MSS provides a wide range of family planning products and services, along with advice from trained and skilled staff to improve the reproductive health of the population of Pakistan.
Description: The contraceptive pill or oral contraception is a common form of contraception for women. There are two main types:
- Combined Oral Pill (COP)
- Progesterone only pill (POP or mini pill)
Combined Oral Pill: – It contains two hormones – oestrogen and progestogen – which prevent ovulation (maturation of an egg), thinning of uterine wall and thickening of cervical (entrance of uterus) secretions.
Considerations: – A full medical history is essential before prescription as this pill is not suitable for women who have certain conditions such as high blood pressure, circulatory disease or diabetes. Mothers feeding child below six months. Women over 35 who smoke are advised to choose another method of contraception (there are several types of pills to choose from for suitability).
The combined pill is not reliable if taken after a 12 hour delay or in symptoms of vomiting and diarrhea. Some drugs such as antibiotics can also affect the pills effectiveness. Some women may experience side effects such as nausea, headaches and weight gain (only 1-2 kg weight is gained after one year use) that is temporary and settle without any treatment.
The pill offers no protection against sexually transmitted infections and diseases such as HIV/AIDS etc.
Non contraceptive health benefits of Pills:
Reduction in following
- Endometrial and ovarian cancers
- Painful and heavy periods, menstrual cycle disorders
- Ectopic (tubal) pregnancy, pelvic inflammatory disease
- Iron deficiency anemia
- Benign breast disorders
- Endometriosis, genital and vaginal infections
In case you forget to take a pill: – If taking of a pill is missed then one pill may be taken immediately or two taken at the usual time. If two or more pills have been missed consecutively from the first 21 pills then one needs to be taken immediately and rest at the usual time. If the woman is having intercourse then condoms need to be used for seven days. In case of not having taken any of the colored pills, the pack needs to be discarded and dosage started with a new pack at usual time.
Availability: – All MSS centres and pharmacies
Effectiveness: – 99% if taken correctly.
MYTHS & FACTS
Myth: – Taking oral pills can cause cancer.
Fact: – On the contrary, Oral pills help to protect against the cancer of the uterine wall and ovaries.
Myth: – Taking contraceptive pills can cause obesity
Fact: – The weight increases only by about one to one and half kilogram, in the first year of use and not in subsequent years. This can be controlled by exercise.
Myth: – Pills cause giddiness.
Fact: – Giddiness may be experienced only during the first few days of use. This can be avoided if pill is taken after dinner or at bed time.
Myth: – The pill causes irregular periods.
Fact: – The pill makes the periods regular rather than irregular.
Description: The condom is a barrier method which prevents entry of sperm into the vagina. It is made of very thin latex rubber. Sperm and disease causing organisms, including HIV, do not pass through intact latex condoms. Condoms are placed on the erect penis.
Condoms are very effective when used correctly. Use of condoms encourages the participation of men in contraception. Condoms are the most effective contraceptive method for protecting against HIV/AIDS and other sexually transmitted infections, and help to protect women against cervical cancer and pelvic inflammatory disease (PID).
Effectiveness: Condoms are 93% effective if used consistently and correctly.
MYTHS & FACTS
Myth: – Condoms can rupture or come off.
Fact: – If used properly Condoms do not rupture or come off. If they do rupture or come off, use of emergency contraception is advised.
Myth: – The lubrication (oily substance) on the Condom is harmful. It is repulsive. It does not give pleasure.
Fact: – The lubrication on the condom prevents friction; hence there is no discomfort or pain. As a matter of fact it gives more pleasure.
Description: An injectable is a hormonal injection that provides a longer-acting alternative to the pill. It works by slowly releasing the hormone progestogen into the body to stop ovulation. Each injection lasts 8 to 12 weeks. Injections may reduce heavy and/or painful periods and may provide some protection against uterine cancer.
Considerations: The injection may cause irregular periods or stopping altogether. It can take over a year for fertility to return to normal after stopping contraceptive injections. Therefore, injections may not be suitable for a woman who is planning to start a family in the near future. It is important to remember the due date for the next injection (which may be every 8-12 weeks, depending on the choice of injection), to continue the contraceptive cover. Injections do not offer protection against sexually transmitted infections or HIV/AIDS.
Availability: MSS clinics and pharmacies.
MYTHS & FACTS
Myth: – Injections cause bloating.
Fact: – Some women experience weight gain of only about 1-2 kilograms in the first year of use, and not in subsequent years. This can be controlled with exercise.
Myth: – Periods stop and the woman becomes infertile.
Fact: – Continuous use of injections can cause periods to stop but does not make the woman infertile. Stopping usage causes periods and fertility to return.
Myth: – The use of injections may cause cancer.
