Planned parenthood: Pros and cons of contraception and birth control | 4 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:

Effectiveness of the methods
Safety of the method
Availability
Social and religious acceptability
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:

Intercare Medfem Hospital

A Johannesburg-based hospital specialising in women’s health. Our modern 21-bed unit is equipped with state-of-the-art technology. We offer a range of gynaecology, fertility, and cosmetic surgery services and work closely with the Medfem Fertility Clinic to ensure holistic care for our patients. We have two operating theatres and a procedure room for less invasive procedures. Talk to us to learn more about our services.