A Deeply Colloquial Guide to Family Planning Methods
Family planning is a big, big, deal in global health. Limiting family size improves the health of mothers and children, and giving individuals control over their own reproduction is the kind of empowerment that changes lives. What follows is a quick guide to family planning methods. Please note: I am not a doctor. This is not medical advice. I'm just summarizing some stuff I've learned about what people like and dislike about contraceptive methods.
Condoms work really well if you use them every time. They prevent against STIs as well as pregnancy, and they're cheap and don't require a doctor. The problem is, people don't use them every time. They require stopping in the middle of a sexual encounter, men complain that they reduce sensation, and they can actually be put on wrong. They also degrade in quality if they're kept in a wallet, and they eventually expire. And they can break.
The intrauterine device, or IUD, has a bad reputation (on account of the Dalkon shield, I suspect, which will subject of a future post on global health embarrassments) - and is probably underutilized - in the United States, but it's a great method of birth control. It's long-term, non-hormonal, and doesn't require any effort on the part of the user. Once put into place, it can stay for up to five years. IUDs aren't perfect; they can make menstrual periods worse, which in turn can worsen anemia in a woman who is already prone.
Oral contraceptives, or birth control pills, come in a variety of hormonal combinations and dosages. There are enough types that most women can find a pill that suits them if they've got access to a range of brands. With so much variety it's hard to lump them into a category - some have to be taken every 24 hours at the same time to work, others have more redundancy built in. They may be one hormone or a combination. They have a lot of side effects. Some are unpleasant - severe headaches or blood clots. Others are actually liked by users, such as clearing up acne or increasing breast size.
When taken properly, oral contraceptives are very effective. Like condoms, though, they're often not taken correctly. It's hard to remember to take a pill at the exact same time every day. This is particularly difficult for women who live unstructured lives or in stressful environments.
Hormonal injections, like Depo-Provera, are given every 3-4 months. They don't require daily or every-time effort on the part of the user, and they're very effective. They tend to stop menstruation, which many women like, but some find disconcerting. They cause weight gain, on average three and a half pounds a year, and in adolescent women they can prevent proper development of bone density.
The contraceptive sponge is a bad method. It's not especially effective, it has the same interruption drawbacks as the condom, and it doesn't provide any protection against STIs. There is some evidence that they can contribute to vaginal infections.
Diaphragms, also not a great method. They have to be fitted they require skill on a woman's part to insert, and they don't protect against STIs.
Still to be discussed in a future post: withdrawal, fertility awareness, lactational amenorrhea, emergency contraception, and cycle beads.
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