Bengaluru: What are methods of Termination of pregnancy- TOP? It can be performed with tablets or with a minor procedure or surgery. It must be performed by a doctor trained to perform terminations. Pre and post procedure counselling are very important to ensure that the complications and sequelae associated with the procedure are minimal.

A checklist before the procedure would include: an ultrasound scan to determine the location and the age of the pregnancy. Blood tests to check that the woman is not anaemic and to note the blood group and to check for sexually transmitted infections. Counselling may be required for women to prevent psychological sequelae. Women with Rhesus negative blood group would require an injection called Anti D post the procedure to prevent Rhesus iso immunization in future pregnancies.  Antibiotics may need to be administered as also pain killers. Post procedure an ultrasound scan would be required if tablets were used, to confirm that complete abortion has taken place.

Contraceptives have been in use for thousands of years. A cave painting in France thought to be 15,000 years old shows what is possibly the first illustration of a man wearing a condom. In ancient Egypt around 1500 BC, women would mix honey, sodium carbonate and crocodile dung into a pessary and insert it into their vaginas before sex. In ancient China, concubines used a drink of lead and mercury in order to prevent pregnancy. Over the centuries, contraception has evolved into what is available today. 

What are the different types of Contraception available to me?

Contraception can be divided mainly into two categories.

Methods with no user failure – methods that don’t depend on you remembering to take or use them Eg. Intrauterine Device (IUD, commonly known as Cu T or the loop) /Intrauterine System (IUS), Contraceptive Injections, Implants, Sterilization and

Methods with user failure – methods that depend on how well you use them eg. Pills, Condoms, Diaphragm, Natural Family Planning methods etc.

They are also divided into Reversible and Irreversible or Permanent Methods. The latter include female and male sterilization. All the other methods fall into the Reversible category.

The most commonly used contraceptive methods in India are condoms, IUD, contraceptive pills, injectables and Female sterilization. Other less commonly used methods are Natural Family Planning methods, Withdrawal, Vaginal ring, Contraceptive patch, Female Condom, Diaphragm with spermicide.

Is Contraception 100% effective?

No.  Each one of them has a failure rate including the sterilization operation.  However, depending on how well they are used, most of them are very effective.

You can discuss failure rates with your doctor.

You cannot get pregnant when you are breast feeding

Pregnancy prevention when breastfeeding is known as the lactational amenorrhea method (LAM). LAM is a good form of birth control for the initial six months after giving birth if all the following conditions are strictly followed - the baby is exclusively breastfed every 4 hours during the day and every 6 hours at night, with no pumping or formula supplementation. Under these ideal circumstances it has a failure rate of 2 per 100 women.

However, with typical use, this method is only 75% effective. Being on the pill reduces your chances of pregnancy in the future. This is a popular misconception. The pill does not affect future fertility.

You must take the pill at the same time every day.

This was true for the older progesterone only pills, but not the common modern pills which your doctor will prescribe. However, it is useful to take the pill at a regular time to help you remember to take the pill everyday and reduce the chances of missing the pill.

I need contraceptive advice should I see a doctor?

Yes, it would be preferable to see your doctor since he/she will need to take a thorough history and do a full examination to help decide which contraceptive method is best for you. Your doctor will also discuss with you the failure rates of the various birth control methods and advise you as to what is to be done in the event of “contraceptive failure”.

With all the contraceptive methods available, be responsible, be safe, use contraception and prevent unintended pregnancies and sexually transmitted diseases. You owe it to yourself.

(Author — Dr Prathima Reddy, MBBS, MRCOG (London), FRCOG (London), FACOG (USA) is the director, senior obstetrician and gynecologist at Fortis La Femme Hospital, Richmond Road, Bengaluru)