Fact: – On the contrary, injections may help protect against uterine and ovarian cancer.
Myth: – The ‘dirty blood’ of periods collects in the body, adversely affecting the eyes.
Fact: – Periods stop due to the thinning of the uterine lining, therefore no blood is collected in the body and the eyes are not affected in any way. Stopping usage causes the uterine lining to be rebuilt again, which allows the menstrual cycle to resume.
Description: – An intrauterine device (IUD), also known as a Coil, is inserted/fitted into the uterus to prevent pregnancy. It works by preventing an egg from being fertilized or implanted in the uterus.
Considerations: The IUD offers no protection from sexually transmitted infections/HIV/AIDS. There is a higher risk of infection for women with more than one sexual partner.
Availability: IUDs must be fitted/inserted by trained service providers. This service is offered by trained service providers at all MSS centres.
Effectiveness: More than 99%.
MYTHS & FACTS
Myth: – The IUD can get ‘displaced’ to the liver or the brain.
Fact: – An IUD cannot pass through the wall of the uterus if placed by a trained service provider.
Myth: – The abdomen becomes enlarged.
Fact: – The IUD is made of plastic and stays inside the uterus in its original shape. It does not affect the metabolism, and hence does not cause weight gain.
Myth: – Some women think that they will have to bear adverse effects for the next five to ten years in case the IUD does not suit them.
Fact: – An IUD is a very safe contraceptive method with very few side effects. In case of any complication, it can immediately be removed by a trained service provider.
Myth: – An IUD will have permanent adverse effects since it is a long-term method of family planning.
Fact: – Despite being a long-term method of family planning, IUDs are safe contraceptives and do not have any permanent adverse effects.
An implant is a flexible tube inserted under the skin of the arm. It releases the hormone progestogen to stop ovulation, thicken cervical mucus to prevent sperm from meeting an egg, and thin the lining of the womb to prevent an egg from implanting.
Works for three years but can be taken out at any time. No other method of contraception is needed for as long as the implant works. Normal level of fertility returns after the implant is removed.
Periods are often irregular, much longer or stop completely for at least the first year. Some women gain weight. Other possible side-effects include headaches, spotty skin, mood changes and breast tenderness.
Over 99% effective. Some medicines may reduce or compromise the effectiveness of the implant, so women are advised to inform their doctors about having an implant in place. Implants must be inserted by trained service providers.
Possible, provided that the implant has been correctly inserted.
Female Surgical Contraception
Description: Female sterilization is the most popular form of contraception in the world. It is a safe, effective method of birth control for women who have the desired number of children or who do not wish to have children. Sterilization works by sealing the fallopian tubes that carry eggs from the ovaries to the uterus. Eggs are prevented from meeting sperm, so pregnancy cannot occur.
Considerations: Tubal ligation (also known as female sterilization) is a permanent, irreversible method of contraception. Therefore, it should only be adopted by those who either do not want children or already have the desired number of children.
Female sterilization offers no protection against sexually transmitted infections and HIV/AIDS.
Availability: Some MSS centres and the government’s Reproductive Health ‘A’ clinics (Family Planning clinics).
MSS centres have carried out innumerable female sterilizations. The service covers consultation/counseling, procedure and aftercare of the sterilization process. The surgical procedure is performed by a highly trained doctor and takes approximately 15-20 minutes. It is carried out under local anesthetic and sedation, using simple techniques to seal the fallopian tubes.
Effectiveness: over 99%.
What Should be Known about Female Sterilization
Female sterilization is a surgical procedure. Pregnancy is no longer possible after sterilization. In case of any questions or doubts before opting for this method, women are advised to consult a doctor or arrange a meeting with clinic staff.
Prior to the operation:
- Women are allowed to have light breakfast on the day of the operation. Eating and drinking is permissible soon after the operation.
- A bath is essential. Before coming to the clinic, the belly button, belly, and genital area needs to be carefully cleansed with soap.
- Women are advised to wear clean, comfortable, and loose cotton attire.
- Presence of a family member or friend to help return home from the clinic is important.
- Women are advised to rest at home for one or two days after the operation. Most normal activities can be resumed within two/three days. However, heavy work or lifting of loads should be avoided for up to two weeks to allow the wound to heal completely.
- The bandage should be prevented from getting wet for one or two days until the wound has dried up.
- Medicines provided by the doctor or clinic should be taken on time.
- Sexual activities may be resumed as soon as it is comfortable. This usually takes one week after the operation.
- Pulling, scratching or irritating the wound is to be avoided.
- It is normal to experience some pain and swelling around the wound after the operation, and hence should not be taken as a cause for concern.
