Contraception has been practised in various forms for thousands of years.
Some of the older methods, like coitus interruptus – or the withdrawal method, as we know it – are still in use today, although it might not be the most effective contraceptive method out there.
Thanks to scientific advances, women now have more choices in terms of how they want to plan their families.
There are now many tried and tested birth control methods available, although some can only be obtained with the help of a medical professional.
Move! asked specialist gynaecologist and obstetrician, Dr Pitsoe Moeng, to assess the most common methods of birth control in South Africa.
NATURAL FAMILY PLANNING
This practice, also known as the rhythm method, is based on abstinence. It dates back to when it was first understood that there was a link between a woman’s menstrual cycle and when she could fall pregnant.
As medical knowledge improved, it became possible to make accurate calculations about when a woman is fertile during her cycle. The problem with this method is that it’s not always easy to tell when a woman is ovulating.
“Both parties need to be well aware and comprehend how the female body works, and when they are in the ‘dry’ period as well as when they aren’t,” Dr Moeng says. “Essentially, a woman’s egg lives for only 24 hours but the male’s sperm can live up to five days.
Therefore, a woman can fall pregnant five days before ovulation, and two days after.” For birth control, it’s essential to either abstain from sex or take other precautions, such as using condoms, during this time.
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BARRIER CONTRACEPTIVE METHODS
The most common of these are:
- Condoms. This is one of the most effective ways to catch sperm during ejaculation, thus preventing pregnancy.
- Femidoms, which are condoms that are worn by women during sex and prevent semen from getting to the womb. “Good quality condoms, male and female, are effective, but depend on where people buy them and the expiry date,” Dr Moeng says. “When condoms are used properly, preventing HIV, sexually transmitted infections and pregnancy is 95% guaranteed.”
SPERMICIDES
These are chemical barriers in the form of foams, jellies, tablets, creams, suppositories or dissolvable films. Chemicals within the spermicide destroy the sperm, preventing it from fertilising an egg. When used alone, spermicides are not that effective – around 70% to 80% – but when combined with condoms they’re about 97% effective in preventing pregnancy.
WITHDRAWAL METHOD
Another option is to interrupt sexual activity by withdrawing before ejaculation. It’s free and has no side effects. However, it requires self-control and is, therefore, not a very effective form of birth control.
Sperm can still enter the vagina if withdrawal isn’t properly timed. Pre-ejaculation fluid also contains sperm and that could be enough to get you pregnant.
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SHORT-ACTING METHODS
These consist of:
- The pill, of which there are many different ones available.
- Injectables, such as Depo-Provera that lasts for around 13 weeks.
- Vaginal rings, which are small, soft, plastic rings that are placed inside your vagina and release a continuous dose of hormones to prevent pregnancy. Both the contraceptive injection and the vaginal ring are more than 99% effective, but some women can experience side effects.
The pill is also more than 99% effective at preventing pregnancy, but it must be taken at around the same time every day. There’s been a lot of talk about a male pill. “There’s a lot of experimentation being done on this, but I think we’re still about five to 10 years away,” Dr Moeng says.
LONG-ACTING METHODS
These include:
- An implant, like Implanon, that is inserted under the skin on the upper arm and remains there for three years before being changed or removed. It releases hormones that prevent pregnancy.
- Copper intrauterine device (IUD), also known as the lube, which can be left in the uterus for up to 10 years. Copper is toxic to sperm.
- Hormonal IUD, also known under the brand name Mirena, which lasts for three to five years. This also releases hormones to prevent pregnancy. The Implanon implant is highly effective and easily available at government clinics, but Dr Moeng warns that many women have complained about severe side effects. He highly recommends the copper IUD.
“It can be inserted in the doctor’s rooms in a couple of minutes and it also works as an emergency contraceptive. It’s convenient because it remains in the uterus for a long time, and it has the least hormonal side effects. “The only drawback is that if a woman has multiple partners she might become prone to long-term infections.”
STERILISATION
This permanent option is available for both men and women. Male sterilisation (vasectomy) is done by cutting and sealing or tying the vas deferens, the tube that carries sperm from the testicles to the penis.
“People need to understand there’s a chance your semen still contains sperm for up to three months after the procedure,” Dr Moeng says. “Fifteen out of 10 000 men will impregnate women in their first year after a vasectomy.”
It’s, therefore, a good idea for a man to get a follow-up test at 12 weeks. For women, sterilisation works by preventing eggs from travelling down the Fallopian tube. A surgeon will block the tubes (tubal occlusion) by either applying clips or rings, or by cutting and removing a small piece of the tube. If you’re unsure of the way to go or are experiencing any side effects from your current contraceptive, see a doctor.
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