of these methods by adhering to prescribed usage protocols will reduce the failure rates.  Otherwise it may lead to failure and one cannot simply blame the medicine for these failures.

Considering the population explosion thus leading to various social, economic problems it is a must to adopt any one of these methods as suitable to them thus helping the nation and themselves.

The article is prepared by Dr T Sumana, Obstetrician & Gynecologist, Apollo Clinics, Nizampet, Hyderabad

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