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What you need to know about contraceptives

September 26 marks World Contraception Day, and there is no better time to bring awareness about the importance of family planning.

I sat down with Thembisile Makhomboti, Head of Preventative Department at Witkoppen Clinic to talk more about the different types of contraceptives, their advantages and disadvantages, and more. 

Who needs to be on a contraceptive?
Anybody who is sexually active and not trying to fall pregnant should be using contraception. Those with multiple sexual partners should consider using external male or female condoms specifically as they offer dual protection against both unwanted pregnancy and STI’s, including HIV.

Different types of contraceptives

Condom:
A condom is a thin film sheath made of latex or polyurethane. They work by catching the sperm as it is released and stopping it from entering the vagina. Condoms come in all shapes, sizes, and materials so that even those with allergies or sensitive skin can use them. There are both male and female condoms.

Pros: They protect against sexually transmitted infections as well as pregnancy; they are good for people who don’t want to use hormonal methods; they aren’t expensive, are easy to access and you can often get them for free.

Cons: It can split or slip off; oil-based products (like body oils, hand creams, and vaseline) can damage the latex and make the condom more likely to split (always use water-based lubricants); they have to be put on before any intercourse.

The Oral Contraceptive Pill
The pill is a small tablet containing hormones that need to be swallowed at the same time every day. The pill uses hormones, similar to the ones in your body, to stop the release of an egg so that it can’t get fertilised. It’s important to ask your healthcare provider whether the pill is a suitable method of contraception for you, based on your medical history and, if yes, which is the best type for you.

Pros: The pill is very effective against pregnancy if used correctly; it makes menstrual periods more regular and lighter; the pill can decrease menstrual cramps and acne;

Cons: The pill doesn’t protect against STIs; you need to remember to take every day at the same time; it can’t be used by women with certain medical problems or by women taking certain medications; it can occasionally cause side effects such as nausea, increased appetite, headaches, and, very rarely, blood clots; you will need a prescription from a doctor.

Intrauterine Device (IUD)
An IUD is a small, often T-shaped birth control device that is inserted into the uterus. It prevents pregnancy by stopping sperm from reaching and fertilising eggs.IUDs are one form of long-acting reversible birth control.

Pros: IUDs are very effective against pregnancy; they provide protection against pregnancy as long as they are in place, so you don’t need to remember to use contraception if you have sexual intercourse; IUDs don’t need daily attention; they are comfortable – you and your partner cannot feel the IUD.

Cons: IUDs do not protect against STIs and need to be used alongside condoms in order to prevent infection; it can fall out; the Copper IUD can have side effects such as menstrual cramping, longer and/or heavier menstrual periods, and spotting between menstrual periods.

The Contraceptive Implant
Contraceptive implants are a long-term birth control option for women. A contraceptive implant is a flexible plastic rod, about the size of a matchstick, that is placed under the skin of the upper arm. It releases a low, steady dose of a progesterone to thicken cervical mucus and thin the lining of the uterus. Contraceptive implants typically suppress ovulation as well.

Pros: The contraceptive implant can be removed at any time, followed by a quick return to fertility; it eliminates the need to interrupt sex for contraception; it contains no oestrogen.

Cons: The contraceptive implant doesn’t protect against STIs; it requires minor surgery and insertion of the tiny rod underneath the skin; it requires minor surgery to remove the device; the implant can cause side effects such as irregular menstrual periods, depression, nervousness, hair loss, and weight gain.

The Contraceptive Injection
The contraceptive injection contains the hormone progestin and is given every three months. It typically suppresses ovulation, keeping your ovaries from releasing an egg.

Pros: Each injection provides three months of protection against pregnancy; it is very effective against pregnancy if used correctly; many women stop getting their menstrual period while getting injections  (this is not a medical problem and periods usually return six to 18 months after you stop taking injections); doesn’t interrupt sexual activity.

Cons: Doesn’t protect against STIs; need to see your health care provider every three months for an injection.

Emergency Contraception Pill (The ‘Morning After’ Pill)
The morning-after pill is a type of emergency birth control used to prevent pregnancy for women who’ve had unprotected sex or whose birth control method has failed. The morning-after pill is intended for backup contraception only, not as a primary method of birth control. Morning-after pills do not end a pregnancy that has implanted. They work primarily by delaying or preventing ovulation.

Pros: Morning-after pills can help prevent pregnancy if you’ve had unprotected sex — either because you didn’t use birth control, you missed a birth control pill, or your method of birth control failed.

Cons: Emergency contraception is an effective option for preventing pregnancy after unprotected sex, but it isn’t as effective as other methods of contraception and isn’t recommended for routine use. Also, the morning-after pill can fail even with correct use, and it offers no protection against sexually transmitted infections.

Contraceptive Ring
The vaginal ring is a hormonal birth control device for women. It is a flexible, latex-free plastic ring that is inserted into the vagina. It contains the hormones estrogen and progesterone, which are released over a three-week period. The hormones prevent pregnancy and suppress ovulation. The vaginal ring is worn for three weeks, and then removed — allowing menstruation to occur — and then a new ring is inserted after a week.

Pros: Makes menstrual periods more regular and lighter; doesn’t interrupt sexual activity.

Cons: Does not protect against STIs; can’t be used by women with certain medical problems or by women taking certain medication; can occasionally cause side effects such as nausea, increased appetite, headaches.

How soon can one take a contraceptive after giving birth?
For hormonal contraception, it is recommended that you start it from around three weeks after birth. External contraception (condoms) can be used immediately after giving birth.

Is it safe to take contraceptives while breastfeeding?
Yes, if you’re breastfeeding, you can safely use hormonal methods. They won’t hurt you or your baby.

What advice would you give someone who’s considering going on the contraceptive?
There are lots of options for contraception, and it’s important know which methods are available to you and understand how they work. We recommend visiting your doctor or a family planning clinic to discuss the contraceptive options that will work best for you, based on your health, lifestyle, and preference. You also need to consider the effectiveness, side effects, affordability of each method before picking one.

About Witkoppen Clinic

Providing comprehensive healthcare to almost 7 000 patients every month, Witkoppen Clinic services around 1.4-million people from informal settlements in Diepsloot, Kyasands, and surrounding areas. The Clinic offers a range of healthcare services, including a family planning and well-woman clinic, HIV and TB testing, antenatal and prenatal care, a mental health clinic and dentist.

Photo by Reproductive Health Supplies Coalition on Unsplash

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