When it comes to contraceptives many girls and women of reproductive age seek information from their social circles first, and the internet, before consulting a health worker.
As a result, they may pick up myths and misconceptions that can influence the uptake of contraceptives. When women get their contraceptive information from specialists, they are more likely to continue with the chosen method for longer and be comfortable with it.
Before settling on a contraceptive, there are factors such as effectiveness, health, age, side effects, cost and lifestyle to look at. The fact that a friend or relative used a certain contraceptive and it worked (or didn't work) for her, doesn't mean you will have the same experience.
As the theme for this year's World Contraceptive Day goes "It's your life; it's your responsibility". Therefore, you cannot leave it to someone else to make this decision for you. Birth control is a personal affair and having the facts at hand will help you make the fitting choice.
Many women are concerned about weight gain, when considering hormonal birth control, and anecdotes from friends may act as a deterrent. It is not a given that you will pile on the kilogrammes if you use a hormonal method. Other factors such as your genes, physical activity or inactivity, diet or change in metabolism, are more likely to influence your weight.
Another concern is whether birth control methods affect sex drive. Many women on hormonal contraceptives report no change in libido; only a small fraction report a reduction. Again, other factors such as dissatisfaction with the relationship, stress and hormonal fluctuations, may be at play.
Do coils (intrauterine devices) make women more prone to pelvic infections? Research shows that they don't. However, if a coil is inserted into a womb with an ongoing, but symptomless infection, the infection will flare up, leading to the mistaken assumption that the coil caused the infection.
Some women fear that contraceptives will make them infertile or that it won't be easy to get pregnant once they stop using the contraceptive. Truth is: No contraceptive, other than sterilisation, causes infertility. Ovulation and fertility resume soon after one stops using a contraceptive.
Moreover, even without prior contraceptive use, a healthy couple may take up to a year to conceive. Therefore, couples are advised to be patient and manage their expectations.
However, whether a couple has a history of using birth control or not, if they have not conceived after a year of regular unprotected intercourse, they should get a medical check-up to establish if all is well.
The last common concern is that the contraceptive might fail. Contraceptives are safe and provide good protection against pregnancy, but nothing is perfect.
Failure rates are very low and depend on the method used. For example, instances of women conceiving while on the coil are very rare, but when they happen, they receive the most coverage.
The reason for conceiving on the coil could be a downward placement or expulsion of the coil due to contractions of the uterus during menstruation. As a preventive measure, women usually receive instruction on how to check for the position of the coil. If there is any doubt about the position of the coil in the womb, a visit to the clinician is required.
Myths and misconceptions aside, many couples wish to delay pregnancy, but are having sex, without the protection of a contraceptive. This high unmet need for family planning is due to many factors such as lack of knowledge, fear of side effects or even opposition from the sex partner or religious beliefs. These barriers affect adolescent girls more than any other age group.
Moreover, frequent stockouts of some or all methods and the cost of some methods such as hormonal coils reduces alternatives especially for couples in low-income brackets.
These gaps need to be addressed by policy and implementation of policy to ensure that couples who need to prevent pregnancy get the contraceptives they need.
Birth control: The different methods and how they work
Contraceptives can be classified under two categories; non-hormonal and hormonal.
Non-hormonal contraceptives include male and female condoms, cervical cap or diaphragm, copper intrauterine device (IUD) commonly called the coil, natural birth control and sterilisation (tubal ligation in women or vasectomy in men).
Hormonal birth control consists of pills, injections, contraceptive patches, implants and the hormonal IUD (coil).
Condoms: the male condom is widely available and prevents both pregnancy and sexually transmitted infections. However, if not used correctly or consistently, condoms can fail a fifth of the time.
Emergency contraceptive pills are among the most misunderstood and abused contraceptives. The most commonly used e-pill contains the hormone levonorgestrel.
It is 98 per cent effective in preventing pregnancy if taken at the earliest after unprotected sex, but within 72 hours of sexual activity. It is more likely to fail if taken after 72 hours of sex, in obese women or if taken repeatedly over short durations.
Unknown to many, the copper coil is an alternative emergency contraceptive that is more than 99 per cent effective and works if fitted up to five days after unprotected intercourse. Moreover, it continues to offer long-term reversible contraception after insertion.
Contraceptive pills require consistent daily intake. If you can’t sustain the daily demand to pop a pill, a contraceptive patch is a good alternative. Stick the small adhesive patch on your skin and change it every seven days. If fixed on dry skin, it will withstand taking a bath and even swimming.
Implants are small flexible plastic rods about the size of a matchstick embedded with hormones and implanted under the arm skin. An implant can last three or five years. An implant prevents pregnancy more than 99.9 per cent of the time.
The most popular contraceptive is the three-month ‘Depo’ injection. It has hormone content like the implant, but is slightly less effective.
Natural birth control methods work by understanding the female reproductive cycle and fertile window. They are used by couples who are either not willing or able to use other contraceptive options. Natural methods require a very predictable, regular cycle, partner cooperation and consistency, so their typical failure rate can fluctuate from one couple to the next and can be quite high.
Male and female sterilisation are permanent birth control options for couples who do not wish to have more children. They entail a small cut to block the fallopian tubes in women or semen passages in men. Both can be performed at an outpatient clinic. Sterilisation is fraught with many misconceptions. The commonest are that tubal ligation diminishes a woman’s libido, causes excessive lubrication during sex or causes menopause. For vasectomy, men express fear that it will diminish their masculinity and libido. None of these is true.
Dr Mwaniki is a consultant obstetrician/gynaecologist at the Aga Khan University Hospital, Nairobi