Contraception for all?

Contraception is an important aspect of our wellbeing, and we take its availability for granted. Yet the number of unintended pregnancies in the western world might surprise you.

She walked in and sat down, barely making eye contact.

“I’m pregnant Doctor. I need an abortion, I don’t want this baby, the timing is all wrong”.

contraceptionNo matter how many times I have this conversation, it is always a difficult one. My role is to help the pregnant woman (and her partner) come to the right decision for them, understanding the different options, and then guide and support them through whatever course they choose to follow. Apportioning blame is not helpful, and there are many different situations that can lead to the request for a termination. No contraception is 100% effective (even sterilization has its failures), and most of us are pretty human, imperfect, in the way that we use it. However there are also times when it is a simple case of not using any contraception.

Sexual health and contraception are highly important aspects of our wellbeing, and often, in our younger years, one of the few times that we come into contact with the medical profession. Fertility is of course a highly emotional issue. Some of us spend our twenties paranoid about getting pregnant and taking the morning after pill if we think that one single sperm might have been set loose within a 5 mile radius. Our thirties might then be spent battling to get pregnant and going through the emotional roller coaster that is fertility treatment. Others get pregnant too easily and have to deal with all the fall out of unplanned pregnancies. And a lucky percentage get through our reproductive years, only getting pregnant when we want to, producing nicely spaced families of 2 or 3 children and completing them well before we reach the dreaded 40!

Numbers speak for themselves

Availability of contraception is something that we take for granted, but the contraceptive pill is one of the most significant advances in health care of the last century. In many parts of the world, reliable contraception is simply not available, and George Bush has a lot to answer for in making it much less available during his time at the White House. In 2008, The World Bank reported that 51 million unintended pregnancies take place each year in the developing world. Of that number, some 68,000 women die as a result of botched or unsafe abortions and another 5.1 million are left permanently disabled by them.

Contraception allows women in developing countries to remain healthy by spacing their children. As Melinda Gates, philanthropist and wife of Bill Gates, says:

“Family planning works, not just because smaller families can be healthier and wealthier, but because empowering women is the key to growing economies and healthy open societies.”

And, as James Grand, the then director of UNICEF, pointed out in 1993:

“Family planning could bring more benefits to more people at less cost than any other single technology now available to the human race.”

Choose your contraceptive method

Yet here we are 20 years later, and large numbers of women in developing countries still do not have access to basic contraceptive methods.

However, there is a myriad of choice these days and it is virtually always possible to find something that suits everyone. They range from the most reliable such as sterilization or the mirena coil, all the way through to the contraceptive sponge, which is not something I would ever recommend to a 20 year old, but might be appropriate for a 51 year old whose periods are tailing off.

In between there are pills and patches, vaginal rings, copper coils (imagine singing this to the Sound of Music song “These are a few of my favourite things”), POPs and COCPs (progesterone only pills and combined oral contraceptive pills), condoms and femidoms, diaphragms, injections, implants, caps and of course the infamous rhythm method.

Some of them can be fitted and forgotten, others have to be remembered on a daily or weekly basis, but these days, apps and SMS services can help us do that. Some will protect us from sexually transmitted infections, and others won’t. All have their fans and their foes, but they are available to us, and we will not have to show the ring on our 4th finger left hand in order to obtain a prescription, as in the good old days!

So we have the choice, we can access it, we just have to remember to use it.

By Susie Tunstall-Pedoe, January 2013

Useful links: NHS on contraception           Patient.co.uk on contraception         AngloINFO with relevant info for Luxembourg

Comments

  1. Whereas I agree with you on most points, I regret that every time this subject is discussed, the responsibility always seems to lie with the women… It’s the women who have to make the tough decisions (and often alone) and the women who have to fill their bodies with hormones to avoid pregnancy (I doubt that men would ever do that if it were possible!). You mention the Mirena coil – which at the moment is subject to massive lawsuits in several countries because of its dangerous side effects. There may be many birth control choices, but all except one depends on the woman and what health risks she’s willing to take. Condoms do not cause blood clots, strokes, pulmonary embolisms or deep vein thrombosis – and so many men refuse to put them on and prefer leaving birth control to the women. There’s still a long way to go…

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