Birth Control - Artificial Contraceptive Methods

Natural methods of contraception (e.g., periodic abstinence, coitus interruptus) have been practised for centuries; however, they are considered unreliable. In modern times, they have been replaced by scientific artificial methods. These methods are broadly classified as Temporary and Permanent methods.

Key Concept: Contraception = preventing the meeting of sperm and ovum OR preventing implantation of the fertilised egg in the uterine wall.

Principle: Physically block sperms from entering the female reproductive tract.
Advantage: Inexpensive, simple, and causes almost no serious side effects.

(a) Male Condom (Nirodh):

• A thin sheath made of latex/rubber, rolled onto the erect penis before intercourse.
• Acts as a physical barrier - ejaculated semen does not enter the vagina.
• Additional benefit: The only contraceptive that also protects against STDs (HIV/AIDS, gonorrhoea).
• In India, the Government provides male condoms free of cost under the brand name 'Nirodh'.
• Condoms are disposable and must never be reused.

Condom for male

(b) Female Condom (Femidom):

• A thin soft polyurethane pouch fitted inside the vagina before intercourse.
• Has an inner ring (inserted deep into vagina) and an outer ring (visible outside).
• Less likely to tear than a male condom.
• Can be self-inserted, providing user privacy.
• Also a barrier against STDs.

Condom for female

(c) Diaphragm

• A rubber cap inserted into the vagina to cover the cervix.
• Prevents sperm from entering the uterus.
• Must be fitted by a doctor or nurse for the first time to establish the correct size.
• Should be coated with a spermicide before insertion for added protection.
• Must remain in place for at least 6 hours after intercourse (to ensure all sperms are dead).
• Reusable.

Diaphragm

(d) Cervical Caps and Vaults

• Rubber devices inserted into the vagina to cover the cervix.
• Prevent sperm from entering the uterus during coitus.
• Reusable.

(e) Spermicidal Agents

• Available as creams, jellies, foams, and suppositories.
• Inserted high into the vagina just before intercourse.
• Chemically destroy or immobilise sperms.
• Less effective on their own - must be used with condoms or diaphragms.

Principle: Devices placed inside the uterus by a qualified medical professional. They prevent fertilisation or implantation of the fertilised egg.

Types of IUDs:

Advantages:

• Ideal for females who want to delay or space pregnancies.
• One of the most widely accepted contraceptive methods in India.
• Long-lasting; reversible.

Limitations / Side Effects:

• Initial insertion may cause cramping and excessive menstrual bleeding.
• Increases risk of Pelvic Inflammatory Disease (PID).
• Raises chances of ectopic pregnancy.
• Does NOT protect against STDs.
• Spontaneous expulsion and occasional haemorrhage are possible drawbacks.

Principle: Hormones (oestrogen, progestogen, or both) alter the body's normal reproductive cycle to prevent pregnancy.

(a) Combined Pill:

Contains oestrogen + progestogen.

Mechanism:

• Oestrogen → stops ovaries from releasing eggs (inhibits ovulation).
• Progestogen → makes cervical mucus hostile to sperm; makes uterine lining unfavourable for implantation.

Taken orally daily for 21 days, then stopped for 7 days (during which menstruation occurs).

If forgotten for even a few hours, it is no longer fully reliable.

(b) Mini Pill (Progestogen-only Pill):

Contains progestogen only.

Does not suppress ovulation.

Works by:

• Preventing a fertilised egg from attaching to the uterine lining.
• Thickening cervical mucus to prevent sperm passage.

Taken every day continuously (no 7-day break).

(c) Saheli: India's Own Oral Contraceptive:

• Developed at Central Drug Research Institute (CDRI), Lucknow.
• A non-steroidal oral contraceptive for females.
• Taken once a week - highly convenient.
• Very few side effects and high contraceptive value.
• Now part of the National Family Welfare Programme in India.

Always Remember: Saheli = Non-steroidal + Once a week + Made in India (CDRI, Lucknow) + Government-sponsored.

(d) Injectables:

• Progestogens or progestogen-oestrogen combinations injected intramuscularly.
• Example: Depo-Provera - effective for approximately 3 months per injection.
• Mode of action is similar to that of pills.
• Effective period is much longer than oral pills.

(e) Implants (Subdermal Implants):

• Tiny matchstick-sized silicon rods implanted under the skin of the upper arm.
• Contain progestogen (and sometimes oestrogen).
• Examples: Norplant, Nexplanon (Implanon).
• Effective for 3–4 years.
• Mode of action is similar to that of pills.

Implanon/ Nexplanon

Surgical methods that permanently prevent pregnancy by blocking gamete transport. Also called sterilisation. Generally advised as a terminal method when a couple does not wish to have any more children.

Comparison: Vasectomy vs. Tubectomy

Important: These techniques are highly effective but their reversibility is very poor. This must be considered a permanent decision.

Intentional or voluntary termination of pregnancy before full term is called Medical Termination of Pregnancy (MTP) or induced abortion.

Indications for MTP:

• Pregnancy resulting from contraceptive failure.
• Pregnancy likely to produce a congenitally malformed child.
• Continuation of pregnancy likely to harm the mother's life or health.
• Cases of rape or casual unprotected intercourse.
• MTP is safest during the first trimester (0–3 months).

Legal Framework - MTP Act, India:

Grounds for MTP (12–24 weeks):

1. Continuation of pregnancy would involve risk to the life of the pregnant woman, or
2. There is substantial risk that the child born would suffer from severe physical or mental abnormalities.

Safe Method: Vacuum aspiration is a safe and effective method for terminating first trimester pregnancies.

Always Remember:

• MTP Act 1971 provided the original legal framework.
• MTP (Amendment) Act 2017 extended the upper limit to 24 weeks.
• Only the consent of the woman whose pregnancy is being terminated is required - no third party consent needed.

Emergency hormonal contraception used after unprotected intercourse to prevent pregnancy.

• Contains progestogen and levonorgestrel (two-tablet treatment).
• Also referred to as the "Morning-After Pill".
• Effective up to 72 hours after unprotected intercourse.
• Progestogens alone / progestogen-oestrogen combinations / IUDs administered within 72 hours of coitus are also effective as emergency contraceptives.

Note: Emergency contraception is a backup measure - it should never replace regular contraception.

Launched by the Government of India in 1951.

Objective: To reduce the birth rate to a level necessary to stabilise the population, consistent with the national economy.

Implemented through state governments with 10% central government financial assistance.

In rural areas, services are provided through:

• Sub-centres
• Primary health centres
• Community health centres

Renamed as Reproductive and Child Health (RCH) Programme in 1997, with a broader focus on overall reproductive health.