A paper on family planning services published in the South African Medical Journal (SAMJ) reveals two-thirds of South African women between 15-49 years old had an unintended pregnancy in the past five years, a quarter of which were as a result of contraceptive failures.
Most women knew of injectable (92%) and oral contraception (89.9%), but fewer of intrauterine devices (56.1%) and emergency contraception (47.3%). So why then are unintended pregnancies happening? Possibly because women aren’t using the right method for them, or aren’t using them correctly.
Dr Elmarie Basson, a healthcare practitioner specialising in Obstetrics and Gynaecology at the Netcare Christiaan Barnard hospital, says patients love to “Google” and visit social chat groups online which, in her opinion, can be a threat to people taking their contraception. On these chat groups, she adds, people tend to share their worst experiences, forgetting that the vast majority of people – who are happy with their contraceptive choices – won’t feel the need to write anything about them. “Non-medical ‘gossip’ can create unfounded anxiety, which is usually the main reason patients discontinue with their contraception,” she explains. And if you’re unsure of whether or not you’d like to fall pregnant, you should be on some sort of contraceptive.
What are the options?
Choosing the correct contraceptive method for you is key. According to the Bhekisisa Centre for Health Journalism, the top five contraceptive methods available to women in South Africa are as follows:
• The implant, a hormone-releasing rod inserted under the skin, is best suited to women who cannot use contraception that contains oestrogen.
Pros: the most effective method at 99.95% efficacy; is long-acting; can be used when breastfeeding.
Cons: a trained healthcare provider must insert and remove the device; may cause weight gain.
• The IUD, a T-shaped copper device placed inside the womb, is best suited for women who want the longest-acting reversible contraception on the market.
Pros: 99% effective; fertility returns to previous levels once removed.
Cons: a trained healthcare provider must insert and remove the device; there is a small risk of infection at insertion or expulsion.
• The injectable, a shot of hormones that lasts up to three months, is best suited for women who are unlikely to remember to take the contraceptive pill on a daily basis.
Pros: lasts for up to three months; may reduce heavy and painful periods.
Cons: patients must keep track of when they received it; can take up to a year for periods/fertility to return.
• The pill, a small hormonal tablet to be swallowed daily, is best suited for women who are sure they will remember to take it at the same time each day.
Pros: at least 91% effective when used as directed; may reduce the effects of PMS.
Cons: it should ideally be tracked with the help of a calendar; may cause blood clots in rare cases.
• The condom, a thin sheath that is placed over the penis before sex, best suited for women who are dating, as they provide protection against HIV and other STDs.
Pros: inexpensive, easy and safe to use.
Cons: can interrupt sex or break if not used correctly; some people are allergic to latex.
These methods are all available from your private gynaecologist or obstetrician, and less expensively from the public health sector; aside from the condom, which can be purchased in boxes of three from your pharmacy and are freely available at government facilities. What’s the best option for you?
The word from Dr Basson is that one needs to individualise when prescribing a contraceptive. “I look for any co-morbid factors: is the patient a smoker; has she, or any of her direct family members ever received treatment for thrombo-venous embolisms; does she take any other medications that may interfere with the metabolism of the contraceptive, and so on. It is also important to assess if your patient is a pill candidate, or is rather someone who is likely to skip a few pills.”
Her take on this important aspect of patient care in her speciality is to explain the possible side effects of a contraceptive option, and to choose the best method for that specific patient. “A patient with weight issues is not a candidate for progesterone injectables, due to their risk of weight gain on this method. Similarly, patients who have been on Roaccutane for their skin need to be warned about the possibility of recurring acne. And so the list goes on. It is therefore vital to individualise, explain and follow up with your patient to ensure the best possible contraceptive suitability and efficacy.”
A visit to your clinic sister
Selected Clinic Clinics offer family planning services. Make an appointment either online or by calling 0860 254 257. Here, you can discuss your options and even have the contraceptive injection, should you already have a script with you from your doctor.
Also read: Do hormonal contraceptives cause infertility?
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