Family planning and birth control have gathered much importance in the recent days thus increasing the demand for contraceptives.  These contraceptives can help in avoiding unintended pregnancies which is one of the crucial public health issues worldwide. The multiple options available today have helped couples plan their family.

A woman can get pregnant when a man’s sperm reaches one of her eggs and fertilize it. Contraception is a way to stop pregnancy by keeping the egg and sperm apart, stops egg production and also prevents the fertilized egg from attaching to the lining of the womb.

There are many contraceptive methods to suit different needs. Listed below are a few popular types of contraceptives: Barrier methods, Emergency Contraception Pill, Permanent Contraception, Long-acting Reversible Contraception and Hormonal Contraception.

1. Barrier Method:In this method, a barrier is used to stop the sperm from entering the vagina. There are two barrier methods: Male and Female Condoms. The ‘male condom’ is one of the most popular contraceptives, where a thin latex or polyurethane sheath is placed around the erect penis before intercourse. The ‘female condom’ is placed inside the vagina before intercourse.

2. Emergency Contraception Pill: This method is followed to prevent pregnancy after sex if contraception was not used. The pill can also be taken if the condom used was ruptured. The pill contains special doses of female hormones. Though the pill is also known as ‘Morning After’ pill, it can be effective up to five days after having unprotected sex. The sooner you take it, the more effective it will be.

3. Permanent Contraception: One should opt for this method only if they are certain that they do not want children in thefuture. This method prevents all future pregnancies and is almost impossible to reverse. That is the reason this method is popularly called as ‘Sterilisation’. The method involves vasectomy and tubal ligation done by a trained health care provider.

4. Long-acting Reversible Contraception: As the name implies, Long-acting Reversible Contraception is reversible birth control that provides long-lasting pregnancy prevention. As you do not have the compulsion to remember it every day, this method is also called ‘fit and forget’ contraception. There are two types in this method: Intra-Uterine Device (IUD) and Implant.

In the Intra-Uterine Device, a T-shaped device is placed inside the woman’s uterus by trained health care provider. Depending on the type of device used, the IUDs can be in place for three to ten years. In the second method, a doctor inserts an ‘implant’ (flexible rods) under the skin of a woman’s upper arm. It releases progestin hormone to prevent pregnancy for three years.

5. Hormonal Contraception: As the name indicates, this contraceptive method uses ‘hormones’ to prevent pregnancy. Hormonal contraception is available in the form of pills and as Depo Provera injection. The pills come in two types: Combined Oral Contraceptive Pill and Progestogen-only Contraceptive Pill. The first type of pills, when taken regularly, prevents a woman’s ovary from releasing an egg during her cycle and the second type of pills (Progestins) makes the mucus around a woman’s cervix thick and sticky and prevent the sperm progressing towards the egg.

If you do not want to take the pills every day, you can opt for the Depo Provera Injection which is given every three months into a woman’s buttock or the upper arm and each injection prevents ovulation. The latest to be added is in this category is the NUVA RING. It is a hormonal method but unlike pill, it is not necessary to take it every day. It is fitted by the user in the vagina once in every 21 days.

Having listed the popular contraceptive techniques, you should be aware of the birth control methods which do not work well. The ‘withdrawal method’ of contraception is widely practised. In this method, the penis is quickly withdrawn from the vagina before ejaculation. The goal is to prevent the sperms from entering the vagina and prevent pregnancy. But the withdrawal method is not an effective form of birth control as the chances of sperm entering the vagina is high if the timing isn’t worked out properly. Also, the pre-ejaculation fluids could contain sperm leading to pregnancy. It is always advised to take the necessary precautions before having sex.

Dr.Anuradha Lokare
Consultant-OBG,
Columbia Asia Hospital Hebbal, bengaluru

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 Men have considerable sexual and reproductive health (SRH) requirements such as services for contraception, sexual dysfunctions, prevention and handling of HIV, infertility, male cancers and erstwhile sexually communicated infections. Yet these SRH needs are often unmet due to a combination of factors, which include lack of service availability, poor health seeking behaviour among men and SRH facilities often not being seen as “male friendly spaces”.

Need for equal and shared responsibility

There is a need for equal and shared responsibility to be taken by men and women in all areas of sexual and reproductive health. This requires working at different levels with varying partners to address the norms that undermine access and perpetuate gender inequality.One of the challenges is lack of male involvement in family planning. The low levels of men’s involvement are reflected, to an extent, in the very low use of male contraceptives. According to the latest data presented in Parliament by union health ministry in 2019, the national average for current use of male family planning methods i.e. male sterilization and condom) is only 5.9%. Male sterilization declined from 1% (NFHS-3) to 0.4 % (NFHS-4).

Significant barriers remain towards increasing male involvement in family planning. One of the barriers is the perception that contraception is a women’s issues. As per NFHS 4, three in eight men believe that contraception is women’s business and that men should not have to worry about it. Secondly the acceptance of male methods of contraception is marred by number of myths and misconceptions. Perceived procedure related barriers are the most important cause for not accepting vasectomy. There has been many discussions and concerns regarding probable negative health consequences emerged from vasectomy.

Increasing male participation in family planning 

Increasing male participation is an integral part of family planning programme intervention. To increase male participation in family planning Government of India is moving forward in a more systematic and sustained efforts such as training of service providers in No Scalpel Vasectomy (NSV) to enhance the pool of service providers, substantial increase in the compensation for male sterilization under the enhanced compensation scheme for sterilization, observation of ‘Vasectomy Fortnight’ every year in all states, condom boxes set up in facilities to enable clients to access condoms in privacy and a 360-degree media campaign underlining the role of men in family planning to encourage men to adopt family planning methods.

Reasons Vasectomy is unpopular:

• Unmet need for family planning expressed by women is found to be more than that by men.
• Socio cultural belief is that family planning is woman’s responsibility.
• Though awareness about vasectomy, not many know about less traumatic, simpler technique of NSV thus, fear of procedure and pain.
• Misconceptions: fear of loss of libido, physical strength
• Family Planning linked largely to Maternal Health and men are left out
• Ground force of health workers mostly women (ASHAs, ANMs) find it easier to convince women for female sterilization
• Shortage of NSV providers
• Very few accredited private health facilities
• Administrative level barriers and delays in the conditional cash transfer.

Several features of Vasectomy:

• Less invasive with minimal tissue trauma,
• Lower discomfort and complication rates,
• No incision, no stiches,
• Faster completion of procedure,
• Minimal post procedure pain and bleeding
• Speedier recovery as compared to recovery after the conventional procedure.

FPA India has long recognized the importance of working with men and boys as clients, partners and agents of change in efforts to promote gender sensitive and rights based sexual and reproductive health services, including Family Planning. Innovative strategies for demand generation and advocacy, quality assured service delivery and capacity building of service providers have been the key markers to improve the uptake of NSV in FPA India.

FPA India is one of the largest sexual and reproductive health organisations in the country. It works to empower all, to enjoy their sexual and reproductive health choices and rights in an India free from stigma and discrimination. FPA India pioneered the family planning programme in India in close collaboration with the government in the 1950s. Since then FPAI has been contributing to Government of India’s national health programme with a pan India presence including West Bengal. Through its 45 branches and projects across the country, FPA India reaches out to over 30 million people every year.

Ms Amita Dhanu
Assistant Secretary General (Programme Implementation)
FPA India

Co-Author: Dr Nilesh Patil, Technical Programme Manager and Project Lead, FPA India

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