A friend once asked me a question. He asked me, “please which do think is the safest form of contraception?” this question was double edged in nature and I told him to re-examine it because it connotes two things. The first is, which of the various methods of contraception is most safe health-wise and the other connotation to the question is which of the various methods of contraception available is the safest in terms of actually preventing the pregnancy. As much as this would seem like a question with a straight answer, I quickly dug up on some facts in other to have an accurate answer to his double edged question.
Contraception is a popular term amongst sexually active adults be it the married or the unmarried ones. It is a useful tool in family planning as well as to prevent unwanted pregnancy after coitus. By definition, contraception is the deliberate attempt to prevent the fertilization of the ovum by the superm that is a consequence of sexual intercourse. Many methods are available for contraception and these different methods have their own advantages and disadvantages. By gross classification contraceptive methods include
PERIODIC ABSTINENCE:
Periodic abstinence by the name means the couple only indulge in sexual intercourse at controlled times. By this technique only the periods in which the woman is least fertile in her menstrual cycle do sexual inter course occur. A woman with a regular menstrual cycle has about 9 or more days each month when she us able to get pregnant. These fertile days area about 5 days before and 3 days after ovulation as well as the day of ovulation so a red alert is placed on these period concerning sex. The success of this method however now depends on how well the woman understands her menstrual cycle and it involves checking cervical mucus (discharge from vagina) and recording body temperature . A woman is most fertile when the mucus is clear and slippery like raw egg whites.
The pros of this method is the fact that it is non invasive in nature, it is the cheapest method of contraception, but the method has huge disadvantages. Firstly it is the least safe method both health wise and pregnancy wise. A record 30 pregnancy could occur out of 100 sexual inter course using this method of contraception. Secondly, this method provides absolutely no protection against sexually transmitted diseases and other infections.
b) BARRIER METHOD:
Here a block or a barrier is put to prevent the entry of the sperm into the uterus to reach the egg. Barrier contraception includes the use of
Conntraceptive sponges : this method is made up of disc shaped device made out of polyurethane foam and contains a spermicide (nonoxynol-9). It is made wet and placed inside the vagina before sex to cover the cervix.
Diaphragm,cervical caps and cervical shields : they are soft domeshaped silicone materials placed in the vagina before sex to cover the cervix and stop sperm getting into the uterus.
Female and male condoms.; male condoms are made of latex and are rolled onto the erect penis before sex. The female condoms are made of similar materials which are placed into the vagina before sex.
For the Pros, the barrier method such as the condom protect the body against sexually transmitted disease. The condoms are easily available and they are cheap in nature. However, condoms may have physical deformity during the sexual intercourse (tearing) that could result due to improper storage or improper use such as the lack of a lubricant. Thus the condoms only provide 79-98% protection from pregnancy.The diaphragm and cervical sponges provide no protection against STIs, they are invasive in nature and may require professional help to apply them before use such as by a nurse. Another disadvantage of the sponge method is that some women are hypersensitive to the spermicidal compound which limits the use of that method in some of these women.
C) HORMONAL METHODS :
this method involves the use of synthetically produced
hormones to alter ovulation,fertilization and implantation of the fertilized egg. They are also known as oral or parenteral contraceptives and they range from combination pills (meaning they contain both oestrogen and progesterone, two important female hormones), progestine only pills, patches,injection and vaginal rings. These pills are taken by different regimens to prevent pregnancy. The combination pills are usually taken for 21 days after which a 7 day free period is left for the menstrual bleeding to occur. Emergency pills or "morning after" pills are progestines(e.g levonogestrel) which are to be taken within 72 hours of unprotected sexual intercourse.
The pros include the fact that hormonal methods are highly safe. A maximum of less than 1 pregnancy can occur out of 100 sexual inter course in which this method of contraception is used. The drugs are cheap and easily available.
The Cons of this method include the fact that it offers no protection against sexually transmitted diseases. Do to tge fact that hormonal levels are externally controlled, side effects such Weight Gain, changes in period, changes in mood, dizziness, stomach upset, heart attack, stroke, etc could occur
D). IMPLANT METHOD:
Implant devices are long term methods of contraception, they consist of small devices that are put in to the body and left for a few years. They include
Implantable rods : which contains progestin and releases it slowly for over 3 years, this stops the sperm from reaching the egg by uttering the uterine lining and ess often it prevents the ovaries from releasing the egg
Intrauterine Devices (IUDs) : the are "T" shaped devices that are place in the uterus. It could be the "COPPER-TYPE" which releases small amount of copper to prevent fertilization and the "HORMONAL-TYPE" that contains progestin which prevents the ovaries from releasing egg and causes cervical mucus to thicker to prevent sperm from reaching the egg.
The advantages of this method is the comfort it provides after administration the patient usually does not worry about pregnancy for a long period of 3 years and would not have to take drugs, it is highly safe in terms of preventing pregnancy as it has a success rate of 99%. The implants do not interfere with everyday life as the are administered under the skin or the uterus.
The method however does not protect against sexually transmitted diseases. The drugs have the same side effects as the pills and some women may become uncomfortable with the lack of menstrual flow that could occur if hormonal types prevent the release of egg.
E) SURGICAL STERILISATION :
This method is irreversible in nature, an operation is carried out to sterilise both men and women. It is highly safe and is 99.5% effective.
In Women, the fallopian tube is tied or blocked which prevents the sperm from reaching the egg, while for men, a vasectomy is carried out. After the Vasectomy the semen usually contains sperm for 3 months after which a semen analysis is carried out to denote the complete absence of sperm .
Sterilisation does not protect from STIs and it is the most expensive method of contraception because it requires surgery. Another shortfall is its irreversibility, it becomes a problem for adults that decide to have babies in the future.
In conclusion, there is no "safest" method for contraception as each has Its own advantages and shortfalls. The choice of contraception should thus depend on every individual bearing in mind
- Cost
- Effectiveness
- Protection from infections
- Side effect profile
- Likelihood of having children in the future
- Comfort of the various methods
Thank You
Enoma Justice
Department of Pharmacy
University of Benin.
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