16-2 CONTRACEPTION FOR FAMILY PLANNINGWomen shelter and feed a child in their womb What is Contraception?for nine months. But most of the time it is Women (and men too) need to knowwomen who have no control over whether ways of controlling how manyor not they wanted to bring a child into this children they want and when toworld in the first place or not ! have them. The is called contraception (kawn-tra-sep-shun). Why Do We need To Limit Our Families ? For women this knowledge is crucialIn most societies here, the husband or the for exercising their right to delay orfamily exercises this control. In early days the prevent pregnancy.joint family system helped take care of manychildren growing up at the same time. But Though there are many ways ofnow families are mainly nuclear and this preventing pregnancy, let us firstsupport is no longer available to mothers. know those that can be easily usedMoreover with things so costly, it is difficult and are available at village level.to look after more than a couple of childrenproperly. Types of ContraceptionBroadly we can divide the methods of contraception into: I. Natural and Unnatural methods. II. Further, the unnatural methods can be further divided into Temporary and Permanent methods.I. Natural Methods1. Abstinence :Not having sex is the surestmethod of avoiding pregnancy,but one which is the toughest tofollow.2. Withdrawal method Withdrawal Often Fails !Man withdraws his penis from the The problem with this method is that the chances of fail-woman just before the semen ure are very high. This is because the fluid that comescomes out. This is the commonest out of the penis when the man is excited (even before the semen is brought out) may also have enough sperms.method couples in rural areas use These can travel up a woman’s uterus and to the tubeto avoid pregnancy. and can cause pregnancy.There are better and safer methods that a woman can adopt if she wants to avoid preg-nancy.
16-33. Rhythm or Calendar methodThis method involves every woman knowing her safe period, that is, the period when awoman is least likely to get pregnant. This method is safest only in those women whogets more or less regular periods.Though there are many ways to calculate “safe periods”, we will earn one of the simplestways. Though slightly more risky, it can be used very well by even women who cannotread or write. Calculating Safe Period A Woman is asked to divide her cycle into (approximately) three equal parts of nine or ten days. Starting the first day of her menstrual cycle as Day 1, the first and the last part of the cycle are considered as her safe period. She should not have sex in the middle part as she is fertile then and could get pregnanat. Else, her partner should use a condom during the “unsafe period”. For example: Suppose your period starts on 7th January. Count that day as Day 1. Now Count off 10 days. Starting with the 10th day, underline the next 10 days in which you SHOULD NOT have sexual contact. Now suppose your next period starts off on the 3rd February. Count off 10 days and mark off the same way as given. Underline the days you must not have sex or make sure your partner uses a condom when you have sex.4. Mucus Method Examine Your Cervical Mucus To Know your FertilityThis method requireslearning. It requires a dry (no mucus); nothing comes on the fingerswoman taking out the (not fertile - can have sexual contactmucus from her vaginabetween her thumb andfinger and checking to see does not stretch; crumbly, cream-like on the finger (not fertile - can have sexual contact)how much it stretches.Mucus does not stretchand breaks easily : Safe to stretches a little but breaks (slightly fertile - do not have unprotected sexual contact)have sexMucus stretches and isslippery : Should NOT have wet; slippery and stretches between fingers (very fertile; dangerous to have unprotected sex; can get pregnant)sex.
16-4II. Unnatural Methodsa. Temporary MethodsMany methods for avoiding pregnancy are nowavailable for couples to choose from. Of the temporaryones are: 1. Condoms (kawn-dem) like Nirodh 2. IU.D. (Intra Uterine Device) or Copper T 3. Oral Contraceptive Pills Planning children is the responsiblility of both husband and wife. Encourage the husband to also be involved in deciding the method of contraception. 1. Condoms Condoms (made of latex rubber) when rolled up on the excited stiff penis of a man act as a barrier. They do not allow the semen (and hence the sperms) to travel up the woman’s uterus and hence avoid pregnancy. This is the only method available for men though not very popular with them. Many men claim that it decreases their Presently, condoms is the only pleasure of sex as one needs to roll it on the penis only method available to men. when it is erect. This interferes with the act of sex at a crucial time. Though men may not like to use condoms, the idea can be popularised by making men realise that: · There is no unnatural method that is 100% safe for women and this is one of the ways that he can show he cares for his wife/partner. · It helps him to avoid getting any disease from his sex partner. Condoms must be put on an erect Condoms must be used only once penis before it enters the vagina and then thrown away properly. Know this about Condoms · Condoms come in three sizes, but the six inches one is considered the regular size. · All Primary Health Care centres and health workers distribute it free of cost as NIRODH. It is also socially marketed cheaply as ZAROOR and may also be purchased from the market under different brand names. · It is important to squeeze air out of the tip as the man rolls it open over his penis or else the tip may burst and leak. · Rarely men may get an allergy to the rubber in the form of a rash.
