 |  | Healthy Women, Healthy Mothers - An Information Guide - Second Edition (FCI, 1995, 241 p.) | ||
 |  | Chapter Seventeen - FAMILY PLANNING AND CHILD SPACING | ||
|  | (introduction...) | ||
| | The Benefits of Family Planning | ||
| | Methods of Contraception | ||
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Family planning refers to the actions couples take to have the desired number of children, when they are wanted. Using a method of family planning means allowing choice, not chance, to determine the number and spacing of children. Planning the family helps protect the woman's and the children's health, and preserves the well-being of the whole family. Decisions about family planning should be made by a woman and man together, since most family planning methods require cooperation to make them work.
Family planning is not a new idea in Africa. For generations, couples have found ways to avoid getting pregnant until they are ready to have a child, or to limit the number of children they have. Most African cultures have always known, for example, that having another baby when the elder child is still too young would be bad for that older child. The Ghanaian word "kwashiorkor" describes the malnourishment of a child weaned too early because his or her mother became pregnant again too quickly. Traditions such as breastfeeding for a long time and avoiding sexual relations for months or even years after the birth of a child (for example, until the child can walk) ensured that a woman could recover fully from one pregnancy before becoming pregnant again. These traditions also ensured that each child could have the mother's full attention during the important early years.
Family planning improves the health of children and mothers. Children are more likely to fall ill and die if they are born too close together (less than two years apart), or born after the mother has already had many children (five, six, or more). Having too many children too quickly also increases the mother's risk of having complications during pregnancy and delivery. As discussed in Chapter 7, if a woman becomes pregnant when she is too young (under 16 or 17 years) or too old (over 40 years), her chances of having a complication are increased.
Finally, family planning helps the entire family - father, older children, and even grandparents. Raising children requires a lot of time, energy, and money, especially if children are given the food, clothing, education, and other opportunities they need to have a good chance in life. By helping parents have the number of children they can raise properly, family planning helps ensure that there are more resources available for every person in the family.
Contraception means preventing pregnancy; a contraceptive is a drug or device used to prevent pregnancy. There are many different contraceptive methods. Most are reversible; that is, a woman will be able to become pregnant again after she has stopped using the method. Some methods, such as surgical sterilisation, are permanent, meaning a woman cannot become pregnant ever again. All methods are designed to work in one of two ways: either they prevent the man's sperm and the woman's egg from coming together, or they prevent the fertilised egg from implanting in the womb.
The effectiveness of a contraceptive method can be described in terms of its "failure rate". If a method has a failure rate of 10%, for example, it means that if 100 couples relied on this method to prevent pregnancy, ten of the women would become pregnant during a year. If 100 couples were not using any method of contraception at all, about 80 of them would become pregnant within the year.
Many factors can influence a couple's decision about whether to use contraception, and which method to use. These factors include:
· Whether the couple wants to stop having children or just delay the next birth by a certain period,· How old they are,
· The number of children in the family, and their ages,
· Whether the mother is currently breastfeeding,
· Whether the mother or father have any health problems,
· What kind of lifestyle the family has,
· The side-effects, advantages, and disadvantages of the different methods.
Their decision will also depend on what methods of contraception are available. Not all those described here may be found at local clinics. Couples should discuss the various methods with a counsellor or health worker at a family planning clinic before deciding which one to use. This chapter only gives basic information about each type of family planning. It does not give all the instructions necessary for use.
BARRIER METHODS OF CONTRACEPTION
Barrier methods prevent the sperm and the egg from uniting, thus preventing fertilisation. Two of these methods - male and female condoms made from latex rubber - are also the only family planning methods that have been proven to offer protection against sexually transmitted diseases (STDs), including AIDS (see Chapter 18). Therefore, women who are at risk of STD or HIV infection (that is, women who have more than one sexual partner, or whose partner has other partners) should be encouraged to use condoms. If they are using another family planning method, they should be urged to use condoms as well.
