Dr Girija Wagh, Obstetrician, Gynecologist, IVF expertMD, FICOG, DIP ENDO, FICS
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Can I avoid an unwanted pregnancy ? Is it safe to do so ? Is it right ? Planned Parenthood is the current in thing !
These are the often addressed questions replete with a lot of doubts. ‘To be or not to be ?’is the classical question. If planning a family is in but then why not avoiding an unwanted pregnancy ? In the today’s world of planning and strategising about work, money, future planning a pregnancy and avoiding an unwanted one is definitely the way forwards.
The 26 th day of September every year is celebrated as the World Contraception Day since 2007 with a purpose of increasing awareness and access to contraception in order to restore the health of women and bring about population stabilisation to overcome poverty and to restore the health of the nation. Contraception is a purposeful use of methods to prevent pregnancy which may occur as a result of sexual intimacy.
Contraception and its awareness and access is a process and surely makes one introspect about many facets to this important social intervention. History is replete with many evidences of use of such birth control methods adopted for avoiding unwanted offsprings since the long past.It is natural therefore to wonder why ignorance about the usage of this method still prevails in such great quantity. Also, the prevailing myths and doubts about the adoption and the safety of these well-researched techniques continue to astound a thinking mind.
Contraception has been identified as one of the important interventions to bring about improvement in the health status of the women. A healthy woman will create a healthy family, healthy society and consequently healthy nations. Ignorance and the taboo approach towards birth control methods are certainly surprising. Various surveys have revealed that women illiteracy is directly proportionate to lack of awareness and adoption of birth control techniques. But such an ignorance amongst the educated and socially well-placed women certainly makes one introspect as to what can be done better to make women feel secure in making the right choice.
It is heartening to note that 48% population in India chooses to use contraception but worrisome is the fact that sterilisation (tubectomy ) ( surgical clamping of tubes in women to permanently block them in order to prevent pregnancy ) which is a permanent method with not always a cent percent reversal is the technique commonly adopted. In addition, very young women seem to be adopting this method despite the availability of safe methods which are temporary and reversible. Is it really rational to take such a permanent decision ? Many a time this is done for convenience or under family pressure or fear of side effects of the temporary methods. We have faced many tragic situations where families have requested for reversal of sterilisation due to the demise of their young kids due to illnesses or accidents and it truly is saddening as not always is the reversal successful.
The health of women is a human right and not a privilege and contraception is an important pathway towards the achievement of such a situation. Educating the society about such techniques, increasing awareness and increasing the accessibility of these methods is the purpose of the World Contraception Day Celebration as proposed by the World Health Organisation.
Let us take an overview of the some of the popular methods of contraception available in India.
’Safe Period’ is a very popular method adopted by many educated couples in which the fertility periods during the menstrual cycle is the time when intimacy is avoided. But this cannot be easily possible for women with irregular menstrual cycles and many a time wrong calculation can cause unwanted pregnancy.
Condoms is another popular method used by men and are safe and non-interventional, to be used externally and offer protection against sexually transmitted infections and consequently diseases. The failure rate, however, is found to be high when the typical use of this was surveyed. This failure is commonly due to an improper technique of use and failure to use the condoms during some acts. Also being a men driven method, it is dependent on the male partner to consistently use it at every act of intimacy.
Oral contraceptive formulations of various strengths, combinations are also available as women contraceptives. These are safe, time-tested and efficacious when used in the properly selected subject. These contain hormones which are similar to the naturally occurring hormones in our body. Taking the levels of these hormones to a higher level brings about changes in such a way that ovulation is prevented and the inner secretions are thickened. These changes help in preventing unwanted pregnancy as well as certain diseases in women. Its immediate benefits are that it helps in regularising the cycles, reducing menstrual blood loss and pain and can help in stabilizing disorders such as Polycystic Ovarian Syndrome ( PCOS ) and Endometriosis. Long-term benefits include reduction in the occurrence of future breast, uterine and ovarian cancers in women who have used these pills for over 5 years during their reproductive age group. Fear of inability to conceive later, side effects such as nausea and vomiting and occurrence of stroke ( very rare incidence ) due to blood thickening deprive women of this useful approach towards planned parenthood. Proper patient selection under the guidance of the doctor helps in making the right choice.
Intrauterine devices are now easily available and are popular as “ copper T “ and are identified as safe, effective and temporary methods of contraception.These devices are gently placed inside the womb and bring about mechanical barrier to pregnancy implantation inside the womb. Copper being inert is safe and various types of such devices are available and the doctor can help the woman make the right decision. The insertion of the device is easy, safe and harmless. The device can be placed immediately after normal delivery and at the time of cesarean section and such an insertion is called as Post-Placental Intrauterine Device(PPIUCD) insertion. A large series of women in the entire country have used this method for the past 2 decades and have vouched for its safety.
Injectable hormonal preparations are also available and this is a depot slow release formulation (DMPA ) of a hormone which helps in preventing pregnancy similar to oral pills. These injections are taken every 3 months and are safe. The side effects associated are irregular cycles or absence of menstruation. Advantages are that it can help treat diseases such as abnormal heavy and painful menstrual bleeding and chronic pelvic pain. The injection is used also as a therapy for some disorders. The Government of India has taken up a campaign of enhancing the awareness of the use of DMPA as well as PPIUCD to help stabilise the population.
It’s essential that the youth today is aware of such techniques. But making them aware is replete with many controversies as imparting such a knowledge can be implied as a support of illegal or illicit sexual associations. But acquiring information and being knowledgeable doesn’t mean that one should immediately indulge into a practical act. Ignorance, however, can lead to the recourse of pregnancy termination which could have been avoided by the adoption of the right method of contraception. Increasing such instances is certainly appalling.
Increasing use of emergency contraception methods is certainly disturbing. On the other hand, it is an insight into the fact that there is a huge need for birth control prevalent in the society and we as a community have not yet been able to reach to satisfy this need. These methods are better used under the doctor’s guidance and a better regular method of birth control be adopted. Every young adult has a right to know about her or his health needs and must approach the doctor for better guidance and this will be the important step towards a healthy tomorrow. Don’t hesitate, do not feel shy. Approach the Doc and ask her all your “how” and “why “??
Wish you all a happy and healthy living ahead !!
Dr. Girija Wagh, MD (Obstetrics & Gynaecology), FICOG, FICP, Diploma (Endoscopy, Infertility), Fellowship of Indian College of Ob-Gynec, Women health care specialist, Academician, Acclaimed Orator & Researcher, B. J. Medical 1990-1992, Topper University Of Pune 1992
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