Explore the connection between birth control and female health with Meri Sehat. Prioritize informed choices for reproductive well-being.

Birth Control: The Female Prerogative, Female Health

Introduction

Despite advancements in modern medicine, prophylactic administration is a concept less practiced in current-day Pakistan. As is the case in the rest of the world, <a href="https://www.merisehat.pk/article/im-a-heart-patient-are-oral-contraceptive-pills-safe-for-me">contraceptive</a> measures, maternal medical assistance, and infant health care are fundamental for safeguarding the strength and wellbeing of Pakistani women, their families and wider communities.

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Statistics from comprehensive surveys in 2017 have found that women in Pakistan have an average of 3.8 million accidental pregnancies every year<a href="#accordion">[1]</a>. A vast majority of these pregnancies result from the lack of accessibility to modern contraception methods<a href="#accordion">[1]</a>.&nbsp;

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Approximately 52% of married women of reproductive age (15-49 years) in Pakistan, who want to avoid pregnancy, are unaware of available contraceptive methods<a href="#accordion">[1]</a>. Fulfilling these contraceptive needs can help cause 3.1 million fewer accidental pregnancies per year, 2.1 million fewer pregnancy terminations, and almost 1,000 fewer maternal deaths<a href="#accordion">[1]</a>.&nbsp; 
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Understanding Female Contraceptives

According to health reports by the state capital, female sterilization and condoms rank above other commonly practiced contraceptive strategies in Pakistan, representing 71% of all the methods common amongst married women<a href="#accordion">[2]</a>. Moreover, 10% of married women depend on injectables, 9% on IUDs, 7% on the pill, and 2% on the implant<a href="#accordion">[2]</a>. 
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<h5>1. Female&nbsp;Sterilization (Tubal Ligation)</h5>

Sterilization also referred to as tubal ligation is the most effective method of preventing unplanned pregnancies, since it&rsquo;s a permanent solution. The surgery involves cutting the fallopian tubes, or obstructing their path by sealing them<a href="#accordion">[3]</a>. In general language, it is occasionally alluded to as getting your reproductive ability limited. The surgery is performed via a minimally invasive medical procedure called laparoscopy. Therefore, it can be conducted soon after a vaginal delivery or a cesarean delivery (commonly known as a C-section).&nbsp;

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Nonsurgical methods include the insertion of devices within the fallopian tubes to seal them. These devices are placed through the vagina and uterus, and the arrangement can proceed manually without the need for an incision. This intercepts the egg from travelling to the uterus and holds the sperm back from entering and fertilizing the egg. By acting as an impediment to fertilization, the individual is unable to conceive<a href="#accordion">[3]</a>. In Pakistan, women generally opt for tubal ligations after exceeding the age of 30 and conceiving six children. More factors, such as urban residence, can also increase its probability. However, due to its nature of irreversibility, tubal ligation is a last resort and cannot be considered a viable contraceptive method<a href="#accordion">[4]</a>.&nbsp;&nbsp;

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<h5>2. Injectables</h5>

The contraceptive injection Femiject and Novaject discharges the hormone progestogen into your circulatory system<a href="#accordion">[5]</a>. The hormone progestogen prevents unwanted pregnancies by delaying ovulation. Moreover, it thickens the cervical bodily fluid, making it hard for the sperm to travel through the cervix. And it diminishes the uterine lining, so a fertilized&nbsp;egg is less inclined to embed itself<a href="#accordion">[6]</a>. These are normally injected in an individual&#39;s bottom, but can be administered in the upper arm as well.&nbsp;

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According to research, injectable contraceptives can be actively recommended due to their promising continuation rate, signs of contentment, and bleeding profile of combined injectable contraceptive (CIC) users<a href="#accordion">[7]</a>. However, such contraceptives only last for a limited duration, ranging from 8 to 13 weeks. Additionally, they are unable to protect against sexually transmitted diseases, and some individuals may witness a gain in weight after switching to injectable contraceptives.

