Contraception (birth control/family planning) is the deliberate use of artificial methods or other techniques to prevent pregnancy due to sexual intercourse. In South Africa, contraceptive products are provided free of charge to citizens at provincial hospitals and clinics. You need a prescription to obtain birth control from a chemist.
The primary forms of artificial contraception are:
1. Barrier methods: Male or female condoms
2. Contraceptive pill: Combined pill which contains estrogen & progestogen (COC pills) or a progestogen-only medicine (POP pills)
3. Injection: contains the hormone progestin; one given every 2 months (eight weeks) or another which is given every 3 months (12 weeks).
4. Patch: that contains the hormones estrogen and progestin.
4. Intra-uterine devices: releases a tiny amount of the hormone progestin into your body over several years.
5. Male or female sterilization.
Opposition & myths surrounding contraception
1. There is a still lack of knowledge about the use of contraceptives in Sub-Saharan Africa.
2. Women are scared they will gain weight on contraceptives – this has not been proven.
3. Men feel contraceptives reduce their masculinity.
4. Some religions teach the use of contraceptives is wrong – e.g. Roman Catholics, Jewish religions.
5. People feel they are playing God by using contraceptives and preventing pregnancies.
6. Women often have difficulty book sterilizations in SA, because they are told they are too young to decide- even if they already have 9 children and are HIV positive.
7. Another myth is that a person who engages in sex frequently has a ”low sperm count” and therefore the chance of pregnancy is slim.
8. They fear contraceptives will lead to permanent infertility.
9. Girls and young women in South Africa are often resistant to go to clinics for contraception or pregnancy, because of the sometimes rude and unprofessional conduct of nursing staff.
Read more: Birth control and religion
What is the cost of contraceptives in SA if bought from a chemist?
1. Condoms: R 23 – R 50 / packet of three
2. The contraceptive pill: R 135 – R 350 per month
3. Intra-uterine device: R 240
4. Hormonal implant: R 1800 – R 2100
5. Hormone patch: R 200 – R 400
6. Contraceptive injection: R 150 – R 250
7. Sterilization: Female: R 22 500 Male: R 6 235 = Private hospital fees.
8. The birth control patch: R 100 for a months supply
Services at primary health care facilities (clinics) in South Africa are accessible for people who are not on medical aid. If you are referred to a hospital, there may be a cost involved. The amount will depend on your earnings and number of dependents, according to the hospital rating scale. The hospital will require a recent payslip/income assessment (IRP5).
What are the most common side-effects of Contraceptives?
- Intermenstrual spotting.
- Breast tenderness.
- Weight gain.
- Mood changes.
- Missed periods.
- Decreased libido.
Condoms are 98% safe to prevent pregnancy. If a condom slips off during sex, you may need emergency contraception. Visit your clinic or local pharmacy as soon as possible, definitely within 72 hours.
Don’t use a condom more than once. Always check the sell-by date on the packaging as well. Also, make sure the condom you use has a CE marking on them. Those are tested to European standards. Don’t use condoms without the CE marking.
How to use a condom
1. take the condom out of the packet, taking care not to tear it with jewellery or fingernails – do not open the package with your teeth
2. place the condom over the tip of the erect penis
3. if there’s a teat on the end of the condom, use your thumb and forefinger to squeeze the air out of it
4. gently roll the condom down to the base of the penis
5. if the condom won’t roll down, you’re probably holding it the wrong way round – if this happens, throw the condom away because it may have sperm on it, and try again with a new one
6. after sex, withdraw the penis while it’s still erect – hold the condom onto the base of the penis while you do this
7. remove the condom from the penis, being careful not to spill any semen
8. throw the condom away in a bin, not down the toilet
9. make sure the man’s penis does not touch his partner’s genital area again
10. if you have sex again, use a new condom
Hormonal contraceptives work by preventing ovulation, changing the thickness of the mucus in the cervix so that sperm cannot pass through and making the lining of the uterus inhospitable for implantation of a fertilized egg.
Birth control pills are usually packaged in packets containing 28 pills, of which seven is a different colour – they are placebo or inactive pills. Some come in a pack containing 21 tablets – of which all are active pills.
How should I take them?
- You start taking the pill on the first day of your menstrual cycle.
- Start with the inactive pills. They are effective from the second month. It is wise to use condoms for birth control during the first month you start on the tablet.
- If you skip a pill, you will have to use another birth control method for that month.
