Planned Parenthood: A Guide to Contraceptives and Family Planning Methods

A woman is faced with many important decisions once she becomes a parent—and one of them is the choice to have another child, or, in some cases, to not have one. Among the reasons why individuals and couples delay conception and therefore practice contraception are timing, spacing, or health and financial difficulties. As Esmeraldo Ilem, M.D., a perinatologist at the Dr. Jose Fabella Memorial Hospital and head of the Comprehensive Family Planning Service, explains, “They may have reasons related to employment, desire for a smaller family, previous difficult delivery, or marital problems.” Sylvia Estrada Claudio, M.D., Ph.D., professor of Women and Development Studies and director of the University Center for Women’s Studies in UP Diliman adds, “Or you might not even be married and don’t have any intention of marrying the person you are sexual with.”

Dr. Ilem cites four guiding principles of family planning in the Philippines, namely 1) respect for life; 2) responsible parenthood; 3) informed choice; and 4) birth spacing of least three years. “Family planning is an intervention to promote women’s health, more so for women who are at high risk to develop complications or even die during pregnancy.”

Read on to learn more about the different methods under natural and artificial contraception, as well as the advantages and disadvantages of each.

 

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Natural contraceptive methods
Women and couples who rely on the Standard Days Method (SDM), Ovulation Method (OM), Basal Body Temperature (BBT), Sympto-thermal Method (STM), Two-day Method (TDM) or Lactational Amenorrhea Method (LAM) choose a natural approach to contraception. Dr. Ilem says that practicing any of these methods (also referred to as fertility-based awareness methods or Natural Family Planning (NFP) involves the “determination and observation of the signs and symptoms of fertility and infertility during the menstrual cycle.” He adds, “Natural family planning can be used anytime by women with regular menstrual cycles, as long as they do not suffer from any medical conditions which can affect these signs and symptoms. It also works well with a couple who is committed to a healthy monogamous sexual relationship, and can abstain from sex despite the urge especially during the fertile periods.”

Mitos Rivera, executive director of the Institute for Reproductive Health (IRH) Philippines (a center committed to mainstreaming modern Natural Family Planning and an affiliate of IRH Georgetown University in Washington, D.C.) explains, “SDM is for women with menstrual cycles between 26 to 32 days. It identifies days eight to 19 of the cycle as the woman’s fertile and infertile days.” A mom who goes by this method relies on a necklace of color-coded beads that come with a movable rubber marker to help track her cycle.

Advantages
According to Dr. Ilem, NFP methods appeal to individuals and couples because they are inexpensive and are actually effective when used correctly and consistently. “There is no prescription nor medicine involved, no physical side effects, and no follow-up medical examination required.” Plus, these methods encourage shared responsibility and better communication between partners and promote a better understanding of sexual physiology and reproductive functions.

Disadvantages
Aside from the required period of abstinence, the daily monitoring and recording can be a negative factor for some couples, while women who do not have a regular menstrual cycle may find it hard to track for fertile and infertile days. Dr. Ilem adds that these methods “may inhibit sexual spontaneity and offer no protection against STI, HIV, and AIDS (same for most methods except relatively with condoms).”

 

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Artificial Contraceptive Methods
Dr. Ilem says these methods are either temporary (pills, the injectables [monthly and every three months], patch, vaginal ring, implants, condoms, Intrauterine Device/IUD [copper and hormonal]; or permanent (bilateral tubal ligation/BTL and vasectomy). There are three possible options as to when these methods can be applied: during the sexual act (e.g. condom); during the first week after the start of menstruation (e.g. pills, injectables, IUD, BTL), or anytime as long as one is certain the woman is not pregnant (also applies for pills, injectables, IUD, BTL). “Men who choose to undergo a vasectomy can do so anytime, provided that there are no medical contraindications,” he adds.

Many turn to these methods if they find it difficult to practice abstinence or cannot resist the sexual urge which is natural especially during a woman’s fertile period (which is also why these methods are most applicable to young, sexually active or charged couples).

Advantages
Depending on the particular method that a woman or couple chooses, these methods are known to be generally safe, effective, and reversible, according to Dr. Ilem. “They can be stopped anytime, require less attention (“use and forget” especially for longer acting methods like injectables, IUD, and implants), and have non-contraceptive benefits (e.g. hormonal contraceptives may protect against endometrial and ovarian cancer, ovarian cysts, iron-deficiency anemia, menstrual cramps and bleeding problems, endometriosis, etc.).”

Disadvantages
Just like the advantages, the disadvantages of using artificial contraceptives also depend on the particular tool that is used. “Some medical conditions prevent a person from using contraceptives (e.g. those who suffer from hypertension cannot use some hormonal contraceptives). There are known side effects, such as changes in weight, mood, or sexual drive (as reported by some women in some methods). Permanence (like for BTL and vasectomy) may be an advantage for many users except for a few clients who regret doing so later on,” says Dr. Ilem.

Kathrina dela Fuente, mom to Joshua Keith, 5, suggests, “You should determine the kind of activities you usually do in order to know the best kind of birth control option for you. For example, if you’re not sure when you and your hubby will make love, it is best to be on the pill so that you are protected anytime. Another thing to consider is your budget. You can choose one from a wide variety of birth control options that is most suitable to your budget.”

 

Conclusion
Rivera recognizes a “big, unmet need” when it comes to fertility awareness and education. She believes that women and couples “need to be provided with as many options as possible—options that suit their particular lifestyles, religious, spiritual, cultural beliefs—so that they can decide and be effective about their reproductive health.” Dr. Estrada Claudio says, “It has to do with the proper approach to reproduction, and looking at it in the totality of your life.” She says that what’s most important above all is that contraceptive methods provide a woman with the right to have control over her body, family, and how she is going to be intimate with a partner. “The greatest way is for society to help women have access to complete information that is not coercive. Just think of women’s lives—things change and lives change so much. It’s important to have methods available for each person, and to have good health practitioners who will provide information that is right for you, at that particular time in your life.”



Photo by Auntie P via flickr creative commons