Conversations around contraception are still stigmatised around the world, even in this day and age. But the fact is, our bodies are just as natural as the fact that humans have sex. If we didn’t, none of us would be born! Contraception methods, on the other hand, are often stigmatised because they are known to block the natural progression to sex—having babies. And yet, as natural as having kids is, family planning, the need for population control, and the prevention of sexually transmitted infections (STIs) led to the invention and use of contraception methods equally naturally.
This is why contraception methods have existed across the world, throughout history—though their efficacy and safety might be questionable today. For example, the ancient Greeks and Egyptians used condoms made of animal bladders, used vaginal douches that slow or weaken sperm, and even used natural remedies like pomegranate seeds, unripe papaya and silphium. Nowadays, we not only have safer and more effective contraceptives available, but also have constitutionally protected rights to access them. Here’s everything you need to know.
Contraception Rights In India
Sexual and reproductive health rights have been accepted as human rights since the 1968 Conference on Human Rights Declaration, the 1979 Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), the 1994 International Conference on Population and Development, and the 1996 International Covenant on Economic, Social and Cultural Rights (ICESCR). The United Nations’ Sustainable Development Goals (SDGs) and Millennium Development Goals also recognise these rights.
As a signatory to these conventions, India also supports all sexual and reproductive health rights—including rights to contraception. In addition, India was the first country to launch a National Programme for Family Planning in 1952. Add the National Population Policy (NPP) of 2000 to this equation, and the sexual and reproductive health rights of all, especially women and children, are bolstered further. This means all Indians have the right to:
• Comprehensive information about safe contraception,
• Access to available, acceptable and safe contraception services, and
• Access to contraception free from coercion, discrimination, stigma and violence.
According to the Ministry of Health and Family Welfare (MoHFW), states with a high contraceptive prevalence rates have a lower maternal and infant mortality rate because these rights are being guaranteed through multiple efforts. Greater investments in contraceptive awareness and usage can also help mitigate the impact of high population growth by helping women in family planning. Contraceptive use can also prevent unwanted pregnancies, the need for abortions, and eliminate illegal abortion-related deaths. In the next few sections, we’ll explain all the contraceptive methods approved and made available by the MoHFW.
Spacing Contraception Methods Available In India
Spacing contraceptive methods are reversible methods of contraception which can be used by women who don’t want any unplanned pregnancies, but do want to have children in the future. These methods include oral contraceptive pills, condoms, and intra-uterine devices (IUDs). Access to these methods is comparatively easier and non-invasive, especially when it comes to oral contraceptive pills and condoms. Though oral contraceptive pills can be accessed through prescription from a doctor, condoms are available over-the-counter in most online and physical stores today. As for IUDs, they require an invasive procedure to be put in place and removed later when you want it.
Permanent Contraception Methods Available In India
As opposed to spacing methods, permanent contraception methods are irreversible and permanent. These methods include female sterilisation, male sterilisation and emergency oral contraceptive pills. Of these, only emergency oral contraceptive pills are non-invasive. Sterilisation, male or female, are invasive medical procedures that require you to be hospitalised. In India, women bear the burden of contraception and in many states, female sterilisation is preferred and pushed over male sterilisation—even though male sterilisation is much less invasive than female sterilisation.
1: Oral Contraceptive Pills
Oral contraceptive pills are hormonal pills which need to be taken by a woman daily, preferably at a fixed time. The pills come in the form of a long strip consisting of enough pills for the month. Some strips also come with additional placebo or iron supplement pills which can be consumed during the hormonal pill-free days. This contraceptive method is used by majority of Indian women, especially if they have been screened by a professional. This is also because these hormonal pills are also used to treat a whole range of reproductive health issues, including polycystic ovary syndrome (PCOS) and fibroids.
It’s important to remember that as contraceptives, these oral contraceptive pills are not 100 per cent effective. This is why always using condoms as a back-up and as an added protection from sexually transmitted infections (STIs) is a good idea. What’s more, if you’re on antibiotics, then the effectiveness of the oral contraceptive pills may be reduced, so let your healthcare provider know about it.
What to do if you forget to take a pill?
