Contraception: Option or Necessity, Especially During a Pandemic

Procreation is a human need. The lockdown and the pandemic have not deterred sexual activity. Sadly, gender-based violence has increased alongside. A woman needs to empower herself to be safe and healthy regarding contraception. This calls for strong commitment and push from doctors, family members and women themselves to be responsible for contraception. Contraception is a method that prevents pregnancy by keeping the woman’s egg and the man’s sperm apart. Some of these contraceptive devices also prevent sexually transmissible infections (STI).
During the pandemic, one of the things which got sidelined and perhaps needs attention now is the common everyday health matters. If not attended to, they will cause issues. One such matter is family planning and birth control - or contraception. 2 million women worldwide and 1.3 million women in India approximately have lost access to contraceptive methods during the lockdown, according to an international survey. That is 9,00,000 unintended pregnancies, 1.5 million unsafe abortions, 3000 maternal deaths. World Contraception day, 26th September, has been an opportunity to create awareness and responsibility in this matter. Especially now as it has been seen in the past that during epidemics and outbreaks, attention was diverted from women’s health, contraception and maternal health.

In developing countries like India, the three most common reasons for delays in women healthcare are -
1. Deciding to seek healthcare
2. Reaching a healthcare centre
3. Receiving appropriate timely care at the centre

The Condom (Barrier Method)
Condoms help in protecting against STI too. Available for males and females, it’s hormone free and can be used on demand. However, it may tear and come off if not used correctly.

The Oral Contraceptive Pill (OCP)
The OCP is a hormonal method to control pregnancies. There are many types available these days. The only-Progestin and the Oestrogen + progestin combination pill allows for sexual spontaneity and is highly effective. It does not interrupt coitus and even controls both hormone levels for irregular menses or hormonal skin outbreaks in women. It is important to remember to take it regularly. Forgetting to take it is not safe. This is not meant for men, and neither does it protect against STIs. It is best to consult a doctor for advice.

Intrauterine device (IUD)
An IUD is a small T-shaped device made from plastic or copper containing progesterone which is fitted by a medical practitioner into the woman’s uterine cavity. The hormones released by the device slowly, over time, prevent pregnancies. The copper and hormone laden devices are 99.8% effective. It requires a qualified person to insert it and does not offer protection from STIs. There may be spotting or bleeding for the first few months. Requires medical professional intervention.

Contraceptive Implant
Contraceptive implant is a small rod containing the hormone progesterone, placed subcutaneously. This hormone prevents the release of the egg. It's very efficacious, long-lasting and has no impact on sexual activity. The contraceptive implant doesn’t offer any protection from STIs either. Requires medical professional intervention.

Contraceptive injection
The contraceptive injection is given intramuscularly, which slowly releases progesterone into the blood. The injection has many advantages and also gives the opportunity to track cycles. It does not protect against STIs. Requires medical professional intervention.

Emergency Pill or Morning After-pill
The Morning pill is hormonal in composition and is used after unprotected sex. This is a common contraceptive used by sexually assaulted women to avoid unwanted pregnancies. Also called the Morning after-pill, it is an over-the-counter pill that any woman can take. It has 85% effectiveness within 3 days of unprotected sex. Maybe self prescribed but as a one off. Repeated use with no medical advise may be harmful.

Contraceptive Ring
The contraceptive ring is a plastic hormone-releasing ring placed in the vagina by women, lasting 3 weeks. One week off and a new ring can be inserted. This cannot be used by women who are advised to not use oestrogen.

The diaphragm is a small silicone dome placed in such a way that it sits on top of the opening to the uterus, the cervix. It can be kept inserted during and after sex for a few hours. It's reusable but takes practice to use. Requires guidance for application initially.

Sterilisation is a minimally invasive, permanent method of contraception for men and women under anaesthesia.

The best method for you should be determined after having an open and complete discussion with your doctor.

During these new times with the pandemic, Seeking help for family planning and contraception is, unfortunately, low on the list of medical issues to venture into a clinic/hospital setting. There is also the concern that we may have reduced stocks of contraceptives from UNFPA or some methods of contraception. For example, Depot hormone implants, Copper Intrauterine Devices (IUD), Oral contraceptive pills (OCP), and condoms. The issue of unavailable healthcare providers or closed clinics is also ever-present. Unintended pregnancies, additional numbers of complications in obstetric care and more women resorting to unsafe abortions will be a setback to people, families and the development of the society, especially in these uncertain times.

The advantages of birth spacing are well known. Avoiding pregnancy is advisable for women who have had childbirth during the pandemic. For their personal health and lifestyle and given the reduced resources or opportunities to receive health care, the need for contraception when not keen to expand family is a must.

The methods easily available are using the Lactational Amenorrhoea Method (LAM). To enhance its efficacy, barrier methods such as the condoms, the oral progestin‐only pill (a minimum of 6 months), and DMPA (look at how to enable self‐administration with subcutaneous route and training) should be advised.

One of the best methods, long‐acting reversible contraceptives (LARCs), can also be advised. Some of these are the progesterone implant and the intrauterine system (IUS). The copper IUD (PPIUD) inserted just following delivery is easily available, safe, convenient and is highly cost‐effective. Infection rates are very low too and when done immediately post-delivery, it is relatively painless.

As the WHO Director General has said, “No one will be safe unless everyone is safe.”
This includes women who are looking to not conceive. At Zoi Hospitals and Clinics, we believe in empowering women to take their health into their own hands. They take expert advise and take a stand. Social distancing, limitation on mobility and attention to COVID-19 requires new ways to take care of contraception and reproductive well-being.

Advice and counselling on contraception can be sought online through virtual audio-video consultation. All one has to do is set up an appointment via a mobile connection and talk to the women’s health experts today. The likelihood of a hospital or larger set up to stock contraceptive methods is higher too. If required, go to the hospital or clinic for insertion of any IUD or depot as it reduces the frequency of hospital visits. And Of course, postpartum contraception is an important access.

We at our centre, believe it is our top priority to provide any service with utmost precautions and care. Strong, aware healthy women is our purpose. With a team of 4 gynaecologists who have been working tirelessly and conscientiously through the pandemic, we want women to stop waiting for things to ‘go back to normal’ and to go forward in ‘the new normal’.
For More information and for guidance for initiating contraception, you can get in touch with our doctors via direct in hospital or nline consultations via our website.


FIGO Wileys Obstetrics and Gynaecology editorial Jun 2020


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