Barrier methods are largely free of side-effects. They do, however, require the couple to make certain preparations before having sexual intercourse.
CONDOM OR SHEATH
Description: The condom is a soft tube made of latex rubber and closed at one end. It is put on the man's erect penis before sexual intercourse (see Figure 17.1). When the man ejaculates, the semen containing the sperm is collected in the tip of the condom. There is a small chance that the condom may tear during sexual inter-course, especially if it is not worn correctly or if it was not stored in a cool place before it was used. It is also important that the man be careful to withdraw his erect penis from the vagina, with the condom still on, so the semen does not spill into the vagina.
Condoms are supplied in different sizes, shapes, and colours; they may come with or without lubrication or spermicide. They should be used only once; they are likely to tear if used a second time.
Effectiveness: Condoms have an average failure rate of around 12%. However, this rate reflects not a failure of condoms but a failure to use them properly. If they are always used correctly and consistently, condoms can be much more effective. If a condom is used with a spermicide (see below), the combined effectiveness is similar to that of oral contraceptives (a failure rate of around 3%).
SPERMICIDES
Description: Spermicides are chemical contraceptives that prevent pregnancy by destroying sperm. They are available in a variety of forms: creams, jellies, foaming tablets, aerosol cans, and suppositories. They are put into the vagina 5-10 minutes before sexual intercourse. Sometimes they are used in combination with other barrier methods (condoms, diaphragms, etc.), which provides greater protection against pregnancy. Spermicides are available at chemists' shops and have no known side-effects apart from occasionally causing skin irritation in some women and men. They also provide some protection against some types of sexually transmitted diseases.
Effectiveness: By themselves, Spermicides are only moderately effective as contraceptives (with a failure rate of 21%). When used with other barrier methods, such as the condom or diaphragm, they are much more effective.
Figure 17.1: Condom or
Sheath
A tube made of thin rubber that is placed over the man's penis before sexual intercourse (see next page).
Figure 17.1: Condom or Sheath
(cont.)
The steps in proper use of a condom include:
1. Place the condom over the erect penis, holding or pinching the tip of the condom so that there is some space;
Figure
2. Unroll the condom down the erect penis;3. Hold the base of the condom when withdrawing from the vagina so that the condom is not left inside and so that none of the semen spills.
FEMALE CONDOM
Description: The female condom is a relatively new form of contraception which is still not available in many areas. It is a thin rubber sheath with two flexible rings, one attached to each end (see Figure 17.2). One ring, at the closed end of the sheath, is placed inside the woman's vagina similar to the way a diaphragm would be inserted, and serves as an anchor. The other ring at the open end of the sheath stays outside the vagina and partially covers the lips of the vagina. It is used once and then thrown away. It also offers some protection against sexually transmitted diseases.
Effectiveness: The typical failure rate among users of the female condom is 21%.
Figure 17.2: Female
Condom
A thin rubber tube with rings at each end. It is inserted into the vagina before intercourse. This new method is not yet available in many areas.
DIAPHRAGM
Description: The diaphragm is a shallow rubber cup with a flexible rim. The woman puts spermicide inside the cup, then inserts it into the vagina before intercourse (see Figure 17.3). When correctly fitted and in its proper position, the diaphragm covers the opening of the womb and prevents semen from entering. Diaphragms come in different sizes; a woman must have a vaginal exam by a trained health worker to find out what size is right for her. A woman must also be taught the correct way to insert the diaphragm, and to check that it is in the correct position before sexual intercourse.
The diaphragm must remain in place for at least six hours and not more than 24 hours after intercourse. If the woman has intercourse again while she is still wearing the diaphragm, she should insert more spermicide into her vagina without removing the diaphragm. After it has been used, it needs to be gently washed with soap and water, air dried, and stored in a cool place. The diaphragm can be used again and again, although it should be checked periodically to make sure no holes have developed.
Effectiveness: The typical failure rate of the diaphragm is about 18%.
