All Things CoNtRaCePtIoN

1. What is contraception?

Contraception also known as birth control is “any method, medicine or device used to prevent pregnancy.”[1] There are different types of preventing with different methods, all are free in South African public hospitals and some medical aids cover them. Some are available over the counter at trusted local pharmacies.

2. Female Contraception available in South Africa

Short- acting methods[2]

· Progesterone only pill: does not contain estrogen for effective results it must be taken at the same time every day. It is for breastfeeding females that are restricted by medical reasons in taking the combined pill.

· Patch: Cream applied to the belly, upper back and arm. Contains both progesterone and estrogen, applied weekly.

· Injection: Contains progesterone for effective prevention of ovulation, shot must administered every 2-3 months.

· Combined pill: A combination of estrogen and progesterone that prevents the ovulation process, must be taken at the same time daily.

Long- acting methods[3]

· Implant: plastic rod inserted under upper arm skin, working like a hormonal IUD releasing progesterone, preventing sperm access to uterus and preventing ovulation. It lasts for 3-5 years, fitted in one required visit to the clinic and is non-invasive.

· Copper IUD (Intrauterine device): An AIUD is small and T-shaped device inserted in the uterus. They kill sperm with a toxic chemical from copper and are also fitted once but require annual checkups. They last 5-10 years and are non-hormonal.

· Hormonal IUS: slow release of levonorgestrel, also known as progestin. It thickens cervical mucus, traps the sperm and stops ovulation. Requires one fitting, annual checkups.

Permanent methods^{^[4]}

· Female sterilization/tubal ligation: the fallopian tubes are surgically severed and tied. This procedure is reversable in some cases and permanent in some cases. It is reported to be 99% effective.

Barrier methods[5]

· Female Condoms: they cover large surface areas than male condoms, they can be inserted 8 hours before sex and will still be fully effective.

Emergency methods[6]

· Copper IUD: this device last up to 10 years and can be fitted as soon as five days after having unprotected sex.

· Morning after pill: this one is for after unprotected sex or when a condom breaks during sex, you forgot to take birth control pills. It has high hormone release levels and is not meant for regular birth-control method. It must be taken within 72 hours after having sex.

3. Unplanned and unwanted pregnancies

There are a lot of these pregnancies in SA, some couples or parents celebrate these as surprise babies and make provisions. Some are unable to be joyous because of current situations or occurrences like paternal denial of the child, unemployment, homelessness, age of the expectant parents etc.

There are also factors like the cause of pregnancy for example rape and molestation, the state of relationship between the parents; they might be on worst terms not even communicating and maybe some form of abuse was involved.

Teenage pregnancy has been on the rise but got worse this year in SA. Gauteng currently reported 23226 girls pregnant in that province, 934 of the babies belonged to girls aged 10-14 and aged 15 to 19 years gave birth to over 19000.[7]

25% of females according to Marie Stopes[8] fall pregnant unexpectedly while on birth control. These are the usual signs and typical occurrences indicating a high risk of pregnancy and need for a change of contraceptive method.

During birth-control

· Always forgetting to take their pill consecutively.

· Constant spotting between periods.

· Contraceptive method not matching or catering for their lifestyle or body.

· Missing required checkups and no consistency.

· Little to no sex drive at all.

· Very bad side effects.

· Constant migraines and obscure vision.

The solution is to visit your doctor/nurse about the issue, get well informed and switch to the best contraception method for you.

Most teens and adults fall pregnant because they are not preventing in any way, these are some reasons why and typical signs.

No birth-control

· No use of any contraception.

· Not knowledgeable or well informed about contraception.

· Relies on the “pull out” method, higher risk of contracting STIs and STDs.

· Practicing the ‘rhythm method’ or natural family planning which is not easy to master, not foolproof, higher risk of STDs and STIs.

· Naïve and careless.

· Ignorant and believes myths about contraception.

There is also a problem of females young and old having no access to contraception due to stockouts experienced by their health facilities. This can go up to 3 months or more, no depo-vera shots, not enough birth-control pills, or IUD devices.

In the latest reports it was mostly because of covid-19 pandemic, stocking of medicine delayed a lot but this out of stock issue has happened before the pandemic.

4. Possible Solutions

Many young and old expectant parents are uninterested in having or raising children. We need to help educate them about their reproductive rights, the available forms of contraception and seeking medical advice on which is best for them. This is to help them make well informed decisions as some of these methods are life altering and non-reversible.

The Department of Health must ensure that the public clinics and hospitals receive enough stock on time and in advance when necessary to prevent running out and help decrease the unplanned pregnancies.

We will create an app called TAKE CHARGE! and website which the people will download and subscribe to. This is for educating everyone especially young people on sexual health and reproductive rights. This app will have:

· music choices for those who like soothing/refreshing background music when reading or doing something.