If you forget to take a pill, take it as soon as you remember it. If you missed the pill altogether, take two the next day—and use backup contraceptive methods for the next seven days in addition to the pills. If you miss two pills on two consecutive days, consult your doctor on what to do, but continue taking the rest of the pills meanwhile.
What are the side effects of oral contraceptive pills?
Because oral contraceptive pills are basically hormone pills, they can lead to some common side effects while your body is still getting adjusted to the influx of new hormones. Usually, these side effects subside after a while, but if they don’t or the reaction is too severe, contact your doctor immediately. Here are some common side effects of taking oral contraceptive pills:
• Slight swelling in hands, feet or abdomen
• Swelling or tenderness in breasts
• Dizziness
• Nausea
• Headaches
• Slight weight gain
• Small amount of breakthrough bleeding
2: Condoms
Condoms are barrier methods of contraception which offer dual protection against unwanted pregnancies as well as sexually transmitted infections (STIs). In India, the male condom brand Nirodh is available free of cost at government health facilities in a drive to increase usage. However, male condoms aren’t the only types you can use as contraception. A condom is definitely a thin, fitted tube, but nowadays, condoms that can be inserted into a vagina or the rectum to prevent STIs are also available—though not cheaply, and not everywhere.
Do condoms work?
Using a condom the right way is a sure-shot way of making sure that it is effective. When used properly, male condoms are around 98 per cent effective, while female condoms are about 95 per cent effective. However, in the case of STIs, condoms are almost 100 per cent effective in preventing transmission of HIV, chlamydia, gonorrhoea and herpes—which is why its use is recommended for people across all sexualities.
It’s also important to remember that condoms have an expiration date. You must always check said dates on the box or wrapper, and make sure the product is sealed properly. Condoms are usually thin, so ensure that they don’t tear or break when you take them out or use them. A tear or breakage usually makes a condom useless.
What should you do if a condom breaks?
If the condom breaks before use, get a fresh one. If it breaks during sex, stop right away and change it. If it breaks during sex and you don’t realise it till later, consult your doctor immediately about using an emergency contraceptive pill and get yourself tested for STIs soon after.
3: Intra-Uterine Devices
An intra-uterine device or IUD is a wire-thin, just over an inch long, vertical stem device which is flanked by two horizontal stems—which gives the device its signature T-shape. An IUD usually comes with an attached string to help its removal when needed. Of course, the placement and removal of IUDs require a small procedure which is usually conducted in outpatient wards of hospitals. IUDs are one of the most effective, reversible and hassle-free method of contraception.
How does an IUD work?
An IUD is inserted into the uterus through the vagina and cervix. Once inserted into the uterus, the IUD either releases copper ions or hormones into the uterus, which make pregnancies next to impossible. Once an IUD is removed, normal fertility resumes within a couple of weeks or months. The procedure itself takes just a couple of minutes, and is done by trained professionals in an outpatient ward, so you don’t need to be hospitalised for it.
How many types of IUDs are there?
There are two types of IUDs:
• The copper-based or copper-T, which releases copper ions to prevent pregnancies. These copper ions work as spermicides and prevent the fertilisation of eggs.
• The medicated or hormone-based IUD, which releases a form of the hormone progestin. Progestin thickens the cervical mucus, making it impossible for the sperm to reach the egg.
What are the side effects of getting an IUD?
Soon after the procedure, you’re likely to have the following side effects:
• Pain and cramping
• Spotting or light bleeding
• Dizziness and weakness
If you go for a copper IUD, you may have the following side effects:
• Severe menstrual pain
• Cramping
• Heavy flow
• Bleeding between periods
If you go for a hormonal IUD, you may have the following side effects:
• Changes in menstrual bleeding
• Missed periods
• Ovarian cysts
In very rare cases, both hormonal and copper IUDs may have the following side effects:
• Cervical or uterine infection.
• Embedment, where the device attaches itself to the uterus.
• Perforation, where the device might go through the wall of the uterus.
• Migration, where the device changes its position, usually within the first three months of insertion.
• Expulsion, where the device moves out of the uterus due to heavy menstrual flow or other reasons.
If you have any side effects from your IUD, consult your doctor immediately.
Can every woman get an IUD?
Unfortunately, IUDs are not for every woman despite being highly effective and reversible. You shouldn’t get an IUD if you have any of the following issues:
• You have a uterine anomaly or issue.