Figure 17.3: Diaphragm with
Spermicide
A shallow rubber cup that is filled with spermicide, then placed inside the vagina before intercourse so that it covers the cervix.
CERVICAL AND VAULT CAPS
Description: These devices, also made of soft rubber, are an alternative to the diaphragm for some women (see Figure 17.4). They act in a similar way to the diaphragm but are smaller and cover only the cervix. After being inserted into the vagina, they work by preventing semen from entering the womb. They also come in different sizes and are used together with a spermicide. They can be left in longer than a diaphragm (up to 48 hours).
Effectiveness: The failure rate of cervical caps varies from around 18% for women who have had no children to 36% for those who have, because of differences in the cervix and vagina.
CONTRACEPTIVE SPONGE
Description: The contraceptive sponge is a small round sponge containing spermicide. It is moistened with water, then placed inside the vagina before sexual intercourse. Each sponge is used only once, and should be thrown away after use. As long as it is left in, it will provide contraceptive protection for up to 24 hours no matter how many times intercourse occurs. It should be taken out six hours after intercourse.
Effectiveness: Failure rates are 36% for women who have had children before and 18% for those who have not.
ORAL CONTRACEPTIVES
These tablets, often referred to as "the pill", contain artificial forms of hormones (chemicals) produced by the body. The most common type of pill is called the combined oral contraceptive, or COC for short. The other type is called the progestogen-only pill (POP), or the "mini-pill". To use either one of these pills, a woman swallows one tablet at the same time every day, whether or not she and her partner have sexual intercourse (see Figure 17.5). Pills should not be shared with anyone else.
Figure 17.4: Cervical
Cap
Similar to the diaphragm, except it is smaller. It is also used with spermicide.
If a woman misses taking the pill for even a few days, it is possible for her to get pregnant. If a woman misses a pill for three or more days in a row, she should use a condom or other barrier method to protect against the risk of pregnancy. Most women do remember to take the pill regularly. Others may have difficulty remembering to take their pills every day. If a woman has problems remembering to take the pills, she should seek advice from a family planning clinic about other contraceptive options or how to restart the pills.
Women on oral contraceptives should see a health worker at least once a year to be checked. Some women believe they should only use the pill for a year or two, and then stop. This is not necessary; the method can be used for many years, provided the woman has regular check-ups.
COMBINED ORAL CONTRACEPTIVES (COCs)
Description: COCs contain a small amount of both types of hormones normally produced by a woman's body: oestrogen and progestogen. COCs prevent pregnancy by preventing ovulation.
Oral contraceptives may cause side-effects in some women. Usually these side-effects go away after the first three months. They may include: feeling sick in the stomach, weight gain, headaches, depression, breast tenderness, and irregular menstrual bleeding. If these side-effects do not go away, the woman may want to switch to a different kind of pill, or to another method.
Usually oral contraceptives reduce the amount of blood lost during menstruation.
Figure 17.5: Oral
Contraceptives
Tablets that contain hormones; the woman swallows one tablet each day.
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Box 17.1: Who Should Not Use Combined Oral Contraceptives A woman should not use oral contraceptives if there is any chance she may be pregnant, or if she: · Smokes cigarettes and is over the age of 35 High blood pressure If she has any of these conditions and uses COCs, the condition may worsen or may require more careful monitoring. |
Although some women are concerned by this, they can be reassured that it is not because the blood is staying inside. It happens because the lining of the womb builds up less when a woman is taking oral contraceptives. COCs also offer protection against some infections of the reproductive organs. When a woman stops taking the pill she is usually able to get pregnant again quite soon.
The most serious, and rarest, side-effect of the pill is that some women develop blood clots. If she falls into one of the categories listed in Box 17.1, a woman is more likely to develop complications from using the pill and should therefore use another method. For healthy women who do not have one of these risk factors, taking the pill is less dangerous than having a baby.
Effectiveness: Oral contraceptives are highly effective; their typical failure rate is around 3%.
