Preventing unplanned pregnancy

Updated: Jun 19, 2020

Techniques or tools used to prevent pregnancy is called as contraception !!! Introduction : It’s indeed a tragedy when a couple decides to end an apparently normal pregnancy because the timing isn’t right. Various reasons are given such as recent marriage, consumption of medicines unknowingly or important career and social priorities. But what has been observed strikingly is, serious lack of knowledge about birth control measures. Safe abortion methods are available, established and permissible by law, within the framework of the Medical Termination of Pregnancy Act of the country. Yes, India has made termination of pregnancy legal, to protect women from stigma, injury and complications. Unfortunately, this has resulted in increased abortions as these pregnancies were a result of ignorance. The failure to use any protective methods, is not deliberate but many a times due to fear of complications or adverse effects. This write up is an attempt to help couples make these decisions with confidence and to empower them with knowledge, which can help and guide them. Is it right to use birth control measures ? Pregnancy should be always be planned and a conscious decision. The “mother to be” should be healthy, physically and mentally prepared, to take on this responsibility and so should be the “father to be”. Basic health checkup and vaccinations, can be undertaken before planning a baby in order to protect the baby from infections and disorders. Pre-pregnancy healthy life style, healthy diet goes a long way in preventing abnormalities in the baby. This is because the earliest time the pregnancy is diagnosed is when a woman misses her periods. By that time the neural tube of the baby is already formed. Deficiencies of nutrients have been identified to be responsible for birth defects in the foetus and also improper formation of the placenta, which is the anchor of the baby, while in the mothers womb. Currently in India what birth control methods are available ?

Indian youth has access to condoms, uterine devices, pills and injectables as temporary birth control( contraceptive ) methods. Are there any natural methods of preventing unwanted pregnancy ? This method is also called as the safe-period method of pregnancy prevention. This is based on the fact that there is a window during the menstrual cycle of the woman during which she can conceive, as the ovum ( egg) which is released from the ovary and the sperms which are deposited in the woman’s body are capable of fertilization and formation of an embryo. This window is called the fertile period and is from cycle day 10 to cycle day 20( First day of the cycle is first day of menses start). But identifying this period can be difficult in women with irregular cycles. Coitus interruptus or avoiding the deposition of the sperms or the male gamete inside the woman’s genital tract is practised. This has a high failure rate as there can be accidental spillage and also the pre- ejaculatory fluid is known to contain sperms. Natural methods fail as identification of the fertile window is difficult and also unpredictable. This can be identified by ovulation diagnosis kits or observing the changes in the cervical mucus which your doctor can guide you. Are there any non-hormonal methods to prevent pregnancy ? Methods such as the natural methods or barriers such as condoms and implants such as contraceptive devices can be non-hormonal methods of contraception. Condoms are of two types such as the male condom or the female condom. Female condoms are not freely available but male condoms are easily available and the government facilities, supply these freely. Many medical stores have condom vending machines too. What are condoms ? Condoms are barrier methods of contraception where in the man uses the latex made sleeve on to his erect organ to avoid contact of the semen with woman’s genital tract and can be disposed without spillage. These also carry a liquid spermicide and offers to protect against pregnancy in case of a spillage. What are the challenges with condoms ?

Improper technique of use, causes rupture of the condom. Failure to use one, has been the cause of failure of this method. Has to be used at every act of intimacy. Interruption in the sexual act and high failure rate makes it unpopular. Advantages of condoms ? Inert method so does not cause any bodily changes. Protects against sexually transmitted infections. Important tips ? Please seek guidance for correct usage technique from a healthcare provider. What are uterine devices ? Copper IUCD or intra-uterine-contraceptive devices of various sizes, shapes, lifespans are available. These are gently placed inside the womb and mechanically prevent the pregnancy from nidating. These are inert and safe, if proper user is used. Are these contraindicated in women who have never had pregnancies ? No, but usually they are kept as a last choice. Do IUCDs have any side effects ? Irregular bleeding, Infections and pelvic pain may occur but are very rare. Do IUCDs cause tubal pregnancy ? Tubal pregnancy is a condition when the pregnancy gets implanted in the oviduct, instead of the womb ( uterus ). This can be a life threatening condition if not diagnosed on time. The IUCD is not recommended in whom ? Women with recurrent pelvic infections, pelvic pain, irregular cycles, heavy menstrual bleeding, previous tubalpregnancy, structurally distorted uterus. When is the IUCD inserted ? Best time is on the last day of the menstrual cycle. Other times are also after delivery immediately or after 6 weeks. There also is a quick start method like for a pill which the doctor will guide you.

