GLOBAL JOURNAL OF MEDICINE AND PUBLIC HEALTH

Contraceptive devices in India

*1 2
Felipe Weinberg , Kadri SM

ABSTRACT
Contraception as a process of preventing pregnancy, in the last decadesand GJMEDPH 2014; Vol. 3, issue 6
increase use of contraceptives methods has been display in developed and less-- *Corresponding Author:
1
developed countries. Barrier methods, hormonal methods and sterilization, plus Medical Doctor,
new contraceptive products or methods are available today. These are new Schomburgstr, 111, 22767 Hamburg,
Germany
implants, a medicated intrauterine device, contraceptive vaginal rings, [email protected]
transdermal patches and several new regimen of combined oral contraceptives.
2
These new or improved methods have been developed to expand the Epidemiologist,
contraceptive choices available to women and men, as well to respond to the Directorate of Health Services,
Kashmir, India
unmet need for contraceptives and to the protection against sexually
transmitted diseases. Various contraceptive methods are being used in India Conflict of Interest—none
today and are effectively prevent unwanted pregnancy but there is a need to
Funding—none
generate awareness and a better sexual and reproductive education that can
serve to the general Indian public to reduce maternal mortality and sexual
transmitted infections.

Keywords: Contraceptive devices, Contraceptive methods, Family planning, India

INTRODUCTION include intrauterine methods such as copper, IUD that

Contraception is the process of preventing pregnancy causes minor inflammatory reaction and prevents
which is achieved by intervention the process of sperm from fertilising the egg. Intrauterine device
ovulation, fertilisation or by preventing implantation that releases a controlled amount of hormone, like
in the uterus. There are various kinds of progesterone, can also prevent fertilisation as well as
contraceptives available today which can be broadly prevent implantation at the same time 1. A permanent
classified according to their mode of action and use. A approach to contraception is sterilisation in which
common form of classification of contraception pregnancy is prevented by preventing release of
methods are: Barrier methods, hormonal methods, sperm or woman from the egg fertilization. This can
emergency contraception, intrauterine methods and be achieved by surgical means and involves tube
sterilisation. The barrier method is the prevention of tightening that puts a barrier to sperm path. Another
fertilisation by blocking the male gamete from method is vasectomy in which the vas deferens is
reaching the ova. Condoms, both male and female surgically blocked or removed. Blockage of fallopian
versions, diaphragms, cervical caps, contraceptive tube is a means of preventing the female gamete
sponges and spermicides are few examples of barrier from being fertilised by sperm.
method of contraception. The hormonal method
modifies the ovulation and womb cycle to prevent METHODS
pregnancy. It can be achieved by means of pills, This paper is a review of secondary data accessed
injections, hormonal patches, implantable rods or through PubMed and Google Scholar. It provides an
vaginal rings. Other methods that are not hormonal

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overview of contraceptive methods in the world and power that is blessed to humans as a means to create
in India. their progeny.2

CONTRACEPTIVES AND ITS IMPACT IN THE WORLD CONTRACEPTIVES AND ITS IMPACT IN INDIA
The use of contraceptives to prevent unwanted The use of contraception in India for population
pregnancies, as well the use of Barrier methods to control started with the widespread family planning
prevent sexual transmitted diseases (STDs) has got a programme that was announced in 1952. Since then
significant impact in modern lives. Both in the the strategy for population stabilisation and control in
developing as well as developed countries, India relies on the various methods of contraception
contraception has played a big role in women available. The nation--wide awareness campaign on
empowerment and a choice to better plan and control use of contraception for birth control has taken a
their lives, sexuality and their families planning as a different form in the modern day as access to
whole. It is a widely accepted fact that, women have contraceptive means becomes easier and rise in
the right and reasons of their own for the use of population of the literate and educated. However, use
preventive measures of pregnancy.2, 3 of contraception, in certain religious groups, still
remains a taboo.5
Factors such as financial implications, social
implications, and sexual empowerment or to keep a It is seen that in a nation--wide survey about 58% of
job may influence the decision of when to have a baby the currently married and non--pregnant women who
and hence compel the use of measures to prevent were between 15–49 years of age were using some
undesired pregnancy. Recognising its impact on the form of contraception although there were variations
present society, the US Centers for Disease Control depending on demographic, social, cultural and
and Prevention (CDC) announced it as among the 10 economic status of women. The data further points
greatest milestones of the twentieth century. 4 With an that the use of contraceptive is directly related to the
aim to improve accessibility to quality care and family economic status of a family and the standard of living
planning choices as well as to set a medical eligibility as well as educational level of either their husband or
criteria, the World Health Organisation (WHO) has the woman. A comparison of rural and urban
issued special instructions that should be followed for population further reveals that the use of birth control
the use of contraception. Apart from family planning methods is higher in urban population as compared to
and social empowerment, some contraception rural areas. This might be linked to educational, social
methods help to reduce the transmission of STDs as and economic status of the rural population. Among
well the control of irregular menstrual cycles, various religious groups Muslim population remains
polycystic ovarian syndrome and the incidence of the least to utilise any birth control methods and
certain type of female cancers. Hindu women were found to be highest. 6