PROGESTOGEN-ONLY PILL (MINI-PILL)
Description: POPs contain only progestogen, and no oestrogen. They work in three ways: they make the mucus (liquid) produced by the cervix too thick for the sperm to go through, they change the lining of the womb so that it is difficult for a fertilised egg to attach itself, and they decrease ovulation. POPs can cause small amounts of bleeding from the vagina between menstrual periods; this may be inconvenient, but is not dangerous. They are ideal contraceptives for women who are breastfeeding a baby under six months of age. Since POPs do not contain oestrogen, they are relatively free of the more serious side-effects of COCs. Because POPs are a lower dose pill, it is important that they are taken at the same time every day. Women who miss one day are at much greater risk of becoming pregnant than those taking COCs.
Effectiveness: POPs are almost as effective as COCs in preventing pregnancy; their failure rate is also around 3%.
LONG-ACTING CONTRACEPTIVES
Long-acting contraceptives were designed to be easier to use. They need no special preparations before sexual intercourse, as condoms and foam do. And the woman does not have to remember to do something every day, as she must with the pill. Three types of long-acting contraceptives are injectables, implants, and intrauterine devices (IUDs).
INJECTABLES
Description: Injectable contraceptives contain progestogen. An injection is given every two or three months, depending on the type, either in the woman's arm or buttocks (see Figure 17.6). The hormones in injectables prevent pregnancy by causing changes in a woman's body similar to those caused by progestogen-only pills (see above). Injectables can be used while breastfeeding the baby, since they do not decrease breast milk. They do have certain side-effects, however. These include:
· Menstrual periods may become irregular or infrequent, or even stop altogether. This side-effect may be inconvenient but is not dangerous.· Once a woman stops using the injectable, she may not begin ovulating and become fertile again for some time, occasionally for as long as 12-14 months.
Effectiveness: Injectables are extremely effective; their failure rate is 0.3%.
Figure 17.6: Injectable
Contraceptive
An injection that is given to the woman every two or three months, depending on the type of injectable; the injection may be given in the arm or in the buttocks.
IMPLANTS (NORPLANT)
Description: Norplant consists of a set of six small, thin plastic tubes containing progestogen. They are placed under the skin of the upper arm through a small cut, during a minor operation (see Figure 17.7). Norplant must be inserted by a trained health worker, who will also remove it later. Once implanted the tubes cannot be seen easily, although they may be felt if the skin in that area is squeezed. Norplant prevents pregnancy by slowly releasing a little of the hormone into the body every day.
Norplant contains a smaller dose of progestogen than the pill or the injectable. It therefore has some of the same side-effects as other hormonal methods, especially the effects on menstruation, but these side-effects are usually minimal. During the first several months, bleeding may be irregular. There may be spotting in between periods, or the periods may be longer or more frequent. Usually menstrual periods will resume their normal pattern within 9-12 months. Once Norplant is removed, fertility returns quickly.
Effectiveness: Norplant is highly effective, with a failure rate of 0.09%. It remains effective for up to five years. It is slightly less effective in women who weigh more than 154 pounds (70 kilos).
INTRAUTERINE DEVICES (IUDs) Description: IUDs are plastic devices inserted into the womb through the vagina by a trained person. They are left in place for a period of time to prevent pregnancy (see Figure 17.8). Some are coated with copper, and some contain small amounts of the female hormone progestogen. Most IUDs have a short "tail" or string that the woman can feel by putting her fingers into her vagina. Generally the string is not felt during sexual intercourse by either partner.
Figure 17.7: Implants
(Norplant)
Six small plastic tubes that are placed underneath the skin in the woman's upper arm through a small cut. The operation must be performed by a trained health worker.
Although IUDs need to be put in by a trained person, very little supervision or follow-up is necessary afterwards. A visit to a doctor or nurse once a year is required to check the position of the device.
IUDs are not suitable for all women, however, because they increase the risk of infection in the reproductive organs. A woman should not use the IUD if she has recently had a sexually transmitted disease or had a serious infection of the reproductive organs in the past. She should also avoid the IUD if she has many sexual partners or her partner has other sexual partners. If she bleeds very heavily during menstruation, or has a disease of the womb such as fibroids, she should not use an IUD.
