Planned parenthood: Pros and cons of contraception and birth control | 3 min read

Birth control allows us to prevent pregnancy and plan the timing of pregnancy.

Birth control choices are highly individual and also acceptable for multiple reasons including personal as well as public health. Here are some facts about safe and effective options available, to help you make an informed decision about contraception that is right for you.

Personal reasons to use contraception include:

  • Postponing pregnancy until financially or professionally ready
  • Avoidance of pregnancy for social, medical, surgical or other reasons
  • Spacing of children
  • Limiting family size


Public health reasons for contraception include:

  • Population size control
  • Avoid consequences of unwanted pregnancies e.g. abortions – legal and illegal
  • Improve maternal mortality and morbidity in reproduction


When you have to choose a contraception method, consider the following factors:

  1. Effectiveness of the methods
  2. Safety of the method
  3. Availability
  4. Social and religious acceptability
  5. Accessibility


The Life table method is used to measure the effectiveness or failure rate of a specific method, using the percentage of women falling pregnant when using a particular method in the first year of use. Other methods e.g. Pearl index state it as the number of conceptions occurring among 100 women using the specific method per year.   

NATURAL OR NON-HORMONAL CONTRACEPTION

METHOD

FAILURE RATE

TECHNIQUE

ADVANTAGES

DISADVANTAGES

Abstinence

0%

Avoid penetrative sex

Very safe for pregnancy prevention and diseases

Will cause marital discourse

 Withdrawal

20-25%

Male withdraws male organ just prior to ejaculation

 Natural, no side effects

Late withdrawal, non-withdrawal due to pleasure at time makes it very unreliable

Rhythm

15-25%

Use law of averages, relying on knowledge that most women ovulate on day 14 of cycle, thus avoid coitus from days 11-16

Natural, no side effects

Some women ovulate earlier or later the average dates

Sympto-thermal

15-25%

Check temperature rise to predict ovulation

Natural, no side effects

Such a drill for women, high failure rate

Barriers  – male and female condoms

 10-20%

Latex or Silastic recepticle to trap sperms

Protection against STDs and HIV

Late insertion, non-insertion, leak, rupture, late removal increase failure rate

Shield, foam and gels

15-20%

Agent in foam or gel which is spermicidal

Easy to use. Recent association with HIV prevention agents

Forgotten, bad press about infections

Sterilisation

<1%

Tubes tied off preventing sperms and eggs from meeting

Needs a small operation

Not reversible, surgical discomfort, ectopic pregnancy, heavier periods compared to other methods

Male sterilization

<1%

 

Surgical sterilisation i.e. vasectomy very effective

Male resistance a hindrance

HORMONAL CONTRACEPTION

METHOD

FAILURE RATE

MECHANISM OF ACTION

ADVANTAGES

DISADVANTAGES

Progesterone only pills (Mini-pill)

2-4%

Inhibits ovulation, makes endometrium non-receptive to early pregnancy

Very low side effect profile

High failure rate, may hold periods back, some breakthrough bleeding may occur

Combined pills

1-2%

Inhibits ovulations, makes cervical mucus hostile to sperms, makes endometrium unreceptive to early pregnancy

Reduces menstrual flow, dysmenorrhoea, risks of ovarian and endometrial cancer. Other uses acne control, management of heavy periods

Oestrogen risk of deep vein thrombosis, fluid retention, headaches, nausea, vomiting, weight gain. Cannot be used in severe diabetics or hypertensive

 Injectables

1-2%

Interferes with ovulation, makes endometrium unreceptive to  pregnancy

Once every 2-3months, reduces forgotten doses

Injections, painful, androgenic side effects on skin, headaches. No menses in 40%, abnormal bleeding in 30-40%

Implants

<1%.

Implant under skin. Progesterone effects on ovulation and endometrium

Work for 3-5 years. Not patient dependent

Androgenic side effects of progesterone, as per injectables

Emergency contraceptives

5-10%

 

Can be used 3-5 days after unprotected coitus. Pills work under 3 days, intrauterine devices work up to 5 days

Pills can cause nausea and vomiting, increasing failure rate

Medical dictionary

Ovulation: The release of eggs from the ovaries
Endometrium: The lining of the womb where the fertilized egg attaches and grows
Hormones: Oestrogen and progesterone produced by growing eggs in the ovaries

Sources:

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