The use of contraceptives may be deterred by various

factors such as personal belief, cultural or religious VARIOUS CONTRACEPTIVE DEVICES USED IN INDIA
aspects. There are conflicts between modern health With development of various contraceptives around
care strategies and religious beliefs. This is more the world like India has followed suit in adopting the
augmented in cases when personal faith in the religion options available for contraception. The available
becomes strong. Therefore enforcers or service contraception methods can be classified into barrier
providers should have a thorough knowledge of such methods, hormonal methods, intrauterine methods
barriers and provide the right means of contraception and sterilisation.
that is acceptable to the region. A study of Jewish
population stated that, increased religiosity is Barrier method
indirectly proportional to use of contraception. This The barrier method of contraception refers to non--
remains true for most of the religious groups of the hormonal approach in which the natural path of the
world as sex is considered a sperm is blocked and prevents it from fertilising the

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egg. There are various forms of barrier methods India. Apart from phased pills which are taken in doses
available for both male and female contraception. This for a definite time during the menstrual cycle there
method includes use of condoms both in male and are pills that are called emergency pills or morning
female variants, spermicidal creams and foams, after pills. These types of pills are taken after sexual
cervical caps and shields. Barrier method is the most intercourse to prevent unwanted pregnancy.
convenient means of preventing unwanted pregnancy Progesterone is the hormone that is used in this type
and should be used only during or after an act of of pills. Examples are I--pill, Oops and pill 72 or
sexual intercourse. Condom is the most widely used unwanted 72. A non--hormonal pill called
barrier method in India as a means of contraception. 7 Centchroman is a birth control pill developed and
available in India. As it is a non--hormonal pill there is
no side--effect which are associated with hormone
India is the first country to start a social awareness pills.8
and marketing campaign of condoms after the launch
of a brand called Nirodh. Since then various Apart from pills there are birth control rings available
organisations which are governmental, non-- for women. The ring contains hormones, which when
governmental or private have actively participated in inserted into the vagina releases controlled amount of
distribution of free and commercial condoms progesterone or oestrogen. It does not need a medical
throughout the country. This is not only to control professional for implantation of the device, rather it
birth but has helped in prevention of sexually can be inserted by oneself. 7 Other hormonal means
transmitted diseases. Due to its widespread include; contraceptive injection which is administered
awareness, condom is widely used as an effective intramuscularly and lasts for more than five months.
contraceptive method. Women receiving such injections will not have
menstrual bleeding for the said period and hence
Unlike the male condom, the female condom also there will be no ovulation during the effective period.
known as Femidom, which is worn by female during Although Hormonal patches and Implants are other
sexual intercourse has limited acceptability in the options available in developed countries, it is still not
Indian context. introduced in India.7
Hormonal Methods Intrauterine methods
The hormonal method of birth control refers to the Intrauterine devices (IUDs) are one of the most
use of hormones that modulates the natural effective types of long--acting reversible birth control
phenomenon of ovulation and implantation to methods. IUDs are non--hormonal means of
prevent pregnancy. There are different types of contraception which is placed inside the womb and
hormonal methods available and types of hormones prevents fertilisation of the egg by disrupting the
used. Pills are based on hormones like oestrogen and sperm mobility and damaging sperm so is prevented
progesterone which is taken independently or in from joining with an egg. Copper T380A is the most
combination. A combined pill contains both cost--efficient means available to postpartum women.
hormones in the form of estradiol and levonogestrel, The device can be safely implanted into the womb
desogestrel etc. These types of pills are available in 21 and can be used without concerning the
day or 28 day packs. Mala D, Ovral, Novelon and breastfeeding status of a woman. 9 The intrauterine
Femilon are few examples of combined pills available postpartum device can be implanted 48 hours after
child birth or after 4 weeks after birth.
in the Indian market.8

Phased pills are also combination of oestrogen and Although IUDs are most cost efficient and effective
progesterone in which the oestrogen dose is kept type of contraception only less than 2% of women
almost at a constant rate and progesterone is using contraceptives depends on it. Understanding
increased gradually in a phased manner. Triquilar and the potential of IUDs and with increased number of
3--Phase are trade name of phased pills available in institutional births, the Government of India has

