Understanding artificial family planning methods

In a previous article, I discussed the methods used in natural family planning. (You may check the article at philstar.com) However, I understand that there are couples who will have difficulty with the natural methods because of the complexities involved.

In Senator Juan Flavier’s book Family Planning Made Easy, he explains his reasons for promoting family planning. According to Dr. Flavier, many Filipino women and babies die because of the consequences of unplanned pregnancies. Some resort to dangerous abortions, which experts estimate at 500,000 cases a year. Oftentimes, the woman is too young to have children, and thus is physically, emotionally, and financially unprepared to care for a baby.

Here are the so-called artificial methods of family planning, including their effectiveness rate in preventing pregnancies in one year. As a point of comparison, natural family planning has an effectiveness rate of between 81% and 95%, depending on the skill of the couple.

• Withdrawal method (81% to 96% effective). Although considered by some experts to still be a natural form of family planning, the withdrawal method is frowned upon by the Roman Catholic Church. However, Protestants are more amenable to this technique when used as a birth control method by married couples.

The withdrawal method involves the man’s ability to withdraw the male organ prior to ejaculation. Withdrawal prevents pregnancy by avoiding the meeting of the male sperm and the female egg. The problem with this method is the high failure rate of four to 19% in the first year of use, depending on the man’s ability to control himself. Although the method is not perfect, there are an increasing number of couples who practice it with success.

• Condom (96% effective). A condom is a plastic balloon-like material that is worn over the male organ to prevent the sperm from entering the vaginal canal. Aside from birth control, condoms have the advantage of preventing AIDS and other sexually-transmitted diseases. There is a female version of the condom called diaphragm.

• Contraceptive pills (97% effective). The pill works by preventing the brain from secreting hormones (called FSH and LH) responsible for the production of the female egg. There are older and newer generations of contraceptive pills. The newer pills have fewer side effects and use substantially lower amounts of estrogen and progesterone. Minor side effects include nausea, breast tenderness, mood changes, fluid retention, and weight gain. However, there are certain women who should probably stay away from contraceptive pills, such as those with a history of smoking, high blood pressure, blood clots, breast cysts and masses, and uterine abnormalities. These women should get a clearance first from their doctors.

• Injectable shots (97% effective). Medroxyprogesterone (brand name: Depo-Provera) is an injectable birth control hormone that can prevent pregnancy for up to three months. Possible side effects include loss of menses (which isn’t necessarily harmful), weight gain, and bone loss. Injectables are convenient and effective, and thus are preferred by some women.

• IUD or intra-uterine device (97% effective). These small plastic or copper devices are relatively safe and commonly used worldwide. The IUD is inserted inside the woman’s uterus and prevents conception mainly by preventing the sperm from reaching the egg in the fallopian tube. An IUD device lasts between five and 10 years. Side effects may include menstrual changes, weight gain, headache, and abdominal pain.

• Ligation in females (99.5% effective). These last two items refer to permanent methods of birth control. Ligation (medically called bilateral tubal ligation or BTL) is a surgical procedure, which involves the tying of the woman’s fallopian tubes. The fallopian tubes serve to connect the ovary and the uterus. The female egg is formed monthly in the ovaries and passes through the fallopian tube where it could meet the male sperm. By blocking the fallopian tubes, pregnancy is prevented in 99.5% of cases. Complications with surgical ligation are rare in the order of 0.1% or one in 1,000 cases.

• Vasectomy in males (99.8% effective). According to Dr. Eduardo Gatchalian, past president of the Philippine College of Surgeons, vasectomy is a simple, safe, and effective procedure. It involves the cutting of the tubes where the sperm passes through prior to ejaculation. These tubes (medically called vas deferens) are located beside the male testes. Vasectomy can be done as an out-patient procedure for 30 minutes and under local anesthesia. Side effects are rare and there is no change in the man’s sex life. The male will still experience normal erection and ejaculation of seminal fluid. The only difference now is that the fluid will not contain sperms. Compared to ligation in females, vasectomy is safer and easier to perform.

In our medical missions, I’ve seen many poor couples who could have benefited from family planning methods. Certain medical conditions may also warrant the use of birth control, such as patients with rheumatic heart disease or heart failure. Oftentimes, a weak heart cannot withstand the stresses of pregnancy, and this can lead to the demise of the mother or the child. Such a situation, choosing who to save or not, is heartbreaking for the family and the attending doctor.

I believe it is our duty to give everyone the correct information about the pros and cons of the different methods of family planning. But in the end, it is up to the patients to decide which method best fits their lifestyles, health conditions, and personal beliefs.