By Dr. Mariyam Sadikot, Aara Health
Artwork by @smishdesigns
“The Pill”. Women young and old, in South Asia and around the world, at some point encounter the inevitable question that marks the moment we take our sexual and reproductive health into our own hands. “Are you on the pill?” often comes loaded with a host of unspoken and unsolicited (and perfectly unhelpful) questions, judgements, diagnoses about our moral repute. Unfortunately, our choices about contraception are often considered less of a personal choice about one’s own body, and more of a juggling act in navigating social taboos and expectations.
“How do I talk to my doctor about it? How do I talk to bae about it? What if my parents ask questions? How will this affect my body? Maybe I don’t need to worry about it.”
The thing is that access to contraceptives can be one of the most definitive factors in a woman’s life. It defines our ability to own, and enjoy our sexual identities, and simultaneously gives us a clear and decisive say in when and with whom we choose to conceive children. And it’s an issue that’s equally as important for a young woman at the start of her sexual identity as it is for the mother of three, or one, or none, who has decided not to have more kids.
In India, an estimated 43% of women aged 15-4, use contraception, while 57% of those in a marriage or with a partner use contraception. The estimated unmet need for contraception use among women 15-49 in India fell just below 10%. Access to safe and voluntary Family Planning - the term regularly used in lieu of contraception - is a human right. It is a cornerstone in women’s agency and empowerment. This is saying a lot because the word “empowerment” gets bandied about a lot, but few recognize how closely tied real empowerment is to our ability to determine when and if we are going to bear a child.
This is why contraception, and safe, informed access to it, is one of the key points within nearly every “empowerment” narrative. So much so that it’s regularly on the agenda of every development organization. The UNFPA points out that “in developing regions, an estimated 217 million women who want to avoid pregnancy are not using safe and effective family planning methods, for reasons ranging from lack of access to information or services to lack of support from their partners or communities. This threatens their ability to build a better future for themselves, their families and their communities.” So today, we’re going to start by informing you. Let’s talk about contraception so that you can then talk to your partners, your families, and your communities. And if you’re not getting the support you need from them, at the very least, you can count on us.
The Myths Around Contraception
Although contraception is a means to prevent fertilization i.e. to prevent pregnancy, reproductive health and mental grounds are now the other considerations for birth control. With hundreds of choices available in the pharmacy, there is still very little awareness about the methods of use and several myths which prevent you from making an informed decision. So, let us evaluate our options and debunk these myths regarding contraception.
Myth 1: All forms of birth control are either 100% effective or they don’t work at all
We all remember Ross yelling in F.R.I.E.N.D.S that condoms only work 97% of the time; This holds true for all contraceptives. They all have their failure rates, but this also depends on the individual’s understanding of the method they’re using and mistakes made while using the method. However, if used correctly most methods are highly effective with OC pills and condoms being about 99% effective.
Myth 2: Natural methods are enough to prevent pregnancy
These methods include having sex only during the ‘safe period’ or the withdrawal method. Considering today’s busy lifestyle, hormonal changes and rising cases of PCOS, it can become very difficult to regularly track your cycle and predict ovulation. Thus, the failure rate can be very high. The same goes for the withdrawal method. This method requires for you to trust your partner, very high motivation, and has no margin for error. Pre-ejaculation fluid can also contain certain sperm and thus conception cannot be ruled out. These methods also do not help prevent STDs.
Myth 3: Oral contraceptive pills [OC pills] make you gain weight
Estrogen and progesterone - the two hormones present in combined pills both have opposing effects on the lipid a.k.a. fat metabolism. And with the low dose combinations available currently, there are very few chances of any metabolic effect of these drugs on one’s body.
Myth 4: Birth control pills will imbalance my hormones and have effects on my mood
Estrogen and progesterone are the two hormones that regulate your natural cycle and these pills work in the same cyclic way thus having minimum extra hormonal effects.
