Contraception, or birth control, allows women and men to control whether and when to have children. There are natural and unnatural contraception methods. Natural methods include abstinence, withdrawal, and tracking menstrual cycles or cervical mucus. Unnatural temporary methods include condoms, IUDs (intrauterine devices like Copper T), and oral contraceptive pills. Condoms must be used correctly to prevent pregnancy. IUDs are inserted by a trained person and can last 2-5 years. Oral contraceptive pills contain hormones and are taken for 3 weeks each month to prevent egg release and pregnancy. Planning family size is a shared responsibility of husbands and wives.

1. 16-1
Contraception for Family Planning

2. 16-2
CONTRACEPTION
FOR FAMILY PLANNING
Women 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 know
women who have no control over whether ways of controlling how many
or not they wanted to bring a child into this children they want and when to
world 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 crucial
In most societies here, the husband or the for exercising their right to delay or
family exercises this control. In early days the prevent pregnancy.
joint family system helped take care of many
children growing up at the same time. But Though there are many ways of
now families are mainly nuclear and this preventing pregnancy, let us first
support is no longer available to mothers. know those that can be easily used
Moreover with things so costly, it is difficult and are available at village level.
to look after more than a couple of children
properly.
Types of Contraception
Broadly 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 Methods
1. Abstinence :
Not having sex is the surest
method of avoiding pregnancy,
but one which is the toughest to
follow.
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 comes
comes 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 tube
to avoid pregnancy. and can cause pregnancy.
There are better and safer methods that a woman can adopt if she wants to avoid preg-
nancy.

3. 16-3
3. Rhythm or Calendar method
This method involves every woman knowing her safe period, that is, the period when a
woman is least likely to get pregnant. This method is safest only in those women who
gets more or less regular periods.
Though there are many ways to calculate “safe periods”, we will earn one of the simplest
ways. Though slightly more risky, it can be used very well by even women who cannot
read 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 Fertility
This method requires
learning. It requires a dry (no mucus); nothing comes on the fingers
woman taking out the (not fertile - can have sexual contact
mucus from her vagina
between her thumb and
finger 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 stretch
and breaks easily : Safe to stretches a little but breaks (slightly fertile -
do not have unprotected sexual contact)
have sex
Mucus stretches and is
slippery : Should NOT have wet; slippery and stretches between fingers (very fertile;
dangerous to have unprotected sex; can get pregnant)
sex.

4. 16-4
II. Unnatural Methods
a. Temporary Methods
Many methods for avoiding pregnancy are now
available for couples to choose from. Of the temporary
ones 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.

5. 16-5
2. Intra Uterine Device - Copper T
Copper T is the commonest and most popular. It is shaped
like the alphabet T and its stem is covered by a Copper wire.
This Copper T when inserted by a trained person inside the
woman’s uterus keeps releasing bits of copper. This reacts
with the uterus so that a fertilised egg (an egg that has been
joined by a man’s sperm) cannot lodge in the uterus.
Copper-T
The effect of most of the Copper Ts lasts for two to three years but we also have new ones that can
last 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 a
pregnancy that gets stuck in the tubes - both situations are emergencies and need an operation.
3. Oral Contraceptive Pills
Made of hormones that are found naturally in women, OCPs stop
the eggs from being released. Pregnancy cannot happen when there
is 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.

6. 16-6
More Questions on OCPs Answered
What are the Problems
associated With OCPs ?
In some women, OCPs may cause a
feeling of heaviness, swelling of feet
and high BP. In those with a tendency
to get blood clots, they may cause leg
swelling and effects on the heart. Many
women get fullness and discomfort in
the breast which pain on pressing. Who should NOT use
Weight 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 for
OCPS can also be used as AFTER-SEX a permanent method of
PILLS. Four tablets taken within 72 contraception. You can use a
hours of sex and repeated after 12 checklist before giving OCPs to any
hours is said to prevent pregnancy. But woman.
it may cause nausea, swelling and
increase in BP temporarily. Even a Checklist
Copper T inserted within 3 days of sex · Above 40 years of age
can 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.

7. 16-7
b. Permanent Methods of Contraception
Operations help prevent pregnancy permanently. For the male the operation is called
Vasectomy and for the woman it is called Tubectomy.
1. Vasectomy (vasek-tummy): Operation For
Men
Vasectomy involves cutting and closing tubes called vas
deferens 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 injection
given on either side to prevent pain sensation. The
operation 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 to
removed 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 body
man may cause pregnancy until six weeks after directly through the blood. So, cutting the tubes
the date of operation of vasectomy. During this in vasectomy makes no difference to the
time, 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 give
expensive than a tubectomy. But more women pain but it disappears. In some the operation
than men get operated. This is because of women’s site may get infected, while in others there may
lower 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.

8. 16-8
2. Tubectomy : Operation For Women
This is the operation that can stop woman from getting
pregnant permanently. In Tubectomy, the surgeon
cuts the tubes of the woman on either side and closes
the ends, so that the sperms from the father cannot
reach the egg in the tube. On the other end, even the
egg cannot travel down to the uterus even if the sperm
were 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 uterus
2. Using Laparoscope Tube.
are cut and tied.
(does not require a large cut on the abdomen).
Laparoscopic Operation
Tubectomy Without Large Cut On Abdo- When Laparascopy is Harmful
men In our country, most tubectomy
The good point of laparascopy is that it can operations are carried out in
be done quickly and one may not need to “camps”. Conditions are far
make the patient unconscious. However, it from ideal and the chances of
requires 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.

9. 16-9
Other Methods Of Contraception Used
1. ABORTION
Medical Termination of Pregnancy (M.T.P.) Conditions For Doctors To Allow
If any woman demands that her pregnancy be M.T.P
ended as her contraception had failed, even if If the pregnancy is less than twelve
there is no way to prove it, under the MTP Act weeks only one doctor can take a
of 1971 she has a right to it. The medical system decision for MTP, but after that
is duty-bound to provide her the facility of MTP and until twenty weeks, two
if her pregnancy is of less than twenty weeks or doctors are necessary for such a
five months duration. decision. The district medical
officer must certify both such
Other reasons sufficient for allowing a doctors and the surgeon to be
pregnancy to be ended before twenty weeks of competent to carry out the
completion 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 week
or 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 OPD
procedure, MR is available free/cheaply at every rural or thirty-bedded hospital. A
narrow tube is inserted into the uterus and a large syringe attached to it sucks out every
thing inside it. Even if there is a pregnancy, the age of the child inside the womb cannot
be 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 permit
abortion.
Couples can use it if contraception has failed. But repeated dependence on such a
procedure increases the chances of the woman to get an infection in the uterus.

10. 16-10
Know the Answers
Contraception for Family Planning
Please 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.