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Which contraceptive? We give you the low-down on the contraceptives around today

Contraception

So you're about to become sexually active. But before you jump in at the deep end, you need to make sure that you are safe - safe from unwanted pregnancies AND safe from sexually transmitted diseases (STDs) including HIV. With so many different types of contraception available these days, how can you choose which method to use? We review ten of the most common methods available for young people to help you decide which one is best for you.

Contraceptive use-effectiveness: indicates how good the method is in practice for protection against pregnancy.

STD/HIV protection: indicates how good the method is for protection against STDs/HIV infection.

Ticks score from one
(low) to a
maximum of five
(high)

For women: For protection against unwanted pregnancy choose one method from 1-8. For protection against STDs including HIV, it is best if your partner uses a condom. Alternatively you can use a female condom.

For men: For protection against STDs including HIV and to reduce the risk of an unwanted pregnancy - always use a condom. At the same time, your partner may wish to use another method for protection against unwanted pregnancy.

1. Pill: combined oral contraceptives

The combined pill contains low doses of the hormones oestrogen and progestogen. It prevents ovulation.

How is it used?

Usually taken each day for 21 days followed by a break of seven days when no tablets are taken. Alternatively, dummy tablets may be taken during the seven day break so that pill-taking is continuous.

Advantages

No action required at the time of intercourse. May decrease menstrual pain and bleeding. Easily accessible in most countries.

Disadvantages

Must be taken daily.

Hot recommended for

Women who have a history of high blood pressure; women who are

Use-effectiveness

STD/HIV protection

NONE

Verdict

First choice oral contraceptive for most women.


Figure

2. Minipill progestogen only pills

Progestogen only pills thicken the cervical mucus, preventing sperm penetration.

How is it used?

Must be taken at the same time every day with no break.

Advantages

No action required at the time of intercourse. Can be used by breastfeeding women.

Disadvantages

Effectiveness is reduced if a pill is missed or taken late. In this respect progestogen only pills are much less forgiving than combined oral contraceptives. Irregular periods. Not widely available.

Not recommended for

Women who may find the strict pill-taking regime difficult.

Use-effectiveness

STD/HIV protection

NONE

Verdict

A good choice if you can't use combined oral contraceptives.


Figure

3. Norplant®

Norplant® prevents ovulation and in addition, thickens the cervical mucus which prevents sperm penetration.

How is it used?

Matchstick-sized capsules inserted under the skin of a woman's arm. Norplant® releases progestogen into the bloodstream, providing up to five years of effective birth control.

Advantages

Removes the need Co take pills every day. No action required at any time during use.

Disadvantages

Expensive (if not used for the full five year period). Not widely available. Needs to be inserted and removed by a trained health worker. Irregular bleeding.

Not recommended for

Women who wish to use short-term conception.

Use-effectiveness

STD/HIV protection

NONE

Verdict

It is expensive but if you find it difficult to remember to take a pill every day and you want Long-term contraception, Norplant may be good for you.


Figure

4. Injectables

There are two major types of injectable contraceptives - progestogen-only injectables such as Depo-Provera® or Noristerat® and combined injectable contraceptives such as Cyclofem® or Mesigyna®. All prevent ovulation and in addition, progestogen only injectables thicken the cervical mucus which prevents sperm penetration.

How is it used?

Depo-Provera® is injected once every three months, Noristerat® once every two months, Cyclofem® and Mesigyna® once a month,

Advantages

Once injected, no further action is required until the next injection.

Disadvantages

Must be injected by trained health personnel. For Depo-Provera® and Noristerat®, irregular bleeding or absence of bleeding.

Not recommended for

For Depo-Provera® and Noristerat®. girls under the age of 16. For Cyclofem® and Mesigyna®, women who have a history of high blood pressure or women who are breastfeeding.

Use-effectiveness

STD/HIV protection

NONE

Verdict

If you do not wish to take a pill every day, injectables are a safe and reliable choice. However, you will have to visit your service provider for each injection.


Figure

5. Diaphragms

The diaphragm is a latex rubber barrier, shaped like a dome and 5-10 cm across, which tits over the cervix.

How is it used?


Before intercourse, the diaphragm is smeared with spermicide, pushed into position and removed at least six hours after intercourse.

Advantages

No side effects.

Disadvantages

Unreliable both as a contraceptive and as a method for the prevention of STDs and HIV. Needs to be fitted initially by a health worker to ensure that the size is correct. Requires action at the time of intercourse.

Not recommended for


Women who want good protection from unwanted pregnancy or STDs.

Use-effectiveness

STD/HIV protection

Good for

If you are unable to confront an unplanned pregnancy - use a more effective method. However, it may be suitable if you are confident that you can use the diaphragm consistently and correctly. Remember, you will still have to use a condom for protection against STDs and HIV.


