WHERE THERE IS NO DOCTOR THE FAMILY PLANNING HAVING THE NUMBER OF CHILDREN YOU WANT
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community HEALTH c SLL
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20
Family PlanningHaving the Number
of Children You Want
This is a reprint from
Where There Is No Doctor
(Indian adaptation)
published by the
Voluntary Health Association of India
C-14 Community Centre
Safdarjung Development Area
New Delhi 110016
329
20
Family PlanningHaving the Number
of Children You Want
THIS FAMILY HAS MANY CHILDREN.
THIS FAMILY HAS FEW CHILDREN.
Some mothers and fathers want a lot of children. Where many children die
young, parents feel they need a large number of children to help with work and to
be sure some remain to care for them when they grow old.
Many mothers and fathers have come to realize that to have a large family may
bring serious problems. For example:
■ With many children it is harder to feed, clothe, and educate them all well.
■ When a mother has child after child, without much space between, she often
becomes weak. Her breasts produce less milk. Her babies are more likely-to
die (see p. 317). Also, after many pregnancies the danger is greater that she
will die in childbirth, leaving many motherless children.
■ If a man and woman have a lot of children, when the children qrow up there
may not be enough land for all of them to grow the food their families need.
Children may begin to die of hunger. This is already happening in many areas.
Although most, if not all, hunger in the world today could be prevented if land
and wealth were distributed fairly, the growing number of people i.<- part of the
problem. If people keep having big families, the day will come when there is not
enough land or food to go around-even if people learn to share.
The situation will get better only when people-as individuals, as families, and
as communities-come to understand the many factors affecting their health and
take action for the good of their children and future generations.
330
FAMILY PLANNING AND BIRTH CONTROL
Different parents have different reasons for wanting to limit the size of their
family. Some young parents may decide to delay having any children until they
have worked and saved enough so that they can afford to care for them well.
Some parents may decide that a small number of children is enough, and they
never want more. Others may want to space their children several years apart, so
that both the children and their mother will be healthier.
Family planning is having the number of
children you want, when you want them.
When a man and woman decide when they want to have children, and when
they do not, they can choose one of several methods to prevent the woman from
becoming pregnant, for as long as she wishes. These are methods of birth control
or contraception.
Couples who want children but are not able to have them should see page 288.
IS BIRTH CONTROL GOOD-AND IS IT SAFE?
1.
Is it good?
In some parts of the world there has been a lot of discussion about whether
different forms of birth control are good or are safe. Some religions have been
against any form of birth control except trying not to have sex together. But an
increasing number of religious leaders are realizing how important it is to the
health and well-being of families and communities that people be able to use
easier and surer methods of birth control.
Also, in many places women who get pregnant when they do not want a child
will go for an abortion, to have the developing baby destroyed or removed. Where
these intentional or provoked abortions are legal, they can be done in health
centers under sanitary conditions, and they are not usually dangerous to the
woman if done within three months. But many women get abortions done
secretly . often in dirty conditions and performed bv unskilled persons.
Thousands of women die from such abortions. If women are given the chance to
use birth control methods, and information to use them wisely, most provoked
abortions, would not be necessary. Much needless suffering and death could be .
prevented.
Some people feel that much of the push for family planning comes from rich
countries or persons who want to keep their control over the poor by controlling
their numbers. The rich and powerful find it hard to accept that the way they
manage the earth's land and resources strongly contributes to world hunger. They
see only the growing numbers of people. In some countries professionals sterilize
poor women by force or experiment on them with new or unsafe methods. For all
these reasons social reformers and spokesmen for the poor often protest against
birth control.
331
This is unfortunate. The object of attack should not be birth control, but
rather its misuse. The attack should be against social injustice and the unfair
distribution of land and wealth. If used well, birth control can in fact help the
poor gain strength to work for their basic human rights. But the decisions and
responsibility for family planning must be in the hands of the people themselves.
Decide for yourself if and how you want to plan your family.
Do not let anyone else decide for you.
2.
Is it safe?
Whether or not different forms of birth control are safe has been much
discussed. Often those who are against birth control for religious or political
reasons try to scare women by talking about the risks. Some methods do have
certain risks. However, the important thing all women should realize is that birth
control is safer than pregnancy, especially after a woman has had many children.
