Dr Meenakshi Ahuja, Senior Director, Obstetrics and Gynaecology, Fortis La Femme, New Delhi and Academic Secretary, Delhi Gynae Forum, President, Delhi Menopause Society discusses complex landscape of contraception
India records a significantly higher rate of unintended pregnancies at 70.1 per 1000 women, compared to the global average of 53, indicative the stigma to openly talk and discuss methods to avoid pregnancy in the first place. An unplanned pregnancy puts an individual’s life trajectory—both their health—and their well-being at risk. Most unintended pregnancies result from not using contraception or from not using it consistently or correctly.
While there is a wide array of contraceptive options available today, reflecting both medical advancements and a growing acknowledgment of the importance of reproductive choice, it is important to understand how to navigate through the information to make an informed choice.
Expanding access to contraceptives is linked to women’s social and economic empowerment. Not only does the use of contraceptives reduce maternal and neonatal deaths by preventing unintended pregnancies, but it also enables adolescents and women to remain in school, pursue further education and plan their future better.
Some of these contraception choices include:
- Hormonal Contraceptives
Hormonal contraceptives, such as birth control pills, patches, progesterone only pills, injections, and hormonal intrauterine devices, work by altering hormone levels to prevent ovulation or thicken cervical mucus, making it difficult for sperm to reach the egg. These methods are highly effective when used consistently and correctly, but they may have potential side effects, including mood changes, weight fluctuations, and increased risk of blood clots. - Long-Acting Reversible Contraceptives (LARC)
Long-acting reversible contraceptives (LARCs), such as Intrauterine Device (IUDs) and subdermal implants, offer a highly effective, set-it-and-forget-it approach to contraception. They last for several years and are easy to use. There are two main types of LARC methods: IUDs and contraceptive implants. Both methods are reversible—if a woman wants to get pregnant or if she wants to stop using them, she can have them removed at any time. - Contraceptive Implants
Small, flexible rods, inserted under the skin of the upper arm releases a progestin hormone over a period of several years, preventing pregnancy by similar mechanisms as hormonal IUDs. The progestin in the implant prevents pregnancy mainly by stopping ovulation. The progestin in the implant also thickens the mucus of the cervix, which makes it harder for sperm to enter the uterus and reach the egg. Progestin also thins the lining of the uterus. Implants are non-uterine, over 99.9% effective, reversible, estrogen free and return to fertility is quick. - Intrauterine Devices (IUDs)
Small, T-shaped devices that are placed into the uterus by a medical professional. IUDs can be categorized into two types: hormonal and non-hormonal. Hormonal IUDs thicken cervical mucus, which makes it difficult for sperm to reach the egg, and by thinning the uterine lining, which may make it less receptive to implantation. Non-Hormonal IUDs are coppor IUDs. They creates an environment that prevents fertilization.
Benefits of LARC contraception:
High Effectiveness: LARC methods are among the most effective contraceptives available, with failure rates comparable to sterilization.
Convenience: LARC methods require minimal attention, and they can provide contraception for several years without daily or frequent administration. It does not interfere with sexual or daily activities. It can be inserted immediately after an abortion, a miscarriage, or childbirth. It can also be used while breastfeeding.
Reversible: Despite their long-term nature, LARC methods are reversible. They can be removed at any time if a person decides to become pregnant or switch to a different method.
Privacy: LARC methods are discreet and do not require daily action, which can be appealing for individuals who value privacy.
Barrier Contraceptives: Barrier methods, like condoms and diaphragms, provide effective protection against sexually transmitted infections (STIs) in addition to preventing pregnancy. These methods are readily accessible, have minimal side effects, and do not require long-term commitment.
Fertility Awareness
Fertility awareness methods involve tracking menstrual cycles, basal body temperature, and cervical mucus to identify fertile and infertile periods. While this approach can be empowering for individuals who want a natural and hormone-free option, it requires dedication and a deep understanding of one’s body. This method may not be suitable for those with irregular cycles or those seeking a high level of convenience.
When considering contraceptive options, it’s essential to take into account individual preferences, lifestyle, health considerations, and long-term plans. Open and honest conversations with healthcare providers can help individuals make the best decision for their unique circumstances. Understanding the various options and considering personal factors is essential for making informed decisions about contraception.
Empowerment and contraception are intertwined, shaping a transformative path. Access to contraception empowers women by granting reproductive autonomy, enabling education, fostering economic independence, and enhancing health. It promotes gender equality, reduces the risk of gender-based violence, and challenges societal norms. This empowers women to participate actively in community and policy decisions, breaking stereotypes and creating inclusive societies. Empowering women through contraception is a fundamental step toward a world where women can control their destinies, pursue their dreams, and contribute fully to the advancement of themselves and their societies.
It’s crucial to be well-informed, consult healthcare professionals, and consider personal factors when choosing a contraceptive method. By navigating this landscape with knowledge and confidence, individuals can take control of their reproductive choices and create a healthier, more empowered future.