Side-effects of the IUD may include:
· Bleeding from the womb and pain in the abdomen or back sometimes occur for a few days after an IUD is inserted. Spotting between periods and heavier bleeding during a period may also occur. Both of these symptoms should stop about three months after the IUD is inserted.· The IUD may come out of the womb by itself, especially during a period, although this is not common. A woman should be taught to make sure the IUD is in place after each menstrual period. She can do this by feeling for the "tail" which lies within reach in the vagina.
Effectiveness: Once correctly inserted, an IUD can be left in place and remains effective for several years. IUDs have a low failure rate: from 0.1% to 2%, depending on the type used.
Figure 17.8: Intrauterine
Device (IUD)
A device that is inserted into the womb through the vagina by a trained health worker.
MALE AND FEMALE STERILISATION
Sterilisation is the most effective and safest form of long-term contraception available. It is also permanent. Therefore, a couple should be very sure they do not want any more children before choosing this method. Sterilisation may also be a good choice if pregnancy would seriously endanger a woman's health. Although it has been possible in a few cases to reverse the operation, success is very rare. Both men and women sometimes fear that sterilisation will make them "cold" or change their sex life, self-image, or energy level. They should be counselled and reassured that the operation will not affect their ability to perform sexually, or their capacity to enjoy sex.
MALE STERILISATION OR VASECTOMY
Description: Vasectomy, or male sterilisation, is a simple and minor operation. It can be performed by a trained person who need not be a doctor. First, an injection is made to numb or deaden the skin of the scrotum so that the man will feel no pain. A small incision (cut) is then made in the skin, and the vas deferens tube, which carries the sperm from the testes to the penis, is cut. The two ends are tied separately. The same procedure is carried out on the tube on the other side (see Figure 17.9).
If performed by a trained person in accordance with proper medical procedures, the incision heals quickly, leaving only a tiny scar. There may be slight infection or a small swelling at the incision, which will soon disappear. A new "no scalpel" method is also becoming more widely available. With this method a special instrument is used to make a small puncture in the skin instead of a scalpel incision. Because there is no cut, this method appears to have an even lower complication rate.
Figure 17.9: Male
Sterilisation
A minor operation during which the tubes that carry sperm are cut and closed. The operation must be performed by a trained health worker.
After the man has the operation, he can still have sexual intercourse and ejaculate semen (liquid). However, the semen will not contain any sperm to fertilise the egg. Immediately after the operation is performed, sperm may still be passing with the semen. An additional form of contraception should be used for the first 15 ejaculations until all the sperm has been cleared.
Effectiveness: Male sterilisation has a failure rate of 0.15%.
FEMALE STERILISATION OR TUBAL LIGATION
Description: Sterilisation in the female involves cutting each fallopian tube in two and tying or burning the two ends separately (see Figure 17.10). To reach the fallopian tubes, the doctor gives the woman a pain-killing injection so that she will not feel anything, then cuts the skin of the abdomen. The most common procedure currently used is called the mini-laparotomy. With this procedure, the cut is made just above the pubic hair. The actual procedure is relatively simple, and the risk of complications is low if performed by a trained person in a good clinical setting. The risks of female sterilisation are higher, however, than for male sterilisation. This is because the operation is more serious. The most common complication is infection at the site of the cut. Other possible complications, which occur very rarely, are injury to the womb, bladder, or intestine. After this operation, a woman will continue to have periods as she did before.
Effectiveness: Female sterilisation has a failure rate of 0.4%.
NATURAL METHODS OF FAMILY PLANNING
Description: Natural methods of family planning include all methods that do not involve taking any drugs or using a device to prevent pregnancy. Most of these methods involve finding out when during the menstrual cycle ovulation occurs. The woman then needs to cooperate with her partner to avoid sexual relations during the days when she is likely to get pregnant. Sometimes couples combine natural family planning with the use of barrier methods. This means they use natural methods to determine when the woman is likely to get pregnant, and use a condom, diaphragm, or other barrier method during those days.
