Picking a method to prevent an unintended birth is more than just popping a pill, wearing a condom or plain abstinence.
You must know the right contraception method to suit your needs and how to use it in order for it to be effective. But it doesn't help when parents and schools in many conservative societies don't teach teenagers about different contraception methods or how to employ them.
Nor do most schools and parents offer help on who to contact or turn to when teenagers get into some kind of sexual crisis, like pregnancy.
It is better to educate young people and even adults well on the right contraception methods than to leave them to grope in the dark, only to find an unwanted baby in the making.
Here's a guide on the best contraception method for you and your partner.
What to consider first
Different methods suit different people in different periods of their life. So it is wise to study the different options available and find out their advantages and disadvantages to you. So you must take into account your personal circumstances when considering a method.
1) First ask yourself this question: How important is for you and your partner to avoid pregnancy? Is it very important, or would you be able to manage if you became pregnant?
2) Your age and state of your health are also important factors. Certain medical conditions may not be good for you to get pregnant while certain contraception methods are best avoided. Your doctor, midwife or service provider should know details of your medical history.
3) The nature of your relationship with your partner needs to be taken into account too. Are you in an open or committed relationship? How often do you have sex? Is your family 'complete' or do you still want to have more children?
4) Do you want a contraception method independent of your sexual activity or could you integrate a barrier or behavioural method in your sexual activity?
2 main types of contraception - hormonal and non-hormonal
Hormonal methods of contraception
A) The combined pill
Effectiveness
Very high reliability when used properly.
What is it?
The pill combines both an oestrogen and progestogen. A pack is given for each 28-day cycle. Depending on the type of pill you take, you take either one pill a day or every day for 21 days, followed by a 7-day break. Or you could take one pill for 24 days, with a four-day break. You can also opt for a longer regimen - take a pill every day for 12 weeks, followed by a 7-day break.
The pill was introduced in 1960. Originally, it contained a high dose of hormones. Now, the modern low-dose pill contains much less. For example, the amount of estrogen has been reduced from 150 to 35 micrograms or less today.
Does it suit me?
As there are many different types of combined pills available, you have more choices. If you have concerns using one type, you can switch to another.
This pill give you benefits like regular periods, fewer or no pelvic cramps, lighter and shorter periods, improved premenstrual syndrome symptoms, and better skin and hair.
Your fertility will return to normal once you stop taking it.
Some women may experience mood swings, changes in sex drive, headaches, cyclical bloating, weight gain or bleeding problems when taking this pill. The symptoms vary from one person to another and according to the type of pill chosen.
Myths and facts of the combined pill
Myth 1: The pill changes women's mood or sex drive Fact: Generally, the pill does not change the taker's mood or sex drive. Some women using it has reported changes in mood and sex drive. But the great majority do not have such changes. In fact, some have said both their mood and sex drive improve. It is difficult to tell whether such changes are due to the pill or other reasons.
Myth 2: The pill makes you gain weight Fact: With the low-dose pills, body weight usually remains constant. However, there may be some women who may put on weight slightly while others may lose weight. But with the development of modern pills, some pills can counteract water retention caused by the estrogen, thereby preventing weight gain due to water retention.
Myth 3: Taking the pill for a long time will make you infertile Fact: Taking the pill will not increase or decrease your ability to bear children. Although some users may need a short period of readjustment to their normal fertility level after discontinuing with the pill, they will usually become pregnant soon, provided they were already fertile before pill-taking.
Myth 4: You really have toct: With high-dose pills, a break or "rest" of two to three months was often recommended after some years of consumption. Experts today agree, however, that with the low-dose pill, you do not need a break even if you have been on it for a long time.
Myth 5: The pill may affect my future babies Fact: Studies show that future pregnancies are not affected by the pill. Miscarriages and deformities don not occur more frequently in women using the pill compared to those not using it at all. Research also disproves the claim of the increased likelihood of having twin births after using the pill.
Risks of the pill
Women with certain health conditions may not be able to use the combined pill. They include heart disease, stroke, liver disease, blood clots in the deep veins or lungs, breast cancer, severe or uncontrolled diabetes, smokers 35 or older, certain types of migraine headaches and severe hypertension. Please see a doctor for a review of the risks and benefits before starting on the combined pill.
B) Contraceptive patch
Effectiveness
Very high reliability, when used properly.
What is it
The thin patch contains an oestrogen and a progestogen. This is affixed to the abdomen, thigh, buttocks or upper arm.
It is not transparent, so this method of contraception is visible. The hormones are released continuously, entering the bloodstream via the skin. You need to change the patch weekly for three weeks, followed by a week's break.
Does it suit me? The patch provides an alternative form of combined hormonal contraception to the combined pill, as it is only changed once a week.