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decided to strengthen the awareness and use of IUDs. Sterilisation

Establishment of national training centers in different Sterilisation is a surgical method of contraception in
regions of the country has further helped in the which the movement of the egg or sperm is controlled
scaling up of use and awareness of the device in by invasive means. In case of females it is achieved by
India.9 cutting, sealing or blocking the fallopian tube. In case
of male sterilisation is achieved by cutting and tying
New generation IUDs contains hormones which are the vas deferens which carries sperm from the testes
slowly released into the womb. One example of such a to the penis. The procedure is called vasectomy.
device is with the trade name Mirena which contains Sterilisation is different from other method of
levonorgestrel, a progesterone analogue. The IUD contraception as it refers to a permanent arrangement
does not disturb the regular period rather helps and and should be used only when people are certain of
reduces heavy bleeding during menstruation. It is also not having any children in future. 12 In India, female
used as treatment of dysfunctional uterine bleeding. 7 sterilisation is the most widely practised procedure as
a means of contraception.13
Emergency IUDs (E--IUDs) A comparison of various means of contraceptive use
Copper--T can also be used as an emergency in few developing and developed countries of the
contraceptive if implanted within 5 days of sexual world revealed that in India female contraception is
intercourse. Copper--T (Copper T380A) is a much more the most widely used followed with a wide difference
efficient emergency birth control mechanism when in numbers by use of condom followed by pills. IUDs
compared to morning pills as it has a chance of more and self--restrain follows the least used means. Figure
than 99% prevention rate.10 A study of use of copper T 1 shows the comparison of different contraception
as an emergency contraceptive in China proved that methods used in developing and developed countries.
the method is highly efficient and can be used anytime 13

during a menstrual cycle.11

Figure 1 Comparison of different contraception methods used in developing and developed world

SOCIAL AND ECONOMIC BARRIERS

The use of contraceptive devices depends a lot on studies that religious and cultural factors have great
socio--economic and religious background of an role in determining the acceptance or rejection of use
individual. This has been observed in different parts of of contraception by couples belonging to different
the world in various studies and applies in the Indian religious groups of the society. 2 Apart from religious
contexts too. It has been observed in earlier beliefs, access to readily available contraceptive

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methods is comparatively less in developing countries or the Supreme Court, all sex education in schools
which is another barrier in the use of contraceptive. should be banned and education should follow in the
The unavailability is further augmented by the laws Indian context. He believes fidelity is more important
and policies that prevents unmarried individuals or than using condoms.17
setting a lower age limit for such facilities. 14 Even after
the contraceptive means are received social barriers FUTURE IMPLICATIONS
do not allow the use. In most developing countries The use of contraceptive is an effective means to
young married women are compelled to bear a child prevent unwanted pregnancy and maternal mortality.
within their first year of marriage and the use of If used properly, it can avoid more than 90% of
contraceptive is not applicable in such situations. abortion related and 20% of obstetric related death in
the world.18 India accounts for more than 20% of
Awareness is a factor that takes a major role in the use maternal death in the world and the figure is not the
of contraception. In a survey conducted in central real figure as there are numerous illegal abortions that
India regarding awareness of contraceptive methods takes place in private clinics. The sheer number of
among women who underwent abortion it was seen abortions and maternal mortality is due to the fact
that almost 85% of the subject under study did not use that very less people are aware of contraception and
any contraceptive. Awareness of emergency pills were absence of a family planning strategy. Even though
among only 1.5% of the study group. The pregnancy contraceptives methods are known, various other
that resulted were due to contraceptive failure or due socio--economic barriers prevent its efficient
to neglect of contraceptive use.15 Since the study was utilisation to prevent unwanted outcomes. 19
conducted in a small sample size in a part of India it is
not representative of the whole nation but portrays a
significant picture of contraceptive use in rural India. With development and improvement in economic
Another nation--wide study revealed that 12% of rural status and growth of awareness among the younger
population and 5% of urban Indian women are still and older generations, it is expected that the number
unaware of any type of contraceptives available as a of contraceptive use would prevail in the near
means of birth control.16 future.20 It has been observed that the younger
generations of medical practitioners are very much
Awareness to various contraceptive methods available willing to impart sexual and reproductive education
and use of it can be imparted to young adults through and services to the general public. However, lack of
imparting sex education. Since young adults are the awareness and abusive use of contraceptives can be
most prone age--group that follows sexual behaviour prevented by imparting the right education. Therefore
that results in unwanted pregnancies, maternal training in contraceptive counselling should be
fatality and abortions. However, as the Union Health incorporated during training of health care
Minister of India puts it, although not officially professionals19 and general public awareness should
approved by the Parliament be imparted primarily.

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