A contraceptive is a barrier that blocks the fusion of sperm with the ovum, thereforeit is defined as a device used deliberately to prevent fertilization”. Contraceptives, fertility control, family planning, and family welfare schemes are used interchangeably. In light of the increasing population explosion and sexually transmitted diseases, many countries in the world are promoting contraceptives. Besides help in controlling the population, some contraceptives assure safe sex practices that can prevent many STDs( Sexually transmitted diseases). Contraceptives are classified as temporary or permanent applications. They are available in a variety of options for both males and females individually.
Major uses of contraceptives:
1.Use of contraceptives to control population explosion ( birth control measure)
There has been a surge in the population globally since almost 4 decades and it is expected to continue. The total global population was around 2 billion (200 crores) in the year 2000 but it has reached up to 6 billion at present and India`s share almost 25% of this number. Fair usage of contraceptive devices has largely helped in spacing and permanently controlling the new births. Statistics in India, suggests that , as the usage of contraception is on the rise, the average family size( number of children) has reduced from 3.5 to 2 in the past 2 decades.
2. Contraceptives as protective devices against STDs
Since 80s, one of the major category of health issues is the sexually transmitted diseases. Illnesses like HIV, Gonorrhea, syphilis, and hepatitis are drastically on the rise, however, usage of condoms has almost reduced 80% of the STDs.
Characteristics of a good contraceptive
A good contraceptive device must be easy to use (user-friendly).
It should be cheap and easily accessible/available from any outlet.
Must have minimal to no failure rate.
Must have tolerable side effects or no side effects at all.
A contraceptive must not interfere with sexual pleasure.
Depending upon whether the couple wants to space( increase the gap between 2 children) or to permanently stop the conception, contraceptives are divided into temporary and permanent methods. A wide variety of contraceptive devices are available in the market however, no contraceptive can do same for all. It is important to choose the best option depending upon the purpose for which a couple uses it. It is essentially important to educate people about the uses, drawbacks, and precautions while using a specific device. As preferences of couples vary, the health care professionals should counsel, guide and facilitate information about the most appropriate contraceptive devices.
Types of contraceptive devices
Though a great variety of contraceptive devices are available , it is important to decide the best possible option by carefully weighing their risk-benefit ratio.It is also important to look into the costs and effectiveness in both long-term and short-term basis. Most commonly used contraceptive methods are classified as :
Barrier methods like IUDs (intrauterine devices)
Medicinal methods such as oral contraceptives, and injectable devices.
Permanent hormonal implants
Surgical methods such as vasectomy and tubectomy
Natural methods doesn't necessarily demand the chemical or injectable intervention into the women`s body hence, it is relatively safe and easy. Calendar method is one of the commonly used natural methods that work by blocking the contact between the sperm and ovum at the time of ovulation. It is more of a mathematical phenomenon than anything else. To prevent fertilization, a safe period is calculated. It is estimated by keeping in mind of the approximate date of ovulation in women. The cycle of menstruation is divided into 4 different phases: secretory phase, proliferative phase, ovulation phase and the regeneration phases. Ovulation is the critical period responsible for fertilization. According to the calendar method, the couple are advised to avoid intercourse during the ovulation period. To be precise, the safest period for intercourse is the 1st 7 days and the last 7 days of the menstrual cycle leaving behind the 14 days at the middle of the calendar.
Coitus interruptus or withdrawal method
In this method, the penile end is withdrawn from the women`s vagina just before the ejaculation of sperms as it helps to prevent the entry of sperms inside women’s reproductive system. However, it is not a completely reliable method as the pre-ejaculatory fluid( before the final release of sperms) may contain some sperms which can enter the female`s system before withdrawing the penis.
Locational amenorrhoea is the suppression of menstruation through breast feeding. Breastfeeding increases prolactin which is an antagonist for most of the sex hormones responsible for reproduction in women. Consequently, the levels of estrogen and progesterone blocks fertilization. Lactational amenorrhea is effective only up to 6 months from the day of childbirth, as prolactin levels gradually decline due to the domination of estrogen and progesterone. However, until 6 months, it is one of the safest method as there are no adverse effects.
