THE USE OF BIRTH CONTROLS FOR WOMEN: IS IT MISLEADINGLY SAFE?

A.    Introduction

The World’s population has been significantly increasing year by year. Any country throughout the world has been striving to control its population growth. One of the popular ways of controlling it is by using a wide variety of birth controls consumed either by men or women. Various campaigns accessible to local communities to familiarize and persuade the people to use the birth controls have been carried out. Even the use of birth controls has been rolled out as a government-funded program, hence it has offered to those who cannot afford them. This has dramatically reduced the risk of having the population explosion.

However, the employed family planning methods have several profound effects on the users’ well-being, in particular women. This finding has raised important questions about the safety of the birth control use, notably for women. To attain safe motherhood, women have already been faced many other life-threatening health problems in relation to their fertility and childbearing.

Every year it is estimated that worldwide, more than 500,000 women die of complications of pregnancy and childbirth. At least 7 million women who survive childbirth suffer serious health problems and a further 50 million women suffer adverse health consequences after childbirth. The overwhelming majority of these deaths and complications occur mostly in developing countries (WHO, 2006).

The present paper addresses the questions of the safety of the use of birth controls for women. To be more specific, the paper extends the discussion of the following problems:

1.      What kinds of birth controls are typically used by women?

2.      What are the side-effects of the use of those birth controls?

3.      What is the safest family planning method for women?

B.     The Kinds of Birth Controls Typically Used by Women

           The birth controls or contraceptives may be employed either by women or men. Gerry et.al (1980: 513-523) has cited that women usually use the following contraception methods:

1.Oral Contraception

     In this contraception method, women are said to be ‘taking the pill’. The pill is a mixture of oestrogen and progestogen, or a progestogen alone, and is usually taken from the 5^th to the 25^th day of the cycle. The pill prevents ovulation. Moreover, changes in cervical mucus make sperm penetration less likely.

     Regarding the choice of pills, there are at least 24 different brands available, using different oestrogen (O) and/or progestogen (P) in different proportions, for instance, High O-high P, High O-medium , Medium O-low P, Low O-low P, and Progestogen only. The oral contraceptive pill has the failure rate of between 0 and 1 per cent. The pill is recommended for limited periods (up to four years) to any woman wishing to avoid pregnancy or to space her family (Brill, 2008: 22)

2.Contraception by Injection or Implant

     Medroxyprogesterone is an effective contraceptive agent, at a dose of 50 mg per month and an injection of 3 ml (150 mg) will give protection for three months. This drug is usually employed for short term contraception, perhaps when the patient is on the waiting list of sterilization.

3.Contraception by the Intra-Uterine Device (IUD)

     An Intra-Uterine Device (IUD) is made usually of polythene, or polythene and copper (gold, silver, and stainless steel have also been used. It is sufficiently flexible to be drawn an introducer for insertion into the uterine cavity.

     The “second generation” of IUDs uses a winding copper wire which is said to increase contraceptive efficiency. The most recent development is the chemical IUD with a silastic chamber containing 38 mg of progesterone which diffuses over a year into the uterine cavity. This is the equivalent of the progesterone-only oral contraceptive.

4.The Vaginal Diaphragm

     This is a rubber diaphragm which when smeared with spermicidal cream will prevent sperms from reaching the cervical canal. The diaphragm must not be removed until six hours after intercourse. If intercourse is repeated in that period more cream must first be injected with an applicator.

5.The Vaginal Spermicides

     Spermicidal creams, gels, pessaries or aerosols can be inserted directly into the vagina. One dose of spermicide must be injected before each act of coitus. The method is not completely reliable, but simpler in practice than the previous diaphragm.

6.The Rhythm Method

     The Rhythm Method means the avoidance of coitus around the time of ovulation. In this case, the woman must take her temperature every morning, watching for the sustained rise which indicates ovulation. Once she has established her normal rhythm she may assume that ovulation occurs between say the 12^th and 14^th days. Another day is added to allow for ovum survival, and as sperms may live for at least 3 days, coitus must be avoided from the 9^th to the 18^th day; and the 7^th to 20^th day would be safer.

7.The Surgical Sterilization

     In this case, the woman may need a surgical measure to prevent her from getting pregnant.

In comparison, the contraception used by men includes:

1.The Coitus Interruptus

      This means withdrawal of the penis just before ejaculation. It is widely practiced and probability adequate for couples of low fertility. In this instance, however, some sperms must enter the vagina and withdrawal at the point of orgasm is unnatural.

2.The Sheath (Condom)

      This is a thin rubber sheath that fits over the penis. It interferes with sensation and is liable to come off as the penis withdrawn after the act. Yet it is a very efficient method if used correctly.

3.The Vasectomy

      The vasa deferentes can be divided by a simple operation done under local anaesthesia. It takes several months to become clear of sperms. It may then take a year before the ejaculate is completely sperm free.

C.     The Side-Effects of the Use of The Birth Controls by Women

Despite evaluating the contraception methods widely considered to be optimal in almost all women and men, the frightening reality is that more and more women have been suffering from hazardous effects of the long-termed use of those birth controls (Philip, 2008: 22). The following reveals the side-effects of using the birth controls by women (Garrey, et.al, 1980: 513-523):

1.      The Oral Contraception

Despite the fact that the oral contraceptive pill is the most acceptable method, it may bring about potential harmful effects. Those effects are impossible to predict in the individual, however, from many studies that have been conducted, certain trends become evident. The effects cover:

a.      The Vascular Disease

The pill-takers run a four times increased risk of myocardial, cerebral, and even mesenteric infraction and deep vein thrombosis. The risk is increased by heavy smoking, hypertension, obesity, and diabetes.

b.      The Tumor of the Liver

The risk of developing this very rare tumor is increased by about four times after five to seven years of pill-taking.

c.       The Reduction in Vitamin Levels

Depression and impaired glucose tolerance due to B₆ deficiency and anaemia due to folic acid deficiency, are known to occur. B₂, B₁₂ and C are also depressed. This may be serious in malnourished women.

d.      The Effect on Cervical Glandular Epithelium

There is no increased risk of breast or cervical cancer, but there is a tendency stimulation of the cervical glandular epithelium which may be undesirable.