Side effects of birth control pills:
- Weight gain
- Sore or swollen breasts
- A small amount of blood or spotting between periods
- Lighter periods
- Mood changes
Serious side-effects that you should see a doctor about are:
- Abdominal pain
- Chest pain
- Blurred vision
- Swelling or aching in legs
Who should not take birth control pills:
- Women above 35 who smoke
- Women who had blood clots in arms, legs or lungs
- Women with serious heart or liver disease
- Women with cancer of the breast or uterus
- Some drugs like antibiotics can interfere with the absorption of the pill. Inform your doctor that you are on the pill if you need medication for some other illness.
There are two makes of the injections available, one protects against pregnancy for 12 weeks, and the other for 8 weeks. The injection is 99% effective in preventing pregnancy. It has the lowest fail rate because you don’t need to remember to take a pill – once the injection has been given, you are safe for a three month period.
Advantages of the injection
- It is effective in preventing pregnancy for three months before you need to bother to get another one.
- It stops menstruation for the time you are using this method.
- Sex can occur spontaneously, without having to stop for putting on condoms or inserting chemicals.
- You don’t have to remember to take anything, for people who forget to take pills.
- It protects you against ovarian cysts, ectopic pregnancy and uterine cancer.
Disadvantages of the injection
There is a good chance of your periods being disrupted in some way for example
- heavy periods
- prolonged periods
- irregular or infrequent periods
- absent periods
- tummy ache
- weight gain
- delayed return of fertility after stopping the injection (anything from three months to one year)
An example of long term pregnancy prevention is the intra-uterine device.
The ”Levonorgestrel-releasing intrauterine system” is a hormone-releasing system placed in your uterus to prevent pregnancy for as long as you want for up to 5 years. It also treats heavy periods in women who choose intrauterine contraception.
These devices are recommended for a woman who already had a child and did not want any more children – because it works for 5 years. A medical doctor must insert the device. Bleeding and spotting may increase in the first 3 to 6 months and remain irregular. Periods over time usually become shorter, lighter or may stop. If you experience prolonged abdominal pain, see your doctor. Very few women get a pelvic inflammatory disease from intra-uterine devices.
Common side effects of an intrauterine device include:
- Weight change
- Mood changes
- Breast tenderness
- Ovarian cysts
- Vaginal discharge
One of the most dangerous side effects of an intrauterine device occurs when the device migrates from its normal uterus position. Even though Bayer claims this is a rare occurrence with an IUD, a study published by the Department of Radiology at the Ronald Reagan UCLA Medical Center ¹ found that this is a “frequently encountered complication.” When the IUD migrates, it can perforate the uterus and enter the abdominal cavity, pelvis, bladder or blood vessels. It can cause pain, infection, and damage to intestines and other nearby organs. This is a serious condition and requires surgery to correct. In some cases, emergency surgery is necessary to prevent further damage.
Please note: If the UID dislodges, use back-up birth control and call your healthcare provider.
Implantation of an intrauterine device such as Mirena® may increase pelvic infection risk, especially within the first three weeks after insertion.
For more information, you can also check out: http://www.drugdangers.com/mirena/
The contraceptive implant (”Implanon”) is a white plastic rod inserted under the skin of the inner, upper arm to stop pregnancy by releasing constant small amounts of progesterone into the body. The implant is approximately the size of a match. It is 99.9% effective in preventing pregnancy.
Cost: ”Implanon” costs from R1 700 in South Africa’s private sector but is free for all women in the public sector.
How do I get the implant?
Two appointments are required. The first appointment is with your health care provider to discuss this method and get a prescription. The second appointment, to insert the implant, needs to be with a doctor trained in this procedure. In South Africa, more than 4000 registered nurses will be introduced in 2014 to do this procedure.
How is it inserted?
An area on the inner arm above the elbow is first numbed with a local anaesthetic. The doctor
inserts the implant under the skin. After insertion, the site is bandaged to reduce bruising.
The bandage should be left on for 24 hours.
When does it start working?
It’s immediately effective if inserted during the first 5 days of your menstrual cycle, starting with the first day of bleeding.
The implant is effective after 7 days if inserted at any other time in the menstrual cycle. Other
contraceptive measures such as condoms should be used for these 7 days.
If changing from the Pill or another contraception method, discuss the best time for insertion with your doctor.
How long does it last?
It is effective as a contraceptive for 3 years. The implant should be taken out and replaced with a new implant every 3 years.