Figure 17.10: Female
Sterilisation
An operation in which the tubes that carry the eggs to the womb are cut and sealed. The operation must be performed by a trained health worker.
Menstruation and ovulation are described in Chapter 4. That chapter describes the process by which a woman's body releases a mature egg, ready to be fertilised by the man's sperm. A woman can become pregnant if she has sexual intercourse one, two, or three days before ovulating, the day of ovulation, or one day after. This period is known as the fertile phase. The rest of the menstrual cycle, when there is no egg to be fertilised, is the infertile phase or the "safe period". To use the natural method of family planning, couples have to avoid sexual intercourse during the fertile phase. Since it can be difficult to tell exactly when ovulation takes place, the best way is to avoid intercourse for about ten days out of every month around the time of the fertile phase.
There are several ways to find out when ovulation occurs. These methods are described only briefly here. If a couple is interested in using one of these methods, they should ask a trained health care provider for more details. These methods can also be used when a woman is trying to become pregnant to help her identify her fertile time.
CALENDAR METHOD: It is possible to use a calendar to estimate the fertile period. If a woman has a very regular cycle (that is, menstruation occurs every 28 days or very close to that), this method is fairly easy to use. Since ovulation occurs about 14 days before the next period is due, a woman should count backward 14 days from when her next period is expected to calculate the day she will ovulate. She should avoid sex from about seven days before that day until about two days after. If a woman's menstrual periods are not very regular, this method can still be used, but it is much more difficult and complicated. A record must be kept for about eight months, and then calculations made to determine the approximate fertile phase.
TEMPERATURE METHOD: A woman's body temperature rises slightly (½ degree centigrade) immediately before ovulation and remains high for several days. To identify her fertile period, a woman must record her body temperature (taken before getting out of bed in the morning) for several months. This indicates when in her menstrual cycle ovulation is taking place. This method may be difficult or impossible to use if her temperature rises because of malaria or other diseases. It can also be difficult to obtain a thermometer, and for people to read and record the temperature properly.
CERVICAL MUCUS TEST: The cervix, or the neck of the womb, produces a fluid called mucus which has a different thickness on different days of the menstrual cycle. Around the time of ovulation, there is a lot of mucus and it feels watery, thin, and slimy. Intercourse should be avoided at this time. During the rest of the cycle, there is not as much mucus and it feels thicker and drier. In order to test the mucus, a woman can put her finger into her vagina and feel the texture of the secretions. During ovulation the mucus makes a long string between the fingers when separated.
There are other methods of family planning that are considered "natural" because they do not involve using any devices or medicines. These methods differ from the ones described above because they do not depend on calculating when ovulation occurs.
WITHDRAWAL: This method of avoiding pregnancy requires the man to withdraw his penis from the vagina before he ejaculates or "comes". It is undoubtedly the most widely used form of family planning since Biblical times. The main problems are that it requires great self-control on the part of the man, and is not very reliable.
LACTATIONAL AMENORRHOEA METHOD (LAM):
In most women, breastfeeding delays ovulation and the return of menstruation. In fact, a woman is protected against pregnancy as much as 98% of the time for the first six months after having a baby, if the following conditions are met: she has not started her menstrual periods, and she is fully breastfeeding (giving the baby only breast milk, and feeding on demand). If her menstrual period starts or if she begins giving the baby food supplements, she must immediately start using another family planning method to avoid pregnancy. The preferred methods during this time are barrier methods or methods that rely on the hormone progestogen (mini-pills, injectables, or implants). Methods that include the hormone oestrogen reduce the mother's supply of breast milk.
The natural family planning methods described above are the only types of family planning approved by the Catholic Church. There are no physical side-effects as there may be from drugs or devices. For some women, however, it can be very difficult to determine exactly when ovulation occurs, which is why these methods have a relatively high failure rate.