16-52. Intra Uterine Device - Copper TCopper T is the commonest and most popular. It is shapedlike the alphabet T and its stem is covered by a Copper wire.This Copper T when inserted by a trained person inside thewoman’s uterus keeps releasing bits of copper. This reactswith the uterus so that a fertilised egg (an egg that has beenjoined by a man’s sperm) cannot lodge in the uterus. Copper-TThe effect of most of the Copper Ts lasts for two to three years but we also have new ones that canlast for five years. Hence, it is the most popular form of contraceptive among women. Problems of Copper T · Most rural women have infections of the genital tract and if due care is not taken for cleanliness, the infection may go up the uterus. · Many women get heavy bleeding because of a Copper T. · Most get cramps in the lower abdomen and pain in the lower back but very often the cramps get better after a month or two. Sometimes, though rarely, the Copper T may damage the uterus or cause apregnancy that gets stuck in the tubes - both situations are emergencies and need an operation.3. Oral Contraceptive PillsMade of hormones that are found naturally in women, OCPs stopthe eggs from being released. Pregnancy cannot happen when thereis no egg for the sperm from the man to fertilize.Where to get OCPs?· The government gives Oral Contraceptive Pills (OCPs) free. Called MALA-N, it costs only Rs 2.00 in the markets for a packet of twenty-eight tablets sold as Mala - D. One packet can be used for a month. It has twenty-one white pills with hormone and seven red pills without any hormones (instead they have iron for the mother’s health). How To Take The Pills? Any woman who wants to prevent pregnancy can start eating a white pill strictly - for the first time — from the fifth day of her menstrual period daily at a fixed time, preferably while going to bed. After eating one white pill every night for twenty-one days, the woman must start eating the red pills that do not have hormones. This withdrawal of the hormones (in the white pills) will allow bleeding to occur. This assures the woman that she is not pregnant. After the whole pack is over she must start with the white pills of another pack.
16-6More Questions on OCPs Answered What are the Problems associated With OCPs ?In some women, OCPs may cause afeeling of heaviness, swelling of feetand high BP. In those with a tendencyto get blood clots, they may cause legswelling and effects on the heart. Manywomen get fullness and discomfort inthe breast which pain on pressing. Who should NOT useWeight gain of a few kgs and OCPs?headaches are also common. It is suggested that OCPs must be given only to women below 40 Are OCPs Useful After Sex ? years. Older women could go in forOCPS can also be used as AFTER-SEX a permanent method ofPILLS. Four tablets taken within 72 contraception. You can use ahours of sex and repeated after 12 checklist before giving OCPs to anyhours is said to prevent pregnancy. But woman.it may cause nausea, swelling andincrease in BP temporarily. Even a ChecklistCopper T inserted within 3 days of sex · Above 40 years of agecan prevent pregnancy. · Above 35 years & heavy smoker · Severe pain in calves or thighs What if You Forget to take the · Fits /seizures Pill for one day? · Vein swelling in the legs Forgetting the pill for even a single day can causing problem put the woman at risk of getting pregnant. · Severe chest pain If she ever forgets, she must take the pill · Unusual shortness of breath immediately and then take the next dose at · Severe headache and the usual time. difficulty in vision · Feeding milk for less than six months 4. Other Hormonal Contracep- · Bleeding between menstrual tions cycles or after sex There are other ways of giving hormones · No periods to women for avoiding pregnancies. · Abnormally yellow skin & eyes · There are once a week pills like Saheli · B.P. more than 140/90 mm Hg that are a bit problematic to remember · Lump in the breast for the first few weeks (when they are · Swollen legs needed to be taken twice a week). If any one of the conditions · We also have three monthly injections listed in the checklist is found, like Depo-Provera and Net -En and the decision to give OCPs must implants like NORPLANT also, but are be left to a doctor. unadvisable in Indian conditions, because if they ever cause bleeding Every woman taking OCPs must problems, it is very difficult to have a be examined every year by a long cure. doctor.
