Contraceptive Methods 

• Many women who express that they have completed their desired family size still do not use contraception, despite being aware of various contraceptive methods. 
• This may be due to limited access to healthcare facilities, poor quality of services, or sociocultural factors. Improving access to contraception could help women choose effective contraceptive methods rather than relying on medical termination of pregnancy, which some currently use as a form of birth control. 
• Contraception encompasses all methods used to prevent conception and regulate fertility. Each method works differently, and no single option is ideal for every woman.

1.0What are the Different Methods of Contraception?

1. Temporary or Spacing Contraceptive Methods

These methods are designed to prevent or delay pregnancy, helping to space out childbirth. They can be categorized into several types:

Natural  Contraceptive Methods

• Natural methods rely on the body's natural processes to prevent the meeting of sperm and egg. 
• Since these methods don't involve using medications or devices, they have minimal side effects. However, they also have a higher likelihood of failure.

Types of Natural Methods

Rhythm or Periodic Abstinence Method

• This method involves abstaining from sexual intercourse during the days of the menstrual cycle when ovulation is most likely to occur, typically from day 10 to day 17. This period is known as the "fertile window" because the chances of fertilization are highest. By avoiding intercourse during these days, the likelihood of conception can be significantly reduced.
• The first 7 days after menstruation and the 7 days before the next menstruation are considered the "safe period." During these 14 days, ovulation has either not yet occurred or is already over, meaning the egg is not present in the fallopian tubes, reducing the chances of fertilization.

Withdrawal Method (Coitus Interruptus)

• In this method, the male partner withdraws his penis from the vagina just before ejaculation to prevent sperm from entering the female reproductive tract, thereby avoiding insemination.

Lactational Amenorrhea Method (L.A.M.)

• This method is based on the natural suppression of the menstrual cycle due to high levels of prolactin during breastfeeding. 
• The absence of menstruation (amenorrhea) occurs because ovulation is inhibited during periods of intense lactation following childbirth.
• As long as the mother exclusively feeds, the chances of conception are very low. However, this method is typically effective only for up to six months postpartum.

2. Mechanical/Barrier Contraceptive methods

These methods work by physically preventing the egg and sperm from meeting, avoiding fertilization.

• Mechanical

Male - Condom

Female - Condom, diaphragm, cervical cap

• Chemical

(Vaginal contraceptives)

Creams - Delfen (nonoxynol-9, 12.5%)

Jelly - Koromex, Volpar paste

Foam tablets - Aerosol foams, Chloramine T or Contab, sponge (Today)

• Combination

Combined use of mechanical and chemical

Condoms 

• Condoms are thin rubber or latex sheaths designed to act as barriers during sexual intercourse. 
• They are worn over the penis in males or inserted to cover the vagina and cervix in females just before coitus, preventing the ejaculated semen from entering the female reproductive tract, thereby avoiding insemination.
• The popularity of condoms has risen in recent years, largely due to their additional benefit of protecting against sexually transmitted diseases (S.T.D.s) and HIV/AIDS. Both male and female condoms are disposable, can be self-inserted, and offer privacy to the user.
• A well-known brand of male condoms is 'Nirodh.'

Diaphragms, Cervical Caps & Vaults 

• These are barrier methods made of rubber that are inserted into the female reproductive tract to cover the cervix during intercourse. 
• While they do not prevent insemination, they block sperm from entering the cervix, thereby preventing conception. 
• These barriers are reusable and are often used in combination with spermicidal creams, jellies, or foams to enhance their contraceptive effectiveness. However, they do not protect against sexually transmitted diseases (S.T.D.s).

3. Chemical  Contraceptive Methods

• Chemical methods involve using substances that act as spermicides or surface-active agents. 
• These chemicals attach to sperm cells, inhibiting their oxygen uptake and killing them.
• Examples: Vaginal Foam/Tablets: 'Today', Cream or Jelly: 'Nim-76'

4. Intrauterine Devices (IUDS) 

• I.U.D.s are contraceptive devices that are inserted into the uterus through the vagina by a doctor or trained nurse. 
• They are an ideal choice for women who wish to delay pregnancy or space out childbirth. I.U.D.s are among the most widely accepted contraceptive methods in India. These I.U.D.s are of the following types- 

Non-medicated I.U.D.s:

• These devices are made of plastic or stainless steel only. 
• Mechanism: Non-medicated I.U.D.s promote the phagocytic cells of the uterus to phagocytosis of sperms within the uterus. 
• For example, a Lippes loop is made of plastic (Polyethylene). 