Some women may experience headaches, breast tenderness, skin irritation and bleeding abnormalities.
C) Injection
Effectiveness
Very high reliability.
What is it?
The injection contains either a progestogen only or a combination of an oestrogen and a progestogen. It is given by a doctor, midwife or nurse either once every month or once every three months.
Does it suit me? The injection is a long-acting hormonal method providing effective contraception without the need for a daily dose Progestogen-only injections are also suitable for women who are breast-feeding, and those who do not tolerate oestrogen.
Injections may also reduce heavy, painful periods and help with premenstrual syndrome symptoms. Depending on the type of injection, periods and fertility may take up to a year to return after stopping injections.
Some women experience headaches, dizziness, pimples and greasy skin, bloating, weight gain, breast tenderness, abdominal discomfort, and changes in mood and sex drive. As the hormones cannot be removed from the body once the injection has been administered, side effects may continue from the time of the injection and for some time, afterwards. With progestogen-only injections, adolescents and young women may have a risk of losing bone mineral density which may up the risk of osteoporosis.
D) Implant
Effectiveness
Very high reliability
What is it?
One or two small, soft, plastic rods containing progestogen are inserted under the skin of the upper arm in a minor surgery carried out by a trained doctor, midwife or nurse. The progestogen is released in tiny doses and the implant is effective for three to five years. It can be removed at any time by minor surgery.
Does it suit me?
The implant is particularly suitable for women who want long-term contraception and do not like the regimen of daily intake of a contraceptive. It is also suitable for women who are breast-feeding, and those who can't tolerate oestrogen.
Your normal fertility level will return when the implant is removed. An additional benefit is that it may also reduce heavy, painful periods.
Some women may experience headaches, breast tenderness, bloating and changes in mood and sex drive. Irregular bleeding may occur in the first few months.
F) The Progestogen-only pill (also known as mini-pill)
Effectiveness
Very high reliability, when used properly
What is it?
This pill contains only a progestogen. A woman takes one pill every day, including her period days, without a pause between packs.
Would this method suit you?
There are different types of progestogen available. The progestogen-only pill is suitable for women who cannot tolerate oestrogens. It can also be used while breast-feeding as it does not affect breast milk.
The progestogen-only pill must be taken each day at the same time or else it will not work. Any delay must not exceed more than three hours for some types of pill, and up to 12 hours with others.
It can cause irregular bleeding, but this can disappear with time. On the other hand, some women experience no bleeding at all. It may also initially induce temporary side effects such as pimples popping out and greasy skin, breast tenderness, bloating and headaches.
E) Emergency pill (often known as the "morning after pill")
Effectiveness
Reasonable reliability.
What is it?
Women should take the emergency pill as soon as possible after unprotected intercourse - ideally within 12 hours, but you can still take it up to 72 hours after unprotected intercourse. The sooner you take it, the more effective it will be. The emergency pill works by inhibiting ovulation. It can contain either a combination of an oestrogen and a progestogen, or a progestogen only pill.
Does it suit me? This emergency method of contraception can be used if unprotected sex has taken place or when another method of contraception has failed (e.g. a torn condom or you forgot to take your normal pill). It should not be used regularly, and is only intended as a back-up. After using emergency contraception, you should switch to another form of contraception for the rest of your cycle to protect yourself if you do not want to become pregnant.
F) Intrauterine system (IUS and also known as the hormonal coil)
Effectiveness
Very high reliability, when used properly
What is it?
A small, soft, plastic device containing a progestogen. It is inserted into the cavity of the womb by a trained doctor, midwife or nurse. The tiny dose of progestogen is released slowly from the system. The IUS prevents pregnancy by thickening cervical mucus at the entrance of the womb, making if difficult for sperm to get through. It also thins the lining of the womb to prevent an egg from being implanted, and inhibits ovulation in some women.
Does it suit me?
The IUS is suitable for women who want a reliable long-term contraception and prefer not to worry about birth control daily. The IUS can stay in place for up to five years, and can be removed any time. The IUS should not be confused with the copper-IUD. As fertility returns quickly after removal of the IUS, it can also be used by young women.
The IUS is suitable for women who cannot tolerate oestrogens. It can also be used while breast-feeding as it does not affect breast milk.
It may give benefits like reducing heavy and painful periods, protection against pelvic infections and cancer of the uterine lining. Some women may have less bleeding and a few may have no bleeding at all, hence reducing the chances of becoming anaemic.
There may be irregular bleeding for the first few months, but this should soon settle down. Initial occurrence of headaches, breast tenderness or nausea are possible. Before insertion or removal, a treatment may be given to avoid pain.
