What does contraception entail?

Contraception is the intentional prevention of conception through the use of various devices, sexual practices, chemicals, drugs, or surgical procedures. Hence, any device or act that prevents a woman from becoming pregnant can be considered a contraceptive (Jain and Muralidhar, 2011). In 2017, an estimated 308 million unintended pregnancies were prevented through the use of modern contraceptive methods (WHO, 2017). A study conducted by Ahinkorah et al., 2021 in some selected African countries, revealed that Zimbabwe and Lesotho had the highest contraceptive use rate at >60% while Nigeria recorded ~19% usage in women of reproductive age. It can be observed in figure 1 below. According to the National Health Management Information System (NHMIS), Nigeria did not meet its yearly national target (43%) for the prevalence of contraceptives in 2020. Bayelsa state had the lowest rate at 2.4% while the Federal Capital Territory (FCT) recorded the highest with ~16% (MSDAT, 2020), this can be observed in figure 2 below.

Figure 1: Percentage rate of contraceptive use in countries of sub-Saharan Africa (Ahinkorah et al., 2021)

Figure 2: Contraceptive prevalence rate (NHMIS, 2020) (Source: The MSDAT)

The Benefits Of Contraception

1. Preventing maternal morbidity and mortality: Family planning has very clear health benefits; the prevention of unintended pregnancies which results in a subsequent decrease in maternal morbidity and mortality. Contraception allows the spacing of pregnancies, delaying pregnancies in young girls who are at an increased risk of health problems from early childbearing, and preventing pregnancies among older women who also face increased risks (Cleland et al., 2012).  It also enables women who wish to limit the size of their families to do so. By reducing rates of unintended pregnancies, contraception also reduces the need for unsafe abortion (Stover and Ross, 2010). However, sub-Saharan Africa has been observed to have the lowest contraceptive use prevalence (<30%) compared to other parts of the world. This can be seen in figure 3 below.

Figure 3: Contraceptive methods commonly used by region (United Nations, 2019)

2. Reducing unsafe abortions from unintended pregnancies: Around the world, unintended and unwanted pregnancies are common challenges that women and couples face. About 44% of all pregnancies worldwide are unintended, and some 56% of unintended pregnancies end in induced abortions (Bearak et al., 2018). An estimated 56 million induced abortions took place between 2010 and 2014, which translates to an annual abortion rate of 35 abortions for every 1,000 women aged 15-44 years (Sedgh et al., 2016). 

3. Reducing newborn and infant mortality: Family planning and contraception can prevent closely spaced and ill-timed pregnancies and births, which contribute to some of the world’s highest infant mortality rates. If full care for all pregnant women and newborns were combined with full provision of modern contraception to women who want to avoid pregnancy, maternal deaths would drop from 308,000 to 84,000 per year, and newborn deaths would drop from 2.7 million to 538,000 per year (Darroch and Sully, 2017).

4. Reducing adolescent pregnancies: Preventing unintended pregnancy is essential to improving adolescents’ sexual and reproductive health and their social and economic well-being (Jacqueline et al., 2016). Pregnant adolescents are more likely to have pre-term and low birth-weight babies. Babies born to adolescents have higher rates of neonatal mortality. Many adolescent girls who become pregnant have to leave school. This has long-term implications for them as individuals, their families and communities (UNFPA, 2014).

5. Preventing HIV/AIDS: In sub-Saharan Africa, approximately 1-in-4 women has an unmet need for family planning, studies have shown that women living with HIV have a higher unmet need for family planning and reproductive health services than the general population (Petruny et al., 2012). Hence, the availability of contraceptive materials has proven to reduce the transmission of this disease by ~93% in men and women and has also helped to reduce the transmission from mothers to newborns (Singh et al., 2014).

Types Of Contraceptive Methods Available; Their Advantages And Disadvantages

There are two basic types of contraceptive methods available that can be used to prevent pregnancy. They are as follows:

1. Traditional or natural methods

2. Modern/artificial methods (Cleland et al., 2012).

Traditional family planning (or “fertility awareness”) is a method of contraception where a woman monitors and records different fertility signals during her menstrual cycle to work out when she’s likely to get pregnant (Brian & Christa, 2012). They include: 

1. Rhythm (calendar) method: Women monitor their pattern of the menstrual cycle (includes fertility awareness-based methods, periodic abstinence). 

2. Withdrawal (coitus interruptus): Man withdraws his penis from his partner’s vagina and ejaculates outside the vagina, keeping semen away from her external genitalia. 

Advantages of the traditional method 

1. It is free

2. Does not involve the use of drugs or any medical procedure (Brian & Christa, 2012).

Disadvantages

1. Offers no protection against sexually transmitted diseases (STDs)

2. It is not very effective in preventing pregnancy

3. It requires keeping track of the female’s menstrual cycle

4. The withdrawal method requires self-control and patience (Brian & Christa, 2012).

Modern methods of contraception are ways in which a person uses a hormonal or non-hormonal product or undergoes a medical procedure to hinder or prevent reproduction from sexual intercourse (Hubacher & Trussell, 2015). They include the following:

1. Female sterilization: This is a permanent contraception method that is done to block or cut the fallopian tubes (also known as tubal ligation). In figure 4, female sterilization is seen as the most commonly adopted method of contraception as observed in 219 million women.

2. Male sterilization: Permanent contraception done to block or cut the vas deferens tubes that carry sperm from the testicles to the penis (also known as vasectomy). 

