Contraceptives

Family planning is regarded as an important preventive measure against maternal and childhood
mortality and morbidity. It is a vital and integral component of primary health care, which aims at
promoting responsible parenthood, controlling population and improving the quality of life of people.

Objectives

A. To prevent unwanted pregnancies

B. To secure desired pregnancies (through counseling and treatment of infertility)
C. Spacing pregnancies i.e. regulating the interval between births to ensure adequate spacing
D. Ensuring that pregnancies occur at the best time in relation to age of mother and other factors
E. Limiting the size of the family

In addition to the health benefits to families, family planning is an effective tool for controlling the
excessive population growth which can affect the ability of a country to achieve its social and economic
growth. Many governments now accept family planning as a necessary ingredient of socio-economic
development and as an important contribution to any efforts aimed at the improvement of quality of life
of the people. These include efforts to;

i. Achieve food self-sufficiency

ii. Increase gross domestic product per capita
iii. Achieve qualitative education
iv. Reduce unemployment
v. Provide adequate and effective health services
vi. Provide enough housing and other services.

Family Planning Methods

An ideal family planning method must meet the following criteria

1) Must be completely safe and without side effects

2) Must be 100% effective
3) Must be completely reversible
4) Must be cheap or free to users
5) Must be acceptable to users
6) Must be easy to use and not under medical control and must be independent of coitus i.e.
unrelated to the time of sexual intercourse

No single method meets all the above criteria and each method has its own advantages and
disadvantages.

1. Abstinence (Natural Method)

Total abstinence
This is the complete avoidance of sexual intercourse. Abstinence is the most effective method of family
planning if strictly practiced but it calls for self-discipline and determination. It has also no side effect
and no complications.

Periodic Abstinence (Rhythm Or Safe Period)

This implies the avoidance of sexual intercourse during the time the woman may be fertile in the
monthly cycle. The rhythm method is not suitable for women with irregular menses and the failure rate
is about 14-50 per 100 women.

Calendar (Rhythm) Method

This method is designated to predict the fertile period based on the duration of the previous cycles.

Basal Body Temperature (BBT)

This involves using the body temperature to detect ovulation. Ovulation is detected by identifying an
increase in body temperature (usually about 0.5oC-1oC) from a relatively lower level following the
release of eggs from the ovary. To avoid pregnancy therefore a woman will abstain from sexual
intercourse from the time of her menses up to three days after the temperature rise.

Cervical Mucus (Billing’s Ovulation) Method

This is based on the woman’s observation of a sequence of changes in the consistency or quality of
cervical mucus. Shortly before ovulation that is at early pre-ovulatory days, the mucus is sticky and
moist. During ovulation the mucus becomes thinner, slippery, watery and stretchy so as to hang in
strings without breaking, this is followed again by immediate postovulatory days of sticky and moist
mucus and subsequently postovulatory days of fertile period of scanty or no mucus in which the woman
feels dry.

2. Contraception

This is the interruption of conception at any level achieved by interfering in the function of the organs of
reproduction or by preventing a normal healthy spermatozoa from reaching and fertilizing a normal
healthy female egg. There are different methods of contraception and they include:

Coitus Interruptus (Withdrawal)

In using this method the man withdraws his penis from the vagina before he ejaculates. This method
costs nothing and if properly carried out is effective. However it needs a lot of self-control and discipline
from the man and sometimes the woman. Continuation of intercourse after ejaculation is not possible in
view of the residual spermatozoa which can be reintroduced into the vagina.

Barrier Method

Condom
The condom is a rubber like balloon which is worn over the man’s erect penis before intercourse to
collect the semen and prevent its entering into the vagina. It acts as a mechanical barrier between the
penis and vagina and also protects against sexually transmitted diseases. If well used a condom can be
highly effective in preventing pregnancy, its disadvantage is that its use may interrupt foreplay and some
users may complain of reduced sensation. There are also cases of allergy to rubber.

Diaphragm and Cervical Cap (Dutch Cap)

These are like condom contraceptive barriers but unlike condom they are used by women. Diaphragm is
the most commonly used. It is made of soft dome shaped rubber resembling a cup with flexible rim. It is
inserted into the vagina before intercourse and acts as mechanical barrier to the cervix by preventing
semen from entering the cervical canal. The addition of spermicidal cream or jelly to a diaphragm before
use enhances its effectiveness.

