Planning is everything | Daily News
[Health Watch]

Planning is everything

Family planning is nothing new to Sri Lanka. But most newlywed couples have qualms in opting for family planning methods, lest it would affect their future plans of conception. Dr Sanjeeva S P Godakandage, a Community Physician attached to the Family Planning Association of Sri Lanka, has a different opinion.

Q: What is Family Planning or Contraceptives?

A: The number of children and timing are important decisions taken by a couple. The best age for a woman to have a child is 20-35 years. An ideal minimum gap of three years is recommended between two births, which may depend on the age of the woman too. Conceptions beyond the fourth pregnancy also pose health risks.

Couples and individual can seek family planning services to achieve the above objectives. A number of temporary and permanent methods are available in Sri Lanka for family planning. The permanent methods for males and females are vasectomy and tubal ligation (LRT) respectively. However a couple needs to be certain that they do not want children in the future, to practise a permanent method. There are hormonal and non-hormonal family planning methods. The non-hormonal family planning methods include the IUD (loop) and the condom. Hormonal methods include oral pill, injectables and implants.

Q: How can a woman select a family planning method and what are the factors that she should consider?

A: A client would select a method based on several factors. One important factor is effectiveness: less chance of failure. If properly used, the chance of failure is rare. Even in the rare case of a failure, where the woman ends up with a pregnancy, there is no evidence that the family planning method does any harm to the foetus, and your service provider will give you necessary advice.

Vast majority of females can practise any of the above methods. However, there may be medical conditions that contraindicate them. A woman having high blood pressure, diabetes, bleeding, infections in the genital area, cancers, thrombosis, circulatory disorders, heart disease, migraine, liver diseases or any other significant medical condition or on long term medications need to discuss with a doctor or a public health midwife regarding a suitable family planning method, as certain methods may not suit them.

Age itself does not contraindicate any family planning method. However, healthcare workers may not consider injectables or IUD (loop) for clients less than 18 years, oral pill for clients more than 40 years, or injectables for clients more than 45 years, as the first-line choice.

After delivery, a woman can undergo sterilization within the first week, or can get an IUD inserted within the first two days. However, all women must ensure that they start practising a method by six weeks after delivery. The methods that can be started at this stage include sterilization, IUD, condom, injectables and implant. A breastfeeding woman can start oral pill six months after delivery.

A menstruating woman can start oral pill within five days or IUD within first 12 days of starting the menstrual cycle. Other methods can be started within first seven days of starting the menstrual cycle.

Q: What are the commonest side effects of those contraceptives and how safe are they to be used?

A: Side effects of family planning methods are rarely significant. Vast majority of cases only need reassurance. Most of these symptoms will disappear within few months. However, if they are serious or bothersome, the client needs to consult the service provider. A woman on hormonal methods may complain of bleeding irregularities. Some clients also complain of weight gain, which is due to increased appetite.

A client on oral pill may experience symptoms such as nausea, vomiting, giddiness or headache, which usually disappear by the end of first cycle of pills. However, if they experience severe pain in a limb, abdomen, chest, head or eye, medical opinion should be sought without delay.

With the IUD, abdominal pain may occur during first few days, and bleeding irregularities within first few weeks.

However, if the client observes any changes of the thread of the device, i.e. long, short or missing, continuous or severe pain or bleeding, missed periods or evidence of infection, medical opinion needs be sought.

Q: What should a married woman/a young girl do if she is being forced to get pregnant (rape and incest for instance)?

A: Other than the medico judicial procedure that needs to be followed following rape or incest, one important consideration should be prevention of an unwanted pregnancy. Emergency contraceptive pills should be taken immediately following such an incident, unless the woman is already on a regular family planning method.

However, it is not effective after 120 hours of the incident. The other option available is IUD, especially if the woman is likely to engage in sex in the future as well. It too needs to be inserted within five days of the incident.

Q: Are male contraceptives available?

A: The most popular family planning method amongst males is the condom. However, its effectiveness depends largely on correct use at every sexual encounter. The added advantage of the condom is that it helps prevent transmission of infections. The permanent method of family planning for males i.e. vasectomy is far less popular nowadays.

Q: How easy is it to buy contraceptives from the local market?

A: It is unfortunate to see the complications, including maternal deaths, due to the unmet need for family planning. Modern methods can easily be obtained free of charge from service providers in government sector throughout the country. The area public health midwife would deliver condoms and oral pills during home visits.

Temporary methods can be obtained from family planning clinics located in the field as well as in hospitals, which are easily accessible to every household in the country. Your General Practitioner too should be able to provide most temporary methods. There are several NGOs who provide temporary methods of family planning. Oral pills and condoms are freely available in the commercial sector as well.

Q: How can married females obtain more information on safe and common contraceptives?

A: It will be easiest for females to approach the Public Health Midwife in the area to get information regarding family planning methods.

Further information regarding family planning methods can be obtained from Consultant Obstetricians and Gynaecologists and Medical Officers of Health and other Medical Officers, and nursing staff providing family planning services. 

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