Birth control : Overview, Contraception and its Methods and Drawbacks

You might have observed that in the last few decades, the population has been increasing rapidly. This rapid increase in population is commonly called population explosion. You know that a large population is one of the problems faced by our country. Hence it needs to be controlled. 

Do you know any way to control this population explosion? Well, one of the ways could be spreading awareness about family planning programs and birth control measures. The prevention of birth of a child by using some kinds of contraceptive measures is called birth control. You might have heard about this but may not have a vast knowledge about it. There are various contraceptive methods which help in preventing unwanted pregnancies. Let us take a deep dive into the details of contraceptive methods in this article. 

Table of Contents

• Contraception
• Natural methods
• Barrier methods
• Intrauterine devices (IUDs)
• Oral contraceptive pills
• Injections and implants
• Surgical methods
• Practice Problems
• FAQs

Contraception

Contraception is a method to prevent unwanted pregnancies. There are various contraceptive methods available, which are enlisted below:

• Natural methods
• Barrier methods
• Intrauterine devices
• Oral contraceptive pills
• Injections and implants
• Surgical methods.

Ideal Contraceptive

All the contraceptive methods will have some characteristic features. The features which make them an ideal contraceptive are as follows:

• It should be easily available and user- friendly. 
• It should be reversible
• It should be effective with least or no side-effects.
• It should not interfere with the sexual act and sexual desire of the user. 

Natural methods

Natural contraceptive methods work on the idea of reducing the chances of the meeting of ovum and sperm. They are of three types as follows:

• Coitus or withdrawal interruptus
• Periodic abstinence
• Lactational amenorrhea

Coitus interruptus or withdrawal

In coitus interruptus or withdrawal, the male partner removes his penis from the vagina immediately before ejaculation to avoid fertilisation. This requires a strong understanding between the partners. 

Periodic abstinence

Periodic abstinence or rhythm method is one such strategy in which couples avoid or refrain from coitus between days 10 and 17 of the menstrual cycle, when ovulation is expected. This period is named as the fertile period because the chances of fertilisation are extremely high at this time. Hence the conception could be avoided by refraining from coitus at this time. It is also called a rhythm method. 

Lactational Amenorrhea

The Lactational Amenorrhea or absence of menstruation technique is based on the fact that ovulation and hence the menstrual cycle do not occur during the postpartum phase of strong lactation. As a result, the chances of conception are almost negligible if the mother breastfeeds the infant exclusively. However, this strategy has only been shown to be effective for a maximum of six months after parturition. These procedures have essentially no negative effects because no medicines or equipment are used. This procedure, however, has a significant risk of failure.

Barrier methods

Barrier methods use barriers to prevent ovum and sperm from physically contacting one other. These methods are available for both females and males. It includes condoms, cervical caps, diaphragms, and vaults.

Condoms

They are thin rubber or latex sheath barriers that are used to cover the male penis or the female vagina and cervix just before coitus to prevent ejaculated semen from entering the female reproductive tract. Nirodh is a well-known brand of male condom. Condom use has risen in recent years as a result of the added benefit of protecting the user from STDs and AIDS. Both male and female condoms are disposable, may be self-inserted, and provide the user with privacy. After using a condom, some people report itching, redness, or swelling. A latex allergy might cause these symptoms. According to a 2016 study, these allergies affect approximately 4.3 percent of the global population.

Diaphragms, cervical caps and vaults

Rubber barriers such as diaphragms, cervical caps, and vaults are put into the female reproductive tract to cover the cervix during coitus. They work by preventing sperm from entering the uterus through the cervix. They can be reused. They need to be kept inserted for at least 6 hours after coitus. They are reusable. 

Spermicidal creams, jellies and foams

To boost the contraceptive effectiveness of the barriers, spermicidal lotions, jellies, and foams are commonly utilised along with them. It can be used alone also. It contains chemicals which prevent pregnancy by killing the sperm, blocking the cervix and entry of sperm to the uterus. It slows down the sperm’s movement. Spermicides creams are applied deep in the vagina and cervix just 10 - 60 minutes before sex. It must stay inside the uterus till 5 - 6 hours after sex. 

Intrauterine devices (IUDs)

These are devices either hormone based or copper ion based. They are placed in the uterus through the vaginal canal by doctors or expert nurses. IUDs are an excellent choice for women who desire to postpone pregnancy and/or space their children. It is one of the most widely used contraceptive methods. They are long lasting contraceptives with minimal side effects. They are mainly of three types as follows: 

• Non-medicated IUDs 
• Copper-releasing IUDs
• Hormonal IUDs

Non-medicated IUDs

They include the Lippes loop, a double S shaped inert flexible plastic loop. It is inserted into the uterus provokes an increase in the immune cells in the uterus which phagocytose the sperm and prevent implantation of the embryo.

Copper-releasing IUDs

 IUDs promote sperm phagocytosis within the uterus, and the Cu ions released reduce sperm motility and fertilisation potential. Examples include CuT, Cu7 and Multiload 375.

Hormone-releasing IUDs

Hormone-releasing IUDs render the uterus unsuitable for implantation and make the cervix hostile to sperm. Examples include Progestasert and LNG-20. 

Oral Contraceptive Pills

They are made up of progestogens or progestogen–oestrogen combinations. They are commonly referred to as pills because they are taken as tablets. The pills must be taken every day for 21 days, particularly within the first five days of the menstrual cycle. It must be done in the same manner after a 7-day break (during which menstruation occurs) until the female chooses to avoid conception. They block or delay sperm entry by inhibiting ovulation and implantation, as well as altering the quality of cervical mucus. Pills are highly effective, have less adverse effects, and are well received by women. Examples include Saheli, Mala-D and Mala-N. 

