Everything You Need to Know About Contraceptives Today

We all want to be protected. But how protected are we, really? Oh, and when we say protection, we mean contraception. Obviously.

We have all heard the saying, ‘Prevention is better than cure’. When the alternative is an unwanted abortion or recovery from an STI (Sexually Transmitted Infection), prevention does sound pretty good. Prevention. Protection. Birth control. A choice. A right.

But what are your options? Read on to find out more.

Contraception, also known as birth control, is primarily used to prevent pregnancy. Some contraception is also used to prevent STIs. There are various different types of contraception that we will discuss in detail.

If you are sexually active, contraception is not just for birth control; it also helps your partner and you stay protected from STIs and other diseases.

The concept of contraceptives has been around for a while. Condoms, which are still the most widely used contraceptive, are thought to have originated as far back as 3000 BC when goat’s bladder was used as a sheath. Needless to say, things have since improved on that front, with rubber condoms being produced in the 1800s and then latex being invented in the 1920s, which is what is still widely used today.

But in the past few decades, thanks to the advancement of technology, better contraceptive methods have been invented and contraception, in general, has come to the forefront of discussions. While it is still a taboo in many parts of the world, it has become a normal fixture for most cultures and demographics.

Now, let’s get to it. Contraceptives widely fall under two categories - reversible and irreversible.

Reversible contraceptive methods allow people the likelihood to become pregnant if they choose to stop the contraception. Irreversible methods, however, are trickier and mostly permanent.

Barrier Methods

1. Male Condom - External condoms or male condoms are the most common type of condoms. They are worn over a man's erect penis before sexual intercourse to provide a barrier that helps prevent pregnancy and reduce the risk of sexually transmitted infections (STIs), including HIV. In fact, they are the only contraceptive that prevents STIs. They are made of latex, polyurethane, or animal membranes.

Condoms are also the only form of contraception for men that is not permanent. They are 98% effective, but only if used correctly.

2. Female Condom - Ever heard of female condoms? Yes, they are a thing, but they’re not so widely recognised or sold because they are usually less effective and also more bothersome to use.

Internal condoms or female condoms also act like a barrier that prevents the sperm from fertilising the egg, thus preventing pregnancy. Even though they provide protection against infections, including HIV, female condoms do not work as well in protecting against STIs. Female condoms are 95% effective but only with perfect use.

3. Spermicide - What can be better at preventing pregnancy than killing the sperm before they can impregnate?

Spermicide is a type of contraceptive that works by damaging or killing the sperm in the vagina. It is available in different forms, like gel, foam, cream, film, or suppository. It needs to be inserted into the vagina at least thirty minutes before intercourse, and it works best if combined with other contraceptives like condoms or diaphragms.

On its own, spermicides are only around 70% effective. They also do not protect against STIs and can actually make any infection worse.

4. Diaphragm - A diaphragm is a flexible, dome-shaped device made of rubber or silicone that covers the cervix (the entrance to the uterus). It is used with spermicide, which blocks the sperm from getting inside the uterus.

For it to be most effective, the diaphragm should be inserted a couple of hours before intercourse and keep it in place for no longer than 24 hours. Leaving the diaphragm in for more than a day can increase the risk of toxic shock syndrome and, hence, must be avoided.

It is reusable and can be used for up to two years unless it shows signs of damage or there are other reasons that require you to replace it.

You should consult a healthcare professional about replacement if you've experienced bodily changes, undergone pelvic surgery, given birth, had an abortion or miscarriage, feel pain during intercourse, or frequently get UTIs. Diaphragms are about 87% effective, but they do not provide protection against STIs.

5. Cervical cap - Cervical caps are similar to diaphragms, and they work in the same manner. The only difference between the two is that a cervical cap is smaller than a diaphragm, and while a diaphragm can be worn for up to 24 hours, the cervical cap can be worn for up to 48 hours. It is also similar to diaphragms when it comes to effectiveness and its ability to protect against STIs.

Short-acting Hormonal Contraceptives

1. Birth Control Pill: A birth control pill is an oral contraception that contains hormones that prevent pregnancy. There are usually two types.

Combination pills combine two hormones, oestrogen and progestin and are the most common type. The other type is called the “Mini-pill” and contains only progestin. This is usually recommended for women who cannot take oestrogen for medical reasons or who are breastfeeding.

Birth control pills are highly effective, but they only work if taken every day without fail. BCPs also do not protect against STIs.

There is also the Morning-after pill that works as an emergency contraceptive but is different from the typical birth control pill. It is most effective if it is taken as soon as possible after unprotected sex. Usually, you have a three- to five-day window of time when the pill is still effective.

Morning-after pills have some side effects, but they are usually mild for most people. Some side effects are - changes in the normal menstrual cycle, headaches, pain or cramps, fatigue and nausea.

2. Birth Control Patch: A birth control patch is a contraceptive that you stick on your skin. They are thin, small squares that can stick to your skin like a bandage. How it works is it releases hormones (oestrogen and progestin) through your skin into your bloodstream to prevent pregnancy. It also does not protect against STIs.

