Biology and Health Sciences

Key unit competency 

To be able to apply the knowledge of pregnancy prevention in sexual and reproductive decisions.

Learning objectives 

After studying this unit I should be able to: 

• Identify effective ways of preventing unintended pregnancy. 

• Outline forms of contraceptive methods and their working mechanisms. 

• Demonstrate confidence in discussing different contraceptive methods. 

• Design and illustrate a model that shows efficient use of male and female condoms. 

• Appreciate the importance of making informed choices about reproduction and family size. 

• Recognise the benefits of child spacing. 

Introduction 

From what you learnt in Unit 14 can you list some of the things that entail good sexual behaviour? Assuming that you have a friend who engages in bad sexual activities, which are some of the risks that face them? How can they avoid such risks? Look at the pictures below. What are the things in the picture used for? Are they good or bad?

15.1 Contraceptives 

Pregnancy can occur when it is not planned for or expected. This is always the case, for example, during rape. 

Research Activity 

1.  Using textbooks and the internet research on the following: 

2. Share your findings with the rest of the class.

Contraceptives are the things that are used to prevent occurrence of pregnancies. 

Common myths about contraceptives 

i. Birth control pills make women gain weight and can cause cancer. 

ii. The birth control pill has to be taken at the same time every day. 

iii. Mothers who breast feed do not need to be on birth control pill. 

iv. Being on the pill for a long time makes it harder to get pregnant later. 

v. Newer forms of birth control methods are not as safe as the older ones. 

vi. Intra uterine device (IUD) should be used by women who already have children. 

vii. It is unhealthy to use birth control to skip your period. 

viii. A girl cannot get pregnant when she has sex for the first time.

Importance of using contraceptives 

Family planning involves using birth control methods to decide how many children to have and when to have them. It allows couples to have their desired number of children, and control the spacing and timing of their births.

Maternal health refers to the health of women during pregnancy, childbirth and after delivery. A woman's ability to space and limit her pregnancies has a direct impact on her health and well-being, as well as on the outcome of each pregnancy. By reducing unintended pregnancies and abortions, and facilitating family planning or spacing of births, effective contraception provides both health and social benefits to mother and her children 

Discussion corner 

1.  Discuss the following with your classmates. 

2. Write your findings in your notebook. 

3.  Share your findings with the rest of the class.

15.2 Natural contraceptives

Natural family planning methods relies on knowledge of the menstrual cycle of the woman. This knowledge enables couples to avoid having sex when the woman is fertile. Natural birth control methods teach women to determine the fertile phase of their menstrual cycle. To avoid pregnancy, women avoid intercourse on their fertile days. In order to effectively use the method, a woman needs to accept responsibility for charting and interpreting her fertility on a day-to-day basis. 

Advantages of natural contraception 

a) Effective method of birth control. 

b) Have no negative health side effects. 

c) An alternative for women who cannot or do not want to use hormonal methods. 

d) Promotes positive body awareness. 

e) Consistent with many religious beliefs and lifestyles. 

f) Alerts women to reproductive health and fertility concerns. 

g) Fosters communication between partners and encourages male involvement. 

Disadvantages of natural contraception  

a) Provides no protection from sexually transmitted infections. 

b) Often difficult to find trained instructors. 

c) Requires time to learn (usually 3 to 6 cycles). 

d) Requires discipline and commitment to chart fertility signs and follow the rules to avoid pregnancy. 

e) Times of abstinence from intercourse may be a challenge for some couples. 

Types of natural contraception 

a)  Abstinence 

Sexual abstinence is the avoidance of vaginal intercourse. It is very effective for preventing unwanted pregnancy and sexualy transmitted diseases. It allows couples to engage in other forms of sexual expression.

Advantages of abstinence 

a) Minimal risk of misuse. 

b) Prevents transmission of STIs including HIV and AIDS. 

c) No physical side effects. 

d) No need to visit a health care provider. 

e) No cost involved .

There are no disadvantages of abstinence so long as a couple is able to maintain a fulfilling relationship without the need for penetrative sex. 

b)  Lactation Amenorrhea Method (LAM)

Lactation Amenorrhea Method (LAM) is used by a mother who has just given birth and is exclusively breastfeeding. This method is highly effective for the first six months after childbirth.  The mother has to breastfeed the baby at least every four hours during the day and every six hours through the night. She also has to be aware of her menstrual period. After six months fertility may return at any time. 

c) Temperature method 

Temperature method is also known as the basal body temperature method. It is a type of natural family planning where a woman measures her basal body temperature: temperature when fully at rest especially after waking up. It is believed that ovulation may cause a slight increase in basal body temperature. Elevated waking temperature for three days in a row is considered confirmation of the post-ovulatory less fertile phase. 

d)  Calendar method 

Calendar method is also known as Rhythm method or cycle beads. It is a much less effective natural birth control method. It predicts a woman’s fertile days using calculations based on the length of past cycles and not daily observations of fertility signs.

f)  The Billings Ovulation Method 

This is a natural method of fertility management. It enables a woman to recognise her body's natural signal of fertility through production of cervical mucus.  The cervix produces different types of mucus in response to changing hormone levels. Once a woman is familiar with these changes they are able to identify their patterns of fertility and infertility in their cycle.

