Advances in Conventional Contraception

1. Dr. Parikshit D Tank, Nowrosjee Wadia Maternity Hospital, Ashwini Maternity & Surgical Hospital, Centre For Endoscopy & ART, Mumbai Advances in Conventional Contraception

2. What is Conventional Contraception? • Contraception with none or minimal medical aids • Examples • Barrier contraception • Spermicides • Periodic abstinence • Withdrawal • Lactational Amenorrhoea Method (LAM)

3. Indian Population Growth

4. The Unmet Need • India has 168 million eligible couples • 56% do not use effective contraception and are at risk for unintended pregnancy • 44% are effectively protected • 75% of these have undergone female sterilization • Hormonal methods and IUCDs are used by a small proportion of urban women • A large number of couples rely on conventional contraception

5. Failure rates during first year of use

6. Barrier Methods • Male Condom • Female Condom • Other barrier methods • Diaphragms • Cervical caps

7. Male Condoms • Give a sense of anonymity and distance from medical intervention • Easy availability • Allows the male to participate • Protection from sexually transmitted infection

8. Male Condoms • Clear instructions • Negotiating use during sex • Teenagers may stop using condoms if “they are going steady” • Typical failure rates are 10 to 15 / HWY

9. Use a new condom for every intercourse Place the condom before vaginal contact Create a reservoir at the tip Withdraw the penis while still erect Hold the base of the condom during withdrawal Male Condom – Teaching Aids

10. Advantages More comprehensive STI protection for women and allows them to be in charge Longer shelf life and can withstand heat and humidity without damage The Female Condom

11. Disadvantages Expensive (Rs.100) Not available freely Requires preplacement May be uncomfortable The Female Condom

12. Other Barrier Methods • Diaphragms, cervical caps are not commonly used in our country • Require fitting, instructions for hygienic care • Require preplacement • Efficacy is lower than a male condom

13. Spermicides • Nonoxynol – 9, benzalkonium chloride, menfegol • Sponges, foams, jellies, creams • Adjunct to diaphragms or cervical caps • No extra benefit when used with condoms in preventing HIV transmission • Frequent use may damage vaginal mucosa and enhance transmission of pathogens

14. Periodic Abstinence • Natural Family Planning (NFP) • Avoiding intercourse during the fertile period • Fertile period in an “average” 28 day cycle with ovulation on the 14th day would be from the 10th to 16th day Pregnancy rates in relation to ovulation

15. Periodic Abstinence Methods • Rhythm or calendar method • Cervical mucus (Billings) method • TwoDay method • Symptothermal method • Hormonal assay • Standard Days Method

16. Standard Days Method and Cycle Beads • Sexual intercourse is avoided between days 8 and 19 of the cycle • Colored beads with a rubber marker helps to count off the days and indicate safe or fertile days

18. Analysis of Periodic Abstinence • Reasonable efficacy (Failure rates 4 to 10%) when used consistently and correctly • Unforgiving of imperfect use • Increased risk of failure in times of stress • Couples with poor attitude towards the rules are more likely to take risks • Couples who get away with taking risks are more likely take risks again

19. Breast feeding and fertility • 30 days : sex steroid levels drop and gonadotropins return • Suckling inhibits gonadotropin release • All contraceptives are more efficacious • Resumption after delivery • Menstruation 28.4 (15 to 48) weeks • Ovulation occurs 33.6 (14 to 51) weeks

20. Issues to address in postpartum contraception • Breast feeding and patterns • Sexual activity • Efficacy • Effect on breast milk and infant growth • Medical conditions esp. risk factors for VTE • Social factors: employment

21. How common is breast feeding ? • Breast is best • Only 1 in 10 women are exclusively breast feeding at 4 months of delivery • Gap between knowledge, attitudes and practices

22. Lactational Amenorrhoea Method • 98% efficacy only if : • Exclusively breast feeding • Less than 6 months postpartum • Amenorrhoeic (no vaginal bleeding after 56 days of delivery)

23. LactationalAmenorrhoea Method • Factors precipitating early return of fertility • Reducing the frequency of feeds • Stopping night feeds as baby grows and sleeps through the night • Separation from baby (Eg: return to work) • Introduction of supplements • Anxiety, stress or illness in mother or baby

24. Conventional Contraception in Context • Advantages • Usually low technology and low cost inputs • Safety profile is excellent • Involves the male partner • Disadvantages • Efficacy rates are lower than hormones, IUCDs • Linked to the act of intercourse • Requires motivation

25. Conventional Contraception Couples • Barrier methods for situations where there is a risk of sexually transmitted infections • An entry into the habit of contraception • Do not accept more effective forms of contraception on personal or religious grounds • Should always be provided with Emergency Contraception as a back up

26. Thanks to all contributors. Dr Adarsh Bhargava. Dr Ashwini Bhalerao. Dr Alka Kriplani. Dr. Kalpana Apte. Dr Mala Arora. Dr.Meenakshi Bharath. Dr. Mandakini Parihar. Dr.Nozer Sheriar. Dr.Parikshit Tank. Dr. Roza Olyai. Dr.Sasikala Kola. Dr.Sujata Mishra.