How do I stop using it?
To stop using the implant, it needs to be removed by a trained medical professional. They will give you a local anaesthetic; make a small cut in the skin to find the implant’s tip and pull it out. It usually takes 5–10 minutes.
When will I be fertile again?
Most women return to their normal menstrual cycle and fertility within a month of removing the implant.
What does it cost?
You can get the implant free of charge from any government hospital or clinic in South Africa. If you go to a private doctor or health facility, the cost can be R 1700.
What are the side effects?
Bleeding patterns are likely to change:
• periods may be at regular times, but they may be lighter and less painful
• periods may stop altogether
• bleeding may happen at times when you are not due
• heavy, irregular bleeding happens sometimes, and if it does not settle, it may be a good reason to take the implant out.
Many women have no other side effects. Some may experience the following problems:
1. Weight gain can occur, but it is often not due to the implant alone.
2. Headaches, breast pain and mood changes can occur and may go away after the initial few weeks.
3. Painful periods and acne usually improve with the implant, though a small number of women
will find that they can develop these problems for the first time after the implant is inserted.
4. Bruising and mild soreness at the insertion site or removal can last up to 2 weeks. A small scar remains.
Who can use the implant?
The method is suitable for most women, from young women to women in menopause. Pregnant women, women with unexplained vaginal bleeding, women who have liver disease or breast cancer should not use the implant.
Sterilization is permanent birth control for males or females. A person must be certain that they do not want to have any more children in the future, before doing this. A partner should not force one to undergo sterilization. It should be completely voluntary.
Sperm and the female egg usually meet in the Fallopian tube. Fertilization takes place in the Fallopian tube. The fertilized egg then moves down the Fallopian tube to the uterine cavity where it implants into the uterine wall. Sterilization prevents this permanently. The Fallopian tubes are folded and tied or cut during this procedure, so sperm can no longer reach the female egg. The procedure is called Laparoscopic sterilization and is done under general anaesthesia. The woman is immediately infertile – although some form of birth control should be used up and until the procedure is done.
Male sterilization (vasectomy) is achieved through a surgical procedure, called a vasectomy.
It is intended to be a permanent birth control method (there is no guarantee that it can be reversed). A vasectomy is a quick, 30-minute surgical procedure performed in the physician’s office in which the vas deferens (the tubes that carry sperm out of the penis) is cut or tied, and then the ends are cauterized (burned). This prevents sperm from coming out in the ejaculate or getting into the vagina. Recovery from vasectomy usually requires only that the patient refrains from physical activity for approximately 48 hours.
Please note: Men are not immediately infertile – it can take months before the sperm count is down to nil. Back-up contraception needs to be used until two follow-up semen tests show no sperm.
The patch is so thin that it can be worn unnoticed under clothing, and does not come off, even in humid conditions or during strenuous exercise.
It is available in South Africa. You’ll need a prescription from your health care provider to use the birth control patch and buy it from your local pharmacy. It is not available at municipal clinics. The patch doesn’t protect against sexually transmitted infections (STIs).
How do you apply a patch?
Does the patch have side-effects?
- breast tenderness
- darkening of facial skin
- nausea, vomiting
- breakthrough bleeding
- skin irritation, redness, itching, or swelling where the patch was worn
- menstrual cramps
- anxiety, mood changes
What are the benefits of using the patch?
It helps to reduce acne.
It helps to prevent bone thinning.
It helps prevent the development of cysts in your breasts and ovaries.
It helps prevents an ectopic pregnancy.
It prevents endometrial and ovarian cancers.
It helps with serious infections in your ovaries, fallopian tubes, and uterus.
It helps prevent iron deficiency (anaemia)
It helps to reduce symptoms of PMS (premenstrual syndrome)
Who should not use the patch?
- who are age 35 or older and smoke
- who have chest pain or a history of heart attack, stroke or severe high blood pressure
- who have a history of blood clots
- who have a history of breast, uterine or liver cancer
- who weigh more than 198 pounds (90 kilograms)
- who have liver disease or migraines with aura
- who have diabetes-related complications of the kidneys, eyes, nerves or blood vessels
- who have unexplained vaginal bleeding
- who developed yellowing of the whites of the eyes or the skin (jaundice) during pregnancy or when previously taking hormonal contraceptives
- who are about to have major surgery and will be unable to move around as usual
- who are taking any medications or herbal supplements
- who are sensitive to any part of the birth control patch