Family Planning/Contraception

Contraceptives & Birth Control Methods

Birth control has been in prime focus since the early 50s. Contraception includes all methods to prevent conception and thus regulate fertility. Each method prevents pregnancy in a different way. The contraceptive methods may be:

  1. Temporary for spacing the first pregnancy or spacing between two child births
  2. Permanent(sterilization) for limiting the family after achieving the desired family size

Spacing methods

The risks associated with contraception are much less than risk of pregnancy, MTP or child birth, therefore it is better to avoid pregnancy by use of contraceptives. There are various contraceptive services and birth control methods available today. They include:

  1. Barrier methods like condom and spermicide help prevent pregnancy. Condom collects semen and prevents it from entering the vagina. The advantages of barrier methods:
    1. It is easily available, easy to carry and cheap
    2. It protects against sexually transmitted diseases and HIV infections
    3. No prescription is needed
    4. Helps prevent cancer cervix in female partner
    5. Useful when other methods are contraindicated for women like heart or liver disease.
    6. Useful when women who are breast feeding and couple need contraception.
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  2. Spermicides are available in the form of creams or foaming tablets or suppositories. “Today is a foaming tablet.
    1. It acts by inactivating the sperms. The protection begins 10-15 minutes after insertion and remains effective for about an hour.
    2. It can be used in women who are breast feeding.
    3. It is easy to use, reversible, no medical intervention or prescription required.
    4. Effective for a short period only.
    5. Must be used before each sexual act.
    6. May interrupt intercourse and requires privacy for insertion.
    7. Some women develop sensitivity to the spermicide and develop irritation.
  3. Oral Contraceptive Pill
    1. It is effective, safe and reversible contraceptive for spacing.
    2. The pills act by suppressing ovulation
    3. Disadvantage is that it has to be taken daily and offers no protection from STD/HIV
  4. Non hormonal oral contraception (Centchroman)
    1. Centchroman is a non-steroidal chemical. It is an anti-implantation agent and is available as 30 mg tablets.
    2. Brands available are Saheli, Centeron.

    Advantages

    1. Normal ovulatory cycle is maintained
    2. Does not cause nausea, vomiting, dizziness, weight gain, bleeding or acne
    3. Contraceptive effect of drug is reversible in 6 months
    4. Subsequent pregnancy is normal

  5. IUCD-Intra Uterine Contraceptive Device:Copper T 200B is a T shaped plastic device made of poly ethylene and impregnated with Barium sulphate to make it radio opaque. It is 3.6 cms in length and 3.2 cms in width. Copper is wound round its vertical stem. Its surface is around 200 mm and the thread is attached to the lower end of the vertical stem.

    Advantages

    1. One time insertion
    2. Readily reversible
    3. Effective for three years

    Mechanism of action

    1. It inhibits sperm migration in the upper genital tract.
    2. It stimulates foreign body reaction in the endometrium and releases macrophages which prevent implantation.
    3. Copper also causes changes in the endometrial cells which prevents implantation.

  6. Sterilization: a permanent method of contraception. It involves blocking of the duct that carries the egg or sperm. Thus the ovum and the sperm cannot meet and no fertilization takes place.

    1. Female sterilization is tubectomy which is done by open or Laparoscopic method.
    2. This can be done within 7 days of the menstrual period.
    3. If it is done in the premenstrual phase the client has to be counselled regarding possibilities of pregnancy
    4. Post-partum sterilization is done between 48 hours to 7 days after delivery. However it can be done at any time if there is no infection or contra indication
    5. MTP and sterilization can be done simultaneously. Spontaneous abortion and sterilization can be done together if there is no anaemia or infection.
    6. Male sterilization is Vasectomy which is done by conventional or non-scalpel method

    Eligibility Criteria for sterilization

    1. Men should be below 60 years and women should be below 45 years and above 22 years
    2. Number of children is not a criterion for eligibility. However it is preferable if the couple have at least one child above one year.