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Healthy Living

Contraception and Family Planning

Contraception means preventing the conception of a child or preventing a woman from getting pregnant. Birth control methods must be used not only to avoid unwanted pregnancies, but also to plan the number of children a couple actually wants and to space them, so that the best possible care and protection can be given to the new born and the mother.

The main methods of birth control now in use are:

  1. The pill
  2. The Intra Uterine Devices (IUD) or loop.
  3. The cap
  4. The condom
  5. Spermicides
  6. Withdrawal methods (Coitus interruptus)
  7. The rhythm method
  8. Emergency contraception
  9. Sterilisation
  10. Abortion or medical termination of pregnancy.

Of these, the pill, the IUD, cap and spermicides are to be used exclusively by women.

The condom and coitus interruptus are the male methods. Both females and males can be sterilised through surgical operation. Abortion has to be performed only as a last resort, when a woman gets pregnant. Whatever may be the method used, the basic principle of birth control is to prevent the sperm uniting with the egg (ovum). Thus fertilisation of the egg is prevented. Without fertilisation there can be no embryo, or child.

1. The Pill: It acts by preventing the ovulation. It contains synthetic versions of the natural female hormones – oestrogen and progesterone. These hormones are involved in the normal monthly cycle of ovulation and menstruation. By altering the natural hormone balance of a woman's body, oral contraceptives interfere with the cycle and prevent the egg from being released from ovary and there by fertilisation is avoided. If used properly, this is a highly effective method. Whenever a woman wants to have a child, all that she has to do is stop taking the pills.

2. The IUD: IUD is known as the Intra Uterine Device or the loop. It is a small, flexible device made of plastic or metal, which has to be placed inside the uterus. The introduction has to be done by a doctor. It comes in various sizes and shapes. The exact mode of its action is not clearly known. It is believed that the presence of IUD in uterus prevents the fertilised egg to rest (sink) on the endometrium. An IUD has to be changed once in 2 to 3 years. The IUD prevents conception about 90% of the time.

3. The Cap: The cap is also known as the diaphragm. It has to be placed inside the vagina between the cervix (mouth of the womb) and the vagina. Once placed, the cap acts as a barrier to sperms. It physically blocks the passage of the sperms into the uterus. The cap is usually made of rubber and metal rim. This has to be worn by the women before sexual intercourse and has to be removed six hours after the intercourse.

Initially the cap has to be fitted by a doctor. Later on, a woman can get herself adequately trained to place it properly. Used alone, the protection given by the cap is not adequate. But when used along with spermicides the effectiveness of the cap is greatly increased.

4. The Condom: It is also known as the sheath, rubber or French leather. It is made of a thin rubber sheath. There is a small chamber at the closed end in which the semen is collected after ejaculation. Thus sperms are prevented from reaching the uterus.

Condom is the only contraceptive that gives some protection against some venereal diseases. It is of utmost importance to check the condoms for any holes before using it. If there are any gaps or holes then semen will leak out and pregnancy can occur. The condom gives about 90% protection against pregnancy.


Using a Condom

The condom has to be used in a proper manner, otherwise there is a likelihood of the condom getting torn and the semen seeping into the vagina and thereby an accidental pregnancy might occur. The diagram below explains the proper method of using a condom.

  • Carefully remove the rolled condom from its foil packet.
  • Unroll about an inch of the condom and squeeze the tip between the thumb and the forefinger to leave an empty space beyond the penis to catch the sperm and prevent the condom bursting.
  • Unroll the condom onto the erect penis. (Either partner can do this and the action can be incorporated into lovemaking) Be careful not to damage the condom with your fingernails. Do not use Vaseline or other grease as a lubricant.
  • After orgasm and before the erection subsides, withdraw the penis from your partner's vagina, taking care to hold the rim of the condom close to the penis.

Open the package carefully so that the condom does not tear.

Pinch the condom's tip between forefinger and thumb.

Continue squeezing the condom tip and unroll the condomto cover erect penis.

After sexual activity remove condom carefully without spilling.