 Advantages  

It allows a woman to understand her fertile and infertile days and helps to safeguard the woman’s reproductive health.  

Disadvantages 

It is not an effective method since the body system can fail. 

Self-evaluation Test 15.1 

1.  _________ is the avoidance of vaginal intercourse. It is the most effective _________ family planning method. 

2.  List down the misconceptions you have heard about birth control methods.

15.3 Artificial contraceptives 

Activity 15.1: Observing artificial contraceptives 

1.  You will be given models of artificial contraceptives. 

2.  Observe the models. 

3.  Share your findings with the rest of the class. 

Artificial birth control is any product, procedure or practice that uses artificial or unnatural means to prevent pregnancy. Barrier methods such as condoms and diaphragms, hormonal methods such as the pill and IUDs, and surgical sterilisation procedures such as vasectomy or hysterectomy are all artificial birth control methods. Most types of artificial contraceptives work by: 

• Preventing an egg from being released every month (hormones). 

• Preventing sperms from reaching the egg (barrier and some IUD methods). 

• Blocking the reproductive function  in men or women (sterilisation). 

• Preventing a fertilised egg from implanting in the uterus (hormones).

Barrier methods 

a) The male condom 

This is a thin rubber sheath worn by a man over an erect penis. It collects semen at its tip so that they are not released into the vagina. Condoms are usually made of latex. It is the most used contraceptive. 

Advantages 

Disadvantages 

b) The female condom 

This is a loose rubber fitting with two flexible plastic rings on either ends. It is inserted into the vagina before sexual intercourse. 

It offers 95% effective protection against pregnancy, as well as some protection against STIs. Female condoms are generally more expensive than the male ones but they are less likely to burst. They can be inserted up to eight hours before sex. 

c) Spermicide 

Spermicide is a birth control method that contains chemicals that stop sperms from fertilising the ova. Spermicides are available in different forms, including creams, film, foams and gels. Spermicide can be used alone, or it can be used with other birth control methods such as diaphragm, to make them more effective. 

Spermicide does not always offer the best protection against pregnancy. It has very few associated side-effects, but it does not protect against STIs. 

d) The Diaphragm

This is a rubber cap inserted into the vagina to cover the cervix. It prevents sperms from entering the uterus.  Diaphragm should be used together with spermicides which kill the sperms. It is inserted at least six hours before sex and it needs to be removed after 24 hours for cleaning. Depending on the material and type of the diaphragm, it can be reused many times.

The diaphragm does not protect against STIs and a doctor is needed to direct on how it should be used.

Hormonal based contraceptives 

This is the use of a mixture of artificial hormones resembling oestrogen and progesterone. They are administered in three ways: 

a)  The Pill 

It is the most popular form of female contraception. It is taken orally in form of a tablet, every day at almost the same time. 

The contraceptive pill will prevent pregnancy 95%. It comes close to providing 99% protection if one pill is taken every day as prescribed. 

The pill does not provide any protection against STIs and a doctor's prescription is required to buy it.

b) Contraceptive Injections 

This is an injection that contains artificial progesterone (progestin). One shot of hormones lasts in the body for 8 to 12 weeks (3 months) and has the same effect as the pill. 

Injections are about 99% effective. It fails if the user forgets to renew the contraceptive shot in time. However, once the shot is given, it cannot be reversed. One becomes effectively infertile for the next three months. Just like the pill, contraceptive injections do not protect against STIs. 

c)  The contraceptive implant 

The implant offers long term protection. It lasts for about three years on average. The contraceptive implant contains progestin (progesterone), the same hormone as the contraceptive pill. The hormone is released into the body at a steady, slow pace for three years, producing the same effects as the pill.

The implant is inserted in the arm by a doctor and must be removed after three years. Since the risk of human mistake is ruled out, the implant has a much higher effectiveness rate than the pill around 99.99%. The implant does not protect against STIs.

d)  The vaginal ring 

The vaginal contraceptive ring is a small, transparent plastic ring that is inserted in the vagina and kept for three weeks. It is removed during monthly periods and replaced with a new one after that. 