16-7b. Permanent Methods of ContraceptionOperations help prevent pregnancy permanently. For the male the operation is calledVasectomy and for the woman it is called Tubectomy.1. Vasectomy (vasek-tummy): Operation ForMenVasectomy involves cutting and closing tubes called vasdeferens so that it cannot transfer the sperms to the semen.The operation is very simple and painless. Most times,the man does not feel more than a prick of the injectiongiven on either side to prevent pain sensation. Theoperation is a simple OPD procedure, and the man can In vasectomy, the tubes car-walk back after his operation. He needs to get his stitches rying sperms from testes toremoved in five days and in a couple of weeks time, he penis are cut and tied.can even lift heavy weights as before. Precaution After Vasectomy Does Vasectomy Make You Weak ?As sperms are stored for a while before release, a In men, the male hormone is sent to the bodyman may cause pregnancy until six weeks after directly through the blood. So, cutting the tubesthe date of operation of vasectomy. During this in vasectomy makes no difference to thetime, the couple is advised to use condoms or person’s capability to have sex or to his voice,OCPs. hair or skin. Vasectomies are safer, simpler, faster and less For a couple of weeks the operation may giveexpensive than a tubectomy. But more women pain but it disappears. In some the operationthan men get operated. This is because of women’s site may get infected, while in others there maylower status in a male dominated society. be swelling and pain. How Vasectomy is Done Vasectomy without Knife A new type of vasectomy called Non Scalpel Vasectomy or NSV is safe, convenient and much more acceptable to many males.The man’s vas is cut and tied through a hole-puncture carried out by a special thick needle. It can be popularised as a ‘’No Cut, No Stitch vasectomy.’’ Every area has Normally the man does not trained surgeons who can feel more than a pin-prick! perform NSV. ASK FOR IT! Can We Reverse the Effects of Vasectomy ? Although considered permanent, if a man for some reason wants to get back his capacity to give birth to a child, his vasectomy can be reversed. By another operation, the cut vas on each side can be joined once again. However the chances of it being successful enough to allow the man to be able to have children are low.
16-82. Tubectomy : Operation For WomenThis is the operation that can stop woman from gettingpregnant permanently. In Tubectomy, the surgeoncuts the tubes of the woman on either side and closesthe ends, so that the sperms from the father cannotreach the egg in the tube. On the other end, even theegg cannot travel down to the uterus even if the spermwere to reach it.Tubectomy can be done in 2 ways :1. Making large cut on abdomen. In Tubectomy, tubes carrying the eggs from ovary to uterus2. Using Laparoscope Tube. are cut and tied.(does not require a large cut on the abdomen). Laparoscopic OperationTubectomy Without Large Cut On Abdo- When Laparascopy is Harmfulmen In our country, most tubectomyThe good point of laparascopy is that it can operations are carried out inbe done quickly and one may not need to “camps”. Conditions are farmake the patient unconscious. However, it from ideal and the chances ofrequires more skill and training of the doctor germ infections are great.who performs the operation. Tubectomy Done In Camps Are Not The Best ! In laparoscopy operations the surgeon has to keep seeing through the tube of a laparoscope while operating. It is easier to see if a germfree gas can be pumped inside the abdomen. However, in most camps it is seen that even dust laden air is often pumped through a bicycle pump! Germs enter the woman’s body. These are considered the biggest reason why many women feel pain and have problems after the operation for life. Also, in such camps doctors try to do many operations as there is always a rush. They may not bother waiting the minimum 20 minutes needed to clean the instruments between one patient and another. Due to this, germs can spread. The commonest problem with tubectomy is seen to be pain and increased bleeding for years after the operation. Though dismissed by doctors, it is often serious enough to prevent the woman from working. This can be prevented if proper cleaning up procedures are followed at the time of the operation. Failure of the operation resulting in pregnancy is another problem of tubectomy. The pregnancy happens because the doctor is inexperienced. Or at times the band applied on the cut tubes slips. A woman whose tubectomy fails and she gets pregnant is liable to get compensation from the doctor/ government hospital for looking after the unwanted child or to undergo abortion. Such cases can be brought to light by forwarding a claim at the district office.
