“Women freely come and ask for contraceptives. But starters are shy,” says Bishnu Baral of Global Pharmacy at Maitidevi. Hormonal contraceptives like Nilocon White sells the most in his pharmacy.[break]
According to gynecologist Anjana Dongol, comparatively it’s the women who are taking the initiative of using female contraceptives to stop unwanted pregnancy if they are informed about it. She has been to several rural parts of the country to conduct health camps.
However, the doctor advises to visit a gynecologist for thorough checkups before using particular birth control methods. “Every contraceptive has its failure and are not 100% effective,” she adds. And one should also revise their medical history to find out which contraceptive is suitable for their body.
Dr. Dongol, who is also a lecturer at Kathmandu University has suggested some of the birth control methods that are available in the local market.
Hormonal contraceptives
Hormonal contraceptives are based on two types of female hormones –estrogen and progesterone.
Oral contraceptives
It is a hormonal birth control method, often known as pill, which should be taken daily. This is suitable for newly married women. There are two types of oral contraceptive—monophasic and multiphasic. Nilocon Tablets are monophasic pills available in the local market.
Monophasic pills provide the same amount of hormones throughout the cycle, and are relatively in higher dose. So side effects may be more. Multiphasic pills provide different hormone concentration similar to what women’s body releases. So hormone concentration is in low dose and side effect will be less.
Though monophasic pills are free of cost in government health posts, it’s better to use multiphasic because it is comparatively low dose and there is less side effects. But it is expensive and is not free of cost at government health posts. Estrogens invite high complications.
Pros: They are inexpensive and are also easily available. If someone has irregular menstruation then these pills help regulate their periods. It works as protection from tumors and diseases like benign breast diseases, ovarian tumor, osteoporosis, acne, anemia and malnutrition etc.
Cons: Liver disease, hypertension or migraine patients should avoid it. As one has to take it everyday, they should be responsible and careful. Some can even gain weight and develop colasma on their faces. For first time users, nausea and headaches are common. It does not protect from STDs.
Injectable contraceptive/The Shot
Depo Provera, Sangini injections are some of the examples of injectable contraceptives available in Nepal. This hormonal birth control method contains only progesterone hormone and once injected, works for three months.
Pros: Easily available. Breastfeeding women should apply this method to avoid themselves from complications that arise from using estrogen containing pills. For instance, estrogen based pills suppress milk. Although progesterone-based pills are available, shot saves one from the hassle of taking the pills daily. It even works as protection agent against ovarian and endometrial cancer.
Cons: It takes comparatively longer time than other contraceptives to resume fertility after one withdraw its use. There can be excessive bleeding during menstruation in the first few months of injection and also a temporary absence of menstrual period. Silent disadvantage like decrease in sexual desire have also been noticed. Users might develop lump in breast; therefore, breast examination is a must for long-term users.
The Implant
Also known as sub-dermal plant, it is a hormonal contraceptive. Six plastic tubes are implanted under the skin of the upper arm in a fan shape, which constantly release progesterone hormone, and this helps prevent pregnancy. However, the modern version of such implant has hit the market where only two tubes are required instead of seven. While the older version works for seven years, the newer version is for five.
It shares similar advantages with the shot.
Pros: Does not affect during sexual act.
Cons: One should visit trained person to insert and remove the implant. One must maintain hygiene; otherwise, abscess might form under the arm.
Emergency Pills
Within 72 hours of unprotected coitus, one should take emergency pills to prevent unwanted pregnancy. However, one should not make the habit of taking it routinely. Normally, emergency pills are taken in two doses. The distance between the first tablet and second should be 12 hours.
Pros and cons: For two years now, emergency pills are easily accessible in the local market. Some women may feel nauseated or may get headaches and abdominal pain after using the pill. However, these don’t last long. The emergency pill may also disrupt periods.
Non-hormonal contraceptives
Intrauterine contraceptive devices (IUD)
It is a T-shaped device that is inserted inside the uterine cavity to prevent conception temporarily. Among the two types of IUDs—hormonal and Copper T IUDs—the latter is popular and available in Nepal. Once inserted, it works for ten years. Copper T does not stop ovulation but prevents the implantation of fertilized ovum. The copper creates sterile inflation and engulfs the fertilized ovum.
One should make the habit of checking to see whether the thread is in place.
It’s available in government health posts free of cost. Insertion is painful. The first few months, the user should make the habit of checking to see whether it’s in place or not.
It is not for the newly married ones. As it is difficult to insert inside, it is apt for the ones who have completed family, who has given birth to the baby.
Copper T can also be used as emergency contraceptive. Fertilized ovum takes six days to reach the uterus, so Copper T can be used within six days of unprotected coitus. The IUD works by not allowing sperm to join with the egg.
Pros: Once inserted, it works for ten years. As it is not hormonal, one can avoid hormonal related complications with the use of this device; for instance, blood vessels related problems. It can be used by women who cannot use estrogen-containing pills. It does not affect during sexual act.
Cons: Usually, women must be counseled before placing Copper T as it involves a foreign object. After insertion, there might be acceptance problem for a few months, which creates uneasiness. The method makes periods heavier. Apart from this, there might be lower abdomen pain and cramping. But once the uterus gets habituated with the device, the problems will vanish. The users must maintain perennial hygiene. And it does not protect against sexually transmitted infections (STI). Women with frequent pelvic infection, liver disease and severe pain should not use it.
Tubal ligations
According to the country’s law, only women with two children can opt for this birth control method. But the second child’s age must be two because the country’s mortality rate is high. This is a good option for women whose family is complete. The ligation involves surgical procedure, where fallopian tubes are blocked through different ways.
Pros: It’s permanent and is available free of cost in government health centers.
Cons: The process is more complicated than vasectomies—men’s permanent method of birth control.
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