Thinking beyond the pill

All you need to know about family planning

Not every baby who sees the light of this world is a result of a planned pregnancy. There are thousands of unplanned babies born and left neglected due to various reasons. This was because their birth was not expected at the first place. Such babies are not ready to be accepted as they progress in life. On top of this, there are hundreds of illegal places where pregnancies are terminated along its course and people just visit them despite the negative consequences because a baby before marriage or a baby without a father is a huge social stigma no matter what the underlying causes or circumstances are. Keeping aside the ethical aspect of single parenthood or being sexually active before marriage, our objective today is to shed light on ‘contraception’ or family planning, what exactly it is, the ways which can be practised in order to protect yourself from unwanted pregnancies despite your marital status and the commonest myths and beliefs prevailing among us regarding them which might hinder its usage.

“Birth control, also known as contraception and fertility control, is a method or device used to prevent pregnancy” explains Dr. Suranga Hettipathirana, Consultant Gynaeocologist and Obstetrician. 

“During sexual intercourse, thousands of sperms enter the vagina of the female and one sperm that wins the race will penetrate the egg, gets fertilized and implants in the womb of the female, thus growing slowly to become a baby. Blocking one or more steps of this process of conception is simply what is meant by contraception” explained Dr. Hettipathirana.
There are various types of contraceptions available in the market and identifying your requirement correctly will help you choose the best option. In fact, the mode of contraception you choose depends on your future fertility wishes, duration of postponement if you are in need of an interval between pregnancies and underlying illnesses etc. Therefore, it is always encouraged to seek medical advice, so that the pros and cons could be addressed based on your need and choose the best option to go ahead with.

Reversible Methods of Birth Control

Barrier Methods

• Condoms-Male and female

There is nothing much to discuss about male condoms as people are aware of its usage. What male condoms do is protect sperms entering the female genital tract and blocking the process then and there. Latex condoms, the commonest type not only prevent pregnancy, but also keep you protected from sexually transmitted diseases and HIV. Owning to a failure rate of about 13%, latex condoms can only be used once and it is highly advised not to use oil-based lubricants like massage oils, baby oil, lotions or petroleum jelly on top as there is a tendency to weaken the condom causing a tear or break.

Although female condoms are not much popular among Sri Lankan women, it is an effective mode of contraception which prevents the sperm from reaching eggs. Usually packaged with a lubricant, female condoms can be inserted up to eight hours before sexual intercourse and protect you from sexually transmitted diseases as well. 

Intrauterine Contraception

• Copper T intrauterine device (IUD)

This is a small device of shape ‘T’ with a copper coil wrapped around which can be placed inside your womb, preventing the implantation of an embryo. The device is placed by a qualified health care professional as an OPD procedure and can be kept inside for up to 10 years. The side effects are minimal since this contains no hormones. 

• Levonorgestrel intrauterine system (LNG-IUD)-Mirena

The LNG- IUD is a small T-shaped device similar to Copper T IUD which releases a small amount of progestin (female hormone) each day, thus ensuring your hormones are not favorable enough for fertilization to occur. This can be kept inside your womb for up to 5 years and is highly effective against heavy menstrual bleeding as well. 

Hormonal Methods

• Combined oral contraceptives Pill

Used by most of our Sri Lankan women of reproductive age group due to its easy accessibility and affordability, COCP contains synthetic hormones-estrogen and progestin in altered concentrations to that of normal body concentrations which will ultimately make the female body unfavourable for a conception to occur. There are certain disease conditions like breast cancer and liver diseases to be excluded before starting COCP so always seek medical advice beforehand.

COCP is ideal for newly married couples who are planning to delay their first pregnancy and own a range of non-contraceptive benefits like protection against endometrial cancer, acne, pre-menstrual syndrome, poly cystic ovarian syndrome etc.

• Progestin only pill

In contrast to combined pill, Progestin-only pill (also called the mini-pill) only contains Progestin as the name itself suggests and can be used in women who have contra-indications to estrogen in COCP and lactating mothers who plan in delaying their next pregnancy (birth spacing).
“Many people tend to believe that these pills can result in permanent infertility, extreme weight gain and several other harmful side effects, which are not true. In our day to day practice, we meet women who are pre-occupied with this misconception and refuse this easily accessible and easily REVERSIBLE preparation, so I would make this an opportunity to highlight the fact that Oral contraceptive pills will never ever make you subfertile where the fertility will reverse just as you stop the pill. When it comes to weight gain, yes there is a risk of gaining some weight when on the pill, but you can control this by adhering to a proper lifestyle modifications including diet and exercise” underscored Dr. Hettipathirana.

• Dermal Implant (JADELLE)

This comes as single or multiple thin rods, releasing Progestin in a rhythmic pattern and can be inserted under the skin of a women’s upper arm (intra-dermally) as an OPD procedure. The device can be kept up to 3 years and the fertility will be returned as soon as the removal takes place.

• Hormonal Injection (DMPA or ‘shot’)

This is an injection called Depot Medroxyprogesterone Acetate, containing the hormone Progestin and given into the buttocks or arms every three months. As the injection is given intramuscularly, the fertility will take up to 12 months to return, but never causes subfertility at all.

In addition to these methods there are several other options available as far as the international health care sector is considered.

Emergency contraceptive pill

This is another important aspect of contraception which should be made aware of among the youth. We never encourage unmarried couples to engage in un-ethical, un-acceptable and un-protected sexual practices but once it happens for some reason, there are safe and sound, medically approved solutions to choose rather than ending your life due to social pressure and terminating pregnancies if at all, putting both maternal and fetal life in danger.

The emergency contraceptive pills available in Sri Lanka (one pill or two pills) should be used within 72 hours of unprotected sexual intercourse and should not be used as a regular mode of contraception. Intrauterine copper device can also be used in such individuals within 5 days of the act but proper medical advice is mandatory before choosing the option.

Permanent Sterilization

• Female Sterilization-Tubal ligation 

A woman who has completed her family, with the consent of her partner can get her fallopian tubes ligated.

• Male Sterilization-Vasectomy

This is a small surgical procedure which seals tubes, carrying sperms to the penis, where the ejaculation will not contain any sperm, required for fertilization. 

Take home message

In Sri Lanka, even with a strong religious background, nearly 900 pregnancy terminations are done daily due to unwanted pregnancies. 
Nearly 40% of maternal deaths are due to unplanned and unwanted pregnancies. 

Contraceptions are extremely important and all sexually active females should be aware that they are available free of charge at MOH and most of the private hospitals.