Barrier methods directly prevent contact between the sperm and ovum by formong a physical barrier. Some of the barrier methods available for both males and females are:
Condoms are the most widely used contraceptive methods. Condoms form a clearcut barrier that prevents fertilization as they are made up of a thin, transparent, smooth rubber latex sheath that covers the penis of the male or vagina and cervix of the female. Due to this, the semen released is collected qt the tip of the condom instead of seeping into women`s reproductive tract. They are one of the cheaper and effective methods, though, the failure rate accounts upto 10-14%. Condoms are also a great way to prevent STDs.
Cervical diaphragms, caps and sponges
The cervical diaphragm is a small, flexible, rubber cup-like structure inserted into the vagina that fit snugly over the cervix. It is effective when used with a spermicide that kills sperms however, the rate of failure is 16% which is slightly higher than condoms. The cervical cap (Fem Cap) is a small, bowl-shaped latex or silicone cup and is inserted into the vagina that surrounds the cervix. It is similar to the diaphragm but a bit smaller. The sponge is a disposable device, made of soft foam containing spermicide but the failure rate is as high as 24%.
Intra-Uterine Devices (IUDs)
The IUDs are excellent, effective and safer ways to block the contact between the sperms and ovum over medium-term. They are one-time investment and can stay in place up to few months requiring some follow-up in the interim.
Disadvantages of IUDs:
Irregular bleeding from the vagina
Absence of menstruation( amenorrhea).
Premenstrual syndrome (PMS) manifested by headaches, vomiting sensation, tenderness of breast and skin discolouration.
Seldom, some IUDs may expel or fall out of their place.
Uterine perforation with heavy bleeding may be observed in extremely complicated cases.
Pelvic inflammatory disease (PID), is observed if the IUD s are inserted improperly.
Types of IUDs:
Non-medicated IUDs are made of plastic or stainless steel. The most common of them is the Lippes loop made up of polyethene. Some of the copper-based IUDs are, Copper-T, CuT-380 A, Multiload- CuT -380A, CuT-380-Ag,CuT 380, Multiload -375 etc. Copper-T is the most commonly used copper-based device. It is T-shaped device inserted through the vagina that drapes over the fallopian tube to block fertilization.
A number of medicated devices are available. One of them is, Progestasert, a T- shaped IUD made of ethylene and vinyl acetate copolymer containing titanium dioxide. Its vertical stem contains a reservoir of 38 mg progesterone along with barium sulfate dispersed in silicone fluid. The progesterone is released at the rate of 65 µg per day. LNG - 20 (Mirena) - This is also a T-shaped device that has a collar attached to vertical arm. It is medicated with 52 mg of levonorgestrel. It releases 15µg of levonorgestrel per day that will not allow fertilization. It works best for up to 10 years.
Oral pills must be swallowed daily over 21 days of the entire menstrual period starting from the 5th day of the Menstrual Cycle. The pills act on the surface of the mucus layer of uterus and ovaries to inhibit ovulation . It also acts by altering the quality of cervical mucus that prevents the entry of sperms into the female system. Pills are very effective with fewer side effects and are well accepted by the females. Estrogen and progesterone pills are taken at different doses individually or in combination. Some injectable estrogen agents are also used but are rare. Additionally, some estrogen implants are placed under the skin and these are known asd subcutaneous or intradermal implants . They act very much similar to oral pills.
They are also called surgical methods or sterilization methods. The selection of appropriate permanent method is based upon whether the couple wants children in the future or not . This is because, unlike temporory methods, permanent methods are irreversible.There are 2 methods under this category: vasectomy and tubectomy. Vasectomy is the surgical intervention on the fallopian tubes (females) or vasadeference (in males) that can permanently block the gamete transportation and implantation into the female reproductive system. Tubectomy is the removal of a small part of the fallopian tube and then ligating (stitching the ends) through a small incision on the abdomen. These techniques are highly effective and does not require long-term follow-up.
Percentage distribution of different contraceptives in use