Various artificial methods of family planning

July 3, 2018

Introduction

Family with many members are not easy to handle and will be problematic as compared to small family.
So, the necessity of planning a family is felt which can be made effective by following various measures.
Several scientific methods of birth control have been developed in order to have a small family.
Thus, family planning can be defined as the practice of controlling the number of children one has and the intervals between their births, particularly by means of contraception or voluntary sterilization.
These may be grouped under two main categories: natural and artificial.
However, they should be used under the supervision of a qualified medical practitioner.
When some external objects are used or family planning it is called artificial method.
The various approved artificial methods of family planning may be classified into two groups. They are:

A) Temporary methods

i)Barrier methods

These methods include a barrier that prevents or blocks sperm cells from reaching the ovum.
These are available for both men and women.
For this, condoms and diaphragms are generally used.

a) Condoms

It is a sheath of animal membrane, rubber, or plastic that is placed on the erect penis.
It is a barrier device since the ejaculate is collected within the condom instead of within the vagina.
It also protects from transmission of various sexually transmitted diseases.
They are the most common contraceptive devices employed worldwide as they are inexpensive, easy to use, do not require medical supervision and have few side effects.
Condoms for both male and female are available.

b) Diaphragms

It is a shallow rubber cup that fits over the cervix (neck of the uterus) to prevent the sperm reaching the ovum.
The cup holds a spermicidal (sperm killing) jelly or cream that immobilizes any sperm that may be present around the edges of the diaphragm.

ii) Spermicidal agents

These are substances that are toxic to sperm cells.
The most commonly used spermicidal agents are foams, tablets or creams that are inserted into vagina before sexual contact.
They kill the sperm cells.
These include KMnO4, ZnSO4, lactic acid, citric acid, etc.
Most commonly used chemicals are Kamalchakki and Today foaming tablets.

iii) Chemical methods

The administration of female sex hormones to suppress fertility is one of the most effective temporary methods for preventing pregnancy.
Birth control pills or oral contraceptive pills usually consist of a mixture of the hormones, estrogens and progesterone.
Both hormones prevent ovulation, if taken in sufficient amount.
They are both synthetic steroids in nature.
They have longer half-life in the circulatory system than the natural steroids, which are rapidly degraded by liver.
Commonly used oral pills in Nepal are Nilokan white, Sunaulo gulaf, Kanchan, Ovaral, Mala-D, etc.
These pills are ingested once in each day for about 21 days.
Then the medication is stopped, or a placebo pill is taken for the next 7 days which is without estrogen and progesterone.
The resulting drops in hormones allow menstruation to occur.
After the stoppage of menstrual flow, the administration of the pills begins again.

iv) Intra-uterine contraceptive devices (IUCDs)

These are tiny plastic and metal (usually copper) loops or coils.
These are inserted into the uterus through the cervix.
These work mainly by preventing fertilization, but may also interfere with the implantation of the fertilized egg into the lining of the uterus.
Some IUCDs also release small amounts of synthetic progesterone into the uterus to prevent conception.
It should be inserted by doctor or nurse as it remains in a place for 3 years.
Its working mechanism is not quite clear but it successfully prevents implantation of the developing embryo with the uterus.
However, some effects are noticed in some women like uterine cramps and increased menstrual flow.
Though it is an effective means some complications are noticed during its use.
Commonly used IUCDs are copper T-200 or loop.

v) Depo-provera

vi) Implant

In this method, two small flexible capsules containing hormones are implanted in the arm of woman by trained health worker.
These capsules release hormones in the body which make the ovum inactive.
So the woman does not become pregnant after sexual intercourse.
A single implant of these capsules acts as contraceptive for five years.
The implants working for three years are also available nowadays.

vii) Norplant

It is a set of six small (3-4 cm long) flexible tubes, which are inserted under the skin of the upper arm through a minor surgery.
Once introduced, it is effective for five years.
It is a progestogen that thickens the cervical mucus, which prevents the sperms from meeting the egg.

viii) Emergency contraceptive pills

These pills are used for emergency purposes.
It prevents pregnancy after unprotected sexual intercourse.
A woman takes two tablets within 72 hours of unprotected sexual intercourse and the second dose of remaining two tablets after 12 hours.
These are available in the name of E-con or i-pills.
However, these pills should not be used frequently as they have various side effects.

B) Permanent methods

These include surgical methods, which are suitable for the couples already having two or more children. These are:

i) Vasectomy

It is a commonly used method that makes a male permanently incapable of fertilization.
In this method, both the spermatic ducts coming from the testes are cut and tied separately within the scrotal sac.
This prevents the sperms from coming out during ejaculation.
Finally the sperm cells are destroyed in the epididymis.

ii) Tubectomy

It is also a common method of permanent birth control in females.
Both the fallopian tubes are tied and cut or clamped through an incision made through the wall of the abdomen.
Laparoscopy is commonly used for this purpose so that only a small opening is required to perform the operation.

iii) Interruption of pregnancy

Surgical procedure called abortion might be used to terminate the unwanted pregnancies.
This method is normally used only in pregnancies not older than 3 months.
An instrument is inserted into the uterus through cervix and the inner lining of the uterus along with the implanted embryo is scraped in this method.
The embryo disintegrates and is suctioned out of the uterus.