The contraceptive methods may be broadly grouped into two classes – the spacing or temporary methods and the terminal or permanent methods.
Contraceptive methods are preventive methods to help women avoid unwanted pregnancies. The term contraception and fertility control are not synonymous. Fertility control includes fertility inhibition or contraception and fertility stimulation. Contraception includes temporary and permanent measures to prevent pregnancy.
The method of contraception by men and women helps families space births, prevents unwanted pregnancy, and in the case of consistent condom use, prevents transmission of sexually transmitted infections (STIs), including HIV.
An ideal contraceptive should be safe, effective, acceptable, inexpensive, reversible, simple to administer, long lasting and should require minimal medical supervision. But there can never be an ideal contraceptive. This is because what is suitable to one group may be unsuitable to another due to different cultural patterns, religious beliefs and socio-economic milieu.
So the search for an ideal contraceptive has been given up. The present approach in family planning is to provide the user a variety of choice from which he may choose according to his needs and wishes and to promote family planning as a way of life. When properly provided and used, currently available contraceptives are safe and effective for the vast majority of users.
i. Spacing or Temporary Methods:
The spacing methods are commonly used to postpone or space births. These methods are commonly used by couple who do not desire to have children.
The temporary methods are of the following types:
a. Barrier Methods:
The aim of the barrier methods is to prevent the live sperm from meeting the ovum. Barrier methods suitable for both men and women are available. They have both contraceptive and non- contraceptive advantages.
The main contraceptive advantage is the absence of side effects and the non-contraceptive advantage is the protection from sexually transmitted diseases or STD. These methods prevent sperm deposition in the vagina or prevent sperm penetration through the cervical canal. This is achieved by mechanical devices or by chemical or combined means.
i. Physical or Mechanical Methods:
The mechanical methods include the condoms for males and diaphragm for females. Condoms are the most widely used barrier device by males and popularly known as ‘Nirodh’ which in Sanskrit means prevention. The condom prevents the semen from being deposited in the vagina and protects both men and women from STD. The diaphragm cervical caps and vaults block the entry of sperm. But they are not popular methods.
ii. Chemical Methods:
Various spermicidal agents are available in the market either in the form of spermicidal cream, jelly or tablets. These agents produce sperm immobilisation and kill the sperms. But these are not popular and the failure rate is quite high. Also, concern about possible teratogenic effects on fetuses has been suggested. There may be occasional local allergic reactions in the vagina.
b. Natural Contraception:
The rhythm method of natural contraception is a method based on identification of the fertile period (between the 13th and 18th days of the menstrual cycle) of a cycle and to abstain from sexual intercourse during that period. Withdrawal or coitus interrupts is another natural method in which the make withdraws his penis from the vagina just before ejaculation so as to avoid insemination.
Lactational amenorrhea (absence of menstruation) method is based on the fact that ovulation does not occur during the period of intense lactation after parturition. But this method is effective only for six months. During this method, no contraceptive devices or chemicals are required. But the failure rate is high.
c. Intra-Uterine Contraceptive Devices or IUCD:
The IUCD is a small device usually made of polyethylene or other polymers. It is inserted into the uterus by a doctor. There are two types of IUCD – the medicated and the non-medicated. The medicated IUD release either metal ions (copper) or hormones (progesterone) gradually into the female’s body. Copper T 200 containing a copper wire, progestasert containing progesterone are some examples of IUCD. The mode of action is not clear, probably it produces non-specific biochemical and histological changes in the endometrium and the ionised copper has spermolytic and gametotoxic effects.
These changes impair the viability of the gamete and reduce the chances of fertilisation rather than its implantation. The copper ions may affect sperm motility, capacitation and survival. The hormone releasing devices increase the viscosity of the cervical mucous and thereby prevent the sperm from entering the cervix. The high levels of progesterone and relatively low levels of oestrogen make it unfavourable for implantation. The IUCD should be changed every three years.
The advantages of IUCD are – simplicity in insertion; insertion takes only a few minutes; inexpensive; virtually free of metabolic side effects associated with hormonal pills; and reversibility to fertility is immediate soon after removal.
The disadvantages are heavy and irregular menstruation and pelvic inflammatory diseases. Pelvic inflammatory disease (PID) is a collective term that includes acute and chronic conditions of the ovaries, ducts, uterus and it occurs as a result of infection. Women with PID suffer from vagina discharge, pelvic pain, tenderness, abnormal bleeding, chills and fever. Some women suffer uterine perforations leading to inflammatory response in the abdomen.
d. Hormonal Contraceptives:
Hormonal contraceptives are the most effective spacing methods of contraception. The gonadal steroids, oestrogen and progesterone are effective in contraception. The synthetic oestrogens used in contraception are ethinyl oestradiol and mestranol. Synthetic progesterones include three groups – pregnanes, oestranes and gonanes. The hormonal contraceptives currently in use are summarised in Table 3.
ii. Terminal or Permanent Methods of Contraception:
Permanent surgical contraception is a surgical method where by the reproductive function of an individual male or female is permanently destroyed. Surgical method is also known as sterilisation. The surgery done on males is vasectomy and on females is tubectomy.
a. Male Sterilisation:
Sterilisation in males is done by vasectomy (Fig. 1). It is a permanent sterilisation done in males where a segment of vas deferens of both the sides is cut and the cut ends are ligated. The technique is simple and can be performed even in primary health centres by trained doctors under local anesthesia. The failure rate is minimal and it is a very reliable method of contraception but it is an irreversible operation. So it is very important to get the consent of the person undergoing vasectomy.
b. Female Sterilisation:
Occlusion of the fallopian tubes is the underlying principle to achieve female sterilisation. This is known as tubectomy (Fig. 2). Female sterilisation can be done by two procedures — laproscopy and minilaparotomy. The technique of female sterilisation through abdominal approach with a special instrument called laproscope is known as laproscopy.
The minilaparotomy is a modification of abdominal tubectomy and requires a small incision in the abdomen and is conducted under local anaesthesia. It is a suitable procedure at the primary health centre and very safe, effective and easy also.