• You have an active pelvic inflammatory disease.
• You are at an increased risk of STIs.
• You have a copper allergy, Wilson’s disease or a bleeding disorder.
• You have breast cancer.
4: Emergency Contraceptive Pills
Often known as the morning-after pill, emergency contraceptive pills can prevent pregnancy after unprotected sex, if taken within three to five days of the event (the sooner, the better). In India, these pills usually come with a 72-hour efficacy period. Emergency contraceptive pills prevent or delay ovulation by releasing certain hormones into your body. It’s important to note here that emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo.
Who can use emergency contraceptive pills?
Any woman or girl of reproductive age has the right to access an emergency contraceptive pill. You can use it if you’ve been in any of the following situations:
• You did not use any contraceptive method during sex.
• You were sexually assaulted.
• You were unable to use other contraceptive methods properly. This could mean anything from a condom breaking to an IUD getting expelled.
However, like with all medications, the emergency contraceptive pill does need to be used with caution. Here are some things you should note:
• If you have severe asthma or allergies, consult a doctor before taking the pill.
• Some medications for epilepsy, tuberculosis and HIV can interact with the pill and lead to severe side effects. Consult your doctor if you have any of these pre-existing conditions.
• If you are on antibiotics, the efficacy of the pill may be reduced. Consult a doctor before mixing the two medications.
What are the side effects of emergency contraceptive pills?
Side effects after taking an emergency contraceptive pill are not common. If they do occur, they are mild and are likely to resolve normally. The following are a few side effects that may occur in rare cases:
• Headache
• Nausea
• Vomitting
• Slight vaginal bleeding
• Fatigue
Please note that if you do vomit within two hours of taking the pill, you should repeat the dose because the chances of it being accidentally expelled are high.
5: Female Sterilisation
Female sterilisation is a permanent type of contraception and is irreversible. Usually, this service is offered to women who have just given birth at a hospital, especially if they’ve already got a number of children and don’t want to risk any further pregnancies. The problem with female sterilisation in India is that most government doctors and hospitals are incentivised for conducting the procedure, which is why many end up pushing it not only on women who have recently given birth, but also those who have reproductive health issues. According to latest NFHS-5 data, most Indian women continue to bear the burden of female sterilisation despite the fact that male sterilisation is a comparatively easier procedure.
What are the types of female sterilisation?
In India, there are two types of female sterilisation methods which are commonly used:
• A minilaparotomy, or a minilap, involves the cutting or blocking of the fallopian tubes. A small incision is made in the abdomen, and the fallopian tubes are then brought to the incision to make the cut, knot or block.
• A laparoscopy involves the insertion of a long, thin tube with a lens into the abdomen. A small incision is made on the abdomen to introduce the tube. The lens enables the doctor to locate the fallopian tubes, after which the tubes are either cut or blocked.
Do I need to be hospitalised for female sterilisation?
The process of female sterilisation may require hospitalisation as the procedure takes time and involves the use of local anaesthesia. Usually though, the hospitalisation isn’t for a day or longer—unless you have severe side effects or the procedure had some issues. In fact, in most cases, a woman is kept under observation until the anaesthesia wears off and no severe reactions show up. After that, you may leave the hospital or clinic.
Many pregnant women choose to get the sterilisation procedure done soon after their baby is born, while they are still in the hospital or clinic. This saves on hospitalisation time and expenses.
However, in case of any health issues soon after the sterilisation procedure, you should contact the doctor immediately.
What are the side effects of female sterilisation?
The following are the common side effects of female sterilisation:
• Abdominal pain and cramping
• Fatigue
• Dizziness
• Shoulder pain
• Bloating and gas
If you experience any severe reactions like bleeding, hot flashes or severe mood swings, consult your doctor immediately.
Making The Right Choice
So, in conclusion, women in India have the right to access many types of contraceptive methods to prevent unwanted pregnancies. It is always a good idea to consult a doctor, however, before you choose the contraceptive method that best suits you. In fact, a doctor can help you make the right choice based on not only your needs but also your personal as well as familial medical histories. This can help reduce any complications in the future too. If you need advise from a doctor regarding the right choice of contraceptive for yourself, go to Her Circle’s Help section right now.