For women of childbearing age, contraceptives are one of the choices to opt for to avoid unplanned pregnancies. However, given that there are several different methods of contraceptives, it makes it harder for most women to choose which one to go for. For that reason, you should consult with your doctor or pharmacist to help you decide on what’s best and suitable for you. In this article, I will outline the effectiveness, benefits, and important notes of some of the commonly used methods of contraceptives.

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  Injection contraceptives (also known as progestogen-only injection contraceptives).

Effectiveness: More than 99% when used perfectly. That means going for your injection as instructed by the healthcare professional without skipping or delaying the appointment. And if not used perfectly, the effectiveness of the injection contraception can go down to about 94%.

Benefits: The injection can last for 8-13 weeks. Compared to the pill, you do not have to remember to administer it every day. It does not interrupt sex and it is safe to use during the lactation period (However, WHO recommends delaying initiation of the injection until after six weeks of giving birth).

NB: If you are planning to get pregnant (say within a year), this method may not be suitable because of delayed return of fertility which is between 6 – 9 months.

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  Implant (also known as Etonogestrel subdermal implant).

Effectiveness: More than 99% when inserted correctly and used properly. This method of contraception is effective for 3 years. However, if you want, you can remove it before the specified duration.

Benefits: It lasts longer (3 years). It also does not interrupt sex and it is safe during the lactation period (same as an injection). It may reduce heavy and painful periods (it is advisable to consult your doctor if bleeding occurs for more than 10 days). According to the NHS, fertility returns to normal as soon as the implant is taken out.

NB: Make sure that you are not “already” pregnant before inserting the implant.

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  Intrauterine device (IUD).

Effectiveness: More than 99% effective when inserted correctly. South African Medicines Formulary (SAMF) notes that copper IUDs have a 5-fold lower failure rate compared to others and therefore should be used preferably.

Benefits: Last longer (up to 10 years). Once inserted (by a certified and trained healthcare professional), you don’t have to think about it, and neither does your partner. It is also safe to use if you are breastfeeding.

NB: It is important to be transparent about your medical and sexual history before insertion to avoid any possible complications and contraindications.

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  Vaginal ring.

Effectiveness: More than 99% effective if used correctly. However, if not used correctly there is a 9% decrease in its effectiveness. This means that there is a chance that 9 in 100 women would get pregnant in a year while using this method of contraceptive.

Benefits: It is easy to insert and remove. It also does not interrupt the sexual intercourse act. Its effectiveness is not affected if you vomit or have diarrhea. In some women, it may help with PMS. And lastly, there is no long-term effect on your fertility associated with this method of contraceptive.

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  Patch.

Effectiveness: 99% effective if used correctly. Apply the first patch on day 1 of menstruation, effective immediately. And then apply a new patch weekly for 3 consecutive days (i.e. on days 1, 8, 15), followed by 1-week patch-free. Commence the next patch cycle after no more than 7 patch-free days. 

Benefits: It is easy to use. Do not interrupt sex. And is not affected by food or gastrointestinal diseases.

NB: Not recommended for women who weigh over 90kg. Speak to your healthcare provider for other possible and effective methods to consider.

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  Condoms.

Effectiveness: Male condoms (82 – 98%); Female condoms (79 – 95%) effective depending on whether it is used correctly or not.

Benefits: The utmost benefit of condoms compared to other methods of contraceptives is that they are effective in reducing the risk of contracting sexually transmitted infections including HIV.

NB: The effectiveness of condoms is significantly increased when used in combination with other contraceptives methods.

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  The pill.

Effectiveness: Both combined oral and progestogen-only contraceptives have a 99% effectiveness when used correctly as indicated by a healthcare provider. That is, taking the pill every day at the same time. If the pill is not taken correctly, the effectiveness decreases. Read the package insert for information on what to do if you miss a pill or vomit within a specific time of taking the pill.

Benefits: Sometimes it can help with acne and it may reduce PMS symptoms. It also doesn’t interrupt sex. Usually, it makes your menstrual blood regular, lighter, and less painful.

NB: New onset of a migraine, the occurrence of aura or crescendo headache, is an indication to stop combined oral contraceptives and consider other alternative methods.

End Note

It is important that before using any of the contraceptive methods above, you speak to your healthcare provider for more and detailed information such as contraindications, drug interactions, precautions, and directions of use. For women who smoke, it is advisable to quit smoking if you are considering using contraceptives. Especially if you smoke and are over 35 years old.

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The use of contraceptives have long been a taboo topic in many communities. They first came under scrutiny in social, religious, and political aspects when they were first introduced in the 50s. It was viewed as a taboo, sinful, and an immoral act in the communities back in the 1950s and 1960s as contraception was a topic that no one wanted to hear or talk about.

