Contraception

Contraception (birth control / family planning) is the deliberate use of artificial methods or other techniques to prevent pregnancy as a consequence of sexual intercourse. In South Africa contraceptive products are provided free of charge to patients at provincial hospitals and clinics.

 

The major forms of artificial contraception are:

1. barrier methods, of which the commonest is the condom or sheath

2. the contraceptive pill, which contains synthetic sex hormones which prevent ovulation in the female

3. The injection, which also contains a synthetic hormone which prevent ovulation in the female

4. intrauterine devices, such as the coil, which prevent the fertilized ovum from implanting in the uterus;

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  to book sterilizations in SA, because they are told they are too young to make such a decision- 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 either contraception or pregnancy, because of the sometimes rude and unprofessional conduct nursing staff.

The cost of contraceptives if you decide to purchase them privately instead of getting them from a provincial hospital or clinic are as follows:

1. Condoms: R 10 – R 20 each

2. The contraceptive pill: R 90 – R 350 per packet

3. Intra-uterine device: R 240

4. Hormonal implant: R 1800 – R 2100

5. Hormone patch: R 200 – R 400

6. Contraceptive injection: R 90 – R 250

7. Sterilization: Charge differs in private hospitals, but could cost thousands of rands.

What are the most common side-effects of Contraceptives?

• Intermenstrual spotting.
• Nausea.
• Breast tenderness.
• Headaches.
• Weight gain.
• Mood changes.
• Missed periods.
• Decreased libido.

Contraceptive choices

A female can get pregnant if the male’s sperm reaches an ovum (female egg). Condoms are made from thin latex rubber and is worn over the penis to prevent  sperm from coming in contact with a female partner. Condoms (if used correctly) have the added advantage that they protect against STD’s as well.

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 jewelry or fingernails – do not open the packet 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

Birth control pills prevent pregnancy by preventing ovulation in the female. It is 99% effective if taken correctly. The pill does not protect against sexually transmitted diseases.

Hormonal contraceptives works 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’s or inactive pills. Some pills come in a packet containing 21 pills – 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 as well during the first month you start on the pill.

If you skip a pill, you will have to use another method of birth control as well for that month.

Side effects of birth control pills:

• Nausea
• Weight gain
• Sore or swollen breasts
• 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
• Headaches
• 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.

Contraceptive injections contains hormones which stop ovulation, thickens the mucus of the cervix and makes the lining of the uterus thinner, so that implantation of a fertilized egg can’t take place.

There are two makes of the injections available, namely Depo-Provera and Noristat. Depo-Provera provides protection against pregnancy for 12 weeks, and Noristat 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:

• heavy periods
• prolonged periods
• irregular or infrequent periods
• absent periods
• headaches
• tummy ache
• weakness
• dizziness
• 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, called the Mirena.

Mirena (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. Mirena also treats heavy periods in women who choose intrauterine contraception.

These devices is recommended for woman who already had a child and do not want any more children – because it works for 5 years. The device must be inserted by a medical doctor. 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 woman get pelvic inflammatory disease from intra-uterine devices.

Common side effects of Mirena include:

• Acne
• Weight change
• Mood changes
• Breast tenderness
• Nausea
• Ovarian cysts
• Vaginal discharge

One of the most dangerous side effects of Mirena occurs when the device migrates from its normal position in the uterus. Despite the fact that Bayer claims this is a rare occurrence with Mirena, a study published by the Department of Radiology at the Ronald Reagan UCLA Medical Center 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.

If the Mirena dislodges, use back-up birth control and call your healthcare provider.

Implantation of an intrauterine device such as Mirena may increase the risk of pelvic infection, especially within the first three weeks after insertion.

For more information, you can also check out: http://www.drugdangers.com/mirena/

The contraceptive implant is a white plastic rod that is 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.

How does it work?
Progesterone is a hormone which works by:
• stopping the release of an egg by the ovary (ovulation)
• making the mucus (sticky fluid) at the opening of the uterus thicker so sperm can’t get through
• changing the lining of the uterus so a fertilized egg can’t take hold.

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 trained during 2014 to do this procedure.

How is it inserted?
An area on the inner arm above the elbow is first numbed with local anesthetic. Then the doctor
puts the implant under the skin. After the implant is inserted, the arm 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, which starts with the first day of bleeding.
The implant is effective after 7 days if it is 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 method of contraception 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 doctor. This involves an injection of local anaesthetic and a small cut to the skin to find the tip of the implant and remove it. 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 the normal 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 site of insertion 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 has 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. One should not be forced by a partner to undergo a sterilization. It should be completely voluntary.

Female sterilization

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 that sperm cannot reach the female egg anymore. 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

Male sterilization (vasectomy) is achieved through a surgical procedure, called a vasectomy. It is intended to be a permanent method of birth control (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 refrain from physical activity for approximately 48 hours.

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.