3. Intrauterine devices (IUD): They are small flexible plastic devices containing copper sleeves or wire inserted into the uterus. Some devices steadily release small amounts of levonorgestrel each day. This is usually inserted and removed by healthcare providers. It can be used for 3–5 years depending on the implant. 

4. Implant: They are small, flexible rods or capsules placed under the skin of the upper arm of a female; it contains either estrogen and progestogen, or progestogen-only. It is inserted and removed by healthcare providers. It can also be used for 3–5 years depending on the implant. 

5. Injectable: These are injected into the muscle or under the skin every 1, 2 or 3 months, depending on the type of product

6. Oral contraceptive pill: Contains either estrogen and progestogen, or progestogen-only. They are to be taken daily, preventing the release of eggs from the ovaries. 

7. Male condom: This is a sheath or covering that fits over a man’s erect penis. It also protects against sexually transmitted infections, including HIV.

8. Female condom: This is a plastic pouch-like device inserted in the vagina before sex that offers clitoral stimulation (Hubacher & Trussell, 2015). 

9. Diaphragm and spermicides: The diaphragm is a soft rubber cap that is fitted into the vagina to cover the cervix. It prevents sperms from entering the uterus and must be left for about 6 hours after sexual intercourse. This method is much more effective when used in combination with a spermicidal cream which inactivates the sperm (Jain and Muralidhar, 2011).  

Figure 4: Estimated number of women of reproductive age using various contraceptive methods in the world (Statista, 2019).
Advantages of the modern contraception methods

1. Female and male condoms offer protection against STDs and are very easy to purchase

2. Condoms can be used alongside other birth control methods

3. Contraceptive pills are quite effective in preventing pregnancies and do not interrupt sexual activities

4. IUDs are long-lasting and may reduce menstrual cramps and flow

5. Male and female sterilization is highly effective

6. Implants are also very effective and can prevent pregnancy (Hubacher & Trussell, 2015).

Disadvantages

1. Condoms may not be as effective as other birth control methods

2. Contraceptive pills must be taken daily and do not offer protection against STDs

3. Pain is experienced when inserting and removing IUDs and it may slip out of place

4. Male and female sterilization requires surgery which is costly and cannot be reversed (Hubacher & Trussell, 2015).

Emergency contraceptive methods are those that can be used to prevent pregnancy within 5 days after sexual intercourse. This can be done through the use of copper-bearing intrauterine devices (IUDs) and emergency contraceptive pills (ECPs). They are capable of preventing 95% of pregnancies (WHO, 2021).

Effects of contraceptive use

Women may experience the following as a result of contraceptive use: 

1. Irregular bleeding

2. Breast tenderness

3. Change in appetite or weight gain: 

4. Depression

5. Hair loss or increased hair on face or body

6. Headache/migraine

7. Nausea

8. Change in sexual desire

9. Irritation of the vagina (DaVanzo et al., 2007).

Conclusion and recommendation

The use of contraceptives is very important as it has several benefits to both males and females and also to the economy of the family and country. However, women should be sure to visit their doctors/physicians before making use of any of the modern contraceptive methods, this will help them seek proper advice on which method is best suited for their bodies. This will help reduce the side effects they are prone to. 

References

Ahinkorah, B.O., Budu, E., Aboagye, R.G. et al., 2021. Factors associated with modern contraceptive use among women with no fertility intention in sub-Saharan Africa: evidence from a cross-sectional survey of 29 countries. Contracept Reprod Med 6; 22.

Bearak J Popinchalk A Alema A Sedgh G. Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. Lancet. 2018; 6: e380-e389.

Brian, A.S. and Christa, M.R. 2012. Natural Family Planning. Am Fam Physician 86(10); 924-928. 

Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A. Contraception and health. Lancet. 2012;380(9837):149– 156. 

Darroch J.E, and Sully E. Adding It Up: Investing in Contraception and Maternal and Newborn Health, 2017. New York. Guttmacher Institute, 2017.

DaVanzo J, Hale L, Razzaque A, Rahman M. Effects of interpregnancy interval and outcome of the preceding pregnancy on pregnancy outcomes in Matlab, Bangladesh. BJOG. 2007;114(9):1079–1087. 

Hubacher, D. and Trussell, J. 2015. A definition of modern contraceptive methods. Contraception 92(5).

Jacqueline, E. D., Vanessa, W., Akinrinola, B., and Lori S. A. 2016. Adding It Up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescents, New York: Guttmacher Institute. https://www.guttmacher.org/report/adding-it-meetingcontraceptive-needs-of-adolescents.

Jain, R.and Muralidhar, S. 2011. Contraceptive methods: Needs, options and utilization. The Journal of Obstetrics and Gynecology of India 61(6); 626-634.

Contraceptive prevalence rate in Nigeria by the National Health Management Information System 2020.

Sedgh G., Bearak J., Singh S., et al., 2016 Special tabulations of updated data from Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends. Lancet. 388: 258-267.

Statista 2019. Estimated number of women of reproductive age worldwide using various contraceptive methods in 2019.

Stover J, and Ross J. 2010. How increased contraceptive use has reduced maternal mortality. Matern Child Health J. 14(5):687–695. doi:10.1007/s10995-009-0505-y.pmid:19644742

United Nations Department of Economics and Social Affairs, Population division 2019. World contraceptive use 2019.

United Nations Population Fund (UNFPA) [Internet]. New York: UNFPA. Population and poverty; 2014. Available from: http://www.unfpa.org/resources/population-andpoverty 

World Health Organization 2021. Emergency Contraception https://www.who.int/news-room/fact-sheets/detail/emergency-contraception