Why a family planning method may fail

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By Joan Salmon

About 53 per cent of unplanned pregnancies occur among women using contraceptives. Dr Susan Atuhaire, a gynaecologist at Mulago National Referral Hospital, says most of these methods will fail if someone does not follow the instructions.
There are several birth control methods and to better cover them, we bundle them in groups such as barrier methods and surgery, among others.

Barrier methods
Dr Paul Kato, an obstetrician and gynaecologist at Span Medical Centre, says these include male and female condoms, cervical caps, diaphragms, and spermicides. He says some of the problems here include placement.
“Caps must be inserted by a qualified personnel. Also, if the wrong size is used, it becomes ineffective as there is no one-size-fits all,” he says adding that a woman should also consider the time factor because if a cap is inserted immediately after delivery, it will be displaced by the blood flow.

Dr Atuhaire says spermicides are also crucial in the performance of caps as they are supposed to be put on the outside of the caps. If they are not applied, sperms that have escaped the cap could fertilize the ovaries. A user also needs to be cautious because leaving a diaphragm or cervical cap in for longer than 24 hours increases your chances of getting toxic shock syndrome, a rare, life-threatening complication of certain bacterial infections.

Condoms
While commonly used, many do not care to look at the expiry date. However, if used past their expiry date, they are ineffective. According to Dr kato, application is also worth considering. “A male condom should only be worn when the penis is erect and the tip must be pressed before use to remove air and roll it to the shaft lest it rolls back during intercourse. Otherwise, poor application will cause situations such as bursting,” he says. Additionally, if the penis remains in the vagina long after ejaculation, there are chances of the condom rolling off causing sperm spillage hence conception.

Spermicides
Some people are allergic to the major ingredient in most; nonoxynol-9, hence developing sores in the vagina or on the penis. This makes one susceptible to HIV transmission during sex in case of an infected partner.
However, one cannot use caps without spermicides, therefore, a person who is allergic to them should opt for another method.

Awareness methods
“These are ideal for those with regular periods,” Dr Atuhaire advises. They include moon beads which she says if someone forgets to move the ring hence miscounting, they can easily get pregnant.
There are also safe days. Here Dr Atuhaire says one can only use them if their cycle is between 26 and 32 days. If your cycle is less that 26 or more than 32 days, then chances are high that it will not work.

Another method here is the 2-day method. “In this method, the woman keeps checking their vaginal secretions and for everyday that they feel the secretion and the next day, chances of getting pregnant are high,” Dr Atuhaire explains.
However if they get an infection, it becomes difficult to differentiate the normal virginal secretion from that caused by the infection hence cannot tell between the dry and wet days. So it is very easy for one to conceive.

Ovulation
“It works by a woman monitoring the times when they feel pain on one side of the body,” Dr Ssewagude elaborates adding that if one has sex, three days before their ovulation, they can conceive there is still sperm in the pelvis.
He also advises couples to avoid having sex two days after ovulation because the egg remains in the reproductive system for 48 hours.

Intra-Uterine Device

Dr Herman Ssewagude of 7 Hills Medical Centre, says in Uganda, the most common method is the Intra-Uterine Copper Device. It can fail due to poor insertion. This device is placed in the upper cervix. However, if it moves to the lower cervix, protection reduces.
Poor insertion causes dislodging. It could also fail when one continuously touches the strings causing dislodging. Women with a heavy period might also find it ineffective because it can sometimes get pushed by the blood.

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