Let’s talk Contraception

By Kalani Kumarasinghe   
Despite improved access to information and knowledge, discussing sexual and reproductive health is still a social and cultural ‘taboo’ for most Sri Lankans. The Annual World Contraception Day campaign attempts to raise awareness about contraception and safe sex. The objective is to enable youth and adults alike to make informed decisions until every pregnancy is a wanted one. In an interview with the Daily Mirror, Consultant Obstetrician and Gynaecologist, Colombo University Medicine Faculty, Professor Hemantha Dodampahala uncovers various myths and misconceptions surrounding contraception and why it is vital to make informed choices. 

QWhy is contraception important?
Contraception is frequently used in developed countries between unmarried partners. Besides this, there are also provisions for the termination of unwanted pregnancies. But in most developing countries, especially in Asia, the termination of a pregnancy is illegal due to various religious and social implications. Therefore, contraception and the knowledge of contraception are important for every woman and man. The world is experiencing a population explosion, particularly in third world countries. 

QHow can contraception be classified?
Contraceptive methods can be divided as non-contraceptive intervention and contraceptive intervention, permanent and temporary methods. Even though Abstention remains an important part of contraception, the practicality of this method is very much debatable. Some couples avoid sexual intercourse during the so-called ‘fertile period.’ This is referred to as the Calendar method, and stands as the most popular technique of contraception in this country. 

QHow does each individual identify which method of contraception fits them best?
For young women, regardless of the marital status, the use of an Oral Contraceptive Pill (OCP) is the ideal choice. This is also recommended for a young married woman who wants to delay a pregnancy for one or two years. This tablet must be taken every day. If you miss a pill, take two pills as soon as you remember it. Missing more than two pills, you need to seek the advice of a doctor. 

QWhat is your opinion on the various misconceptions surrounding this method? 
There are misunderstandings among women that the use of OCP will lead to permanent infertility. Such theories are time-proven and scientifically disqualified. Even after years of use, women can still regain their ovulation and conception capability. So there is absolutely no risk of infertility or sub-fertility due to the prolonged use of OCP. However, please do remember the pill will not protect you from STDs including HIV. If you ever have to have sex with a person whom you don’t know, for an instance when travelling abroad, use a condom during the whole period of sexual intercourse is advised. 

QHow and why should married couples with children use contraception?
It is an important duty for a couple to have children, at least three per family, because there is a negative population explosion taking place in the country. A woman who has one to five children must consider using an Intra Uterine Contraceptive Device (IUCD). This device is placed in the womb which will not have any hormonal effects on the body. Women can also opt for injectable-implants. This method does not interfere with the day-to-day sexual activity and can be used up to five years. 

QWhen is the use of Emergency Contraception appropriate?
Sometimes with unforeseen circumstances, married or unmarried couples have unprotected sex. In such instances, according to the common practice in Sri Lanka, the woman must take two tablets of Levonorgestrel 750 micrograms, 12 hours apart within the first 72 hours of having unprotected sex. If a woman forgets to take the second tablet, she can still take it up to the first 100 hours, but the success rate will drop from 95% to 75%. All these methods can increase the risk of conception at an abnormal site. Such as ectopic pregnancy when a fertilised egg implants outside the uterus.

However, even if you find yourself pregnant after taking Levonorgestrel, there is no cause for worry. I have seen many such patients.