You can put the patch on your upper arm, lower back, below your belly button or on your upper back near your shoulder blades. It works in the same way as birth control pills.

You wear the patch for three weeks, and then you take it off for the fourth week, which allows menstrual bleeding to take place.

3. Vaginal Ring: Probably not the kind of ring you thought you would wear.

A vaginal ring is a small soft plastic ring that contains the same two hormones - oestrogen and progestin and works in the same manner as the combination pill.

To use it, you can squeeze and insert the ring into your vagina, similar to inserting a tampon. You would need to keep it inserted for three weeks, and then you take it out and dispose of it.

You can then wait seven days before putting in a new one. You will have your menstrual bleeding a few days after removing the ring, but you can skip your period by inserting a new ring right away. If used correctly, vaginal rings are almost 99% effective in preventing pregnancy. But it does not protect against STIs.

Long-Acting Reversible Contraceptives(Larcs), AKA ‘Fit and Forget’

1. Copper Intrauterine Device (IUD): The Copper IUD is a T-shaped plastic device that is inserted into the uterus. The IUD is wrapped with copper wire, which keeps the sperm from fertilising an egg, effectively preventing pregnancy. Copper IUDs can be left for five to ten years after insertion, depending on the brand.

There are several advantages of using the Copper IUD, including 99.5% effectiveness. Since it contains no hormones, it causes no hormonal side effects. It can also be used as emergency contraception if it is inserted within five days after unprotected sex.

There is also no rebound effect—your fertility returns to normal immediately after you take it out.

2. Hormonal IUD: The hormonal IUD is a T-shaped plastic device that is inserted into the uterus. It releases progestin to prevent pregnancy. Hormonal IUDs are also over 99% effective and offer three to eight years of protection.

Even though IUDs are effective, long-term and reversible, it is important to note that IUDs do not prevent STIs or HIV. Since they are hormonal, there might be side effects, so please consult your doctor before you decide on this.

3. Implantable Rod: Yes, you read that right. A rod. But a small one. The birth control implant is a small plastic rod that is about the size of a matchstick, and that is put under your skin in your upper arm.

The rod slowly releases the hormone progestin into your body and can be used for up to three years before needing to be replaced. This method is over 99% effective if the implant is replaced every three years.

Although it does not offer any protection from STIs, it is reversible, oestrogen-free and allows you to start trying to get pregnant as soon as you remove it.

Irreversible Methods of Contraception

Irreversible methods are, well, not fun. They are mostly permanent, and it’s important to do thorough research before opting for it.

1. Vasectomy - A vasectomy is a surgical method in which the tubes that carry the sperm are cut and sealed, which stops the sperm from being released. Even though vasectomy is considered permanent, the procedure can be reversed through surgery and is almost 100% effective at preventing pregnancy.

There are not many risks or side effects to getting a vasectomy. There may be some discomfort, but there are no reports of serious problems, infections or any risk of heart disease or cancer.

2. Sterilisation - Sterilisation is also a surgical procedure in which clips are placed on the fallopian tubes to prevent eggs from getting released into the uterus. It is a permanent and irreversible method.

Even though sterilisation is a one-time surgical procedure, there are risks associated with the procedure itself. So, it is best to discuss all aspects of the procedure with your healthcare provider to fully understand its implications.

It is important to note that neither sterilisation nor vasectomy can protect against STIs, and it would be best to use condoms.

We have talked about contraception and its various types. But why do we need contraception at all?

• Family planning - You have just gotten married and moved into a new house. There are bills piling up, and you are struggling to get to a financially secure place.

  You and your partner know you want kids, but the timing is just not right. Contraception gives you the freedom and control to decide when you want to have children, how many children you want to have and the spacing between each pregnancy.

• Practising safe sex - A more obvious reason to take contraception is to protect oneself from contracting any STIs. It is particularly important to educate yourself on the various contraceptive methods and which is best for you if you have multiple sexual partners so you are well protected.

• Health benefits - There are some health benefits to taking contraception. For some, it may help to regulate their menstrual cycle. Especially for those who have irregular periods or heavy bleeding, taking birth control pills may help regulate your periods by making them more consistent and lighter.

• Help manage PCOS - Polycystic Ovary Syndrome(PCOS) is a condition in which women have a hormonal imbalance due to the production of excess testosterone.

  In this scenario, birth control pills can help balance the hormones and regulate the side effects caused by PCOS. You should definitely check with your OB-GYN first before taking pills and check if it is safe for you to go for it.

• Provides protection against cancer - According to research, there has been some evidence that women who take birth control pills have a lower risk of developing ovarian and endometrial cancer. There is around 30%-50% reduced chance of developing ovarian cancer and about 30% lower chance of endometrial cancer.

What Is the Impact of Contraception?

Of course, if you are trying to stop the regular flow of nature, there will always be some chances of side effects. It is important to know the side effects of contraceptives.