Effectiveness: The overall failure rate of natural methods of family planning is about 20%. This may be greatly improved depending on the motivation and willingness of the couple, and if two or more methods are combined.
TRADITIONAL METHODS
Most cultures have a variety of traditional methods that are believed to prevent pregnancy. These include using charms or spells, such as tying a string around the waist, drinking teas made from certain leaves or roots, or eating certain foods. There is no scientific evidence that these methods work; in fact, there is quite a bit of evidence that they do not. Some people also believe that jumping up and down or exercising in other ways just after sexual intercourse will prevent pregnancy. Sometimes women try douching, or washing the semen out of the vagina, immediately after intercourse. These methods do not work because sperm reach the womb and the fallopian tubes very quickly. Less than a minute after the man has ejaculated in the vagina, sperm have already reached the fallopian tubes. If an egg is available, a sperm may have already fertilised it.
As long as a traditional method does no harm, there is no reason to discourage people from practising it; but they should be strongly advised to use another method as well, such as one of the methods described earlier in this chapter.
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Summary: Family Planning and Child Spacing |
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FAMILY PLANNING METHODS VARY WIDELY, AND CAN BE DIVIDED INTO SEVERAL CATEGORIES: |
FAILURE RATE: |
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BARRIER METHODS: These prevent the sperm from fertilising the egg. CONDOM: A latex rubber tube which is closed at one end. It is placed on the man's penis before sexual intercourse. |
12% |
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FEMALE CONDOM: A thin rubber sheath which is placed inside the vagina before sexual intercourse. |
21% |
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SPERMICIDES: Chemical contraceptives placed inside the vagina before intercourse. Often used together with other barrier methods. |
21% |
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DIAPHRAGM: A rubber cup with a flexible rim. It is inserted into the vagina before intercourse and placed so that it covers the opening of the womb. |
18% |
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CERVICAL CAP: A small rubber cup similar to the diaphragm. |
18-36% |
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SPONGE: A sponge with spermicide. It is placed inside the vagina before intercourse. |
18-36% |
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ORAL CONTRACEPTIVES ("THE PILL"). Tablets containing hormones. The woman has to swallow a tablet every day. | |
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COMBINED ORAL CONTRACEPTIVES (COCs): Contain oestrogen and progestogen. |
3% |
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PROGESTOGEN-ONLY PILLS (POPs, OR "MINI-PILLS"): Contain only progestogen. |
3% |
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LONG-ACTING CONTRACEPTIVES INJECTABLES: An injection containing hormones that prevents ovulation. Given to the woman every 2-3 months. |
0.3% |
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IMPLANTS: Several small, thin plastic tubes that are placed in the upper arm of the woman through a minor operation. The tubes contain a hormone that prevents ovulation. The implants must be inserted by a trained health worker. |
0.09% |
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INTRAUTERINE DEVICE (IUD): A plastic device inserted in the womb by a trained health worker. |
0.1-2% |
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Family Planning and Child Spacing (cont.) |
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FAMILY PLANNING METHODS VARY WIDELY, AND CAN BE DIVIDED INTO SEVERAL CATEGORIES: |
FAILURE RATE: |
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SURGICAL CONTRACEPTION: These two methods are permanent and irreversible. Both must be carried out in a properly equipped health facility, by a trained health worker. | |
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MALE STERILISATION (VASECTOMY): An operation in which the vas deferens, which carries sperm, is cut and sealed. This prevents sperm (but not semen) from leaving the man's body. |
0.15% |
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FEMALE STERILISATION (TUBAL LIGATION): An operation in which each fallopian tube is cut and tied to prevent the eggs from reaching the womb. |
0.4% |
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NATURAL METHODS: These include a variety of methods that do not involve the use of medicines or devices to prevent pregnancy. For most of these methods, the woman uses various signs or calculations to determine when she can become pregnant, and avoids having intercourse during that time. |
20% |
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