Spermicides

These are chemical substances inserted into the vagina shortly before sexual intercourse to inactivate
the spermatozoa and also prevent them entering the uterus. Spermicides may be in form of foams,
creams, jellies, tablets, or pessaries. Apart from having a high failure rate, spermicides have a short
lasting effect and require a short waiting time of about 10 minutes between insertion and sexual
intercourse. Some couples also consider spermicides messy. Otherwise it is easy to use and has no
serious side effects.

Intra Uterine Contraceptive Device (IUCD)

These are plastic or metal (silver or copper) devices inserted into the uterus to prevent pregnancy. There
are different types of IUCDs and include the Lippies ‘loop’ (the coil), copper T, copper 250, 375, 380, and
multi load. The mode of action of IUCDs is not confirmed but it is believed that their presence in the
uterus interferes with conception either by immobilizing or inactivating the spermatozoa, interfering
with the eggs or acting as local foreign body to prevent implantation of the ovum. They are very
effective and do not interfere with intercourse. They are easily reversible, disadvantages include risk of
pelvic inflammatory disease and attendant infertility, IUCD is not advised for nulliparous women and
also for women with multiple sexual partners. Ideally IUCDs should be inserted at the time of
menstruation so as to ensure the woman is not pregnant or immediately post-partum.

Hormonal Contraceptives

Pills

The oral contraceptives consist of two types of female hormones, the oestrogen and progesterone. The
hormones suppress ovulation by interfering with the hormonal changes in the endometrium lining of
the uterus making it become thinner, thus preventing implantation and pregnancy. In addition progestin
itself alters the mucus in the cervix and makes it thick and impregnable to the spermatozoa.
Oral contraceptives are available as combined pills or preogestagen- only pills. Some side effects include
weight gain, hypertension, leg pain, nausea etc.

Injectable Contraceptives

These are injections of long acting progestins, the most commonly used being medroxy-progesterone
acetate (deponprovera) and norethindrone enanthate (NET) given every two or three months. They
suppress ovulation with the same mechanism as oral contraceptives, the main disadvantage is
menstrual disturbance with irregular bleeding at first and amenorrhoea later, also weight gain, and
delay in return of fertility.

Implant (Norplant)

This involves the use of implants of a progestagen contained in capsules under the skin of the upper arm
or elsewhere. The mode of action and other effects are similar to the pills and injectable. The effects of
implants last for about 5years after which a new one can be inserted under the skin again. There is
return of fertility after the removal of the implant.

Post-Coital Contraception (Morning After Pills)

This is contraception administered after unprotected intercourse usually in cases of emergency such as
burst condom or rape. It is usually taken within 72hours after intercourse at a dosage of two tablets of
combined oral contraceptive containing 0.25mg levonorgestrel and 50 microgram of ethinyl oestradiol
followed by two or more tablets 72hours later. Side effects include nausea and vomiting.

3. Sterilization (Surgical Contraception)

This is a safe and often permanent contraception of either a female (tubal ligation) or male (vasectomy).

Tubal Ligation

In women the sterilization operation involves blocking or cutting both fallopian tubes to prevent the
passage of ova and spermatozoa. The operation must be voluntary and after proper counseling and can
be performed just after delivery or abortion or at any point between pregnancies. The operation has no
effect on feminity, menstruation, sexual relationship or health of the woman.

Vasectomy

This is a similar operation and involves the cutting and tying of the vas deferens- a thin tube responsible
for the transportation of the spermatozoa from the testes to the penis during intercourse. Like tubal
ligation, vasectomy does not affect the man’s health, potency, sexual drive or masculinity

4. Breastfeeding As A Contraceptive Method

Ovulation and therefore conception is unlikely to occur for about five to six weeks after delivery, but
after this time pregnancy is possible. Lactational amenorrhoea can be prolonged by prolonged
breastfeeding. Frequent stimulation from suckling of the baby is sufficient to prevent ovulation. The
suckling baby on the mother’s nipple sends messages back to the pituitary gland that prevents the
production of gonadotrophine, follicle stimulating and lactating hormones and so stop ovulation. The
commonest disadvantage is that there is always a risk of pregnancy and the taboo against sexual
intercourse during lactation is still practiced in some cultures.