Family planning done right

A responsible use of contraception prevents unwanted pregnancies and abortions, suggests Dr Prathima Reddy

Most unintended pregnancies happen because of lack of information about contraception or a lack of responsibility towards preventing a pregnancy. Hence, the responsible use of contraception prevents unwanted pregnancies, abortions and their complications.

World over, the unintended pregnancy rate is high and this was estimated as 70 per 1,000 women, aged 15–49 in India in 2015, which is similar to the rates in neighbouring Bangladesh (67) and Nepal (68), and much lower than the rate in Pakistan (93). This translates into an abortion rate of 47 per 10,000 women.

What is termination of pregnancy
or abortion?

It is the removal of products of conception or the fetus and placenta from the uterus. The terms fetus and placenta are usually used after eight weeks of pregnancy, while the other terms describe the tissue produced by the union of an egg and sperm before eight weeks. The commonest reason for a voluntary termination of a pregnancy is an unintended or unwanted pregnancy. Malformations or abnormalities of the baby incompatible with life are also a reason for a medically indicated termination.

According to the MTP Act of India, it is illegal to terminate a pregnancy beyond 20 weeks of gestation. On an average, 56 million abortions took place all over the world during 2010 - 2014. Of this, 25 million were unsafe abortions. Most of the unsafe abortions take place in the developing world. Even in the 21st century, on an average, 13 women die due to unsafe abortions in India. And this happens despite termination of pregnancy being legal up to 20 weeks in this country. Unsafe abortions can cause morbidity, mortality and long-term sequelae, leading to pain and infertility. They also have a huge emotional impact on the women.

What are the methods of
termination of pregnancy?

A termination of pregnancy can be performed with tablets or with a minor procedure or surgery. It must be performed by a doctor trained to perform terminations. Pre- and post-procedure counselling are very important to ensure that the complications and sequelae associated with the procedure are minimal.

What are the different types of contraception?

Contraception can be divided mainly into two categories.

Methods with no user failure: Methods that don’t depend on you remembering to take or use them such as intrauterine device (IUD) or intrauterine system (IUS), contraceptive injections, implants and sterilisation.

Methods with user failure: Methods that depend on how well you use them such as pills, condoms, diaphragm, natural family planning methods, etc.

Contraceptions are also divided into reversible and irreversible methods. The latter include female and male sterilisation. All the other methods fall into the reversible category. The most commonly used contraceptive methods in India are condoms, IUD, contraceptive pills, injectables and female sterilisation. Other less commonly used methods are natural family planning methods, withdrawal, vaginal ring, contraceptive patch, female condom, diaphragm with spermicide, and more.

Is contraception 100% effective?

No. Each one of them has a failure rate, including the sterilisation operation. However, depending on how well they are used, most of them are very effective.

If I need advice on contraceptives, should I see a doctor?

Yes, it would be preferable to see your doctor since he/she will need to take a thorough history and do a full examination to help decide which contraceptive method is best for you. Your doctor will also discuss with you the failure rates of the various birth control methods and advise you as to what is to be done in the event of ‘contraceptive failure’.

With all the contraceptive methods available, be safe, use contraception and prevent unintended pregnancies and sexually transmitted diseases.

( The author is senior obstetrician and gynaecologist, Fortis La Femme)