Family Planning covers a broad spectrum of reproductive health services including contraception, abortion, fertility management, counselling, regular check-ups, etc. It provides individual/s, families the autonomy and agency to plan and control their reproductive choices regardless of where they live. It helps them answer some questions like whether they want children, if yes then when and how many children they want.
Contraception is a collection of methods used to avoid unintended pregnancy. They are of different categories and various types of contraception are available for both men and women (Figure 1).
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Figure 1:
Contraception: categories and types for men and women
Temporary?
They can be reversible; short term and Long Acting Reversible Contraceptives (LARCs)
Permanent?
They are non-reversible contraception.
Natural?
It uses the body’s natural physiological changes and symptoms to identify the fertile and infertile phases of the menstrual cycle. Such methods are also known as fertility-based awareness methods. It takes time to practice and use them properly. For women, the following methods are advised:
- Lactational Amenorrhea Method (LAM): It is for six months only and based on three criteria: (1) A woman’s menstrual cycle has not returned. (2) The baby is exclusively breastfed frequently day and night with no top feeding. (3)The baby is less than six months old.
- Fertility awareness (period abstinence): Tracking the menstrual cycle and identifying the fertile and infertile phases through the rhythm (calendar) method, basal body temperature (BBT) method and cervical mucous (ovulation) method.
Artificial?
These are hormone/ non-hormone based. Many temporary methods, especially those for women, fall under this category.
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Contraception effectiveness
Each contraception method has been rated as per its effectiveness to prevent the unintended pregnancies (Table 2).
It is usually stated that the best contraceptive is abstinence.
A condom is the only contraceptive to protect against sexually transmitted infections (Gonorrhea, Chlamydia, Herpes, etc.), including the Human Immunodeficiency Virus (HIV).
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Table 2:
Contraception effectiveness (Rates of unintended pregnancies per 100 women)
| Family Planning method | Consistent and correct use | As commonly used |
| Implants | 0.1 | 0.1 |
| Vasectomy | 0.1 | 0.15 |
| Tubectomy | 0.5 | 0.5 |
| Copper IUD | 0.6 | 0.8 |
| Lactational Amenorrhea Method (LAM) | 0.9 | 2 |
| DMPA-IM (Antara injection) | 0.2 | 4 |
| Combined Oral Contraceptives (COCs) | 0.3 | 7 |
| Progestin only Pills (POPs) | 0.3 | 7 |
| Male condoms | 2 | 13 |
| Fertility awareness | – | 15 |
| Withdrawal | 4 | 20 |
| Spermicide | 16 | 21 |
Key | ||
| 0-0.9: Very effective | ||
| 1-9: Effective | ||
| 10-19: Moderately effective | ||
| 20+: Less effective |
Myth buster for contraceptive pills for women:
Contraceptive pills (hormonal/ non-hormonal) are available in different compositions. They do not interfere with fertility and future conception.
- For Combined Oral Contraceptives (Mala D, Novelon, etc.), usually, when a woman stops using pills her fertility resumes (one to three months) and she can conceive.
- For Progesterone only pills, after stopping the pills the bleeding pattern returns and she will conceive within a few months.
- For Centchroman (Chaya), menstrual cycles are prolonged but it normalizes after stopping the pills and fertility resumes.
- For Emergency Contraceptive pills (I-pill, etc.), evidence shows that it doesn’t cause birth defects and will not in any way harm the fetus if a woman is already pregnant when she takes the pill or if the pill fails to prevent pregnancy.
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Contraceptive and life-stage relationship for women:
Contraceptives follow the rule of ‘one size doesn’t fit all’. Each method is designed and developed by researchers considering the requirement (delaying, spacing, or no pregnancy) and ease of use for the women in different stages of her life.
Let’s assume, young married women in her early 20’s would like to delay her pregnancy to complete her education or explore employment opportunities. Women opting for abortion, resort to abortion services because it was an unintended pregnancy but we must understand that abortion is not a method of contraception! Women who had completed her family and want no further children had a unique requirement.
Each woman described above is distinct and needs quality healthcare services which are non-discriminatory, ensure privacy and confidentiality and she is fully informed about the available contraceptive options during her decision-making process.
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Family planning and men, a responsible behaviour:
Both men and women are two wheels of the family cycle and it’s their collective responsibility to decide about their future and well-being. For decades, family planning focus has been on women and this way we have realised only 50% of our opportunity. Men’s engagement in family planning or in any other family healthcare programs will have a positive influence on individual/s, communities and societies to promote gender equality and sustainability.
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Quoting from a famous author Nell Zink:‘ If and when family planning is the responsibility of females, males are best kept under lock and key.’
Declaration: This is the original work of Dr. Sanchika Gupta. For any queries, please contact at sanchika12@gmail.com
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