The risk of serious illness or death resulting from pregnancy is many times
greater than the risks involved in using any of the common methods of birth
control.
There is much talk about the risks of taking birth control pills (oral
contraceptives). But the risks with pregnancy are many times greater. The pill
works so well in preventing pregnancy that for most women it is safer—in terms of
protecting their lives—than any of the other 'less risky' but less effective methods.
CHOOSING A METHOD OF BIRTH CONTROL
On the following pages several methods of birth control are described. Some
work better for some people than others. Study these pages, and talk with your
midwife, health worker, or doctor about what methods are available and are likely
to work best for you. Differences in effectiveness, safety, convenience, availability,
and cost should be considered. Husbands and wives should decide together, and
share the responsibility.
AVERAGE EFFECTIVENESS OF DIFFERENT FORMS OF BIRTH CONTROL
and this many must (or
on the average this many
Of each 20
should) stop the method
are likely to get pregnant
women using
this method . . . in spite of the method . . . because of problems.
PILL
CONDOM
DIAPHRAGM
FOAM
I. U. D.
PULLING OUT
STERILIZATION
SPONGE
■RHYTHM
MUCUS
A
41
ah
Lhjj
H
A
A
*
HA
ahhaa
H4HAA lc°M.BlNED
H444H
* With sterilization, problems occasionally result from surgery but the
method is permanent.
332
BIRTH CONTROL PILLS (ORAL CONTRACEPTIVES)
When taken correctly, the 'pill' is one of the most effective methods for
avoiding pregnancy. However, certain women should not take birth control pills
if they can use another method (see p.334). If possible, birth control pills should
be given by health workers, midwives, or other persons trained in their use.
The pills usually come in packets of 21 or 28 tablets. The packets of 21 are
often less expensive, and of these, some brands are cheaper than others. The
amount of medicine differs in different brands. To pick the kind that is right for
you, see the GREEN PAGES, page380.
PACKET OF 21 PILLS
PACKET OF 28 PILLS
ooooooo
ooooooo
ooooooo
OOOOOOO
OOOOOOO
ooooooo
ooooooo
How to take the pills—packet of 21:
Take-the first pill on the fifth day from the beginning of your period, counting
the first day of the period as day 1. Then take 1 pill every day until the packet is
finished (21 days).
After finishing the packet, wait 7 days before taking any more pills. Then begin
another packet, 1 pill each day.
This way, you will take the pills for 3 weeks out of each month, then go 1
week without taking any. Normally, the menstrual period will come during the
week when the pill is not taken. Even if the period does not come, start the new
packet 7 days after finishing the last one.
If you do not want to get pregnant, it is important to take the pills as directed
—1 every day. If you forget to take the pill one day, take 2 the next day.
Packet of 28 pills:
Take the first pill on the fifth day of the period, just as with the packets of 21
Take 1 a day. Seven of the pills will probably be a different size and color. Take
these pills last (one a day) after the others have all been taken. The day after you
finish the packet of 28, start another packet. Take 1 a day without ever missing a
day, packet after packet, for as long as you do not want to become pregnant.
No special diet must be followed when taking the pill. Even if you happen to
get sick with a cold or something else while taking birth control pills go right
on taking them. If you stop taking the pills before the packet is usedup you
may become pregnant.
333
Side effects:
Some women get a little morning sickness, swelling of the breasts, or other
signs of pregnancy when they first start taking the pill. This is because the pill
contains the same chemicals (hormones) that a woman's body puts into her blood
when she is pregnant. These signs do not mean she is unhealthy or should stop
taking the pill. They usually go away after the first 2 or 3 months. To relieve
morning sickness, see page 294..
Some women may bleed a different amount than usual in their monthly period
when they are taking the pill. These changes are usually not important. Some
times they can be corrected by changing to a brand with a different amount of
hormone. This is discussed in the GREEN PAGES (p.426).
“Is it dangerous to take oral contraceptives?"
Like all medicines, birth control pills occasionally cause serious problems in
certain persons (see next pages). The most serious problems related to the pill are
blood clots in the heart, lungs, or brain (see stroke, p. 373). However, the
chance of getting dangerous clots is even higher when women get pregnant than
when they take the pill.