In addition, according to Harimurti (2008: 12) one of the contributing factors of a congenital heart disease is the use of oral contraceptives by the mother.

2.      The Contraception by Injection or Implant

Progesterone side-effects such as menstrual irregularities, depression and loss of libido tend to be experienced. Moreover, change in hair growth and bone mineral change (may increased risk of osteoporosis) may also occur.

3.      The Contraception of the Intra-Uterine Device

Polythene IUDs tend to cause rather heavier periods, and potentially-increased liability to infection. In addition, it is at present under suspicion of contributing to an increase in tubal pregnancy.

4.      The Vaginal Diaphragm (‘Dutch Cap’)

It is less efficient than oral contraceptives or IUDs unless used strictly according to instructions. However, it still produces some side-effects, such as Toxic Shock Syndrome, possible allergic-reactions to the rubber, vaginal infections or irritations, vaginal discharge, spotting between periods, elevated blood pressure, darkening of skin, and acne worsening.

5.      The Vaginal Spermicides

The repeated and long-term use of such chemical substances will make the woman at risk for acquiring infections and subsequent diseases associated with the remaining substances in her body. This persistent infection may develop cervical, vulvar, or vaginal diseases.

6.      The Rhythm Method

This semi-celibacy is unreliable because it depends too much on regularity of ovulation.

7.      The Surgical Sterilization

Some women may experience pain at the surgical site. Possible risk of octopic (tubal) pregnancy may also occur. Psychological reactions such as regretting are possible as well.

D.    The Safest Family Planning Method for Women

Based on the previous discussion, to fully assess the long-term safety of the use of the contraception methods, a more thorough study is required to guarantee that they will, in the long run, remarkably safe for women. Furthermore, many women are still unaware of the health consequences and this lack of knowledge may increase the rapid rise in women’s mortality. This has raised a question about what sort of family planning method that is truly safe and harm-free for women.

To start with, let us have a look at the comparative failure rates of different Methods of Contraception summarized in the following table:

Figure 1: The Comparative Failure of Different Methods of Contraception

No	Methods of Contraception	Failure Rates (%)
1	Oral Contraceptives/Injection/Implant	1
2	Vasectomy	1
3	IUD	3
4	Condom	13
5	Diaphragm	14
6	Withdrawal	18
7	Spermicides	24
8	Rhythm Method	35
9	No method	85

                                                                        (Yulia, et.al., 1999: 68)

These failure rates are based on the failure rate on the number of pregnancies per 100 women per year. These figures are very approximate.

Based on this table, it seems obvious that the safest method best offered to women is the one(s) that has the least effects on the women’s wellness even though it affects the couple’s sexual wellness. They include the rhythm method, the withdrawal, or no method at all. Last but not least, the couple should give up themselves to The Almighty God and let Him decide what will happen to both of them; whatever will be, just will be. They may enjoy their making love without any fear of getting pregnant. Even when they fail or get pregnant, God will always turn unto them and reach out His helping hands. God is the Most Knowing and Wise. By doing so, why should we worry?

E.     Conclusion

In a review of the previous discussion, it is clear that each method has its own strengths and weaknesses. A contraception method may be safe and fits to some people but not safe and does not fit to other people. However, the safest contraception method for women is those which do not expose a multiple-risk factor harmful for the women themselves. Before making a decision on what method is going to be employed, the women and their sexual partners need to have open and mutual discussions and to eventually find the best solution to reduce the risk of deadly health consequences the women, in particular, may have.

To achieve safe motherhood that will lead to the family wealth and prosperity, the women are the most crucial factor that should be considered most. It is very important to remember that health education is a critical component in the prevention and managements of women’s risk factors. Extending reach to the lay public will help to raise the awareness of such side-effects of the birth controls. Accordingly, taking all of this into account, this will no longer mislead the people that the birth control methods will only bring about minor ones.

 Finally, it is therefore crucial to ensure that this knowledge is disseminated through every possible avenue. Though it is still a challenge for government and education policies, health care providers and the wider community as well, we need to be optimistic.

REFERENCES

Brill, David. 2008. Tainted illegal sex drugs caused extensive permanent brain damage. In Medical Tribune, December edition, p. 22. Hong Kong: CMPMedica.

Garrey, Matthew M., Govan, A. D. T., Hodge, Colin, and Callander, R.1980. Obstetrics Illustrated: Third Edition. London: Churchill Livingstone, Medical Division of Longman Group Limited.

Harimurti, Ganesja M. 2008. Deteksi Dini Penyakit Jantung Kongenital. Paper presented in 20^th Weekend Course on Cardiology (WECOC) on 7-8 November 2008. Jakarta: the Department of Cardiology, Medical Faculty, University of Indonesia.

Philip, Richard. 2008. Ovarian cancer screening still questionable. In Medical Tribune. December edition, p. 22.  Hong Kong: CMPMedica.

WHO. 2006. Foundation Module: The midwife in the community: Education    material for teachers of midwifery. Geneva: Department of Making Pregnancy Safer Family and Community Health.

Yulia, Toto, Hidayat, and Liwandaw, Hellen. 1999. Kesehatan Keluarga: Penuntun Kesehatan bagi Setiap Keluarga. Jakarta: PT. Mediprom.