Opinion – Let’s talk about contraception
Contraceptive methods are used by individuals and couples to help prevent pregnancy, expect and achieve a desired number of children, or determine the pregnancy distance.
There are several methods of contraception available and selection should be based on an informed decision by the user after appropriate advice.
The choice of method of contraception may depend on the user’s personal needs, preferences and ability to comply, medical contraindications, safety, availability, previous problems, and expected effectiveness.
When choosing a method of contraception, the dual protection against the simultaneous risk of HIV and other sexually transmitted diseases (STDs) should also be considered.
Almost all contraception methods are available on prescription or can be issued by the pharmacist without a prescription.
This enables appropriate advice and information from the medical professional. However, condoms are available from most retail outlets.
The most important methods of contraception include hormonal, intrauterine and barrier contraceptives.
Hormonal methods contain either one (progestin only) or two (estrogen and progestin) synthetic sex hormones that are similar to those naturally produced by a woman’s body and come in a variety of dosage forms and drug delivery systems.
Hormonal methods prevent a woman’s ovaries from releasing an egg every month.
In the absence of an egg, the sperm released by the man during sexual intercourse will not be able to combine with the egg and fertilize it, and therefore pregnancy cannot occur.
It also thickens the mucus produced by the cervix, which prevents the sperm from entering the uterus and causing changes in the lining of the uterus, making it difficult for a fertilized egg to attach to the uterine wall.
Oral contraceptive tablets: These are taken orally once a day – at the same time each day to keep the hormone levels in the body constant.
They contain either one or two hormones.
Progestin: Only tablets are recommended for breastfeeding women as they do not reduce the production of breast milk. This method is 91% effective. Examples in Namibia are Ginette, Ovral, Yaz and Yasmin.
Another oral contraceptive pill known as emergency contraception (EC) or morning-after pill is taken by a woman after unprotected sex to prevent unwanted pregnancy.
It contains a progestogen hormone in higher amounts than other contraceptive pills.
Although it provides immediate contraception, the e-cigarette is not the recommended long-term contraceptive.
The pill should usually be taken within 72 hours of unprotected sex for it to be most effective.
The sooner they are taken, the more effective they are – an example is Norlevo.
Transdermal patch: The patch is a 4 cm2 polyester that contains both hormones and is placed on the upper arm, buttocks or stomach. The hormones are absorbed through the skin. The patch needs to be changed every week for three weeks – and it is not worn for the fourth week – and the woman has her regular period. This method is 91% effective. Evra patches are an example.
Injection: Injectable hormonal contraceptives contain only progesterone and are injected into a woman’s upper arm or buttocks. After the injection, the hormone is slowly released from the injection site into the bloodstream. The injection is given every three months. This method is 94% effective. It can be used by women who cannot take estrogen – for example, women aged 35 and over, smokers, or mothers who are breastfeeding. Examples are Isterate-only and Depo-Provera.
Implant: The implant is inserted directly under the skin on the inner arm above the elbow, where it continuously releases a low dose of a progestin hormone into the bloodstream over a period of three to five years, depending on the type of implant. This method is 99% effective. The most common side effects include spotting; Periods can get longer and heavier, or stop altogether. One example is Implanon NXT.
Intrauterine device (IUD): It’s a small, flexible T-shaped device that is inserted into a woman’s uterus by a doctor. An IUD may or may not contain hormones. The non-hormonal coil prevents the egg cell from hitting the sperm and attaching it to the uterine wall. The IUD contains the hormone progesterone, which is slowly released into the bloodstream. IUDs can protect for five to seven years or more, depending on the type of IUD. It can be removed at any time. This method is 99% effective. One example is Mirena.
Barrier methods are devices that either physically prevent sperm from reaching an egg or chemicals that kill or damage the sperm in the vagina. Barrier methods should be used every time a couple has sexual intercourse.
Condoms: A condom acts as a physical latex barrier that prevents sperm from entering the uterus and reaching an egg. Both female (internal) and male condoms are available. It’s worth noting that this is the only contraceptive that can also protect against sexually transmitted infections. This method is 79-85% effective.
Spermicides: Spermicide is a chemical that inactivates sperm. In the form of a cream or gel, a spermicide is inserted into the vagina near the cervix. It takes 15-20 minutes to be effective. This method is 72-86% effective.
The diaphragm: The diaphragm is a small, dome-shaped device made of silicone or latex that fits inside the vagina and covers the cervix. It must be used with spermicide. The diaphragm must remain in place for six hours after intercourse, but no longer than a total of 24 hours. This method is 88% effective.
It is important to note that to date the condom is the only method of contraception available for men. The minor surgery (vasectomy) is usually permanent.
Because there are several methods available, including surgical methods, which are not discussed here, it is important for couples and individuals to obtain more information from their healthcare professionals, pharmacies, doctors, nurses, etc., in order to help them make the appropriate choice to advise.
* Compiled by Nadine Mouton and Frieda Shigwedha