Death related to taking the pill is rare. On the average, pregnancy and child
birth are 50 times as dangerous as taking the pill.
Of 15,000 women who become
pregnant, 75 are likely to
die from problems of pregnancy or
childbirth.
Of 15,000 women who take birth
control pills, only 1 is likely die
from problems related to having
taken the pills.
11 ill1 til11lilt
Conclusion:
IT IS MUCH SAFER TO TAKE THE PILL THAN TO BECOME PREGNANT.
For most women, birth control pills are relatively safe. Certainly they are far
safer than becoming pregnant. However, for some women both pregnancy and
taking birth control pills have a higher risk. These women should use other
methods of birth control.
334
Who Should Not Take Birth Control Pills?
A woman who has any of the following signs should not take oral (or injected)
contraceptives:
• Deep or steady pain in one leg or hip.
This may be caused by an
inflamed vein (phlebitis or blood
clot). Do not use birth control
pills. (Women with varicose veins
that are not inflamed can usually
take birth control pills without
problems. But they should stop
taking them if the veins become
inflamed.)
Stroke. A woman who has had
any signs of a stroke (p. 373)
should not take the pill.
Hepatitis (p.'2O9), cirrhosis (p.374), or other liver disease.
Women with these problems, or whose eyes had a
yellow color during pregnancy, should not take the pill.
It is better not to take oral contraceptives for one year
after having hepatitis.
Cancer. If you have had or suspect cancer of the breast or womb, do not use
oral contraceptives. Before beginning oral contraceptives, examine your
breasts carefully (see p. 325). In some
health centers you may also be able to
get a simple test (Pap smear) to check
for cancer of the cervix or opening of
the womb. Birth control pills do not
cause cancer, but if cancer of the breasts
or womb already exists, the pill can
make it worse.
• A woman who is breast feeding her baby should not take birth control pills.
Some health problems may be made worse by oral contraceptives. If you have
any of the following problems, it is better to use another method if you can:
• Migraine (p. 199). Women who suffer from true migraine should not take
oral contraceptives. But simple headache that goes away with aspirin is no
reason not to take the pill.
• Urinary infection with swelling of the feet (p. 278).
• Heart disease (p. 37.1).
• A great deal of blood loss during the menstrual period.
if you suffer from asthma, tuberculosis, diabetes, or epilepsy, it is best to get
medical advice, before taking birth control pills. However, most women with these
diseases can take oral contraceptives without harm.
335
Precautions Women Should Take when Using Birth Control Pills
1. Examine the breasts carefully
every month for lumps or possible
signs of cancer (see page 3 2 5)
2. Have your blood pressure
measured every 6 months.
Watch for any of the problems mentioned on page334, especially:
3.
• Severe and frequent migraine headaches (p. 199).
• Dizziness, headache, or loss of consciousness that results in difficulty in
seeing, speaking, or moving part of the face or body (see Stroke, p. 373).
• Pain with inflammation in a leg or hip (chance of a blood clot).
o Severe or repeated pain in the chest (see Heart Problems, p. 371).
If one of these problems develops, stop taking the pill and get medical advice.
Avoid pregnancy by using another method, as these problems also make
pregnancy especially dangerous.
Questions and Answers about Birth Control Pills
Some people claim birth
control pills cause cancer. Is
this true?
No! However, if cancer of the
breast or womb already exists,
taking the pill may make the
tumor grow faster.
Can a woman have children
again if she stops taking the
pill?
Yes. (Sometimes there is a delay
of a month or 2 before she can
become pregnant.)
\ Is the chance of having
f twins or defective children
greater if a woman has used
oral contraceptives?
No. The chances are the same as
for women who have not taken
the pill.
0
?
??
Most women are not affected.
But some mothers produce less
milk, or stop making it altogether,
when they start taking the pill.
For this reason it is a good idea for women who are breast
feeding to use another method of birth control during the first
6 months, and then change to the pill.
Is' it true that a mother's
breasts will dry up if she
starts taking birth control
For information on birth control pins, see the Green Pages-p.425-
336
OTHER METHODS OF BIRTH CONTROL
THE CONDOM (also called 'prophylactic', ’rubber', or
sheath) is a narrow rubber or latex bag that the man wears
on his penis while having sex. Usually it works well to
prevent pregnancy, it also helps prevent spreading of
venereal diseases, but is not a complete safeguard.