It was only around 1969 when the pill was legalized for menstrual problems that there was a shift. But still the pill was only available for married women which caused a lot of issues for unmarried woman who wanted access to it. This was a suppression of yet another right for women- the right of freedom to sexual and reproductive health.

Amongst users, there were some raised concerns about side effects like headaches, blood clots, dizziness, and nausea which instigated more research. With more investigation over the years, it appeared that the dose of progestogen and estrogen in the pill was too high and hence the effects. This evidence led to lessened trust in the public. In 1974, an IUD was introduced and within 3 years, it was withdrawn from the market for infertility concerns. Another reason which dissuaded many people from using contraceptives.

It was in the 1990s when various new methods of contraception were introduced with lowered dose and fewer side effects that people started to open up to the idea of contraceptives. Now they are safer and there is more knowledge about the use of contraception, what to expect, and how to take them according to an individual’s wellbeing.

It is important to take note that if you are a woman who smokes and over 35 years, the risk of developing adverse effects from contraceptives is higher than non-smokers. Therefore, you must use contraception with extra caution.

Correcting some of the myths and misconceptions

• You don’t need parental consent to purchase contraception
• Birth control pills do not cause ectopic pregnancy (pregnancy that occurs in Fallopian tubes). They prevent it as much as they prevent overall pregnancy.
• Long-acting birth control pills, IUDs, patches, morning-after pills do not cause abortion. They work by preventing the release of an egg (ovulation) and by preventing fertilization (fusing of an egg and sperm). Which means there is no pregnancy at all. If maybe the woman is already pregnant, the contraception will not do anything to either the woman or the developing embryo.
• It is normal and expected to have Menstrual changes a few days after using the oral contraceptives.

Oral contraceptives do not cause acne, they help clear it (with time).

• IUDs do not cause pelvic inflammatory disease. They also do not travel through the pelvis into other organs like the heart. IUDs are one of the most effective methods of contraception to prevent pregnancy among others.
• Oral contraceptives, IUDs, and other methods do not cause infertility. Depending on which method of contraception, you can fall pregnant. Immediately or within a few months after discontinuing the use of contraceptives. 

• A person does not get cancer from using the pill or IUD. Some methods prevent and lower the risk of gynecological cancer.
• IUDs do not get stuck in the uterus.
• Only Condoms prevent STIs if used correctly and consistently.

What are some myths that you have heard about contraceptives?

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What to know about emergency contraceptives (morning-after pill)

Emergency contraceptives (ECs) commonly known as the morning after pill refers to the methods of contraception used to prevent an unwanted pregnancy following unprotected sex. They can also be used in cases where there is a possibility of other contraceptives failure or incorrect use. These can include  – broken or slipped condom, inconsistency in taking monthly pills, or in case of rape and/or incest. The Emergency contraceptives work by stopping the ovaries from releasing an egg (a process known as ovulation). Or by stopping the sperm from penetrating the released egg (fertilization).

The emergency contraceptives methods are available in two formulations. As oral contraceptives (morning after pill) and intrauterine devices (IUDs). Both methods are safe and effective if used as per instructions. That is: within 3 – 5 days of unprotected sex. The efficacy however decreases with each passing day, which means the sooner you take it the better.

Examples of emergency contraceptives

Some of the registered and commonly used emergency contraceptives in South Africa include Norlevo and Escapella which are known as progestogen-only regimens. The active ingredient in these products is Levonorgestrel. Other products that are safe and effective but not registered specifically for this use include Microval and Nordette tablets. Plan B is also one of the commonly used and approved pills. But it appears to have more side effects compared to progestogen-only regimens and it is taken in two divided doses as opposed to progestogen-only pills which are taken once.

To ensure proper use and dosage, as well as more information on the choice of contraception, make sure to ask the the pharmacists (or other healthcare professionals) to explain and answer questions upon purchase of the morning-after pill.

Accessing emergency contraceptives

Emergency contraceptives are available for everyone. Regardless of age or sexual status. And can be purchased over the counter in the pharmacy. This means you do not need to see a doctor or get a prescription to purchase these products and you don’t have to be of a certain age to be allowed to use it. However, in cases where an IUD is preferred, medical assessment by a doctor is essential before inserting the device.

Like every other medication, the use of contraceptives may come with side effects depending on the method, duration, frequency, dosage, and the individual’s overall wellbeing. The side effects may include headaches, abdominal pains, nausea, and sometimes menstrual changes which may last for a few days. These side effects come with the medication and do not imply that there is something wrong with you or the medication.

If the pill is vomited within two hours of taking it, the medication won’t work. This means another pill should be taken immediately or consider another emergency contraceptive method like inserting an IUD.

Long term use of emergency contraceptives

And whilst the morning after pill is considered an emergency contraceptive. It is important to note that it is just that, for emergencies ONLY. And should not be used in place of other contraceptives such as condoms or the pill. As using the morning after pill too many times can have long lasting effects on your hormones and body.

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