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Introduction to Contraception and Family Planning

Human Reproductive Biology for Latest Approaches to Contraceptives.

Contraception is the use of devices, chemical substances, procedures and other methods in the effort to prevent conception that results from sexual activity between a male and female of fertile age bracket (Jones & Lopez, 2014). Contraception is usually referred to as birth control or family planning. There are several contraceptive methods which are meant to be used by both males and females separately, but most of them are intended to be used by women. Contraception has been in existence since ancient Greece, Egypt, and Mesopotamia among other regions globally (Tone, 2013). The principal purpose of employing birth control is to prevent or avoid pregnancy if the individuals are not ready to meet the demands that come with conception and childbearing. On the other hand, it is used for health purposes to safeguard the mothers that are at high risk of complications associated with pregnancy such as those with sickle cell anemia trait, severe hypertension, and extreme deformations on the abdominal, pelvis and the spinal cord among other medical conditions.           

In this modern era, various approaches have been used in family planning and contraception. These methods are broadly classified as mechanical or barrier, chemical, surgical and natural methods. Under each category, there is a number of options from which the consumer can choose. For instance, mechanical or barrier approach of contraception involves the use of male and female condoms, intrauterine contraceptive device (IUCD), diaphragms, cervical caps and contraceptive sponges.  Mechanical or barrier methods are meant Chemical approach entails the use of spermicides and hormones that are packaged in various forms such as injectable form, oral pills, and implants. In almost all instances, the use of hormone based contraceptive methods is used exclusively by females. However, there have been researchers that have tried to find out the possibility of using the hormonal method of contraception among males. None existence of the hormonal contraception use among the male population is attributed to the undesirable side effects that come with their prolonged use which typically pose a number of health risks to the users. As well, surgical means of contraception entails two significant operational procedures conducted in both males and females. In females, it can either be tubal ligation, tubectomy or laparoscopic occlusions. With men, the only available surgical method of contraception is known as vasectomy. These methods are the commonly used ones globally. Nonetheless, there are also natural methods of birth control some of which were utilized in the ancient times for the same purpose and are still employed currently but in a more efficient manner with the thorough understanding and establishment of the human reproduction. These approaches classified as natural use no devices or chemicals to achieve their intended purpose. They include lactation amenorrhea, rhythm or calendar method, coitus interruptus or withdrawal, basal body temperature monitoring method and abstinence (Mastroianni, Donaldson, Kane & Committee on Contraceptive Development 2012).

Mechanical or Barrier Approach of Contraception

However, even though there is the existence of these methods of contraception, they are not used by all individuals in the society due to issues related to cultural beliefs, religion, and ethics. This has prompted the establishment of regulations, guidelines and laws governing the use of these methods in different states. Although contraception has not been fully accepted in all societies worldwide, there has been a consistently relative improvement over time with the use of it. This can be greatly attributed to improved access to medical care in most countries, advanced medical assistance, health education, literacy, globalization and dissemination of information from concerned government and medical and reproductive research agencies to the consumers and the general public.

Notably, a number of factors are considered when one is choosing the kind of contraceptive approach most suitable to them. Not all of these approaches can be used everyone, and therefore explicit explanation, advice and health education should be provided to the interested users in order for them to have an insight of what each of the approaches entails. The factors commonly considered while selecting the most suitable method of birth control include availability. Availability is the ease of access to the various options provided in either local health care facilities or other pharmaceutical outlets. Some methods may be widespread in certain areas than others due to this factor. Another factor associated with the availability and plays a role in the selection of an approach is cost and affordability of the method. Most individuals prefer the most cost-effective method. Another essential consideration is reversibility of the method of choice. Some people may want to conceive and bear children in future while others may want to prevent the possibility of conception permanently. Due to this reason, there are options provided for each of these parties that fit their interests, and it is a major factor that is considered before choosing any of the available methods (Ory, Forrest & Lincoln, 2013). Additionally, the effectiveness of a birth control approach is put into consideration. The level of effectiveness of each of the methods used differs from each other. Some have high failure rates than others as indicated in table 1 therein according to DuPré (2014). Intrauterine contraceptive device is the most effective and reliable among the mechanical methods. Other mechanical contraception options are equally effective but with a comparatively higher failure rates as they result in more unintended pregnancies. With chemical means, hormonal methods have higher success rates in prevention of conception while other chemical non hormonal options result in more unintended conceptions. Nevertheless, they are all better in terms of success rate when compared with natural methods which pose the highest risk of failure. Therefore, the only methods that are regarded to be 100% effective and reliable in prevention of conception as stipulated in table 1,are surgical tubal ligation, tubectomy, vasectomy and abstinance but only if these procedures are done correctly without any medical error. However, contrary to expectations based on its success rate, it’s the least used approach. Consequently, due to the reliability issues of some of these methods being more reliable than others, has led to those with high effectiveness and reliability percentage being common and widely used (Senanayake  & Potts, 2015). Moreover, another crucial issue considered is the side effects and adverse reactions associated with a particular approach. The body response and reaction to these approaches is not the same in all individuals. In some instances, an approach may result in an adverse reaction and undesirable side effects that pose a health risk to an individual. In such circumstances, medical and reproductive advice is sort and the person offered other more tolerable birth control approaches. Furthermore, acceptability of a method by both partners is taken into account before selecting it. This factor is specifically influenced by beliefs, psychological perceptions and all other factors that have been noted earlier.