The ring contains the same hormones as the contraceptive pill (progesterone and oestrogen), therefore providing the same kind of effective protection. A doctor's prescription is required and just like other hormonal contraception, the vaginal ring does not protect from STIs. 

e) The contraceptive patch 

The contraceptive patch is exactly the same thing as the contraceptive pill but in the form of a patch. It provides the same effective protection against pregnancy. It does not protect from STIs. There is however a risk of skin irritation, and a (rare) chance that the patch accidentally comes off.

f) Emergency contraception 

Emergency contraception assists to stop pregnancy in cases of eventualities such as rape or unprotected sex. This method is for one-off occasions and is not recommended for daily use. After 72 hours (3 days) the effectiveness drops to below 50%. 

Non – hormonal based contraception methods 

a)  The Intrauterine Device (IUD) 

An intrauterine device (IUD or coil) is a small contraceptive device, often 'T'shaped. It often contains either copper or hormones. It is inserted into the uterus. It offers   long-acting reversible contraception. Therefore it is the most effective type of reversible birth control.  It is kept inside the vagina for up to five or ten years.

The effectiveness rate for IUDs is above 99%. However, it provides no protection against STIs. It requires a doctor to properly insert it and to make periodic follow ups. 

b) Permanent contraception methods 

Sterilisation 

Sterilisation is a procedure that closes or blocks fallopian tubes in women and sperm duct in men. This prevents movement of the ova and sperm respectively. Sterilisation is an option available to both men and women. 

i)  Vasectomy 

This involves tying off and cutting the tubes that carry sperms; the vas deferens. It provides no protection against STIs and the effects are permanent. In very rare cases (less than 1%), the tubes can grow back, making pregnancy a risk.

ii) Tubal ligation 

• Surgical sterilisation:  This involves cutting and tying the fallopian tubes so that they cannot link the ovaries with the uterus any more. The effects are permanent.

•  Non-surgical sterilisation: This involves placing a coil in each fallopian tube through the vagina and uterus.  Scars appear and eventually block each tube completely. The scars may take up to 3 months to completely block the tubes, so you need to use another method of contraception in the meantime. 

Both options also offer more than 99% of protection against pregnancy. In rare cases the blocked tubes can grow back and reconnect. However the method offers no protection against STIs. 

Discussion corner 

1. Discuss with your classmates about abortion and menopause in relation to pregnancy conception. 

2.  Share your findings with the rest of the class.

Abortion 

Abortion is the deliberate process of prematurely terminating a pregnancy usually before the embryo or foetus is capable of independent life. Depending on the number of weeks it has, a pregnancy can be terminated either by taking medication or through a surgical procedure. 

The following are some of the reasons why a woman might decide to have an abortion:

• Personal circumstances including risk to the wellbeing of existing children. 

•  Health risk to the mother. 

• A high chance that the baby will have a serious abnormality either genetic or physical. 

Menopause 

This is a term used to describe that state when a woman stops having monthly periods and is no longer able to get pregnant naturally. Monthly periods become less frequent over a few months or years before they stop altogether. In some women they stop abruptly. 

Most women will experience menopausal symptoms. Some of these can be quite severe and have a significant impact on a woman’s everyday activities. Common symptoms include: 

Menopausal symptoms can begin months or even years before the periods stop. They can last around four years after the last period, although some women experience them for much longer. 

Self-evaluation Test 15.2 

1.  Should abortion be allowed for unwanted pregnancies in teenagers? 

2. Why are spermicides not good for preventing pregnancy? 

3. The following are artificial contraceptives. 

Male and female condoms, diaphragm, implants, the pill and spermicides 

Identify the ones that require a doctor’s prescription.

Unit summary 

• Contraceptive is a device or drug that serves to prevent pregnancy. 

• Sexual abstinence is a choice not to participate in any sexual contact. The choice is usually made for a specific moral, religious, legal or health reason. 

• There are a number of birth control methods that are highly effective in preventing pregnancy. There is also a lot of misinformation about how to use birth control, as well as some methods that simply do not work. 

• Natural family planning methods work by observing and recording the body’s different natural signs or fertility indicators on each day of the menstrual cycle. 

• Natural family planning methods include: calendar methods, lactation amenorrhea, billings and withdrawal method.

• Artificial birth control methods include barrier methods, hormonal based, non-hormonal and permanent contraceptive methods. 

• Abortion is the deliberate termination of pregnancy, most often performed during the first 28 weeks of pregnancy. 

• Menopause is the cessation of menstruation. It is the period in a woman's life (typically between 45 and 50 years of age) when this occurs.