If you need contraception, use it; if you don’t, be a source of information for other people. For many people, particularly teens, abstinence is the ideal contraception. Since contraception is the best way of decreasing the need for abortion, most people agree that good contraceptive services are beneficial.
We have come a long way in the eighty years since Margaret Sanger started the first family planning clinic in this country. Contraception is legal, we have much more effective methods, and contraception is available from many sources. You don’t have to go to a special clinic any more. Furthermore, people talk about family planning more freely. Do you remember when “rubber” was a dirty word?
There is room for improvement, however. We need new, better methods of family planning. How about a pill for men, for instance? We especially need methods that protect against sexually transmitted diseases (such as AIDS) as well as prevent pregnancy. Most of all, we need less irresponsible sex, both in real life and in the media. In the average year of watching TV an adolescent is exposed to over 12,000 sexual encounters, but only 1 percent mention contraception. Abstinence is still the best way to avoid pregnancy for most teens.
For specific questions about birth control, you should contact your health care provider. The most authoritative source of information on contraception is Contraceptive Technology (Irvington Publishers, New York). My favorite web site is www.plannedparenthood.org; look under “Health Info”.
Unfortunately, there are many misconceptions about contraceptive methods. For instance, some people are afraid to take birth control pills because they think that “the pill” causes cancer. The truth is that birth control pills protect against cancer of the uterus and of the ovary. They also help prevent anemia, ovarian cysts, breast lumps, menstrual cramps and pelvic inflammatory disease. Although they do have some serious side effects, these are amazingly rare with the newer, low dose pills.
The same hormones as in “the pill” also offer protection against pregnancy if a woman takes them after unprotected intercourse. Called emergency contraception pills (ECP’s) or “the morning after pill”, this is one of the best-kept medical secrets. ECP’s are indicated in cases of rape, a condom failure or if a couple fails to use contraception. ECP’s can reduce the proportion of unplanned pregnancies in the USA.
Innovative means of delivering hormonal contraception are available. Some women love the shot that lasts three months, Depo Povera, although it usually causes menstrual irregularity. It often eventually stops all bleeding, which many women like. There is also a monthly shot. Lunelle has the advantage of relatively normal periods. Using it means a trip to the office or clinic every month, but women appreciate its dependability.
Hormone patches have proven popular with menopausal women. Soon a contraceptive patch, Evra, will be available. Each Evra lasts seven days. The first is placed while the user is menstruating, then she replaces it at the end of a week. After the third, she goes patch-free for a week, during which her period will start.
The Nuvaring is a small ring placed in the woman’s vagina for three weeks. It is then removed, and during the week without the ring, her period will start. Neither man nor woman is aware of Nuvaring when it is in place. Both Evra and Nuvaring have been shown to be more effective than birth control pills, although women who cannot take hormones shouldn’t use them.
Barrier methods are designed to prevent sperm and egg from getting together. They include male and female condoms, diaphragm and cervical cap and several different forms of spermacides (foam, creams, gels and film). Some barrier methods are available without prescription, and some provide partial protection against sexually transmitted diseases.
Perhaps the most cost-effective means of family planning is the Intrauterine Device (IUD). Recent studies suggest that it is even safer than previously thought. There are two available in the U.S.A. The Paragard lasts for up to ten years and uses copper to be 99% effective in preventing pregnancy. Mirena is good for up to five years. It is filled with a hormone to make it 99.7% effective while decreasing menstrual bleeding and cramps. Either can be removed in case of problems of if the woman wishes to conceive.
Fortunately, there are many contraceptive methods that are effective, safe, and some even stop the transmission of disease. Hopefully the future will bring even better methods. We should all be well informed about family planning techniques.
© Richard Grossman MD, 2004