Birth control method

Failure rate per 100 women

Natural methods

13-30 conceptions  per 100 women

chemical (hormonal) methods

3 or fewer conceptions per 100 women

Mechanical methods (barrier)

2-18 conceptions per 100 women

Chemical (non-hormonal) methods

20 conceptions per 100 women

Mechanical methods ( intrauterine contraceptive device)

1-3 conceptions per 100 women

Surgical methods

0 conceptions per 100 women.

Chemical Approach of Contraception

Table 1: Failure rates of various contraceptive methods.

Particular contraceptive method with associated advantages and disadvantages

Male and female condoms

The male condom is made of latex and is open on one end only It is worn over an erect penis before sexual intercourse. It works by blocking entry of sperms and semen ejaculated. Thus the ejaculate is collected inside the condom which is discarded afterward. By preventing successful entry of the ejaculate into the uterus, pregnancy is also avoided since fertilization of a viable ovum cannot take place. Similarly, female condoms prevent entry of sperms into the female reproductive system. It is inserted into the vagina through the vulva before sexual intercourse. The most outstanding advantage of using condoms as a birth control method is that it is the only way that also prevents transmission of sexually transmitted infections (STIs) including HIV/AIDS if used in the right manner. Moreover, its use doesn’t need any medical supervision. However, the couples are supposed to have knowledge on the correct use in order to prevent ineffectiveness and failure cases. It is readily available in most places, relatively cheap and accepted by most couples since it is entirely reversible but some may argue that it reduces pleasure. Notably, it may cause an allergic reaction in some individuals who have an allergy towards latex. Another advantage is that rupture of the condom can result in conception or transmission of STIs and HIV virus (Briggs, Kovacs & Guillebaud, 2013).

Diaphragm

This is a thin rubber that is inserted through the vagina and fitted on the cervix just before intercourse to prevent entry of sperms into the uterus. Cervical caps also use the same principles as a diaphragm. A spermicidal cream is applied to the diaphragm before this insertion. It is also supposed to be left intact for 6-8 hours after intercourse before it is removed or up to 16 hours if sex is desired again in which case additional spermicidal cream is applied without removal of the device. However, those having uterus prolapse and highly relaxed vaginal muscles are advised not to use this method as it may lead to further complications. It is moderately effective for highly motivated couples and is completely reversible but just like condoms; there can be rare occasions where allergic reactions can ensue (Zorea, 2012).

Intrauterine contraceptive device (IUCD)

It is also referred to as a coil or loop. It is a small plastic coated with copper or hormones. It is introduced by insertion into the uterus by a reproductive health expert to prevent fertilization or implantation of any fertilized ovum. Under normal circumstances, it doesn’t interfere with menstrual cycles or hormonal balance. It is stipulated that the best moments for this procedure to be performed is 4-6 weeks after delivery or soon after menstruation whereby the cervix is dilated, and one is sure not to be pregnant (Churchill Media, 2004). However, this method is discouraged and should not be used by women with heavy and painful menstruation, uterine malignancies, present infection on the reproductive system and those with irregular vaginal bleeding of unknown etiology. It is very effective, completely reversible and acceptable since it doesn’t interfere with regular intercourse. Some of the side effects associated with it are increased menstrual bleeding, discharge from the vagina, severe menstrual cramps and increased vaginal infection risk (Association for Voluntary Surgical Contraception, 2014).

