There is a second group of women
who start using contraceptives only when they discontinued breastfeeding : But this phylosopy is wrong and
unscientific because many woman do omlete after six month of childbirth
insitite of continued breastfeeding. There is a third group of couple who would
like to commence contraceptive whenever menstruation resumes in postpartum
period. This philosophy apparently sounds well but a doption of this method of
initiating contraceptive is also unscientific such policy may giverise to
unintended pregnancies because in many breastfeeding women ovulation precedes
visible event of menstruation. Thus scientifically speaking restoration of
menstruation also cannot be used as an index of initiation of contraception.
I.
What woman expects from Science ?
Most
couple would like to start contraceptive when ovulatin resumes and dislike
using contraceptive unnecessarily before resortion of ovulation. There is a
real taste of science in this belief. Thus return of ovulation as an indexx of
starting contraception though scientifically correct but the process of
ovulation can’t be gauged at the present state of knowledge.
No
cheap method for detection of resumption ovulation is available. It would have
been easier on the part of couple and scientists too if there have been a easy
ready made low cost but predictable monitoring method of assessing maturation
and release of eggs. Unfortunately whatever home monitoring tests for ovulation
exist that are too costly for planning contraceptive use. Till date the use of
these tests are limited to infertility treatment only.
II.
On which factoros the present day
woman should depend on initation of Contraceptive?
Thus till date couple as well as
scientists are arbitrarily guided by three indices. These are a) nature and
freqauently of breastfeeding b) the event of return of menstruation. And c)
resumption of sexual activity. Return of ovulation though the most decisive
index of commencing contraceptive cannot be used by couple as index of
initiation of contraception population at the present state of knowledge.
Additionally
in office seeting i.e. when a couple
come to clinic for advice in postpartum period the contraceptive specialists
usually require on nature of breastfeeding practice and return of menstruation
as the two indices for planning on contraceptive use in postpartum period and
the HCP thus tries to correlate the possibility of return of ovulation with
these to events. This is just a gress of prob ability of becoming
pregnancy.Couple too have relied either on return of menstruation or initiation
of sexual activity as indices of initiation of contraceptive and of they at all
rely on nature of breastfeeding they consider wearing as the index.
Contraceptives which are licensed abroad but not available in India
(Newer birth control
options):
1)
Extra-pleasure
condms, Oscillating condms, Glow-in-dark condms, Extra strenth-Cond ms, Extra thin-Condms , Baggy Design Condms
etc etc.
2)
Synthetic
Male Condoms
3)
Newer
Oral Contraceptives, (Minesse, Sesonale).
4)
Monthly
Injectables (for women e.g. Lunella)
5)
Newer
quarterly shots (Sub cut route)
6)
Contraceptive
Impalnts (Implanon)
7)
Transdermal
patch (Ortho Evra patch), application weekly.
8)
Vaginal
rings (NUVARING)
9)
Frameless
IUD & other newer IUD’s
10)
Newer
contraceptive sponge e.g. (conceptral & Protectaid sponge)
11)
Electronic
Fertility Monitor (persona)
12)
Reddy
Female Condom
13)
New
certical barriers (Fem Cap/Lea’s shield)
This description does not cover all
new contraceptive that have been released abroad.
III. Summary of the present problem : Where we are now?
Principally there are four factors which control return of ovulation and
the restoration of fertility and each of the factors mentioned below deserve
detailed discussion. The factors are a> Frequency and duration of
‘breastfeeding’, b> Restoration of ovulation, c> Resumption of
‘menstruation’ after childbirth and above all, d> initiation of ‘sexual
intercourse’. Let us now analyse the role of each of these four factors and
each of these four factors incluence return of fecludity independently it is
worth remembaring that though breastfeeding, take a lead role but the process
of restoration of ovulation resumption of mensturation are usually but not
always interrelated. We shall see in the following pages that always choice by
benefit for and resumption of menstruation. The process of ‘ovulation’ and
‘resumption of menstruation’ are not always controlled by breastfeeding. Giving
identical time in breasefeeding two woman will outlet in different times. Thus
it is this natural ovulation which cause much concerned to couple to fix up a
time for initiation of contraceptives.
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