Natural Methods of Contraception and Miscellaneous Method

Methods of contraception include oral contraceptive pills, implants, injectables, patches, vaginal rings, Intra uterine devices, condoms, male and female sterilization, lactational amenorrhea methods, withdrawal and fertility awareness based methods. These methods have different mechanisms of action and effectiveness in preventing unintended pregnancy. 

Effectiveness of contraceptive methods are measured by the number of pregnancies per 100 women using the contraceptive method per year. Methods of contraceptives are classified by their effectiveness as commonly used into:

1. Very effective : 0-0.9 pregnancies per 100 women.
2. Effective : 1-9 pregnancies per 100 women.
3. Moderately effective : 10-19 pregnancies per 100 women.
4. Less effectively : 20 or more pregnancies per 100 women.

In this chapter a detail of natural and miscellaneous contraceptives methods are given bellow.  

Abstinence

The only method of birth control which is completely effective is complete sexual abstinence. No sexual activity with the opposite sex means that there is no chance that a man's sperm can fertilize a women's egg.

Coitus Interruptus

This is the oldest method of voluntary fertility control. It involves no cost or appliances. It continues to be a widely practiced method. The male withdraws before ejaculation, and tries to prevent deposition of semen into the vagina. Some couples are able to practice this method successfully, while others find it difficulty to manage. 

The chief drawback of this method is that the precoital secretion of the male may contain sperm, and even a drop of semen is sufficient to cause pregnancy. Further, the slightest mistake in timing the withdrawal may lead to the deposition of a certain amount of semen. Therefore, the failure rate with this method may be high.

Safe Period/ Rhythm Method

This is also known a the "Calendar Method" first discovered by Ogino in 1930. The method is based on the fact that ovulation occurs from 12 to 16 days before the onset of mensuration. The days on which conception is likely to occur are calculated as follow.

Safe period in a 28-days cycle

The shortest cycle minus 18 days gives the first day of the fertile period. The longest cycle minus 10 days gives the last day of fertile period. The above picture shows the fertile period and the safe period in 28-days cycle.

However, where such calculations are not possible, the couple can be advised to avoid intercourse from the 8th to the 22nd day of the menstrual cycle, counting from the first day of the menstrual period.

Disadvantage of the Safe Period Method

1. A women's mensural cycles are not always regular. If the cycles are irregular, it is difficult to predict the safe period.
2. It is only possible for this method to be used by educated and responsible couples with a high degree of motivation and cooperation.
3. Compulsory abstinence of sexual intercourse for nearly one half of every month - what may be called "programmed sex".
4. This method is not applicable during the postnatal period.
5. High Failure Rate.

Natural Family Planning Methods

The term natural family planning is applied to three methods.

[A] Basal Body Temperature Method

[B] Cervical Mucus Method

[C] Symptothermic Method

The principle is the same as in the calendar method, but here the women employs self-recognition of certain physiological signs and symptoms associated with ovulation as an aid to ascertain when the fertile period begins. For avoiding pregnancy, couples abstain from sexual intercourse during the fertile phase of the menstrual cycle; they totally desist from using drugs and contraceptive devices. This is the essence of natural family planning.

Basal Body Temperature Method (BBT)

The basal body temperature method depends upon the identification of a specific physiological event - the rise of basal body temperature at the time of ovulation, as a result of an increase in the production of progesterone.

The rise of temperature is very small, 0.3 to 0.5 degree C. When no ovulation occurs (e.g. as after menarche, during lactation) the body temperature does not rise. The temperature is measured preferably before getting out of bed in the morning. 

The basal body temperature method is reliable if intercourse is restricted to the beginning of menstruation. The major drawback of this method is that abstinence is necessary for the entire pre-ovulatory period.

Cervical Mucus Method 

This is also known as "billings method" or "ovulation method". This method is based on the observation of changes in the characteristics of cervical mucus. At the time of ovulation, cervical mucus becomes watery clear resembling raw egg white, smooth, slippery and profuse.

After ovulation, under the influence of progesterone, the mucus thickens and lessens in quantity. It is recommended that the women uses a tissue paper to wipe the inside of vagina to assess the quantity and characteristics of mucus.

To practice this method the women should be able to distinguish between different types of mucus. This method requires a high degree of motivation than most other methods.

Symptothermic Method

This method combines the temperature, cervical mucus, and calendar techniques for identifying the fertile period. If the women cannot clearly interpret one sign, she can "double check" her interpretation with another. Therefore, this method is more effective than the "Billings method".

To sum up, natural family planning demands discipline and understanding of sexuality. It is not meant for everybody. The educational component is more important with this approach than with other methods.

Breast Feeding (Lactational Amenorrhea)

Field and laboratory investigations have conformed the traditional belief that lactation prolongs postpartum amenorrhea and provides some degree of protection against pregnancy. The effectiveness of lactational amenorrhea is no more than 2% of women conceive pregnancy if it is effectively used.

However, once menstruation returns, continued lactation no longer offers any protection against pregnancy. By 6 months after childbirth women are menstruating are in need of contraception.

Birth Control Vaccine

Several immunological approaches for men and women are being investigated. The most advanced research involves immunization with a vaccine prepared from beta sub-unit of human chorionic gonadotropin (hCG), a hormone produced in early pregnancy. Immunization with hCG would block continuation of the pregnancy. Antibodies appeared in about 4-6 weeks and reached maximum after about 5 months and slowly declined reaching zero levels after a period ranging from 6-11 months. The immunity can be boosted by a second injection. Two types of pregnancy vaccines employing variants of the beta sub-unit of hCG are now about to go into clinical trial. Research on birth control vaccines continues. The uncertainties are great.