Surgical Means of Contraception

Hormonal contraceptives

This involves utilization of hormones to prevent conception. The hormones are introduced into the woman’s body through either oral intake of contraceptive pills, injection or implantation of hormonal implants. There are two types of oral contraceptives, namely the combined oral contraceptives (COC) and progesterone only pills (Drill, 2016). The earlier comes in three major combinations: monophasic, biphasic and triphasic and its mode of action is inhibition of ovulation by altering the hormonal profile in the female consumer. Monophasic pills are composed of the equal amount of progesterone and estrogen hormones. Drospirenone/ethinylestradiol is an example of such a pill. Biphasic pills contain the two hormones, progesterone, and estrogen with two different dose combinations. On the other hand, triphasic pills have three types of two separate combinations of estrogen and progesterone. The second category, progesterone only pills, is composed of progesterone hormone only. They also change the hormonal profile in the body throughout the monthly cycle hence also preventing ovulation (Drill, 2016). Injectable contraceptives are equally based on the principle of preventing ovulation. A 150 mg dose of medroxyprogesterone acetate is injected intramuscularly after every three months. Likewise, implants are small devices that have hormones majorly levanogesteral. They are inserted into the groove between the biceps and triceps of upper forearm. All these options provide 100% conception prevention if used according to the recommendation. The use of these methods is completely reversible albeit not immediately. Some of the effects associated with their use are breast tenderness, weight gain, headache, nausea and slightly rise in blood pressure, spotting, irregular menstruation, excessive bleeding and in some instances reduced menstrual flow. Emergency contraceptive pills are high dose progesterone or estrogen based pills that are taken after unprotected sexual intercourse to prevent fertilization and implantation. They are supposed to be taken within 72-120 hours after the intercourse for them to be effective. They may also cause side effects such as nausea, vomiting, and headache besides making the menstrual cycle become irregular for some time.

Surgical methods: Tubal ligation, tubectomy, and vasectomy

Surgical methods of birth control are also known as sterilization since they are permanent except for tubal ligation. In females, tubal ligation involves the tying both fallopian tubes to prevent movement of the ovum into the uterus as well as preventing the sperms from reaching the ovulated egg for fertilization. This method is surgically performed and is reversible.on the other hand; tubectomy is the surgical cutting of the fallopian tube hence causing as a disconnection between the ovaries and the uterus. Thus there is no release of the ovum into the uterus or possibility of fertilization. In males, a vasectomy involves surgical cutting of the vas deferens from each testicle hence preventing sperms from being released to mix with semen before ejaculation. Tubectomy and vasectomy are permanent and completely irreversible. These surgical methods, however, offer 100% effectiveness and have no known adverse side effects. However, they are relatively expensive than the rest of the available methods and may pose psychological challenges (Association for Voluntary Surgical Contraception (U.S.), 2014).

Natural Methods of Birth Control

Natural methods

Cervical mucus monitoring method: This is the monitoring of cervical mucus to determine the most likely time of one to conceive. During ovulation the mucus is thin, and there are high chances of fertilization (Kher, 2012). During other occasions, the mucus is usually thick, and the ability of sperms to penetrate through the cervix is low hence conception is unlikely.

Basal body temperature: Monitoring of body temperature guides one to know the likeliest time to conceive. Basal body temperature rises during ovulation and remains elevated until the next menstruation (Kher, 2012). An individual therefore knows the time of their ovulation and avoids sexual intercourse. Cervical mucus and basal body temperature monitoring may be combined in a method called the symptom-thermal method. In the same way, rhythm method monitors ovulation cycle, and avoidance of sex are practiced when ovulation occurs.

Coitus interruptus, abstinence, and lactation amenorrhea:  Coitus interruptus works by a man withdrawing the penis out of the vagina completely before ejaculation to avoid deposition of sperms and semen into the vagina. Abstinence which is avoidance of sexual intercourse also provides 100% effectiveness. Lactation amenorrhea is based on continuous breastfeeding by a mother resulting in lack of physiological changes such as resuming of ovulation after delivery that favor conception (Kher, 2012).

References

Association for Voluntary Surgical Contraception. (2014). Postpartum IUD insertion: Clinical

and programmatic guidelines. New York: Association for Voluntary Surgical Contraception.

Association for Voluntary Surgical Contraception (U.S.). (2014). Informed consent and

voluntary sterilization: An implementation guide for program managers. New York: Association for Voluntary Surgical Contraception.

Churchill Media, (2004). Birth control: Myths and methods. Williston: Discovery Education.

Drill, V. A. (2016). Oral contraceptives. New York: McGraw-Hill.

DuPré, A. (2014). Communicating about health: Current issues and perspectives. New York:

Oxford University Press.

Jones, R. E., & Lopez, K. H. (2014). Human reproductive biology. Amsterdam :

Elsevier/Academic Press.

Kher, S. (2012). Gynecologic Endocrinology - ECAB. London: Elsevier Health Sciences APAC.

Mastroianni, L., Donaldson, P. J., Kane, T. T., & Committee on Contraceptive Development

(U.S.). (2012). Developing new contraceptives: Obstacles and opportunities. Washington, D.C: National Academy Press.

Ory, H. W., Forrest, J. D., & Lincoln, R. (2013). Making choices: Evaluating the health risks

and benefits of birth control methods. New York: Alan Guttmacher Institute.

Senanayake, P., & Potts, M. (2015). Atlas of contraception. London: Informa Healthcare.

Briggs, P., Kovacs, G., & Guillebaud, J. (2013). Contraception: A casebook from menarche to menopause. Philadelphia: Elsevier

Tone, A. (2013). Devices and desires: A history of contraceptives in America. New York: Hill

and Wang.

Zorea, A. W. (2012). Birth control. Santa Barbara, Calif: Greenwood.

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