In the last century an all-round development in various fields significantly
improved the quality of life of the people. However, increased health
facilities along with better living conditions had an explosive impact on
the growth of population. The world population which was around
2 billion (2000 million) in 1900 rocketed to about 6 billion by 2000 and
7.2 billion in 2011. A similar trend was observed in India too. Our
population which was approximately 350 million at the time of our
independence reached close to the billion mark by 2000 and crossed
1.2 billion in May 2011. A rapid decline in death rate, maternal mortality
rate (MMR) and infant mortality rate (IMR) as well as an increase in
number of people in reproducible age are probable reasons for this.
Through our Reproductive Child Health (RCH) programme, though we
could bring down the population growth rate, it was only marginal.
According to the 2011 census report, the population growth rate was
less than 2 per cent, i.e., 20/1000/year, a rate at which our population
could increase rapidly. Such an alarming growth rate could lead to an
absolute scarcity of even the basic requirements, i.e., food, shelter and
clothing, in spite of significant progress made in those areas. Therefore,
the government was forced to take up serious measures to check this
population growth rate.
The most important step to overcome this problem is to motivate smaller
families by using various contraceptive methods. You might have seen
advertisements in the media as well as posters/bills, etc., showing a happy
couple with two children with a slogan Hum Do Hamare Do (we two, our
two). Many couples, mostly the young, urban, working ones have even
adopted an ‘one child norm’. Statutory raising of marriageable age of the
female to 18 years and that of males to 21 years, and incentives given to
couples with small families are two of the other measures taken to tackle
this problem. Let us describe some of the commonly used contraceptive
methods, which help prevent unwanted pregnancies.
An ideal contraceptive should be user-friendly, easily available,
effective and reversible with no or least side-effects. It also should in no
way interfere with the sexual drive, desire and/or the sexual act of the
user. A wide range of contraceptive methods are presently available which
could be broadly grouped into the following categories, namely
Natural/Traditional, Barrier, IUDs, Oral contraceptives, Injectables,
Implants and Surgical methods.
Natural methods work on the principle of avoiding chances of ovum
and sperms meeting. Periodic abstinence is one such method in which
the couples avoid or abstain from coitus from day 10 to 17 of the menstrual
cycle when ovulation could be expected. As chances of fertilisation are
very high during this period, it is called the fertile period. Therefore, by
abstaining from coitus during this period, conception could
be prevented. Withdrawal or coitus interruptus is another
method in which the male partner withdraws his penis from
the vagina just before ejaculation so as to avoid
insemination. Lactational amenorrhea (absence of
menstruation) method is based on the fact that ovulation
and therefore the cycle do not occur during the period of
intense lactation following parturition. Therefore, as long
as the mother breast-feeds the child fully, chances of
conception are almost nil. However, this method has been
reported to be effective only upto a maximum period of six
months following parturition. As no medicines or devices
are used in these methods, side effects are almost nil.
Chances of failure, though, of this method are also
In barrier methods, ovum and sperms are prevented
from physically meeting with the help of barriers. Such
methods are available for both males and females.
Condoms are barriers made of thin rubber/
latex sheath that are used to cover the penis in the male or
vagina and cervix in the female, just before coitus so that
the ejaculated semen would not enter into the female
reproductive tract. This can prevent conception. ‘Nirodh’ is
a popular brand of condom for the male. Use of condoms
has increased in recent years due to its additional benefit of
protecting the user from contracting STIs and AIDS. Both
the male and the female condoms are disposable, can be
self-inserted and thereby gives privacy to the user.
Diaphragms, cervical caps and vaults are also barriers
made of rubber that are inserted into the female reproductive
tract to cover the cervix during coitus. They prevent
conception by blocking the entry of sperms through the
cervix. They are reusable. Spermicidal creams, jellies and
foams are usually used alongwith these barriers to increase
their contraceptive efficiency.
Another effective and popular method is the use of Intra Uterine
Devices (IUDs). These devices are inserted by doctors or expert nurses
in the uterus through vagina. These Intra Uterine Devices are presently
available as the non-medicated IUDs (e.g., Lippes loop), copper releasing
IUDs (CuT, Cu7, Multiload 375) and the hormone releasing IUDs
(Progestasert, LNG-20) . IUDs increase phagocytosis of sperms
within the uterus and the Cu ions released suppress sperm motility and
the fertilising capacity of sperms. The hormone releasing IUDs, in addition, Condom for female Condom for male
make the uterus unsuitable for implantation and the
cervix hostile to the sperms. IUDs are ideal contraceptives
for the females who want to delay pregnancy and/or space
children. It is one of most widely accepted methods of
contraception in India.
Oral administration of small doses of either progestogens
or progestogen–estrogen combinations is another
contraceptive method used by the females. They are used
in the form of tablets and hence are popularly called the
pills. Pills have to be taken daily for a period of 21 days
starting preferably within the first five days of menstrual
cycle. After a gap of 7 days (during which menstruation
occurs) it has to be repeated in the same pattern till the female desires to
prevent conception. They inhibit ovulation and implantation as well as
alter the quality of cervical mucus to prevent/retard entry of sperms. Pills
are very effective with lesser side effects and are well accepted by the females.
Saheli –the new oral contraceptive for the females contains a non-steroidal
preparation. It is a ‘once a week’ pill with very few side effects and high
contraceptive value.
Progestogens alone or in combination with estrogen can also be used
by females as injections or implants under the skin . Their
mode of action is similar to that of pills and their effective periods are
much longer. Administration of progestogens or progestogen-estrogen
combinations or IUDs within 72 hours of coitus have been found to be
very effective as emergency contraceptives as they could be used to avoid
possible pregnancy due to rape or casual unprotected intercourse.
Surgical methods, also called sterilisation, are generally advised for
the male/female partner as a terminal method to prevent any morepregnancies. Surgical intervention blocks gamete transport and thereby
prevent conception. Sterilisation procedure in the male is called ‘vasectomy’
and that in the female, ‘tubectomy’. In vasectomy, a small part of the vas
deferens is removed or tied up through a small incision on the scrotum whereas in tubectomy, a small part of the fallopian tube is
removed or tied up through a small incision in the abdomen
or through vagina. These techniques are highly effective but their
reversibility is very poor.
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| Vasectomy | Tubectomy |
It needs to be emphasised that the selection of a suitable contraceptive method and its use should always be undertaken in consultation with qualified medical professionals. One must also remember that contraceptives are not regular requirements for the maintenance of reproductive health. In fact, they are practiced against a natural reproductive event, i.e., conception/pregnancy. One is forced to use these methods either to prevent pregnancy or to delay or space pregnancy due to personal reasons. No doubt, the widespread use of these methods have a significant role in checking uncontrolled growth of population. However, their possible ill-effects like nausea, abdominal pain, breakthrough bleeding, irregular menstrual bleeding or even breast cancer, though not very significant, should not be totally ignored.
