With a population of over a billion, India sure needs a comprehensive family planning program and a contraceptive culture in place. Also, with rising incidence of HIV/AIDS the usage of condoms both as a contraceptive and protection from sexually transmitted diseases (STD) is vital. With increasing number of women concentrating on their careers and delaying their marriages and pregnancy, the practice of contraception assumes even more significance.

Contraception is effective when one has the knowledge of various forms of contraceptives and their usages. Lack of knowledge and the belief in the myths around contraception result in unwanted pregnancies and sometimes unsafe abortions. It is important to educate ourselves and remove any doubts on contraception to lead a healthy and balanced family life.

Forms of Contraceptives

There are various types of contraceptives used as birth control methods. However, not all are equally effective. Depending on their convenience, it is for the couple to decide on the type of contraception. Importantly, the pregnancy or failure rate is the primary consideration for choosing a contraceptive.

Natural forms of contraception
These methods are based on the principle that conception can be avoided by abstaining from sex during the woman’s most fertile period. Withdrawal method, a natural form, works on the assumption that sperms do not enter the vagina. However, they are efficient only when combined with other forms of contraception such as condoms, otherwise they have high failure rate. Natural forms are withdrawal, temperature method, rhythm method and mucus method.

Barrier methods
These methods mechanically block the sperm from entering the uterus. These include condoms, diaphragms (soft rubber cup-like devices used with sperm-killing cream, inserted into the woman’s vagina before intercourse), female condom etc. In addition to contraception, the advantage of these barrier methods is that they prevent the spread of AIDS and other sexually transmitted diseases.

Oral contraceptive pills
Birth control pills, also called oral contraceptives, contain hormones like estrogen and progesterone. Birth control pills are specially designed to control the hormone levels of the woman. These pills need to be taken daily, for the entire duration that the woman is sexually active and does not wish to conceive. If taken correctly and daily, success rate is close to 100%. However, if a woman is breast feeding she should not take the combined oral contraceptive pills as they may decrease the quantity of milk supply. Instead they could take the estrogen only pills. It is best to consult a doctor before starting a hormonal contraceptive.

Intrauterine devices (IUD)
The insertion of this device results in 99% prevention of pregnancy. However, a skilled person is required to insert it and there exists a slight risk of infection. Especially, the risk of STD increases following sexual intercourse if the partner is infected.

Of all these, natural family planning and barrier methods have no side effects but increase the risk of an unwanted pregnancy. On the other hand OC pills and IUDS are very effective but may have some side effects than some of the other methods mentioned. The primary goal should be to balance benefits versus side effects or risks in choosing a contraceptive.

Demystifying contraception

One of the main reasons for lower adoption of contraceptives in India is the myths that have been built around them. This is primarily due to the lack of correct information on contraceptive methods. Contraceptive behaviour is characterized by four parameters namely, knowledge of contraception, current contraceptive use, future intention to use contraception and desire for additional children. Knowledge of contraception is defined as complete knowledge (awareness) of all the major methods of population stabilisation -sterilization, the IUD, oral pill and condom and the decision on the contraceptive of choice should be based on the right information, and not myths.

One of the myths that deter women from using oral pills is that they cause cancer. In reality it is quite the opposite. Women on pills have less risk of cancer of ovaries, uterus and possibly less risk of cancer in the bowel. The other myth surrounding pills is that it causes infertility when intake is stopped. Again, this is not true, as no such link has been found in various scientific studies conducted so far. The third myth on pills is that it causes weight gain. Actually, only 13 per cent of the pill users gain weight while most of them weigh the same and a small percent actively loses weight. For women who are religion conscious, abortion is not caused by pills for the simple fact that they do not even allow the sperm and the egg to meet. No conception, no abortion!

Besides causing mild infection, IUDs are considered dangerous which is not true. As mentioned earlier, IUDs require a specialist to insert the device properly. The IUD has to be placed properly inside the uterus. The only possible risk is that the IUD may not be placed correctly, and it may have to be removed surgically.

In a country where an estimated 50 per cent of all pregnancies are unplanned and certainly most of the unplanned ones being most unwanted, it is high time there is a change in the mindset on contraceptive usage. This can only happen when people are fully aware of the various contraceptive methods so that they are confident about using them.

BY DR. DURU SHAH

( Dr. Duru Shah is one of India’s top gynaecologists & infertility experts who runs Gynaecworld – The Women’s Clinic)

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