Contraception

Contraception
Contraception

Contraception is a very important tool in attaining good maternal and child health. The unmet need for Family Planning has declined in most countries. Sub-Saharan countries however have continued to have an increase in unmet need for Family Planning. It is well known that the inability of women to use contraception can increase their risk of maternal death. This has adverse consequences for schooling and health care of the orphaned children.

 

Increasing access to all methods of contraception, improved sex and relationship education and wider issues like poverty reduction strategies and Universal Education all contribute to reducing the incidence of unintended pregnancy and abortion.

 

‘Long acting reversible’ contraceptives are the most effective methods in avoiding unintended pregnancies. The long acting reversible methods are defined as methods that require to be administered less than once a month. In simple words one dose will last longer than a month at a time before the next dose becomes due. The do not depend on the user remembering to take them, eliminating any contraception failure due to poor compliance.

 

The different types of contraceptive methods available include the following,

 

  1. Long acting reversible contraceptives(LARCs)
    1. Cupper Intra-uterine Devices. These are made of plastic and contain cupper. They have a T-shape and are over 99% effective as contraceptives and have a lifespan of 5-10yrs. It is fitted inside the uterus (womb).
    2. Mirena intra Uterine System (IUS) or the Levonorgestrel containing intra uterine device. This contains levonorgestrel, a progestogen. It is over 99% effective and has a life span of up to 5yrs and is fitted inside the uterus (womb).
    3. Progestogenic Contraceptive Implants, some of these include Implanon, which is a single matchstick sized plastic rod. It contains etornogestrel and is inserted under the skin of the inner side of the non-dominant arm. It is over 99% effective and has a life span of 3yrs. The other contraceptive implant is Norplant. It contains six small plastic rods and contains the chemical levonorgestrel. The life span is 5yrs and it is inserted under the skin of the inner side of the non-dominant arm. It is also over 99% effective. The other examples of contraceptive implants include Jadelle.
    4. Progetstogenic Injectable contraceptions are of two types. The first is Depo-Provera and contains medroxyprogesterone acetate. It is given as a deep injection into the muscle of the buttocks every 12 weeks, and is over 99% effective. The other injectable method of contraception is Noristerat, containing Noritherone. It is given as an injection every 8 weeks into the muscle of the buttocks.
  2. Oral Contraceptive Pills. These are about 92-99% effective and come in two classes,
    1. Combined oral contraceptive pills. They contain a combination of a progestogen and an estrogen. Administered same time orally once a day for twenty-one days followed by a seven-day break during which a withdrawal bleed occurs.

       

    2. Progestogen only Pills as the name suggests, contain only progestogens. They are taken as one pill orally at the same time every day with no breaks.
  3. Contraceptive Patches. This contains combined oestrogen and progestogen. It is attached to the skin one patch per week for three weeks followed by a one-week break when the withdrawal bleed occurs. It is over 99% effective.
  4. Vaginal Combined Contraceptive Rings. This is a very new method of contraception and contains the combined progestogen and estrogen in a soft plastic ring. One ring is inserted into the vagina and is left there for three-weeks before removal followed by a seven-day break when withdrawal bleeding occur. It is over 99% effective
  5. Barrier Methods. These include the following;

    Male Condoms are made of latex (rubber) or non-latex material called polyurethane. They are 85-98% effective in preventing pregnancies and offer protection against sexually transmitted infections.

    Female condoms are made up of polyurethane and are 80-95% effective in preventing pregnancies. They also offer protection against sexually transmitted infections.

    Other Barrier methods include Diaphragms, Caps and Sponges. These are used with spermicides and form a mechanical barrier against sperms and in so doing prevent pregnancy occurring. They are 92-96% effective in preventing pregnancies.

     

  6. Permanent Methods. These include the following,

    Female Tubal Sterilisation, where the fallopian tubes are clipped at surgery by keyhole (laparoscopic) or open surgery under general anaesthetic. It is 99.5% reliable.

    Male Sterilisation also called vasectomy, involves cutting and tying off a segment of the male vas, the tube through which semen passes from the testis to the outside. It is ten times more effective than female tubal sterilisation.

    A new method of female sterilisation is the Esure procedure. It involves applying fibrosing titanium coils to block off the internal opening of the fallopian tubes inside the womb by a hysteroscopic route. (Putting a camera into the womb) This can be done in an out patients clinic setting and is as reliable as other methods of female sterilisation.

     

  7. Natural Methods. These include,

    Lactational Amenorrhoea Method (LAM), which is supported by the World Health Organisation as being over 98% reliable. The three conditions that have to be met are that the woman should be fully or almost fully breast feeding, must have no periods (amenorrhoea) and must be within the first six months of having had a baby.

    The Rhythm or Safe period involves avoiding sexual intercourse during the more fertile days of the menstrual cycle.

    The Withdrawal method involves removing the penis from inside the woman before ejaculating outside her body.

    The Rhythm and Withdrawal methods are not very reliable methods.

     

  8. Emergency Contraception. The Two forms of emergency contraception available are the emergency Cupper intra uerine device and the progestogen Levonorgestrel oral pill (levonelle).

    The Cupper Intra Uterine Device can be inserted into the womb as an emergency method up to five days after unprotected sexual intercourse. It is over 99% effective.

    The Progestogen levonorgestrel (Levonelle) emergency oral contraceptive pill can be taken orally up to three days after unprotected sexual intercourse. It is most effective if taken within the first 12 hrs after unprotected sexual intercourse. Up to 98%, 85% and 58% of pregnancies are prevented if it is taken within the first 24hrs, 48hrs and 72hrs respectively after unprotected sexual intercourse.

    Combining any of the Long Acting Reversible Contraceptives with usage of male or female condoms is a wise approach to preventing both unintended pregnancies and sexually transmitted diseases.

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