Reproductive health means total well-being in all aspects of reproduction, i.e., physical, emotional, behavioral, and social. “Reproductive health” this chapter deals with problems due to population explosion, strategies for birth control, medical termination of pregnancy, and sexually transmitted diseases. Though in this article, we will be focusing on the topic of birth control, its need, and different types of birth control methods.
Need for Birth Control
Birth control is required to avoid unwanted pregnancies to overcome the population explosion issue. Birth control methods are also known as contraceptive methods. These are also helpful in preventing sexually transmitted infections.
Contraceptive methods are broadly divided into two types:
- Temporary Methods
- Permanent Methods
Temporary Methods of Contraception
By this method, the contraception is temporary. The temporary method is easily reversible. The different temporary methods are:
Natural Methods of Contraception
- Rhythm method /safe period / periodic abstinence /calendar method-A safe period is a period in which there are fewer chances of fertilization. It is before the 10th day and after the 17th day of the menstrual cycle.
- Withdrawal method /coitus interruptus method-In this method, the penis is to be withdrawn before ejaculation. This is not effective due to its highest failure rate.
- Lactational amenorrhea-Absence of menstrual cycle at the time of lactation. As a result, sexual intercourse during the lactation period will not lead to fertilization.
Barrier Methods
Prevent fertilization Ovum and sperm are prevented from physically meeting with the help of a barrier
- Condoms- It is irreversible. It prevents STDs and AID’s. It is made of thin rubber or latex sheath. Furthermore, it covers the penis in males and the vagina and cervix in females. It is used just before coitus so that ejaculated sperm would not enter the female reproductive tract. It can be self-inserted, thus giving privacy to the user. ‘Nirodh’ is a popular brand of condoms for males.
- Fem shield (female condoms)- It is irreversible and also prevents STDs and AIDs.
- A cervical cap, Diaphragm, and Vault- These are reusable, are made of rubber, and can be inserted into the female reproductive tract. They cover the cervix during coitus and prevent the entry of sperm through the cervix and thus prevent conception. Spermicidal jellies, Creams, and foams are used along with these to increase their efficiency.
Chemical Methods (Spermicidal Agents)
These are available in the form of creams, tablets, jellies, and foams and contain chemicals like citric acid, boric acid, and zinc sulfate. These chemicals kill the sperm by disrupting its membrane.
Intrauterine Devices (IUDs)
Doctors or expert nurses insert intrauterine devices into the uterus through the vagina. They increase phagocytosis of sperms within the uterus, and the copper ions released suppress the motility and fertilizing capacity of sperm. They are ideal contraceptives for females who want to delay pregnancy or space between children. This is one of the most widely accepted contraceptive methods in India.
Types of Intrauterine Devices
- Non-medical IUDs – They just increase the phagocytosis of sperm. Example – Lippe’s loop.
- Copper-releasing IUDs- Copper IUDs commonly called ‘copper -Ts’ contain ionized copper which slowly diffuses at the rate of 50 micrograms per day. It has a local anti-fertility effect by bringing about the release of toxic cytokines from the uterine wall. This suppresses the motility and fertilizing capacity of sperm, and also increases the phagocytosis of sperm. Examples– CuT 200, Multiload CuT 375, CuT 380, CuT 250, CuT 7. Due to calcium ion (present in the female reproductive tract) deposition on copper-Ts, releasing of copper stops over time.
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Hormone releasing IUDs-They release progesterone which inhibits gonadotropic-releasing hormone and LH and FSH and stops the menstrual cycle. Hormone IUDs make the uterus unsuitable for implantation-
- Due to the absence of the menstrual cycle, the development of follicles does not occur. Thus, there is no source of estrogen, and thickening of endometrium does not occur, which makes the uterus unsuitable for implantation.
- Cause changes in cervical mucus that make the cervix hostile to sperm.
- Causes anovulation
Examples:
- Progesterone IUDs (progestasert)
- Levonorgestrel IUDs (LNG 20)
Hormonal IUDs act as emergency contraceptives if used within 72 hours of unprotected sex.
Oral Contraceptive Pills
They contain only progesterone or progesterone- estrogen combination.
Hormonal pills act in four ways:
- Inhibition of ovulation.
- Alteration in the uterine endometrium makes it unsuitable for implantation.
- Changes in cervical mucus impair its ability to allow passage and transport of sperms.
- Inhibition of motility and secretary activity of fallopian tube.
Synthetic progesterone and estrogen are used in these pills
- Synthetic Progesterone-Levonorgestrel, Ethinyl oestradiol
- Progesterone and estrogen combination pills –
These pills are taken orally for 21 days in a menstrual cycle from the 5th day to the 25th day and then restarted after a gap of 7 days. After the 5th day, the artificial thickening of the endometrium starts with the help of artificial estrogen. Artificial estrogen inhibits natural thickening by stopping the menstrual cycle. After the 25th day, no pill or iron pill is taken and the level of progesterone and estrogen decrease, and menstrual flow starts.
