Dr KK Aggarwal, National President IMA
Dr RN Tandon, Hony Secretary General IMA
Dr Rishma Pai, President FOGSI 2017
Dr Hrishikesh Pai, Secretary General FOGSI 2017
Today is World Population Day, a day earmarked by the United Nations to create awareness about population issues worldwide. The importance of family planning is one such very important issue.
In a momentous occasion, 3 lakh doctors of the Indian Medical Association (IMA) and 37,000 doctors of FOGSI, the Federation of Obstetric and Gynaecological Societies of India, have joined hands to create awareness about a paradigm shift in contraception in a bid to empower women with choices available and help them to make the right choice for themselves.
There is now a basket of choices available in our country, from the irreversible tubectomy to the reversible long-acting spacing methods of contraception such as the intrauterine device (effectiveness lasting for 3-year duration or 10-year duration) and the implants.
Injectable contraceptive has recently been added as a new contraceptive choice.
The various methods of contraception can be categorized into three groups based on their effectiveness.
· Most effective: These include the long-acting reversible contraception and sterilization, which is a permanent method. The pregnancy rates are the lowest because their effectiveness is minimally influenced by the actions of the user or adherence.
· Effective: In this category, the injectable contraceptives have the highest effectiveness. Other options are the oral contraceptive pills, transdermal patch and the vaginal ring. But their effectiveness rests on the user and incorrect or irregular use is associated with higher pregnancy rates.
· Least effective: Diaphragms, cervical caps, sponges, male and female condoms, spermicides, periodic abstinence and withdrawal are associated with much higher pregnancy rates.
Contraceptive counseling also involves informing the woman about the various choices available in the country today along with the associated risks and benefits in addition to educating them about contraception, their present and future contraceptive needs and the risks of unintended pregnancy so that she can balance the advantages of each method against its disadvantages and side effects and decide on a preferred method.
Emergency contraception is another important option that young adults should be aware of including the right way to use it to prevent an unplanned pregnancy. For individuals at risk of sexually transmitted infections, the use of condoms is recommended.
Instead of the doctor taking a decision alone on behalf the woman, the two should together decide on what would be the best method of contraception taking into consideration the personal preferences, social and cultural factors along with the efficacy, safety and side effects of different contraceptives.
A judgment of the UK Supreme Court in 2015 in the case of Montgomery vs Lanarkshire Health Board changed the law on informed consent in the UK. According to the judgement, when counseling the patients about the benefits and risks of various treatment options, doctors are now required to ensure that “the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments”. And, to consider whether “a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would be likely to attach significance to it."
Data show that women prefer the long-acting reversible contraception as a first choice of contraception over sterilization. It is a highly efficient method with failure rates equal to or better than the permanent method; moreover, it is non-surgical, cost-effective and reversible.
Instead of opting for irreversible tubectomy, there is now an alternate choice of reversible long-term contraception.
Women who request a sterilization should also be counseled about the long-acting reversible contraception as a method of choice of contraception marking a paradigm shift from permanent method to the long-acting reversible contraception.
Dr KK Aggarwal
National President IMA & HCFI