The Basics

What Is Contraception

Contraception refers to the intentional prevention of pregnancy using various medical, surgical, physical, or behavioral methods. It plays a vital role in empowering individuals and couples to make informed reproductive choices, ensuring maternal health, supporting family planning, and reducing unintended pregnancies.

Why use contraception

Contraception helps in spacing or limiting pregnancies according to individual or couple preferences. It is not just about preventing pregnancy; certain methods also offer non-contraceptive benefits. For example, oral contraceptive pills can help manage conditions like polycystic ovarian syndrome (PCOS), endometriosis, acne, and menstrual irregularities. Barrier methods such as condoms are the only methods that offer dual protection—against pregnancy and sexually transmitted infections (STIs). For women in the postpartum period, specific methods like progestin-only pills, intrauterine devices (IUDs), and injectables can be safely used while breastfeeding.

TYPES OF CONTRACEPTION

Contraception is broadly classified based on the reversibility of the methods used :

Temporary

These methods are reversible and further classified into depending on the duration of use, user dependency, and frequency of use :

A. Short-acting methods offer protection for a short duration (per act of intercourse, daily, weekly, or monthly) and must be used frequently or regularly.

1. Barrier Methods: Physically block sperm from reaching the egg.

e.g. Male condom, Female condom, Diaphragm, Cervical cap(not available in India ), Contraceptive sponge(not available in India)

1. Hormonal Methods (Short-acting): Use synthetic hormones to prevent ovulation or fertilization.

e.g. Combined oral contraceptive pills (COCs), Progestin-only pills (POPs), Contraceptive patch (weekly), Vaginal ring (monthly)

1. Natural Methods: Rely on tracking fertility signals to avoid sex during fertile days.

e.g. Calendar method, Cervical mucus method, Basal body temperature method, Withdrawal method

1. Emergency Contraception: Pills or Devices used after unprotected sex to prevent pregnancy.

e.g. Emergency contraceptive pills (Levonorgestrel, Ulipristal acetate)

B. Long-Acting Reversible Contraceptives (LARCs)-Long-acting reversible contraceptives (LARCs) provide contraception for months to years without requiring frequent user action.

1. Intrauterine Devices (IUDs)- T-shaped devices inserted into the uterus to prevent fertilization or implantation.

e.g. Copper IUD (effective up to 10 years), Hormonal IUD (LNG-IUS, effective 3–5 years)

1. Long acting hormonal method - Includes injections and implants that contain synthetic hormones which prevents ovulation and fertilization.

e.g. Implanon, DMPA

Summary of Short acting and Long acting methods of contraception

Criteria	Short-Acting Methods	Long-Acting Methods (LARCs)
Duration	Per act to 1 month	3 months to 10 years
Frequency of use	Daily, weekly, monthly, or per act	Once every few months to years
User involvement	High	Low after initiation
Examples	Pills, condoms, patches, rings	IUDs, injectables, implants

Permanent

Irreversible surgical procedures to prevent reproduction

1. Tubectomy - surgical procedure to block, clip or seal the fallopian tube preventing the transport of egg (ovum) and thus prevents fertilization.

2. Vasectomy - Surgical procedure to block, clip or seal the vas deferens preventing sperms from entering the semen.

References:

1. Trussell J, Jordan B. Contraceptive Technology. 21st ed. New York: Ayer Company Publishers, 2018.

1. World Health Organization. Medical eligibility criteria for contraceptive use. InMedical eligibility criteria for contraceptive use 2015.

1. Selected Practice reccomendations for contraceptive use :Third edition 2016

1. Ram F, Sheckar C , Chowdhury B. Use of traditional contraceptive methods in india and its socio-demographic determinants :Indian JMed Res.2014 Nov;140(Suppl 1):S17-S28