Copper releasing I.U.D.s:

• Mechanism: Copper-releasing I.U.D.s release Copper ions, which suppress sperm motility and the fertilizing capacity of sperms. 
• e.g. CuT, Cu7, Multiload-375 

Hormone releasing I.U.D.s:

• Mechanism: The hormone-releasing I.U.D.s make the uterus unsuitable for implantation and the cervix hostile to the sperms. 
• e.g. Progestasert, LNG-20 

5. Hormonal Contraceptive Method 

These are the most widely used and most effective methods (almost 100% effective) 

In this method, oral pills, injections and implants are used. 

(i) Oral Pills 

• Pills are very effective with fewer side effects and are well accepted by females. 
• The daily oral pills are started preferably within the first five days of the menstrual cycle. For 1 to 21 days, Hormonal pills are given, and Iron or Fe pills are given in the last 7 days for recovery of blood loss in menstruation flow and to maintain regularity of pills.  
• Composition of an oral pill 

(a) Synthetic progesterone – High concentration 

(b) Synthetic Estrogen – Low concentration 

• Mechanism: The action of the combination oral pill is to prevent ovulation from the ovary. This is achieved by blocking the pituitary secretion of gonadotropin (F.S.H. and L.H.), which is necessary for ovulation. 
• Progesterone-only preparations render the cervical mucus thick and scanty; this prevents / retard entry of sperms. So fertilization does not take place.
• Daily oral pills for females: Mala–N, Mala–D

(ii) Implants & Injections 

• Females can also use progestogens alone or in combination with estrogen as injections or implants under the skin.
• In these implants/injections, a high level of progesterone Hormone is present, which inhibits the secretion of gonadotropins, so ovulation is absent. 
• e.g. Norplant (implant) 

(iii) Male Pill 

• Progesterone hormone can be used in male oral pills. 
• In July 2000, China made progesterone pills for males (the first time in the world). 

(iv) Saheli 

• Weekly oral pill 
• Non-steroidal & non-hormonal pill. (Developed by scientists at CDRI Lucknow). 
• There are few side effects and high contraceptive value. 
• Mechanism: it blocks estrogen receptors in the uterus and prevents implantation. 

(v) Emergency Contraceptive Methods 

• Contraceptive methods which are used within 72 hours of unprotected sexual intercourse are known as emergency contraceptives or post-coital contraceptives. 

(a) Emergency contraceptive pills - progesterone-only pill. e.g. i-pill, unwanted-72 Emergency Contraception with IUDs:

(b) Intrauterine devices (IUDs) can also serve as emergency contraceptives by preventing implantation of a fertilized egg. For effective emergency contraception, progestogens, progestogen-estrogen combinations, or an IUD can be administered within 72 hours of intercourse. This approach is highly effective for preventing pregnancy resulting from rape or unprotected casual sex.

6. Permanent Contraceptive Methods 

Surgical Methods (Sterilization)

• Surgical methods, commonly referred to as sterilization, are permanent solutions used to prevent future pregnancies. 
• These procedures work by blocking the transport of gametes, thereby preventing conception. While these methods are highly effective, they are generally not easily reversible.
• For Males - Vasectomy: This procedure involves removing or tying a small section of the vas deferens through a small incision in the scrotum.
• For Females - Tubectomy: This procedure involves removing or tying a small portion of the fallopian tubes through a small incision in the abdomen or via the vagina.

2.0Amniocentesis 

• In the 14th to 16th week of pregnancy, with the help of a long surgical needle, amniotic fluid is taken out from the uterus. Few embryo cells (skin, liver and placenta) are present in this fluid. 
• These cells are tested to know. 
• (i) Genetic disorder/chromosomal abnormalities like Down syndrome. 
• (ii) Metabolic disorder (deficiency of protein, enzymes, hormones). 
• (iii) Detection of Sex (Barr bodies).