Knot the open end of the condom

Wrap the condom in a paper and throw it in a dustbin.

5. Spermicides: Spermicides are chemical products that either destroy the sperms or create a barrier of foam or fluid to sperms. They come in various forms like creams, jellies, aerosol foams and pessaries (tablets which can be introduced into the vagina). As mentioned earlier they have to be used along with the caps. By themselves, they are not a hundred percent effective.

6. Coitus Interruptus: It is also known as the withdrawal method. The male partner withdraws his penis from the woman's vagina just before orgasm and ejaculates outside. Thus, it is ensured that the semen does not enter the female genital tract. This is a highly unreliable method. The fluid, which oozes out of the penis during the foreplay, may contain sperms. And normally it is very difficult for the majority of people to withdraw the penis at the right moment.

7. Rhythm Method: It is also known as the safe period and natural birth control. It is based on an understanding of a woman's natural monthly cycle and involves having sexual intercourse only during the least fertile (safe) periods of the month. This means that the sexual intercourse must be avoided around the time of ovulation (when an egg is released from the ovary). Generally, ovulation occurs around the 14th day of the normal and regular menstrual cycle.

The greatest likelihood of pregnancy taking place is around this time. Since the exact date of ovulation cannot be judged accurately, some couples avoid sexual contact the week prior to the 14th day and the week after. The main problem in this method is to establish accurately the time and date of ovulation. Many women may not have a regular 28-day cycle. A lot of self-discipline is required to practice this method.

8. Emergency Contraception: When an unprotected sexual intercourse takes place due to unavoidable circumstances, emergency contraception can be resorted to. The woman may take high doses of synthetic oestrogen within 72 hours of intercourse. This synthetic hormonal pill is also known as “morning after pill”. This method is about 98% successful. Though the method of action is not clear, the pill acts probably by preventing the ovum from travelling through the fallopian tube or by preventing the fertilised ovum from settling down on the inner lining of uterus “endometrium”. This method of contraception has some side effects like nausea, vomiting, giddiness etc. If there is vomiting, the doses have to be repeated.

9. Sterilisation: It is an ideal method of contraception for couples that want no further children. It is highly effective and the best solution to the problem of birth control. Contrary to popular misconception, it does not decrease the sex drive. In fact, by removing the fear of pregnancy, sexual pleasure and drive are increased.

Female sterilisation or tubectomy is a surgical procedure in which the fallopian tubes, which carry the eggs from the ovaries to the uterus, are cut and ligated (tied). Thereby the eggs are prevented from reaching the uterus and getting fertilised. In earlier days, this operation has to be done through the abdominal route and required five to six days' stay in the hospital. Today, a more simplified method, which does not require hospitalisation, has been developed. In this method, a laparoscope is introduced through a tiny opening in the abdomen and the fallopian tubes are blocked by cauterisation (electrical destruction of the tissue). Male sterilisation or vasectomy is a minor surgical operation in which the tubes that carry sperms from the testes to the penis (vas deference) are cut and tied. The man continues to ejaculate as before but the semen no longer contains sperms, which are re-absorbed by the body. Vasectomy, the safest surgical method for birth control is performed in the out-patient clinic and takes only a few minutes. Most men can return to work the same day. The choice of the contraceptive procedure to be followed rests with the couple. But it is advisable that the couple chooses the proper method after consulting the family physician.

10. Abortion (Medical Termination of Pregnancy): Abortion means the deliberate termination of a pregnancy by medical or surgical means. This method actually does not prevent pregnancy. Instead, it prevents childbirth by terminating the pregnancy.

The usual methods employed for this purpose are:

  • Dilation and Evacuation or Menstrual Regulation: In this method, under anaesthesia, the cervix (the entrance to womb) is gently dilated with the help of an instrument and the contents of the uterus are evacuated either with the help of a suction apparatus or through instruments.
  • Dilation and Curettage: In this method the cervix is dilated and the contents of the uterus are scraped out with a metallic instrument known as “Curette”. It is advisable to undertake abortion within the first three months of pregnancy, whichever be the method resorted to.


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