Bengaluru: Across the world, unintended pregnancy rate is high and this was estimated as 70 per 1,000 women aged 15–49 in India in 2015 (The incidence of abortion and unintended pregnancy in India, 2015  S Singh et al, Glob Health 2018; 6: e111–20 Lancet) which is similar to the rates in neighbouring Bangladesh (67) and Nepal (68), and much lower than the rate in Pakistan (93). 

This translates into an abortion rate of 47 per 10,000 women. Most unintended pregnancies happen because of lack of information about contraception or a lack of responsibility about preventing a pregnancy. Hence responsible use of contraception prevents unwanted pregnancies, abortions and their complications.

What is Termination of pregnancy (TOP) or Abortion - it is the removal of products of conception or the fetus and placenta (afterbirth) from the uterus. The terms fetus and placenta usually are used after eight weeks of pregnancy, while the other terms describe tissue produced by the union of an egg and sperm before eight weeks.

The most common reason for a voluntary termination of a pregnancy is an unintended or unwanted pregnancy. Malformations or abnormalities of the baby incompatible with life are also a reason for a medically indicated termination.

What is the legal limit of termination in India - According to the MTP act of India, it is illegal to terminate a pregnancy beyond 20 weeks of gestation.

On an average 56 million abortions took place all over the world during the years 2010 - 2014.  Of this 25 million were unsafe abortions. Most of the unsafe abortions take place in the developing world. Even in the 21st century on an average 13 women die due to unsafe abortions in India. And this happens despite termination of pregnancy being legal up to 20 weeks in this country. 

Unsafe abortions can cause morbidity, mortality and long-term sequelae leading to pain and infertility. They also have a huge emotional impact on the woman.

What are methods of Termination of pregnancy- TOP 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 anemic 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

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.

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”.

Finally, 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 gynaecologist at Fortis La Femme Hospital, Richmond Road, Bengaluru)