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Since it is the woman who has to carry a baby for 40 weeks — with its attendant nausea, food fetishes, backache and swollen feet — she should have a right to choose when she wants to have children and how many.
This is where prevention of pregnancy or contraception comes in. There are 15 or more methods of contraception available internationally. They are both temporary (for spacing) and permanent. Most require access to clinics and medical personnel. Understanding each method and choosing the correct one requires intelligence and some level of education.
Sterilisation (tubal ligation) involves tying off the tubes leading to the uterus. This is a short surgical procedure, which requires only local anaesthesia. Though it is a “permanent” method, it can be reversed with a 40-80 per cent success rate. Men can also have surgical and even “non-scalpel” vasectomy. Reversal is successful in 50 per cent cases. The procedure in men is simpler and less prone to complications. Despite that it is not very popular.
The oral contraceptive pill is 99.9 per cent effective if used correctly. A medical check up should be done before starting “the pill” and yearly after that. Fertility returns within 3-5 months of stopping the tablet.
Rings impregnated with estrogen and progesterone can be inserted into the vagina. They have to be removed after three weeks and a new ring reinserted a week later. Hormonal patches (Ortho Evra) can be stuck on the skin. They need to be changed every week.
Injections of long acting progesterone can be administered every 12 weeks. They may cause some weight gain and irregular bleeding. Implants are small, hormone-impregnated rods that can be inserted beneath the skin under local anaesthesia. They need to be replaced every three years.
Intrauterine devices can be inserted into the uterus and left there for periods varying from three to five 10 years. A medical professional needs to insert and remove them.
The I-pill or morning after contraceptive is used for unexpected unprotected intercourse. The pill should be taken within 72 hours. Since it contains a high dose of hormones it should be used for emergencies only. It is not suitable for frequent use.
Condoms are available for both men and women. They should be used from the beginning to the end of intercourse. Their effectiveness increases if used in combination with spermicides like Today or Durafoam vaginal tablets, Delfen or Volper cream.
Diaphragms, cervical caps and sponges can be inserted just before intercourse. They can be combined with spermicidal jelly or foam. Women need to be fitted with a device of the correct size and taught to insert it. It needs to be left in place for at least six hours after intercourse. It is washed, dried and used again.
If any of these contraception methods fail, pregnancy can occur, even in breast-feeding mothers or women who have not yet had their periods after childbirth.
Abortion is legal in India and can be surgical or medical. There are protocols in place for the use of surgery or tablets for safe abortion. Please do not purchase tablets over the counter or attempt abortion without medical guidance.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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