• Physical Impact - There are immense physical effects like changes to the menstrual cycle, no menstrual cycles, extra bleeding, spotting, nausea, migraines, breast tenderness, weight changes, acne, skin irritation due to allergies, and UTIs.

In some cases, there are also extreme physical side effects like increased risk of deep vein thrombosis, high blood pressure, stroke, heart attack, breast cancer, gallbladder disease and toxic shock syndrome.

• Psychological Impact - Hormonal contraceptives, especially long-term options, can have a significant hormonal impact, but they are also among the most effective methods of contraception. Taking hormonal contraception can have a huge impact on mental health.

There have been studies that showed how hormonal contraception can increase the risk of depression. Hormonal side effects have been known to cause mood dysregulation and an increase in anxiety.

There have also been reports of fatigue, low libido, neurotic symptoms, compulsion, anger and adverse effects on menstrual health.

• Social Impact - The social impacts of contraception can be immense. It empowers young people to take control of their bodies and helps reduce the number of unintended pregnancies.

This, in turn, reduces the need for unsafe abortions, which can have serious psychological and physical effects on women. It also reduces the risk of HIV transmission from mothers to new-borns.

In a lot of societies, women still do not feel completely in control of their bodies, and motherhood is often an imposition rather than a choice. Early marriages and young motherhood can have a huge impact on a young woman. Contraception allows a chance to choose, prioritise education and participate in society.

Needless to say, there are high risks associated with contraception. And this irrevocably affects only women.

There is an almost unsaid taboo about contraception. There is still a dearth of information available, and no one is really openly talking about it. This is especially true in India, where there is widespread ignorance about contraceptive methods, especially modern reversible ones.

In India, sex is still taboo. It’s hushed. Practising sex as an unmarried woman or man is still seen as a “SIN”. This creates a challenging situation when it comes to educating oneself or talking about contraception, with the added judgment and innuendo surrounding premarital sex.

If you're married and choose to take the pill, it often comes with increased scrutiny that you don't want to have children. This reflects a misogynistic belief that women, once married, are expected to dedicate their lives to having children and building a family. When a woman challenges this expectation, she faces judgment and criticism, which often leaves her feeling targeted.

For better protection, we need education; for education, we need resources; and to access those resources, we must talk about it.

Government Policies and Contraception

Historically, family planning policies in India have focused more on controlling population growth than on promoting women's reproductive rights and choices.

According to research published in 2021 using data from the Indian National Family and Health Survey-4 (2015–2016), the majority of women in need of contraception (76.1%) were opting for female sterilisation. Condoms and contraceptive pills were the second and third most commonly used methods, at 11.8% and 8.5%, respectively, while only 3.2% reported using an IUD.

It is also interesting to note that among sterilised women, 43.2% underwent the procedure before the age of 25, 61.5% received financial compensation for sterilisation, and 20.8% were not informed that sterilisation would prevent future pregnancies.

The reality is that the use of reversible contraceptive methods and male sterilisation remains low in India. According to the latest National Family Health Survey-V (2019-2021), in India, fewer than one in ten men use condoms, while nearly four in ten women opt for sterilisation as a method of contraception to prevent pregnancy.

There is so much misinformation that surrounds contraception that it is absolutely necessary to address it. So, let’s talk about contraception myths.

• Contraception causes infertility - The most rampant myth surrounding contraception is that its usage (especially LARCs) could make you sterile. This in no way has any truth to it.

• Contraception causes health problems - There’s also the belief that contraceptive methods, especially contraceptive pills and IUDs, could cause various health problems and may even cause cancer.

Even though it is true that there are quite a few side effects to some contraceptive methods, it is necessary to do thorough research and talk to your healthcare provider before discarding it altogether.

• Sensationalisation of condoms by the media - In India, condoms have often been over-sexualised in advertisements, making them seem scandalous rather than promoting a sex-positive message.

This could make accessing condoms – a simple and responsible act – seem improper or disreputable.

• Religious misinformation - In India, especially in rural areas where access to reliable information is limited and religious and cultural influences heavily shape perceptions of contraception, there is often an undertone of resistance.

Contraception is sometimes viewed through a lens of moral or religious opposition, leading to misconceptions and hindrances in its acceptance and use. This creates barriers for individuals seeking to make informed, autonomous decisions about their reproductive health.

Visits to the Doctor

While we have a whole assortment of birth control options available to us, nonetheless, it is imperative to schedule a visit to your healthcare provider to see what contraceptive would be ideal for your particular use.

It is important to research the side effects and long-term effects of any contraception and be aware of your medical history before you make a decision.

Contraception is a way to take control of our bodies by preventing pregnancy or planning the timing of pregnancy. It should be an empowering decision that prioritises our health and allows us to choose the most optimal solution.

Protection, birth control, contraception, precaution—these are just a few terms that represent a fundamental right. It's a choice—one that not only affects our physical health but also our mental well-being. But we are still not talking about it enough.

It's 2025 – a new year, a fresh start! Let's make a commitment to take our health more seriously. And if you're reading this, congratulations – you're already on the right track!