Myth 5: Condoms interfere with sexual pleasure
This is a highly controversial topic and it depends on an individual’s perspective. With plenty of varieties available now, with thinner materials that feature various textures and lubricants, modern condoms can increase pleasure, and best of all, can protect against STDs. This should be the topmost priority while selecting a contraceptive method when having intimate relations with a new partner. Better safe than sorry, ladies.
Myth 6: You cannot get pregnant while breastfeeding.
This is one of the common misconceptions that while breastfeeding a woman cannot get pregnant. 20% of breastfeeding women will ovulate as soon as 3 months after delivery. Ovulation often occurs before menstruation, and these women are at risk for unplanned pregnancies if care is not taken. In breastfeeding women, hormonal contraceptives can interfere with milk production so it’s best to consult your doctor and opt for a safer barrier or non-hormonal contraception.
Myth 7: I cannot get pregnant if I douche after sex
Myths like this are not only wrong but very dangerous. Sperms are highly motile and they usually enter the cervix and uterine cavity after ejaculation, making douches ineffective. Practising regular douches is strongly inadvisable as it strips off one’s natural healthy bacteria off of one’s vagina and causes pH imbalances, which predisposes to infection. Unless medically advised, douches should not be performed.
Myth 8: Birth control pills can have negative effects on future pregnancies
Almost all women will have normal menstrual cycles after stopping OC pills after a couple of months. There is also no evidence that it will affect the fetus or increase the chances of abortion. There is no evidence that suggests any negative effect of birth control pills on pregnancy or any fetal malformations.
Myth 9: OC pills once missed can disrupt your entire cycle
If you’ve missed one pill, you can take two tablets the next day and continue your cycle. If you’ve missed for more than one day you’re no longer protected and should use a barrier method along with that cycle.
Myth 10: OC pills can cause Pelvic Inflammatory Disease (PID)
Actually, it’s the opposite. Progesterone thickens the mucus and prevents entry of organisms in the uterus, thus decreasing the chances of PIDs. However, the risk of PIDs is lowest with barrier contraception. With IUCDs there are some chances of infection. They don’t cause new infection but can potentially aggravate existing undetected infections.
Myth 11: Birth control pills cause cancer
This is also another common misconception. OC pills actually reduce the incidence of ovarian and uterine malignancy. By inhibiting ovulation, they reduce the wear and tear on your ovarian surface which reduces the chances of injury. It also reduces the risk of anorectal cancer. When you use birth control pills for a long term (years), your chance for breast or cervical cancer may increase – but only slightly. However, your risk for ovarian or endometrial cancers goes down by 30-50%!
Myth 12: You cannot use hormonal pills If you’re suffering from PCOS
You should always take advice from your doctor regarding your method of contraception. However, as the two hormones - estrogen and progesterone, present in OC Pills mimic the natural cycle of women, they are used to treat PCOS to regulate the hormonal imbalance. They are also used as a treatment in certain forms of acne and endometriosis.
Myth 13: The morning-after pill or emergency contraception is like an abortion
Firstly, this should only be used in an emergency and not as a primary method of contraception. These pills do not end a pregnancy that already has an implanted zygote (fertilized egg). They instead work by preventing or delaying ovulation, fertilization, and implantation. They are completely different from abortion pills.
You may unwillingly sit through disclaimers in movies, but this one is rather important so please bear with me. This should be a very informed decision and before using any method, getting advice from a doctor is highly recommended. This not only will help you select the right contraceptive method but also is required for your overall mental and physical wellbeing.
And above every myth listed above, most importantly we have to debunk the myth of not having a sexual life (if you are in fact having one), and not needing to speak to your doctor about contraception. Find a doctor you trust, be honest about your sexual health, and take care of yourself and your reproductive health.
This article is part of the TLP x Aara Health #InvisbleConversations Series
About the author
Dr Mariyam Sadikot recent medical school graduate from Ahmedabad, India, working to pursue a residency in the United States. Interested in Internal Medicine, Endocrinology and Neurology, and keen on research.
About Aara Health
Aara Health is a women's health platform aiming to build awareness and services around feminine health in India. Follow them on Instagram @aarahealth