G) Intrauterine device (IUD, also known as the coil)
Effectiveness
Very high reliability.
What is it?
A small, soft device with a copper thread or copper cylinders. It is inserted into the cavity of the womb by a trained doctor, midwife or nurse. It can be left in the womb for five to 10 years, depending on the type.
The IUD affects the way the sperm or the egg moves. It releases a substance that immobilises the sperm and makes it difficult for the egg to travel along the Fallopian tubes. If the egg becomes fertilised, the IUD controls the movement of the egg so that it does not travel too fast and gets implanted in the womb.
Does it suit me?
The IUD provides a long-term contraceptive option. Because of the way it works after fertilisation, the IUD can also be used as an emergency contraception if fitted up to five days after unprotected sex. If it's used as an emergency contraceptive, proven to be effective and it causes no problem to the user, it can be left in the womb as an ongoing contraception.
It is not usually the first choice for women with anaemia. The IUD neither protects nor increases the risk of pelvic infections. The IUD can also cause increased cramping, dizziness, and heavier and prolonged periods.
Non-hormonal methods of contraception
A) Male Condom
Effectiveness
Reasonable reliability if used properly.
What is it?
A latex or polyurethane sheath that fits over the penis when it is erect. It is closed at one end with a 'teat' at the top to hold the sperm when a man ejaculates. The condom is rolled down over the erect penis before sexual intercourse to prevent sperm from entering the vagina during intercourse. The condom should be held in place on the penis as soon as ejaculation has occurred, to ensure that it does not slip off and to prevent any sperm from escaping as the penis is withdrawn.
Does it suit me? The male condom provides protection against most sexually- transmitted infections (STIs) if used properly. It is recommended that you use or your partner use it when you have sex with a new partner, have multiple sexual partners or are unsure of your partner's sexual history.
Condoms can be used at short notice. Some people find it fun to integrate the use of condoms in birth control, but others find that they interfere with spontaneity and sensation.
Condoms can fail by tearing or when they come off during sex. Oil-based lubricants should not be used with condoms as they can weaken the latex and cause it to break.
B) Female sterilisation (tubal ligation)
Effectiveness
Very high reliability when done properly.
What is it?
It is a surgical procedure which cuts or blocks the Fallopian tubes (which carry the egg from the ovary to the womb) so that the sperm cannot meet the egg.) The operation affects a woman's fertility potential but does not weaken the libido or the user's ability to have sexual intercourse.
Does it suit me?
Sterilisation is only for people who have decided they definitely do not want to have children, either now or in future. If you change your mind after the procedure, it can be reversed but it is complicated and rarely successful.
Very occasionally, there can be a technical failure during the procedure where the Fallopian tubes reopen, or closure is incomplete.
C) Male sterilisation (vasectomy)
Effectiveness
Very high reliability.
What is it?
Vasectomy is a surgical procedure to cut the ducts that carry sperm so that, while a man can still ejaculate, there is no sperm present. The operation, which can be carried out under local anaesthetic, affects a man's fertility potential and has no effect on the libido or the ability to have sexual intercourse.
Does it suit me? This method of contraception is permanent and only suitable for those who do not want to have children. Although there is a chance of reversal, the procedure is complicated and rarely successful.
Sperm is still present in the male genital organs immediately after the operation, so one or more semen analyses are required to check whether the sperm has cleared. Other contraceptive methods should be used during this time.
D) Fertility Awareness
Effectiveness
Low reliability when done properly.
What is it?
There are several fertility awareness methods. All of them are based on the fact that there are only a few days in each menstrual cycle - the days before and during ovulation - when a woman can get pregnant. The menstrual cycle begins the day a woman starts her period (bleeds) and ends the day before her next period. The fertility awareness method requires a woman to observe fertility signs (for example, changes in body temperature and cervical mucus). Others, such as the Standard Days Method, Two Days Method, and Symptothermal Method help a woman know the days she can get pregnant by keeping track of her menstrual cycles.
Does it suit me? If you are using the fertility awareness method, you are advised to use a barrier contraception (for example, diaphragm, cervical cap or condom) or abstain from sex on the days you are fertile. If you want to get pregnant, fertility awareness can help you to know which days you should have sex.
The disadvantage of fertility awareness is that it does not take into account the fluctuations in menstrual cycle. Many circumstances in everyday life can influence the rhythm of the cycle, making reliable calculation of fertile and infertile days difficult.
E) Withdrawal (also known as coitus interruptus)
Effectiveness
Unreliable.
What is it?
The man withdraws his penis from the vagina before ejaculating.
Does it suit me?
This method frequently fails because small drops of sperm may have already escaped from the penis into the vagina before the man ejaculates. It also impairs sexual climax.
