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FAMILY PLANNING: All women should know

By:-Dr Pooja Mittal, Senior Consultant (Obstetrics and Gynae), HCL Healthcare22 Mar, 2018


What is Family Planning - Methods / Options with Risks

 

WHY IS FAMILY PLANNING IMPORTANT?

It is a matter of personal preference when a couple is ready to have a child.  This is where family planning becomes important.  Family planning encompasses preventing an unwanted pregnancy, spacing between births, and also protection against sexually transmitted diseases.

 

IDEAL SPACING BETWEEN BIRTHS

Research has shown that an interval of at least 18 to 24 months but less than 5 years before becoming pregnant again is ideal to avoid complications for both mother and her baby. For women more than 35 years of age, an interval of at least 12 months is acceptable in view of the concerns regarding decline in fertility.  After a miscarriage, it is prudent to wait for 2 to 3 months to let the body recover.

 

WHAT ARE THE OPTIONS AVAILABLE?

There are many options available for men and women. For women, various options available are:

  1. Barrier methods: Female condoms (akin to male condoms), diaphragm and cervical cap.  Male and female condoms are the only methods that protect against sexually transmitted diseases, but they need to be used continuously and have higher failure rates
  2. Hormonal methods: Birth control pills, vaginal ring (such as Nuvaring), contraceptive injections (such as Depoprovera) and hormone releasing implants (such as Implanon).  These methods are highly effective with low failure but may have side effects (owing to hormonal content) and can't be used in some specific health conditions. So, one should consult the doctor before using these methods.
  3. Intrauterine contraceptive devices (IUCDs): Copper-containing IUCD (such as Copper-T) and hormonal IUCDs (such as Mirena). They are highly effective and don’t require regular efforts but they have to be inserted into the uterus through a short outpatient procedure done by doctor. Once inserted, they remain functional for a number of years depending on the type of device used. Upon removal, the effect gets reversed immediately.
  4. Natural family planning methods: They include rhythm method, withdrawal method and basal body temperature chart. They require diligence in practicing and self control and have higher failure but they have no side effects and are cheap.
  5. Sterilisation: Tubal ligation for women (counterpart in men is vasectomy).  They are irreversible and require a surgery but they are highly effective and don't require regular efforts. 

 

SPECIAL MENTION

It is also important to know about emergency contraception or the ‘morning-after’ pill which is taken within 72 hours of an unprotected intercourse to prevent pregnancy. This is highly effective and is available over the counter but taking it repeatedly can cause irregular periods and hormonal disturbance.

 

HOW TO CHOOSE WHAT IS APPROPRIATE FOR YOU?

Consider the following in order to choose an appropriate measure for you:

  • Effectiveness / Failure rates: Natural and barrier methods have higher failure rates than pills and IUCDs.
  • Reversibility: Tubal ligation is a permanent method and hence suitable if the family has been completed. On the other hand, an IUCD once removed has its contraceptive effect reversed rapidly and completely.
  • Convenience of use: For some people, convenience may mean an easy over the counter availability; for others, it may mean that sexual experience is not altered. Still others might not like the idea of regular and continuous efforts.
  • Cost.
  • Side effects: Each method has its own side effects. Hormonal pills and injections have side effects owing to their hormonal content. IUCDs can cause cramping in tummy and heavy bleeding.
  • Does the method offer additional benefits: Male and female condoms are the only methods that protect against sexually transmitted diseases.  Some other benefits like predictable and lighter periods (which accompany pills and other hormonal methods) may influence the choice.
  • Acceptability to the partner.

THE BOTTOM LINE

An appropriate measure for you is the one that is beneficial and acceptable to you and your partner. Talk to your Gynaecologist to help you guide what is right for you.