Saheli

It is a new female oral contraceptive. It has a non-steroidal formulation. It is a once-weekly pill with little adverse effects and a high contraceptive effectiveness. It is developed by CDRI, Lucknow. 

Implants

Females can utilise progestogens alone or in combination with oestrogen as implants under the skin. Their method of working is similar to that of tablets. But their action duration is significantly longer compared to contraceptive pills. Within 72 hours following coitus, progestogens, progestogen-estrogen combos, or IUDs have been found to be particularly successful as emergency contraceptives, as they can be used to prevent pregnancy due to rape or unprotected intercourse.

Vaginal Rings

They are small, flexible, soft plastic rings. They release a continuous dose of oestrogen - progestogen combination. They can be inserted into the vagina. 

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Skin patches

They are transdermal patches applied to the skin. They contain oestrogen - progestogen combination. They can be kept in the upper torso, upper outer arm, buttock and abdomen. They need to be replaced after 28 days. They show 99% of efficiency.

Drawbacks of Hormonal Contraceptives

The common drawbacks of hormonal contraceptives are enlisted below:

• They can cause irregular periods.
• It may result in mood changes and depression.
• It may result in gaining weight. 
• It also causes sore breasts, vaginal irritation or inflammation. 
• It will not provide protection against Sexually Transmitted Infections (STI).
• It affect the sexual desire of the partner (low sexual drive in females).
• It can cause migraine and nausea. 

Surgical Contraceptive Methods

Surgical procedures, often known as sterilisation methods. They are generally recommended for the male or female couple as a last resort to avoid more pregnancies. Surgical intervention prevents conception by blocking gamete transit. Although these procedures are quite effective and their reversibility is weak.

Vasectomy 

The male sterilisation treatment is known as a 'vasectomy,' A tiny portion of the vas deferens is removed or tied up through a small incision on the scrotum in vasectomy.

Tubectomy

 The female sterilisation procedure is known as a 'tubectomy’ in which a small portion of the fallopian tube is removed or tied up through a small incision in the belly or by vaginal surgery.

Practice Problems of Birth Control

Q1. Select the incorrect statement about intrauterine devices.

1. They can be placed only by doctors and practice nurses
2. They are ideal contraceptives to have space between the children
3. They last long
4. They can prevent from sexually transmitted diseases

Solution: Intrauterine devices do not act as a barrier between the sperm and vagina. Thus, the exchange of body fluids can take place. Hnece, it cannot prevent from sexually transmitted diseases.

Q2. Read the given assertion and reason and select the correct option.

Assertion: Lactational amenorrhea is based on the principle that during the intense lactation period of the mother, the chances of ovulation are less and so is fertilisation.

Reason: It is not an effective method of contraception and has significant chances of failure.

1. Both assertion and reason are true, reason is the correct explanation of assertion.
2. Both assertion and reason are true but reason is not the correct explanation of assertion.
3. Assertion is true, Reason is false.
4. Both assertion and reason are false.

Solution: Lactational amenorrhea works on the principle that during the first six months after parturition, when the mother breast feeds a child, the levels of FSH decreases. This prevents ovulation. Thus, fertilisation is also prevented. However, it is not a fool proof method of contraception and has high risks of failure. Hence, option b is correct.

Q3. Why is ‘Saheli’ considered as an excellent contraceptive pill?

Solution: Saheli is considered as an excellent contraceptive pill because of the following reasons:

1. It is a non-steroidal pill, thus, it will not affect the hormonal levels of the user.
2.  It is a once a week pill rather than other oral pills which need to be consumed regularly for 21 days.
3. It has high contraceptive effectiveness. 
4. How do hormone-releasing IUDs act as contraceptives?

Solution: Hormone-releasing IUDs render the uterus unsuitable for implantation and make the cervix hostile to sperm. Examples include Progestasert and LNG-20.

Q4. What is the fertile period in the menstrual cycle? Why is it important? Which method of contraception can be used during this period?

Solution: Fertile periods are the days from day 10 to day 17 of the menstrual cycle when there are high chances of ovulation. Periodic abstinence is preferred during the fertile period in which coitus is avoided during this time period.

FAQs of Birth Control

Question1. Why are barrier methods mostly accepted for contraception?

Answer. Barrier methods prevent the physical meeting of ovum and sperm by preventing the entry of sperm in the vagina. They also prevent from sexually trnamsitted disease by preventing the mixing of body fluids. This cannot be provided by any other contraceptive methods. 

Question2. Which method of contraception is commonly used?

Answer. The most common contraceptive methods currently used are female sterilisation. As per the National Survey of Family Growth, it is 18.6%.

Question3. What is considered as the oldest method of contraception?

Answer. Ancient Egypt and Mesopotamia as far back as 1850 BC were using contraceptive methods. During research scientists found the papyrus scrolls with information regarding contraceptive methods. These papyrus scrolls had directions on how to make contraceptives, using honey and acacia leaves. They used to make cervical caps from lint to prevent sperm from entering the womb.

Question4. What are male contraceptive pills?

Answer. These are pills with the formulation Dimethandrolone undecanoate (DMAU). It inhibits sperm production (spermatogenesis) in testes. DMAU inhibits the pituitary gland from releasing LH and FSH. So there won’t be any testosterone and sperm production (spermatogenesis). 

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