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<h5>3. IUDS&nbsp;</h5>

Called an intrauterine device, it is carefully inserted inside an individual&#39;s uterus<a href="#accordion">[8]</a>. IUDs generally have a long active period. Non-hormonal copper IUD (ParaGard) can last up to 10 years, while <a href="https://www.merisehat.pk/article/what-is-hormonal-acne">hormonal</a> IUDs should be replaced after 3-5 years. The two kinds of IUDs make it harder for sperm to fertilize&nbsp;the egg.&nbsp;

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Less than 8 out of 1,000 women with IUDs get pregnant<a href="#accordion">[8]</a>. They are preferred by women all around the world because of their low maintenance, and the association with lighter and shorter menstrual cycles. However, IUDs are not the most affordable contraceptive method. Moreover, copper IUDs are more painful and can also disrupt menstrual cycles.&nbsp;

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The Marie Stopes Society set out its portable outreach service program to encourage and expand the current demographic of users of IUDs, and to improve the accessibility of quality contraceptive administrations. The program is especially aimed at women residing in difficult and inaccessible regions. Medical care professionals ought to be prepared in dealing with clients&#39; concerns about the IUDs, and provide alternates in case they choose to discontinue<a href="#accordion">[9]</a>.&nbsp;

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<h5>4. Birth Control Pills</h5>

There are two main types of birth control pills readily available in Pakistan:

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<ul>
	<li>Combination Pills</li>
</ul>

The combination oral contraceptive pill (COCP) likewise alluded to as &quot;the pill&quot; is a contraception pill that constitutes a blend of two engineered hormones, estrogen and progestin<a href="#accordion">[10]</a>. They are generally taken daily, for 28 days to resemble the period of an average cycle for a woman. However, before jumping on the COCP bandwagon, it is important to consult with a gynecologist to discuss the dose of such pills, the preferred brand, and the period of use to ensure maximum viability. Common COCPs in Pakistan include Diane-35 which may also be prescribed to regulate polycystic ovarian syndrome (PCOS) symptoms such as excessive hair growth (hirsutism) and cystic acne<a href="#accordion">[11]</a>. COCPs are productive and convenient, and if administered properly, can be 91% effective, considering possible human errors such as missed doses<a href="#accordion">[10]</a>. However, they do not protect against sexually transmitted diseases (STDs) and may lead to breast tenderness in some individuals. 
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<ul>
	<li>Progestin-Only pills</li>
</ul>

One more kind of contraception pill is the progestin-only pill (POP), also known as the mini-pill<a href="#accordion">[10]</a>. Contrary to its equivalent, this conception prevention pill is just comprised of progestin. This is an efficacious method of contraception, especially in women who are unable to naturally produce estrogen because of health complications. Apart from a few exceptions, a wide variety can select the scaled-down pill as their favored conception prevention strategy. Additionally breastfeeding women favor the mini-pill as it is known to influence breast milk supply<a href="#accordion">[10]</a>. Gynecologists may prescribe any POP which is readily accessible in most pharmacies in Pakistan. Adverse side effects may include weight gain, nausea, breast tenderness, and increased blood glucose levels<a href="#accordion">[11]</a>. 
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<h5>5. Implants</h5>

Norplant sub-dermal implant system spans a thorough and protracted duration. Developed by the International Committee for Contraception Research (ICCR) of the Population Council, the implant provides a conveniently reversible and promising contraceptive option<a href="#accordion">[12]</a>.&nbsp;

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It comprises six adaptable enclosed capsules made of Silastic (dimethyl siloxane/methyl vinyl siloxane copolymer). The intention of inserting the Silastic cases under the skin assists with guaranteeing that they can be eliminated effectively later, if the individual chooses to discontinue.&nbsp;

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Once the doctor has effectively placed all the six capsules and they are set up, the healthcare professional conducting the procedure closes the point of incision with the help of a cement bandage. No stitches are required, and dressing over the whole region with compresses and gauze is purely for the prevention of possible infections at the site of entry. The entire procedure generally requires 8-10 minutes<a href="#accordion">[12]</a>. However, implants are not the most sustainable form of contraception as each implant is expensive, may influence menstrual cycles, and does not protect from sexually transmitted infections (STIs).

