Perspectives

The continual search for the perfect contraceptive

A woman's ability to plan her reproductive life without outside interference and to possess the information, education, and means necessary to do so is basically her right to family planning.

Obstacles in the way of women's access to contraceptive choices - by strictly regulating or prohibiting contraceptive methods and information, or by requiring a husband's consent for the use of contraception - violate her right to family planning. For a couple, where both the partners are working, contraception or the ability to choose and plan their families is a pressing issue that needs to be dealt with. In today's uptight urban world you just cannot afford to be callous about such crucial decisions.

The right to plan one's family gives rise to a governmental duty to ensure that men and women have equal access to a full range of contraceptive choices and reproductive health services and that they have accurate information about sexual and reproductive health. Nearly 1 in 6 women of reproductive age, lack information on and access to a full range of contraceptive methods, which results in more unwanted or mistimed pregnancies. To avoid such unnecessary traumatic encounters a full range of contraceptive methods are accessible for you to avail.

"There are two methods available, temporary and permanent. It has been seen that females, most of the times are adapting to contraceptive methods. There are also other natural family planning methods like calendar method, using condoms during danger period when a female ovulates, however these are extremely unreliable methods because ovulation time might shift or differ in one's monthly cycle," says Dr. Nusrat Zaman, Associate Professor in Obstetrics and Gynaecology, Comilla Medical College.

The temporary methods for females are pills, IUCD, injection and implants, for males it is the condoms and the permanent methods for women are bilateral tubectomy and males is non-scalpel vasectomy.
Pills are the most reliable method because of its 100 percent safety margin. It is suitable for the newly weds, though our society has prejudices against newly weds adapting to this method. Family elders or mothers say that if newly married couples are on pills it takes a while to conceive or they think that in later years it'll cause them problems but this theory is absolutely baseless, explains the doctor.

"It is 100 percent safe and later on does not interfere with the menstrual cycle. The female partner can enjoy her periods. The pills available in our country are the 'new generation pills', which are low dosage," she says.
Previously, 'high dosage' pills had side effects. New generation pills like Marvelon, Femicon, Nordette 28 etc and Shuki in rural areas, are widely accepted. Recently new mini pills like Minicon, are used by lactating mothers and do not effect lactation. The pill as a whole is suitable for newly married couples, though specialists should advise couples prior to its usage.

Women suffering from liver, heart, blood clotting disorders, migraine, breast tumours should resort to other methods because these are the only few contra-indication for using pills. Low dosage pills have no side effects. Few side effects like weight gain, symptoms like headache, nausea, are usually adjusted within a few months, Dr. Zaman relates the basics.

"Then there is the 'Morning after' pill or emergency contraception pills like Postinor-2 which are taken only in case of unprotected sex, where two tablets are required to be taken within 72hrs of unprotected sex," she says.
While contraceptive pills are 100 percent effective when it comes to birth control, one must remember that it does not provide any protection against STD's (sexually transmitted diseases).

The concept of IUCD (Intra Uterine Contraception
Device) or more commonly known as copper T, is age old. It is a T shaped plastic material coated with copper placed inside the uterine cavity and by its presence prevent conception. It is very popular in China where different shapes of IUCD are available.

Copper T coated with the hormone progesterone is used in the western world but are unavailable here. Females who have had one or more child are advised to use it. Side effects of copper T may be slightly increased periods and occasional discharge and the person should maintain regular contact with the physician. It is safe and well accepted but rejected by some, as it may feel uncomfortable. Rumours say it could cause cancer, however it is well accepted by users and many prefer this rather than taking pills every day. Devices available in our country are for three years and should be re-introduced.
Injections are hormones of the group progesterone and are given in tri-monthly intervals widely used in the rural community because of their convenience and few side effects. Minor menstrual disturbances or stopping of periods during its use are its side effects. Implants consist of six plastic sticks of lev-norgestron that inserted in the upper arm, and these remain active till five years. They are widely used among the rural community because of its convenience and longer duration.

The only temporary method available for males is the condom, definitely the ideal method to prevent AIDS or other sexually transmitted diseases. "Among the high-risk group i.e. commercial sexual workers and for those who maintain relationship with promiscuous partners, condom method is the best option. But for those married couples this method, though it is well- adjusted for some,
depends entirely on the active co-operation of the male partner, for many couples do have unwanted or accidental pregnancy during its improper use," she points out.

Permanent methods are bilateral tubectomy to cut the two tubes in order to interfere with conception. Minor operation is done under local anaesthesia with a small incision in the abdomen and the patient can go home taking a little rest and does not interfere with her daily activities.

The permanent method for males is known as vasectomy, now done by non-cut techniques, known as non-scalpel vasectomy (NSV). Both the permanent methods are quite popular and are carried out both by the government and NGO level and are accepted by those couples who have at least two or more children or have completed their families. The permanent method does not interfere with the potency or conjugal life of any partners.

It is a matter of fact that all available choices of contraception target the female population, mainly because conception is her business, thus it's her body her choice. Females have the right to choose their own method of contraception and should always be helped to choose from all the options and decide on the method most comfortable for them. It is the basic right of a female, and for any modern couple this should not pose as a dilemma.

Myths on Contraception
There are few birth control methods that are medically proven to be effective in preventing an unwanted pregnancy. There are also other methods that people think will work to avoid pregnancy, but they don't. Here
are some such myths on contraception.

"Let a woman eat a bee and she shall never conceive"
- 14th century book.

This happens to be just one example of the several fabulous fictions in which medieval minds seem to specialize. But in truth, people all over the world have used several forms of contraception, since time immemorial. Strange as they might seem to use today, these methods were the result of the continual search for the perfect contraceptive.

The 4000 year old Kahun Papyrus, the oldest written document on birth control, refers to vaginal pessaries made of crocodile dung and fermented dough.

Arab traders were the first to use intra-uterine devices. When taking camels to the market they placed small stones in the uterus of the female camels to avoid them becoming pregnant on the way.

Condoms made of linen, and the skins of sheep, goats, even snakes have been used.

Cotton soaked in lemon and dried fish were also considered to prevent pregnancy.

In Constantinople, women used sea sponges, sometimes soaked in lemon juice or vinegar.

Dried ground up cow dung mixed with honey was placed inside the vagina as a form of birth control.

Over 4000 years ago, women in China drank mercury to prevent unwanted pregnancies.

In India, carrot seeds were used as a means of oral contraception.

In North America, women in New Brunswick made a kind of white soup brewed with dried beaver testicles.

Silphium, a species of giant fennel that once grew in North Africa, was the aristocrats' contraceptive -- the classical equivalent of lambskin condoms.

The Victorians were fond of the block pessary -- a square block of wood with concave sides. It was finally condemned in 1930's as an instrument of torture.

In Persia, the pennyroyal herb along with pomegranate pulp, willow leaf and colocynth were used to end a pregnancy.

Queen Anne's Lace or Wild Carrot was considered to be highly effective. This plant was used 2000 years back. Hippocrates mentions it in his writings as an oral contraceptive and as an abortifacient.

"Breast-feeding is a complete and reliable natural contraceptive"

This misconception often leads to unwanted pregnancy and induced abortions.

By Raffat Binte Rashid
Special thanks to Dr Nusrat Zaman Associate Professor in Obstetrics and Gynaecology Comilla Medical College.