- However, the clinic, doctor or health worker must be notified immediately if any of the following symptoms occur:
- Fever within one week of the operation
- Constant pain in the belly, or pain that becomes worse with time
- Pus/discharge from the wound
- Distension of abdomen
MYTHS & FACTS
Myth:- Women experience weight gain.
Fact:- The increase in weight is a result of age and not due to the operation.
Myth:- The period flow increases.
Fact:- Any irregularity in periods is because of age or some other reason that needs to be diagnosed. It has nothing to do with the operation.
Myth:- One can still have children after the operation.
Fact:- If the tubes are ligated properly, then a woman cannot conceive as tubal ligation is a permanent and irreversible contraceptive method.
Male Surgical Contraception
Description: Vasectomy (male sterilization) is the only permanent method of contraception for men. It is a safe, simple and effective minor surgical procedure to seal the tubes (called vas deferens) that carry sperm. This stops sperm from being passed into the ejaculated fluid.
Considerations: Vasectomy is a permanent and irreversible method, and should only be adopted by those who either do not want any children or already have the desired number of children.
Vasectomy offers no protection against sexually transmitted infections and HIV/AIDS.
Availability: Some MSS centres and government RHA centres.
Effectiveness: over 99%.
Precaution: Vasectomy is not effective immediately, therefore condoms should be used for the next 25 ejaculations; or the partner must use contraceptives for the next three months.
MSS services include every aspect of the vasectomy process: consultation/counseling, procedure, aftercare and follow-ups.
The procedure is performed by highly trained doctors and is very simple. It is carried out under local anesthetic, involves simple techniques to seal the tubes, and takes 5-10 minutes to complete. No stitches are required and post-operative recovery is very quick.
- Intercourse, strenuous activity or exercise is to be avoided for 48 hours after the operation.
- The incision needs to be kept dry for three days. However, the area around the incision may be washed 24 hours after the operation.
- The clinic, doctor or health worker must be contacted in case of any problem, such as fever, and swelling and pain in the wound.
- Condoms should be used for the next 25 ejaculations in case the partner is not using any form of contraception.
Myths & Facts:
Myth:- There is loss of libido after the operation.
Fact:- The operation has no effect on male sexual desire.
Myth:- An infection may occur after the operation, which may be dangerous.
Fact:- No infections are developed if the operation is done under hygienic conditions.
Myth:- The operation can be unsuccessful.
Fact:- The operation cannot be unsuccessful. There is a collection of sperm (male seeds) in the ducts that are discharged for three months after the operation. Therefore, contraceptive methods, such as condoms, should be used during this period.
This is a method of contraception that can be used after unprotected sex – whether in the absence of a contraceptive method or in instances where a contraceptive method has failed (a leaked condom, missed pill, etc.). Emergency contraception is not to be considered a regular method of contraception. It is essential to use a reliable contraceptive method and to be aware of the risks carried by unprotected sex, such as sexually transmitted infections and HIV/AIDS.
Methods of Emergency Contraception
There are two methods of emergency contraception that can be used.
Up to five days: Emergency Contraceptive Pills
Description: Also known (incorrectly) as the ‘morning after pill’, it must be taken within 120 hours (five days) of unprotected sex. A specially formulated emergency contraceptive pill, such as Postinor, may be taken.
Four pills from a regular monthly contraceptive pill packet, available at MSS centres and most pharmacies, can also be taken. The first dose should be taken as soon as possible after unprotected sex and a repeated dose should be taken after 12 hours.
The pills work by stopping an egg from being released, stopping the sperm from reaching an egg, or preventing a fertilized egg from settling in the uterus. A second pill needs to be taken immediately if vomiting occurs within two hours of taking the first pill. Some women may experience a change in their menstrual pattern or some irregular bleeding or spotting.
Availability: All MSS centres.
Effectiveness: It is 95% effective if taken within 24 hours after unprotected sex. Effectiveness reduces with the passage of time.
Up to five days: Intrauterine Device (IUD / Coil):
If it is too late for taking the emergency contraceptive pill, then an IUD, also known as a Coil, can be inserted/fitted up to seven days after unprotected sex to prevent pregnancy. The IUD works by preventing an egg from being fertilized or implanted in the uterus. The IUD can be left in as a form of regular contraception or can be removed when need be.
Description: An IUD (also known as a Coil) is a small plastic and copper device, usually shaped like a T (Copper T) or inverted U (Multiload), which is fitted into the woman’s uterus by a doctor using a simple procedure. It works by preventing an egg from settling in the uterus. An IUD can stay in place for five years (Multiload) or twelve years (Copper T).
Considerations: An IUD offers no protection from sexually transmitted infections and HIV/AIDS. It may cause heavier, more painful periods, which settle within three months of insertion.
Availability: All MSS centres.