You*can buy condoms in most pharmacies. Some are
cheaper than others. Before using it, fill it with water to make
sure it does not leak.
THE DIAPHRAGM is a shallow cup made of soft rubber.
A woman wears it in her vagina while having sexual
relations. It should be left in for at least 6 hours afterward.
It is a fairly sure method—especially if used together with a
contraceptive cream or jelly. A health worker or midwife
should help fit the diaphragm, as different women need
different sizes. Check the diaphragm regularly for holes
and get a new one each year. They are not expensive.
CONTRACEPTIVE FOAM comes in a tube or can. The
woman puts it into her vagina with a special applicator. It
must be applied no longer than 1 hour before having sex,
and left in for at least 6 hours afterward. The application
should be repeated before each time the couple has sex,
even if this is several times in one night. It is a fairly sure
method if used correctly, but a nuisance.
THE INTRAUTERINE DEVICE (IUD) is a plastic
(or sometimes metal) object that a specially trained
i
health worker or midwife places inside the womb.
While in the womb, it prevents pregnancy. IUDs fall
out of some women, yyfter every menstrual period
check if the IUD is still in place. In other women they
cause pain, discomfort, and sometimes serious
1
problems, but for some women they give no trouble
at all. For these women, the IUD may be the simplest
and most economical method.
WITHDRAWAL OR PULLING OUT (COITUS INTERRUPTUS) is a method
in which the man pulls his penis out of the woman before the sperm comes. This
method is perhaps better than none, but is disturbing to the couple and does not
always work, because some sperm often leaks out ahead of time and can cause
pregnancy.
Menstrual Regulation: If a woman thinks she is pregnant, she can get menstrual
regulation done within 10 days of missing her periods, at a health centre. Do not use
this as a birth control method. Use another method which can prevent pregnancy.
337
METHODS FOR THOSE WHO NEVER
WANT TO HAVE MORE CHILDREN
INJECTIONS. There are special injections to
prevent pregnancy. Depo-Provera is one. An injection
is usually given every 3 months. Sometimes women
cannot become pregnant ever again after they have
had these injections, so generally only women who
will never want more children should use this method.
Side effects and precautions are similar to those for
birth control pills.
Injections are useful for women who are sure they
do not ever want to become pregnant again—
especially those who have trouble remembering to
take pills or for other reasons have difficulty taking
them.
STERILIZATION. For those who never want to have more children, there are
fairly safe, sifnple operations for both men and women. In our country these
operations are free. Ask at the health center.
For men, the operation is called a vasectomy.
It can be done in a doctor's office or a health
center. Small cuts are made here
so that the tubes from the man's
testicles can be cut and tied.
The operation has no effect at all on the man's
sexual ability or pleasure. His fluid comes just the
same, but has no sperm in it.
For women, the operation is called a tubal
ligation, which means to tie the tubes. It
can be done simply and quickly, and
usually without putting the woman to sleep.
One method is to make very small cuts
in the lower belly so that the tubes coming
from the ovaries, or egg-makers, can be cut
and tied.
This operation has no effect on the
women's menstrual periods or sexual
ability, and may make having sex more
pleasant because she does not have to
worry about becoming pregnant.
338
HOME METHODS FOR PREVENTING PREGNANCY
Every land has 'home remedies' for preventing or interrupting pregnancy.
Unfortunately, most either do not work or are dangerous. For example, some
women think that to wash out the vagina or to urinate after having sex will
prevent pregnancy, but this is not true.
THE SPONGE METHOD. Here is a home method that is not harmful and some
times works. You cannot be sure it will prevent pregnancy every time, but it can
be used when no other method is available.
You will need a sponge and either vinegar, lemons,
or salt. Either a sea sponge or an artificial sponge will
work. If you do not have a sponge, try a ball of
cotton, or soft cloth.
♦ Mix:
2 tablespoons vinegar in 1 cup water
or
1 teaspoon lemon juice in 1 cup water
or
1 spoon of salt in 4 spoons water
♦ Wet the sponge with one of these liquids.
♦ Push the wet sponge deep into your vagina
before having sex. You can put it in up to an
hour before.