Figure

6. Intra-uterine devices (IUDs)

The copper-releasing intra-uterine device (IUD) is a small piece of plastic with copper wire wrapped around it which provides long-term contraceptive protection.

How is it used?

Inserted into the uterus of a woman by trained health personnel.

Advantages

Long-term protection. Less expensive per year than other methods.

Disadvantages

IUDs can sometimes fall out (usually during menstrual bleeding). Can increase the risk of pelvic inflammatory disease in women who are at risk of (or have) a sexually transmitted disease.

Not recommended for

Young women at risk of an STD, such as those with multiple sexual partners (or whose partner has multiple partners) and those who have never had a child.

Use-effectiveness

STD/HIV protection

NONE

Verdict

IUDs are not normally recommended for young people since they increase the risk of pelvic inflammatory disease, which can cause infertility. For that reason the IUD is not suitable for women who have never had a child. However, if you have already had one or more children and wish to have long-term contraceptive protection, lUDs could be a good bet


Figure

7. Male condoms

The male condom is made of thin latex rubber. Condoms are available in a variety of sizes, colours and even flavours. Most condoms are lubricated with spermicide to make them easier and safer to use.

How is it used?

Fits over the erect penis before intercourse.

Advantages

Easily available; inexpensive: protects against STDs/HIV as well as unwanted pregnancy; allows men to be involved in disease and pregnancy prevention.

Disadvantages

Requires action at the time of intercourse. Not highly effective as a contraceptive and therefore needs to be used with another method of contraception; can sometimes break or slip off.

Not suitable for

No one - everyone can and should use male condoms for protection against STDs/HIV.

Use-effectiveness

STD/HIV protection

Verdict

Essential for safer sex. If you're safe, you can relax. If you relax, sex is more enjoyable. It's as simple as that. Look at condoms as being part of foreplay. Be creative!


Figure

8. Female condoms

The female condom is a lubricated plastic tube, closed at one end, which lines the vagina completely.

How is it used?

It is pushed, before intercourse, into the vagina by means of a ring at the closed end.

Advantages

Allows women to take responsibility for safer sex; protects against STDs and HIV as well as against unwanted pregnancy.

Disadvantages

Requires action at the time of intercourse. Not highly effective as a contraceptive therefore may need to be used with another method of contraception. Not widely available.

Not recommended for

No one.

Use-effectiveness

STD/HIV protection

Verdict

Allows women to protect themselves against STDs and HIV without relying on their partner to wear a condom. May be worth a by - some people prefer them to male condoms.


Figure

9. Natural methods

A. PERIODIC ABSTINENCE

How does it work?

A couple has sex at the time during the menstrual period when the woman is unlikely to become pregnant.

Advantages

No physical side effects.

Disadvantages

It is very difficult to predict menstrual cycles, especially for young women whose cycles may be irregular. Highly dependent on the commitment and co-operation of both partners. Requires long initial training.

Not recommended for

Young people who lack high motivation and self-control, or young people who engage in short-term or casual relationships.

Use-effectiveness

STD/HIV protection

NONE

Verdict

Periodic abstinence may be suitable if moral or religious objections to contraception prohibit the use of modern, more effective methods.

B. WITHDRAWAL (coitus interruptus)

Withdrawal (or coitus interruptus) is when the man withdraws his penis from his partner's vagina before he ejaculates. Withdrawal only reduces the risk of pregnancy since sperm may be present in pre-ejaculatory fluid. This method does not protect against STDs including HIV. In addition, many young men find it difficult to control the response of their bodies and both partners may find that withdrawal can be an unsatisfactory and frustrating method of contraception. However, it may be the only method that is always accessible.

MYTHS - the following methods will NOT prevent a pregnancy:

· If you wash immediately after having sex
· If you jump up and down after sex
· If you only have irregular or infrequent intercourse
· If you have genital contact but no penetration (heavy petting)
· If you have sex standing up
· If the girl does not have an orgasm

10. Luck!

How does it work?


Use no method at all.

Advantages

NONE

Disadvantages

No protection from unwanted pregnancy or STDs and HIV. Fear of pregnancy and STD or HIV infection may make sex less enjoyable.

Not recommended for


Anyone who wishes to avoid an unplanned pregnancy or an STD/HIV infection.

Use-effectiveness

NONE

STD/HIV protection

NONE

Verdict

Good for couples who want to start a family. Otherwise, AVOID.

