Novel contraceptive choices for women

Thanks to advances in medical technology all you need to do is to pick a contraceptive method that is right for you, with a little planning and some knowledge.

Currently our family planning programme offers a mix of five methods at public health centres – female sterilisation, male sterilisation, IUCD, combined oral contraceptive pills, and condoms. The private sector in India provides more options of contraceptives, so those who can afford it have a wider choice.  

Couples’ contraceptive needs and choices vary from time to time in their reproductive cycle, thus a wider range of options are required especially for spacing. Immediate options could be progestin-only pills and injectables as these are approved and available in private sector; implants for which Phase-III multi-centric clinical trial is complete by the Indian Council of Medical Research (ICMR), besides LNG-IUS (hormonal IUD), diaphragm and female condoms.

However, only four modern contraceptive methods have been approved for use and are available in the private sector. They are mostly progesterone-only products which can be safely used by women after delivery while breastfeeding and by those who cannot use oestrogen containing products.

Modern methods
a) Injectable contraceptives: For women who have trouble remembering to take pills, or do not want or cannot use an IUD or implant, or cannot take oestrogen, the injectable shot could be taken as a method of contraception. It contains synthetic progesterone (progestin) that is given to women every three months to prevent pregnancy.

The shot works primarily by suppressing ovulation, so that ovaries do not release an egg and also makes the inner lining of uterus thin which prevents fixation of fertilised ovum, if it so happens by chance.

b) Progestin-only pills (POP): POPs, often referred to as mini pills, are oral contraceptive pills that contain a small amount of progestin, the synthetic form of the hormone progesterone. Unlike birth control pills or combination pills, they do not contain oestrogen and are a good alternative for women who want to use oral contraceptives but are breastfeeding or cannot take oestrogen for some other reason.

The pill is most effective during the first six months especially after giving birth, when mothers are exclusively nursing their baby and still have not had a period. Women should take one pill every day at a fixed time so that they get a steady dose of the hormone.

c) Intra Uterine System (LNG-IUS): It is an IUCD in which the vertical limb of the T has progestogen hormone (Levonorgestine) covered with a sleeve that releases the hormone slowly inside the uterine cavity at a constant rate. It has an affectivity of five years. The contraceptive effect is primarily in preventing fertilisation of the ovum and also prevention of fixation of fertilised ovum into the uterus, if it so happens.

d) Implants: A birth control implant is a small, thin, flexible plastic rod each about the size of a match stick that’s placed under the skin of the upper arm and continually delivers small amounts of progestin. It works by thinning the lining of the uterus, inhibiting ovulation and thickening cervical mucus (which prevents the passage of sperm into the uterine cavity).

It lasts for three years and is safe to use even while breastfeeding. These devices are effective within 24 hours of insertion, and fertility returns soon after the implant is removed. They are not available for use in India yet and therefore many women have to travel to foreign countries to get them inserted.

Injectable contraceptive (DMPA – three monthly dose), Progestin-only pills and implants (Implanon – single rod device) are very effective contraceptive methods, which prevent unwanted pregnancies for over 99 of every 100 women during the first year that they are used. Injectables, if taken every three months, can prevent unwanted pregnancies for 99.7 of every 100 women in the first year of its use.

The health benefits of increase in contraceptive choices are dramatic. Universal access to reproductive healthcare could prevent two-thirds of unintended pregnancies, 70 per cent of maternal deaths, 44 per cent of newborn deaths, and three quarters of unsafe abortions in the world.

(This article is based on inputs from Prof Suneeta Mittal, Former Head, Obstetrics & Gynaecology, AIIMS and Dr Alok Banerjee, Senior Medical Advisor, Parivar Seva Sanstha, an NGO working on reproductive health)
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