16-9 Other Methods Of Contraception Used 1. ABORTIONMedical Termination of Pregnancy (M.T.P.) Conditions For Doctors To AllowIf any woman demands that her pregnancy be M.T.Pended as her contraception had failed, even if If the pregnancy is less than twelvethere is no way to prove it, under the MTP Act weeks only one doctor can take aof 1971 she has a right to it. The medical system decision for MTP, but after thatis duty-bound to provide her the facility of MTP and until twenty weeks, twoif her pregnancy is of less than twenty weeks or doctors are necessary for such afive months duration. decision. The district medical officer must certify both suchOther reasons sufficient for allowing a doctors and the surgeon to bepregnancy to be ended before twenty weeks of competent to carry out thecompletion can be: procedure. Other than at 1. Where the pregnancy is likely to affect the government institutions, MTPs physical or mental health of the mother, can be carried out only at places 2. Where the yet unborn child is likely to have a that are permitted to do so by the serious handicap due to physical/mental government. abnormality, 3. Where pregnancy is a result of rape and However MTP must not be used 4. Where actually or in the near future, the or abused as a method of post-sex pregnancy could endanger the health of the contraception. Repeated MTPs mother. affect the health of the woman very badly. Any abortion beyond twenty weeks pregnancy (5 months) or by unqualified doctors is ILLEGAL. Both doctor and patient can be sent to jail ! 2. Menstrual Regulation (M.R.)This is a simple procedure that can be used if a woman’s periods are delayed for a weekor so and is not sure if she is pregnant.It can be done on a woman with less than two weeks of delayed periods. A simple OPDprocedure, MR is available free/cheaply at every rural or thirty-bedded hospital. Anarrow tube is inserted into the uterus and a large syringe attached to it sucks out everything inside it. Even if there is a pregnancy, the age of the child inside the womb cannotbe more than six weeks. By this age, it is not expected to have any sensation or feelings,hence such a procedure is accepted by all religions that may otherwise do not permitabortion.Couples can use it if contraception has failed. But repeated dependence on such aprocedure increases the chances of the woman to get an infection in the uterus.
16-10 Know the Answers Contraception for Family PlanningPlease Fill in the blanks:1. The natural methods of family planning are __________ , ____________, ____________ and ____________________.2. In Calendar Method ( or Rhythmn Method) , a woman must divide the month into ____ number of cycles, each cycle must be of ______ days. The first cycle starts with the ____ day of her monthly periods.3. In Mucus Method, the most fertile period is when the mucus is ______________________ and at this time the couple should _______ have sex.4. _______________ is the only contraceptive device for men.5. ____________________ for women is effective for 2-3 years once it is put.6. There are _____ number of pills in OCPs. The woman must take _____ pill every day starting with the ______ colour pill on the _____ day of her monthly period.7. _________________ is the permanent method for men and for women it is called __________________.8. Mentrual Regulation can be done in women less than _____ weeks of menstrual periods.“Right” or “Wrong”1. Only women should know contraception methods as they are the ones who have to bear children.2. Calendar or Rhythm method is only good for women whose periods are regular.3. Condoms can be washed and re-used again and again.4. If a woman is using OCPs and forgets to take her pill for 1 day, she should take it immediately and continue the next dose next day.5. Abortion beyond 5th month of pregnancy and done by unqualified doctor is a crime.