Birth Control — Need and Methods of Contraception

Birth control, or contraception, means the deliberate, planned prevention of pregnancy, achieved by a medical or behavioural method rather than left to chance. Its importance is felt at two levels that reinforce each other. At the level of an individual couple, being able to decide freely when to have a child, how many children to have, and how widely to space them, allows both partners to plan their lives, protects the health of the mother by avoiding pregnancies that are too closely spaced or come at physically unsuitable times, and generally improves the health outlook for children who are born into a family prepared and able to care for them. At the level of the country as a whole, a large and rapidly growing population places proportionately greater demand on food production, housing, healthcare, education and employment, so wider, easier access to reliable contraception is one of the principal, non-coercive means by which a country works toward population stabilisation over time.

There is no single method that suits every couple, and the choice depends on factors such as age, health, whether the couple wants to delay the very first pregnancy, space subsequent children, or stop childbearing altogether once their family is complete. Broadly, the methods taught at this level fall into five groups.

NATURAL (or traditional) methods rely on avoiding the biological conditions needed for fertilisation, without any device or medicine. Periodic abstinence means avoiding sexual intercourse during the fertile phase of the woman's menstrual cycle, roughly the days surrounding ovulation; coitus interruptus (withdrawal) means the male withdraws before ejaculation, so that sperm are not deposited in the vagina; and the lactational amenorrhoea method relies on the natural, though temporary and not fully dependable, suppression of ovulation that tends to occur during a period of intense, frequent breast-feeding after childbirth. These methods require no device and have no direct side effects, but depend heavily on correct timing or self-discipline and are, as a group, less reliable than the methods below.

BARRIER methods work by physically stopping sperm from reaching the cervix and uterus. The male condom, a thin sheath worn over the penis, and the female condom, worn inside the vagina, are the most familiar examples; diaphragms, cervical caps and vaults are dome- or cup-shaped devices inserted to cover the cervix, generally used together with a spermicidal cream, jelly or foam to increase reliability. Barrier methods have the added, important advantage — unlike almost every other method described here — of also reducing the risk of transmitting sexually transmitted diseases (Section 3.3), since they form a physical barrier not only to sperm but also to many infectious organisms.

INTRA-UTERINE DEVICES (IUDs) are small devices inserted into the uterine cavity by a trained health worker. Copper-releasing IUDs, such as the widely used Copper-T, work chiefly because copper ions released within the uterus reduce sperm motility and their capacity to fertilise an egg, and also increase the local destruction of sperm by white blood cells (phagocytosis); hormone-releasing IUDs additionally alter the uterine lining so that it becomes unsuitable for implantation, and thicken cervical mucus to hinder sperm entry. IUDs are a popular choice for couples who want reliable, longer-term but still reversible contraception without the need to remember a daily routine.

ORAL AND OTHER HORMONAL methods use small, carefully measured doses of hormones — either a progestogen alone or a progestogen-estrogen combination — taken as a pill on a regular daily schedule, or, in other forms, given as a periodic injection or a small implant placed under the skin. Their principal action is to inhibit ovulation, so that no egg is available to be fertilised in that cycle; they also thicken cervical mucus, further hindering sperm movement. Being reversible and highly effective when used exactly as directed, these methods require the discipline of correct, regular use to remain reliable. …