“Contraception often has a bad reputation – particularly hormonal contraceptives – and in some instances rightfully so,” says Dr Mpume Zenda aka Dr Gyae, an Obstetrician - Gynaecologist and Sexologist. “I would like to share a more neutral and hopefully empowering stance around contraception.
"Firstly, any type of contraception is a choice. It is important that as women we are as informed as possible so we can make choices that are suitable for our individual needs. It is also not for everyone, and at different stages of your reproductive life you may or may not need contraception.
"The need for contraception also varies. It may be primarily for the prevention of an unintended pregnancy, but that is not the only benefit of contraceptives. Remember, you are not married to any one contraceptive. If it does not work for you, change it. Discuss this with your healthcare provider for a smooth and safe transition from one mode to another.”
Here are some of the common medical contraceptive methods available in South Africa:
Female sterilisation or Choice Tubal Ligation - less than 1/100 women are likely to fall pregnant.
- More than 99% effective.
- The fallopian tubes are cut or blocked permanently. This is difficult to reverse.
- Suitable for someone who has completed their family.
- The male version of this procedure is known as a vasectomy. Tubes carrying sperm are blocked/cut therefore ejaculate/semen does not contain sperm.
An intra-uterine device (IUD): 1/100 women are likely to fall pregnant in the first year after insertion.
Option 1: Non-Hormonal/copper IUD
- This is a long-acting, reversible contraceptive.
- A T-shaped device is inside the uterus. This is generally done in a doctor’s rooms, including removal.
- Lasts up to 10 years.
- It works by causing an unfavourable environment for implantation, and thickens cervical mucus, making it difficult for sperm to meet the egg.
- It may increase the volume of menstrual bleeding.
- Available free in public health.
Option 2: Hormonal IUD
- This is a long-acting, reversible contraceptive.
- A T-shaped device is fitted inside the uterus. This is generally done in your doctor’s rooms, including removal.
- It lasts up to 5 years.
- It releases a small amount of progestin, that suppresses the growth of the lining of the womb, making it unfavourable for implantation
- Very helpful in women with heavy periods as it decreases them.
Implants: 1/100 women are likely to fall pregnant.
- It is long-acting and reversible
- A flexible rod that releases a progestogen is inserted in rooms, just under the skin of the upper arm.
- Lasts 3-5 years.
- Available free in public health.
- Speak to your healthcare provider if you experience break-through bleeding.
Injectables: 3/100 women are likely to fall pregnant.
- Needs to be administered by a clinician every 2-3 months.
- There is a 2-monthly (8 week) and a 3-monthly (12 week) option.
- Falls within the long-acting, reversible contraceptive group.
- May cause prolonged break-through bleeding initially, and later the absence of a period. Please note that this is because of the diminished lining of your uterus. So you can rest assured that there is no blood accumulating internally.
- It may take 6-12 months to return to an ovulatory cycle after stopping this method.
Combined hormonal contraceptives (CHCs)
- These contain both progestin and oestrogen. While the oestrogen is the same in all, the amounts differ, and the progestins also differ significantly. CHCs come in the following forms:
- The daily pill: 9/100 women are likely to fall pregnant.
- The patch, which requires weekly replacement.
- The ring, which requires monthly replacement.
- Please note there is a progestin-only pill if you are unable to take anything with oestrogen.
Non-medical contraceptives:
- Barrier method, ie condoms: 15/100 women are likely to fall pregnant.
- Male and female condoms are available.
- Dual purpose is that it prevents pregnancy and sexually transmitted infections.
- Requires the cooperation of both partners.
- Must be used every time for most efficacy.
- Other older forms of barrier method include diaphragms and cervical caps.
Lactating : 2/100 women likely to fall pregnant (if all criteria are met).
- This method is based on exclusive breastfeeding.
- Most effective up to six months post delivery.
- It does require mom to not have had a period yet, be exclusively breastfeeding, and baby to be less than 6 months old.
Fertility awareness method: about 25/100 women likely to fall pregnant.
- A woman either uses a calendar, ovulation symptoms or a combination to know her most fertile period.
- Requires partner cooperation and commitment.
Coitus interruptus or “pulling out”: 27/100 women likely to fall pregnant.
- One of the least effective methods.
- Promotes male involvement.
IMAGE CREDIT: 123rf.com