· Listed, explained rights and corresponding responsibilities.

· provide one on one consultations with nurses, psychologists and group sessions with other members.

· options for online and offline booking of these sessions.

· Question and answer slots, ready to read and some recorded for the blind and those who prefer voice interaction.

· Short fun educational games and quizzes.

· Information on all sexual health related topics and related issues.

· Contain period, ovulation tracking calendars.

· Reminders of appointments with health staff (contraception dates, checkups etc).

The campaign and continuous deals on this app will be done on days like

· Valentine’s day- 14 February

· Human Rights Day- 21 March

· Freedom Day- 27 April

· Youth day and the whole month of June- 16 June

· National Women’s Day, the whole month of August- 9 August

· World Contraception Day, the whole month of September- 26 September

· And during Festive Season, December holidays.

These dates are very important and correspond with encouraging the youth to sign up, download and get informed on their sexual health and reproductive rights.

5. Male contraception[9]

Full planning for pregnancy prevention, types for men available in SA:

Vasectomy: The best reliable option, surgical tying of the sperm duct so no sperm is released. There are very slim chances of it being reversible, in most cases the chances are non-existent.

Vasalgel: a type of vasectomy that is non-hormonal. It is reversible as it is non-surgical and only uses gel to block sperm in the sperm ducts.

Vasectomies are quick, non-expensive most reliable method of male contraception. They are free in public/government hospitals in South Africa but there are waiting lists. For private patients some medicals cover vasectomy.

Condoms[10]: made to fit the male penis it’s a sheath shaped barrier device used to reduce the chances of pregnancy, STIs and STDs during sex. Not full proof but very effective. Usually made out of latex, safe and strong rubber and well lubricated and not fit for use after the expiry date printed on the cover.

Dimethandrolone Undecanoate (DMAU) Pills[11]: these pills contain doses of synthetic progestin and testosterone. To be taken once daily, it stops release of natural testosterone.

Male roles in female contraception

The males are not all aware they play a huge role in increasing the already heavy burden of family planning females bare alone. The discussions on how many children they want and can afford with their partners are barely had and most times the male as ‘the head of the family’ has the final say

Role males can play to help lighten and share the load are encouraging and giving full support to their partners, young nieces, sisters, and daughters who want to contracept when they become of age to contracept.

The most crucial of all is them actually choosing a method and contracepting. Also educate, support young nephews and sons who want to or might need to contracept once they become of age to do so.

Shared contraception responsibility is the future and it should be our present.

Male contraception benefits:

· Sheds family planning weight on female shoulders.

· Helps females that are unable to take the shots or pills due to medical reasons.

· Less permanent compared to surgical vasectomy.

· Scientific research proves that male libido will not be altered by the pills.

· Men will have their fair share of birth control side effects, no revenge just joint experience.

· Males will be buying their own, birth control costs for females would decrease.

Open educational discussions

Discussions in homes, community halls, in schools and churches.

This is best successful when both parents and the youth engage in conversations, this shows where they each are in terms of mindset and perceptions. The young females and males need to be made fully aware of the humongous time and money one child needs.^{^[12]} They must be educated about sexual health and well informed on their reproductive rights. The parents/guardians and community members should also be educated and advised on how to approach and engage in these topics at home. This way the parents can apply, incorporate what they learnt and were advised on to their daily raising of their children. This makes it easier for young ones to open up about their experiences, desires regarding reproduction and embrace their rights with full amour and support. The churches should also encourage use of contraception, no sex before marriage is not practical for everyone; some will still do it. The church should encourage safe sex and provide a safe judgement free zone for everyone and emphasize God’s unconditional immeasurable love and grace.

There are organizations dedicated to educating the youth and general public on sexual health and contraception like Marie Stopes South Africa,

Other ways we can get the youth, guardians/parents and all community members to support reproductive rights and responsibilities concerning contraception are to:

· Organize annual peaceful marches and walks on 26 September World Contraception Day.

· Get people to wear and distribute relevant contraception merchandise to the audience.

· Handout informative pamphlets and carry contraception promoting signs and banners.

· Place posters on taxis and at the taxi ranks.

· Post on social media platforms and spread awareness

· Go live or post edited series of events on YouTube.

[1] Women’s health “Birth control methods” (14 February 2021) https://www.womenshealth.gov/a-z-topics/birth-control-methods (accessed 2023-10-02).

[2] Marie Stopes South Africa “different types of females contraception available in South Africa” (25 September 2018) https://www.mariestopes.org.za/2018/09/25/ (accessed 2023-10-02).

[3] Marie Stopes https://www.mariestopes.org.za/2018/09/25/ .

[4] Ibid.

[5] Ibid.

[6] Ibid.