Is the insertion, after period and the removal painful ? Insertion is a OPD procedure not requiring any anaesthesia. Some cramps pains and discomfort is expected for a few days after insertion. Is removal an easy procedure ? Any complications ? Rarely it may get displaced, may get imbedded and the woman may still conceive despite. What are hormonal contraceptives ? These are various formulations prepared synthetically and very similar to the naturally occurring hormones in our body. The principle behind using these is to elevate the levels of the hormones in such a way that it will prevent the usual cyclical events to prevent the ovulation and also cause changes in the womb lining and the cervical mucus to prevent pregnancy. These changes are subtle and temporary as the amount of the hormones used in all the recent combinations are very low. Are they harmful ? If the candidate is properly chosen, they are not. There are certain red flags on using these formulations which the doctor can help you in choosing. In fact there are some immediate and long term benefits, such as reduced blood flow, less menstrual pain, improved complexion, regular cycles ,reduced incidence of ovarian and endometrial cancers in future and protection against evolving diseases such aspolycystic ovarian syndrome and endometriosis. Any side effects ? Acidity, nausea, indigestions, headache, exaggeration of migraine headache are seen in few women. Disadvantages ? Has to be taken daily and if missed, can cause bleeding and increase the chances of unwanted pregnancy. Can these medications be injected ? Yes a slow release formulation of injectable hormone is available and is safe. Disadvantage is that, it causes irregular cycles but this is acceptable.

What are I-pills ? I pill is a popular brand of emergency contraception and consists of hormones. What is emergency contraception ? It is a method of birth control, adopted in case of an unprotected sexual intimacy, to prevent pregnancy which may result due to that particular encounter. Is it safe ? Yes, “if consumed once” but many women today, consume it repeatedly and indiscriminately, leading to issues such as bleeding irregularities and bloating, which can be harmful. Some realtime experiences to drive the point across. Renu has married recently and missed her very first cycle. She came for abortion, as she did not want such an early pregnancy but had not used any birth control measure. When asked, both Renu and her husband Ajit said, they were not aware of any such (birth control) measures. Lesson learnt : Please consult a gynecologist even before you get married, for guidance, family planning and sexuality. Anita was recently married and tested positive for pregnancy within 6 months. Decided to continue the pregnancy being the first time. At 4 months the baby was diagnosed with a defect which needs termination of pregnancy : Lesson learnt : Plan pregnancy with proper pre-pregnancy guidance Netra had gone for a business tour with her fiancé and did indulge into intimacy, thrice during the fortnight. She took I-pills all the three times and has now reported with absence of periods, increased weight gain and pain in abdomen. She needed to take treatment for 8 months, to resume her normal self. Lesson learnt :

Take guidance and do not self medicate. Sonali had irregular cycles and pain. She tested positive for pregnancy and her sonography showed a tubal pregnancy. She had taken I-pill but it failed. She now needed to undergo a surgery to remove this pregnancy to prevent haemorrhage and the hospital wanted a blood relative to sign her consent and not the boyfriend as the situation was critical. Lesson learnt: One can have a tubal pregnancy needing intervention. It is important that young couples are aware of these methods and come out of the belief that brith control is harmful. Proper choice, discussion and guidance with the doctor can go a long way in reducing unnecessary physical harm and frustration.

Gynaecologist, Obstetrician,

IVF Specialist

Cloudnine Hosptial

Axon Building, Survey No 28/1, Bhamburda, Shivajinagar, Pune, Maharashtra 411005

Bharati Hospital

Satara Rd, Bharati Vidyapeeth Campus, Dhankawadi, Pune, Maharashtra 411043