Emergency contraception

If you have had sex without using a contraceptive or if you had an accident with your contraceptive method (e.g. condom broke or slipped off) and you are worried about the risk of pregnancy, you should consult your doctor or visit your family planning service provider as soon as possible. There are two options open to you to prevent pregnancy. One option is to use emergency contraceptive pills. These are sometimes referred to as "morning-after pills" which is misleading because they are effective for up to three days after unprotected intercourse. Emergency contraceptive pills (ECPs) are the same as regular combined oral contraceptive pills. The number of pills taken is dependent on the dose of the pills. Therefore it is very important to check the dose of the pills beforehand. The modern, more commonly available pills are typically low dose (30 mcg) but high dose (50 mcg) pills may also be available.

TAKE THEM AS FOLLOWS:

(i) Low dose pills, 30 mcg take 4 pills within 72 hours of unprotected intercourse and 4 pills 12 hours later.

(ii) High dose pills, 50 mcg take 2 pills within 72 hours of unprotected intercourse and 2 pills 12 hours later.

· ECPs may cause nausea and vomiting.

· ECPs will not protect you from pregnancy for the remainder of the menstrual cycle - if you have sex again during the same cycle, you should use a method of contraception such as a condom.

· If your period is more than a week late, consult your doctor or family planning service provider as soon as possible to eliminate the possibility of a pregnancy.

EMERGENCY CONTRACEPTION IS ONLY FOR EMERGENCIES.

Emergency contraceptive pills will only reduce the chances of pregnancy by 75 percent. Therefore, you cannot rely on emergency contraceptive pills for continuous contraceptive protection.

Alternatively you can have an IUD inserted within five days of unprotected intercourse. This method is usually not recommended for young women (see "intra-uterine devices").

And the winner is...

Well, there is no winner. Choosing a contraceptive is about choosing what's best for you. Before you have sex, you are faced with two important decisions. First, you must decide how you are going to protect yourself from STDs and HIV. There are two choices available to you - you can either abstain from sex (the only 100 per cent safe method) or you can use a condom (male or female). Second, if you want to use contraception, visit your family planning service provider to discuss the options available to you. Not every method listed here is available in every country. Your service provider can advise you as to which method is best for you. At the end of the day, the decision is yours. If you remove the fear of pregnancy and STDs or HIV (and the stress and anxiety that it causes), you and your partner can focus your energy on having a fulfilling and satisfying sexual relationship.

TWO to tango

"I think it affects anyone, you and me. People should be even more careful about contraceptives, now people have to care more and be even more trusting of their partners. You have to be responsible."
19, F, Japan

"Those who use contraceptives become prostitutes."
18, F, Uganda

"If he does not have a condom, the woman should say: 'If you don't have, you can't get'. If he don't have he should not go on."
18, M, Trinidad and Tobago

"Contraceptives should be made available only to married people. They should not be given or even discussed with unmarried young people or teenagers."
22, F, Jordan

Who is responsible?

"It takes two to tango, so two people are responsible for it."

18, F, USA

"Men ore equally responsible since a sperm is needed to create a baby."

19, F, India

"We are all responsible but our minds have culturally been turned to believe that women are the ones to take the responsibility."

20, M, Lesotho,

"It takes two!" If the partners are mature enough for sex, they are mature enough to consider and deal with the consequences together."

17, F, UK

"It's a joint responsibility between the man and the woman. A woman does not have sex on her own."

21, F, Iraq

"It is the man's responsibility. After ail, the man controls the woman."

19, M, Ghana

"Women are responsible because it is them who become pregnant and carry the baby for nine months."

18, M, Zambia


Figure

How would you feel if you couldn't use contraceptives?

"Very bad. It is like wanting to kill me."
19, M, Cameroon,

"Very worried, frightened about a partner
21, M, UK

"I think it's a violation of a human right not to be allowed to use contraceptives."
21, F, Sri Lanka,

"I would not even have sex. I would feel like shit."
16, F, New Zealand

"My mother told me that when she was young she didn't use contraceptives. They were too expensive or she couldn't get them so they practised withdrawal where the boy had to go out before ejaculation: well, I am the result of that."
16, F, Netherlands

"According to the Bible, the use of contraceptives is bad so I will not worry."
19, M, Ghana

"Without contraceptives, I would feel like a fish without water."
18, F, Albania

"I would feel that my right as a sexually active person Co protect myself from STDs and unwanted babies is violated."
24, M, Grenada.

"No contraceptives? No fret. If you have to die by AIDS you die. If you get pregnant you mind the child."
17, M, Trinidad and Tobago

"If I didn't have contraceptives, I wouldn't have sex. I'd feel cheated."
18, F, UK

"I would feet nude. unwanted, deceived, insulted, hated, despised. In short, BAD."
22, F, Cameroon


Figure