Injectables (Depo-Provera or DMPA)
Progesterone alone or in combination with estrogen can also be used by females as an injection. DMPA (Depot-medroxyprogesterone acetate). This injection is effective for 3 months.
Implants or Norplants
These are progesterone-containing devices that are implanted subdermally (below the dermis) providing long-term contraception (3 to 5 years). They slowly release progesterone into the blood. Norplant-It is a device containing progesterone only. It has 6 small silicon permeable capsules containing levonorgestrel and these are inserted under the skin of the left upper arm. It is also called as ‘Freedom Five’ because it provides contraception for 5 years. It is the most effective contraceptive device (99.99%)
Emergency Contraception
Emergency contraception or morning-after pills are used to avoid possible pregnancies due to rape, missed pills, or casual unprotected intercourse. Emergency contraception can be done within 14 weeks of unprotected sex by removal of the corpus luteum because the Corpus luteum maintains pregnancy for 14 weeks. But the removal of the corpus luteum is not practical. Insertion of intrauterine devices or administration of progesterone or estrogen-progesterone combination within 72 hours of coitus is effective because it will make the uterus unsuitable for implantation.
Mifepristone(RU486) called antiprogesterone bind to the progesterone receptors preventing the binding of progesterone and in this way, it avoids unwanted pregnancy. When used in combination, mifepristone (RU486) and Misoprostol are more than 95% effective during the first 50 days of pregnancy.
Side effects of contraceptive methods
- Nausea
- Abdominal pain
- Breakthrough bleeding
- Irregular menstrual bleeding
- Breast cancer
Permanent Methods
Surgical interventions block gamete transport and thereby prevent conception that is fertilization. This method is highly effective, but reversibility is poor.
Vasectomy
It is a permanent method of contraception for males. In this method, both vas deferens are first ligated then bound, and then cut. It is a minor surgical procedure that is done free of cost at government hospitals. The release of testosterone, spermatogenesis, ejaculation, and erection continues but ejaculated semen is without sperm. It cause no effect on sexual desire. It is not effective immediately because sufficient sperms are present in the upper tract of the sperm duct (ampullary duct).
Tubectomy
It is a permanent method of contraception for females. In this method, a small part of the fallopian tube is removed or tied up through a small incision in the abdomen (laparotomy) or through the vagina or C-Section or Caesarean Section. It is effective immediately. The release of estrogen, menstrual cycle, and ovulation continues but the released oocyte is destroyed by phagocytosis in the fallopian tube.
FAQs on Contraceptive Methods
Question 1: What should be the properties of an ideal contraceptive?
Answer:
The properties of an ideal contraceptive are as follows:
- user friendly
- easily available
- effective and reversible with no or least side effects.
- it also should in no way interfere with the sexual drive or sexual desire.
Question 2: What are the merits and demerits of natural methods of contraception over artificial methods?
Answer:
Merits
- They do not cause any side effects.
- They do not interfere with the sexual drive or sexual desire.
- They are cost effective
- They do not involve any surgical interventions.
- They are reversible unlike artificial methods like vasectomy and tubectomy.
Demerits
- less effective
- very high failure rate.
Question 3: Write the way of action of hormonal pills.
Answer:
Hormonal pills act in four ways:
- Inhibition of ovulation.
- Alteration in the uterine endometrium makes it unsuitable for implantation.
- Changes in cervical mucus impair its ability to allow passage and transport of sperms.
- Inhibition of motility and secretary activity of fallopian tube.
Question 4: Why progesterone estrogen combination pills are better than only progesterone-containing pills?
Answer:
The absence of a menstrual cycle in females leads to problems like vomiting, nausea, and a decrease in Basal metabolic rate. Only progesterone-containing pills stop the menstrual cycle while progesterone estrogen combination pills maintain menstrual flow only and thus body feels like the menstrual cycle is occurring and show no side effects.
Question 5: Why Vasectomy is not effective immediately?
Answer:
Vasectomy is not effective immediately because sufficient sperms are present in the upper tract of the sperm duct (ampullary duct), so if intercourse occurs it will lead to fertilization. The life of sperm is about 3-4 days, so this contraceptive method is effective after 3- 4 days of surgery when the already present sperms will die.
Question 6: What are the side effects of contraceptive methods?
Answer:
The side effects of contraceptive methods are as follows:
- Nausea
- Abdominal pain
- Breakthrough bleeding
- Irregular menstrual bleeding
- Breast cancer etc.