♦ Leave the sponge in at least 6 hours after having
sex. Then take it out. If you have trouble getting
it out, next time tie a ribbon or piece of string
to it that you can pull.
The sponge can be washed and used again, many
times.
You can make up the liquid in advance and keep
it in a bottle.
BREAST FEEDING. While a woman is breast feeding her baby she is less likely to
become pregnant—especially when breast milk is the only food her baby receives.
The chance of her becoming pregnant is much greater after 4 to 6 months, when
the baby begins to get other foods in addition to breast milk. To be more sure she
will not become pregnant, the mother who is breast feeding should begin some
method of birth control when the baby is 3 to 4 months old. The earlier she
begins the surer it will be. (Before the baby is 6 months old, a method other than
birth control pills is better because the pills cause some women to produce less
milk.)
339
METHODS THAT DO NOTWORK VERY WELL
THE RHYTHM METHOD:
This method is not very sure to prevent pregnancy, but it has the advantage of
not costing anything. It is more likely to work for a woman whose periods come
very regularly, more or less once every 28 days. Also, the husband and wife must
be willing to pass one week out of each month without having sex the regular
way. .
Usually a woman has a chance of becoming pregnant only during 8 days of her
monthly cycle—her 'fertile days'. These 8 days come midway between her periods,
beginning 10 days after the first day of menstrual bleeding. To avoid getting
pregnant, a woman should not have sex with her man during these 8 days. During
the rest of the month, she is not likely to get pregnant.
To avoid confusion the woman should mark on a calendar the 8 days she is not
to have sex.
For example: Suppose your
period begins on the 5th day of
May.
MAY
-(V)
Mark it like this:-—
6
1
8
7
2
9
3
10
4’
11
1
12
13
14
15
16
17
18
1
19
Then count 10 days. Starting
with the 10th day, put a line
.X 26
under the 8 days that follow,
s'
like this:----------------- -------------- '
20
21
22
23
24
25
.
27
28
29
30
31
During these 8 'fertile days',
do not have sexual relations.
JUNE
Now suppose your next period
begins on the first of June. Mark
it the same way, like this:------'
Once again count off 10 days
and underline the following 8
days in which you will not have
sexual contact.
__________——!
(Pl
~2
9
3
10
4
11
5
12
6
13
7
14
8
15
16
17
18
19
20
21
22
.
23
24
25
26
27
28
29
I
30
I
i
If the woman and her husband carefully avoid having sex together during these
8 days each month, it is possible that they will go years without having another
child. However, few couples are successful for very long. This is not a very sure
method, unless used in combination with another method such as a diaphragm or
condoms.
340
THE MUCUS METHOD
This is a variation of the rhythm method that is being encouraged by some
religious groups. It works fairly well for some people but not for others. In
general it cannot be considered a very sure way of preventing pregnancy, but it
costs nothing and has no other risks than those that come with pregnancy itself.
Every day, except during her period, the woman should examine the mucus
from her vagina.
Take a little mucus out of your vagina with a clean finger and try to make it
stretch between your thumb and forefinger, like this:
As long as the mucus is sticky like
paste—not slippery or slimy—you
probably cannot become pregnant,
and can continue to have sexual
relations.
When the mucus begins to get slippery
or slimy, like raw egg, or if it stretches
between your fingers, you may
become pregnant if you have sexual
relations—so do not have sex when the
mucus is slippery or stretches.
The mucus will usually become slippery during a few days midway between
your periods. These are the same days you would not have sex with your man if
you were using the/hythm method.
To be more sure, use the mucus and rhythm methods together. To be still more
sure, see below.
Combined Methods:
If you want to be more certain not to become pregnant, it often helps to use
2 methods at the same time. The rhythm or mucus method combined with the
use of a condom, diaphragm, foam, or sponge is surer than any of these methods
alone. Likewise, if a man uses condoms and the woman a diaphragm or foam,
the chance of pregnancy is very low.
Strength lies not in numbers, but in having enou^i to eat.
Consider planning your family.
The book Where There Is No Doctor is available
at Rs 29/- plus postage. Multiple copies of reprints
of various chapters are also available.
■ I
Please write to:
Publications Officer
Voluntary Health Association of India
C-14 Community Centre
Safdarjung Development Area
New Delhi 110016
I
Rs.
1.00
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