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A matter of choice
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There are several methods of contraception. Choose the right one
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TANUSHRI IS looking forward to her wedding day. In the midst of all the frenetic preparations, Tanushri also has an appointment with her gynaecologist.
She and her fiancé have decided to wait for a year before planning a family.
Sumangali has just had a baby. At her postnatal check-up, her obstetrician discusses birth control with her. She wants to avoid a pregnancy for a few years.
Dhanalakshmi has two children and wants a permanent measure to avoid further pregnancies.
The need for contraception varies with each individual. It is important to choose the right method of avoiding a pregnancy.
What is contraception?
Contraception (birth control) is the term used for the prevention of pregnancy. There are many ways to prevent pregnancy. Some are much more effective than others.
They include the use of hormone medications, contraceptive devices (barriers), periods of avoiding sex (the so called `safe period'), and surgery. The revolution in contraception has empowered women and given them several safe options. Knowing what methods are available, will help you decide which method is right for you and your lifestyle. What are the different methods of contraception?
Hormonal methods
Birth control pills (oral contraceptives) and injectable hormones contain manufactured forms of the hormones estrogen and/or progesterone.
The hormones stop a woman's ovaries from releasing an egg each month.
They also cause the mucous in the cervix (mouth of the uterus) to thicken, which then acts as a barrier to sperm.
Birth control pills are ideal for somebody who is recently married and wants to postpone a pregnancy for a while.
A woman takes birth control pills according to a daily schedule prescribed by her gynaecologist.
An injectable hormone preparation is available which prevents pregnancy for 3 months.
The myths
Women are concerned that they will put on weight with birth control pills.
This is not true. A minimum gain of 1 or 2 kilos may occur because of water retention.
The fear of cancer also worries women.
It is interesting to note that birth control pills actually protect women against ovarian cancer.
Condom: It provides the best protection against sexually transmitted diseases, including HIV and hepatitis B. Condoms have a high failure rate (15 per cent) and should be used only if an unintended pregnancy will not pose a problem.
The intrauterine device (IUD): This is a small plastic device containing copper or hormones, which is placed inside the uterus.
Instead of stopping sperm from entering the uterus, the IUD changes the physical environment of the reproductive tract, which prevents the egg from being fertilized or implanting and growing in the uterus.
An IUD is inserted into the uterus by a gynaecologist.
Depending on the type, it may be worn from 3 to 5 years before it must be replaced.
It has a low failure rate (3-5 per cent) and is ideal for a woman who has already had a child.
`Safe period' and the withdrawal method:
The natural family planning methods of birth control do not depend on any devices or drugs.
To prevent pregnancy, intercourse is had only during the first seven days of the cycle (counting from the first day of the period) and the last seven days before the next expected period, the so called `safe period'.
Obviously, it can only be used in women who have regular periods.
The failure rate of this method is 25 per cent.
The withdrawal method is unreliable. The failure rate of this method is 20 per cent.
Sterilisation
Sterilisation is the surgical closing of the tubes that normally carry the sperm or eggs. A woman or man who undergoes sterilisation will no longer be able to conceive children.
In a vasectomy, a surgeon cuts and seals off the tubes that carry sperm in a man. When a woman is sterilised, her fallopian tubes, which carry the eggs from the ovaries to the uterus, are sealed off.
A vasectomy is a more minor surgical procedure than female sterilisation.
The failure rate with a sterilisation procedure is less than one per cent in both males and females.
Emergency contraception
In the event of having unprotected intercourse, or if there is a failure of condom usage, emergency contraception or the `morning after pill' may be used.
This is a hormonal tablet, which must be taken within 72 hours and has to be repeated after 12 hours.
Ask your gynaecologist about the method.
It cannot be used on a routine basis.
How well do the various methods prevent pregnancy?
When a couple uses no contraception, the rate of pregnancy is 80 per cent in a year.
Other than permanent sterilisation, the hormone medications and the IUD are the most effective methods of birth control.
The least reliable methods are the `safe period' and the withdrawal method.
GITA ARJUN
(The author is a Chennai-based obstetrician and gynaecologist with a special interest in women's health issues)
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