AskDoctorKT

Congratulations on the arrival of your new baby. Olóhun á dáasí. You’ve survived the first few months of sleeplessness. The postpartum bleeding has stopped. You’ve gotten your body back and Mr. Husband cannot hold it again… Now, we don’t joke about our fecundity for religious and cultural reasons but we have to create a reasonable space in-between pregnancies to allow the body to heal and rest before another baby comes.

At the family planning clinic, you will be interviewed, examined and counselled in order to determine your eligibility. You will learn that there are various methods of family planning which have different pros and cons. I’ll try to summarise some of them here.

*Periodic Abstinence. Avoiding intercourse during ovulation stage (somewhere in the middle of the cycle) . Pros: natural, noninvasive. Cons: menstrual cycle must be known and regular, high failure rate.

*Withdrawal method (coitus interruptus). Removal of the phallus prior to ejaculation. Pros: natural, noninvasive. Cons: unreliable, high failure rate, reduces sexual pleasure.

*Lactational amenorrhoea. When a woman breastfeeds exclusively and she has not resumed her menses, she is about 99% protected from pregnancy in the first 6 months and about 97% by 1 year. There will be need for a backup from 6 months onwards.

*Combined oral contraceptive pills: Failure rate is 0.2-0.3/100WY (ie. if 1000 women use it for a year, only 2-3 will get pregnant). Pros: reduces menstrual pain and amount of blood loss, controls irregular menstrual cycle, reduces risk of ovarian cancer. Cons: headache, weight gain, small increase in the risk of stroke and some cancers. Unsuitable for obese women, breastfeeding moms and patients with certain diseases eg. Hypertension.

*Progesterone-only pills (POP). Failure rate is 0.3-4/100WY. Pros: Useful during breastfeeding. Cons: irregular or total cessation of menses, headaches, mood swings, bloating.

*Injectable contraceptives. Failure rate is <1/100WY. Pros: highly effective, more convenient/better compliance than pills. Cons: irregular menses, delay in conception after stopping , bone loss.

*Contraceptive implants. These are tiny hormone-containing devices, about the size of a match stick, which are inserted into the inner aspects of the upper arm through a very small incision. They can provide contraception for 3 – 7 years and they are more than 99% effective. Side effects are similar to that of the pills and injectables. They can be removed anytime conception is desired and this can be achieved almost immediately. 
*Intrauterine contraceptive devices (IUCDs). They are effective, up to 99%. The insertion is easy and almost painless. The main side effects are irregular bleeding, higher risk of infection and ectopic pregnancy. It can stay for up to 10years and can be removed anytime you feel like conceiving. 

*Barrier methods. Male and female condoms, diaphragms. May or may not contain spermicides. Failure rate is highly dependent on technique. Also protects against STIs

*Female sterilisation. Includes clipping or ligation of the fallopian tubes and removal of the uterus. Requires thorough counselling to avoid regret. Suitable for women with debilitating medical conditions in which pregnancy would be risky, >40 years of age, after 3 caesarean sections, tumours/cancers of the genital tract etc.

*Male sterilisation. Also known as vasectomy. Highly effective. Slight possibility of reversal. Very low uptake due to fear of future regret.

What does Islam say?
1. The intention should be for spacing and not capping of family size or fear of poverty. (… We shall provide for them as well as for you… Quran chapter 17 verse 31)
2. Temporary methods are preferred to permanent or near-permanent methods unless there’s a clear medical indication.(The Prophet {saw} forbade men from castration – Al-Hadith)
3. Natural methods are preferred to hormonal and invasive methods. (Guarding of the nakedness and dignity)
4. The fewer the side effects, the better. (Do not inflict harm and do not harm yourselves – AlHadith)