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Despite Pakistan generously and liberally disbursing an average of US$81 million every year on contraceptive administrations, there remains an inexplicable gap in such services reaching pertinent individuals<a href="#accordion">[1]</a>. While critics would hold this evident deficit as a reflection of the annual insufficiency of US$92 million to cater to the magnitude of the situation, there are deeper, and more intricate factors that hinder a woman&rsquo;s prerogative to choose a contraceptive method.&nbsp;

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A detailed research study highlighted six major obstacles that may hinder or result in unprecedented hesitation to use contraception<a href="#accordion">[13]</a>. Such impediments included:

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(i) A woman&rsquo;s reluctance to delay pregnancy as an ode to motherhood

(ii) Lack of sufficient knowledge and awareness of contraception

(iii) The societal stigma associated with contraception

(iv) Priority of a husband&rsquo;s desire and preference

(v) Perceived myths of health risks due to contraception

(vi) Inaccessibility to affordable and quality contraceptive services.

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Conclusion

If the above concerns are responded to through an erudite discussion, and in a compassionate tone, then more women will practice healthy methods of family planning and contraception.&nbsp;

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This could curb the exponential population growth, the extrapolating economic crisis of an average family, and diminish the increasing health risks associated with unplanned pregnancies.

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[1] Sundaram, A., Hussain, R., Sathar, Z. A., Hussain, S., Pliskin, E., & Weissman, E. (2019, September). Adding It Up: Costs and Benefits of Meeting the Contraceptive and Maternal and Newborn Health Needs of Women in Pakistan.

[2] National Institute of Population Studies (NIPS). (2019). Pakistan Demographic and Health Survey 2017-2018. Islamabad: NIPS and ICF.

[3] Brito, J. (2018, September 27). What Every Woman Should Know About Female Sterilization. Healthline.

[4] Khan, A. A., Khan, A., Abbas, K., Tirmizi, S. F., & Islam, Z. u. (2013). Specific Issues in Family Planning in Pakistan. Journal of the Pakistan Medical Association, Volume 63, Issue 4.

[5] Greenstar. (2022). Injectables.

[6] NHS. (2018, February 7). The contraceptive injection.

[7] Izhar, R., Husain, S., Tahir, M. A., & Husain, S. (2020). Femiject, a once-a-month combined injectable contraceptive: experience from Pakistan. The European journal of contraception & reproductive health care: the official journal of the European Society of Contraception, 25(5), 359-364.

[8] Johnson, T. C. (2020, May 6). What Are Your Birth Control Options? WebMD.

[9] Azmat, S. K., Hameed, W., Mustafa, G., Hussain, W., Ahmed, A., & Bilgrami, M. (2013). IUD discontinuation rates, switching behavior, and user satisfaction: findings from a retrospective analysis of a mobile outreach service program in Pakistan. International journal of women's health, 5, 19–27.

[10] Oladoc. (2022, January 26). Birth Control Pills in Pakistan: Here’s What You Need to Know.

[11] Anwar, O. (2022, June 16). Everything You Need to Know About Birth Control Pills in Pakistan. Healthwire.

[12] Shamim, N., Rehan, N., & Inayatullah, A. (1994). Use of Norplant in Pakistan: Two Years Experience. Journal of the Pakistan Medical Association, Volume 4, Issue 1, 3-7.

[13] Casterline, J. B., Sathar, Z. A., & Haque, M. (2001). Obstacles to Contraceptive Use in Pakistan: A Study in Punjab J. Studies in Family Planning, Volume 32, 95-110.

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