Since the 1960s there have been many different methods of birth control available but, unfortunately, there are still many unwanted pregnancies. Couples in many countries, including Anguilla, have the option of choosing from a variety of safe methods of birth control – and although only abstinence is 100 percent effective, many others come pretty close.
How to decide
Couples often visit their healthcare provider seeking advice on the correct method. With so many options, choosing a form of birth control can be daunting. Several things must be discussed and taken into account when making a decision. Several questions need to be answered such as: Do you need to protect against STDs? Is cost important? Do you have medical disorders? Are you a smoker? The answer to these and other questions might influence the type of birth control you use. You and your healthcare provider will be able to come up with the right method.
Birth control options
There are a number of birth control methods available in Anguilla. The following are some options available:
Fertility awareness
This is also called natural family planning. Fertility awareness means avoiding sex when the woman is most fertile. The most reliable way to do this is to watch for changes in cervical mucus and body temperature. To use this method correctly, it is best to get training from a healthcare professional. The main disadvantage of this method is its high failure rate where up to 25 percent of users get pregnant. It is therefore seldom recommended by many healthcare providers.
Male condom
The latex condom is the classic barrier method. It prevents sperm from entering the woman’s body, protecting against pregnancy and most STDs. Of couples who rely only on male condoms, 15% get pregnant in a year. Please not that it is only effective if used correctly every time. Heat can make condoms less effective.
Female condom
The female condom is a thin plastic pouch that lines the vagina and can be put in place up to 8 hours before sex. Users grasp a flexible, plastic, ring at the closed end to guide it into position. It is somewhat less effective than the male condom, with about 21 percent of users getting pregnant. Women should not used a female condom with a male condom, to avoid breakage.
Birth control pill
The most common type of birth control pill uses the hormones oestrogen and progestin to prevent ovulation. When taken on schedule, the pill is highly effective. About 8% of typical users get pregnant, including those who miss doses.
Women who use the combined oral contraceptive pill have more regular, lighter periods, and less cramping with their periods. Some individuals experience some side effects, including breast tenderness, spotting, serious blood clots, and raised blood pressure. Some women, such as smokers over the age of 37 years, and women with history of blood clots in legs or lungs, should not use birth control pills. Despite what many women think, not all women on the Pill gain weight. In fact, a significant number of women do not notice any weight change – even after five years – when using the low dose birth control pill.
Birth control patch
Women who have trouble remembering a daily pill may want to consider the birth control patch. The Ortho Evra patch is worn on the skin and changed only once a week for three weeks with a fourth week that is patch-free. The patch releases the same types of hormones as the birth control pill and is just as effective. The patch is fairly expensive and may cause skin irritation or other side effects similar to birth control pills. Like the Pill it does not protect against STDs.
Injectable progesterones
The most common injectable long acting contraceptive available in Anguilla is Depo Provera (‘injection’) It is a hormonal injection that protects against pregnancy for three months. For the typical couple, it is more effective than the birth control pill — only 3% of users get pregnant in a year. It might cause a few side effects such as vaginal spotting and slight weight gain. It does not protect against STDs.
Implant
The birth control implant is a matchstick-sized rod that is placed under the skin of the upper arm. It releases the same hormone that’s in the ‘injection’, but the implant protects against pregnancy for 3 years. The failure rate is less than 1%.
The implant is much more expensive than many other options, and may cause side effects, including irregular vaginal bleeding. The implant does not protect against STDs.
IUD
IUD stands for intrauterine device, a T-shaped piece of plastic that is placed inside the uterus (womb) by a doctor. The copper IUD works for as long as 10 years. The hormonal IUD, Mirena, must be replaced after 5 years but can lighten periods and ease cramps. Both types make it more difficult for sperm to fertilize the egg. Fewer than eight in 1,000 women get pregnant.
Tubal ligation
This should only be done if the woman is sure she does not want biological children in the future, as it is considered as a permanent birth control. The traditional method for women is called tubal ligation or “having your tubes tied.” A surgeon closes off the fallopian tubes, preventing eggs from making their journey out of the ovaries. This method is very effective but it requires surgery, and may not be reversible.
Vasectomy
Besides condoms, a vasectomy is the only birth control option available to men. It involves surgically closing the vas deferens – the tubes that carry sperm from the testes through the reproductive system. This prevents the release of sperm but doesn’t interfere with ejaculation. Unfortunately, this method is not very common in Anguilla as many men in Anguilla are reluctant to use this surgical procedure. This method is permanent, cheaper than tubal ligation, and almost 100% effective.
Options for older women
Women can still become pregnant between 40 and 50 years once they are still ovulating. Age and lifestyle are important factors in choosing a form of birth control. If you are over age 35 and smoke or are obese, the combination birth control pill, patch, are not recommended. It is important to consult your gynaecologist about safe alternatives.
Conclusion
There are a number of contraceptive methods available for individuals who are sexually active and do not want to become pregnant. Abstinence is still the most effective method, especially for teenagers and young adolescents. If individuals are sexually active they must ensure they protect themselves from sexually transmitted diseases, and must choose a form of birth control because without using any form of birth control, 85% of sexually active couples will get pregnant within a year. If you have any questions related to reproductive health and birth control talk to your healthcare provider or contact the Anguilla Family Planning Association.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
