Contraception is a choice. A choice to prevent the fertilisation of sperm with egg, thereby, preventing conception.

The ability to use a contraceptive device, however, goes beyond the physiology of birth. With the flood of female-specific devices available today, a woman sees the freedom in making a decision for herself, not necessarily dependent on the partner.

A lot of contraceptives are anyway used in therapy, to regulate the menstrual cycles of a woman and certain hormone levels; for women with health issues, polycystic ovaries and hormonal imbalances. But this is more about the preference of women to use devices as lifestyle options to prevent conception. A number of women, in pursuit of a career, are looking at postponing child bearing itself, and seeing contraceptives as more than just for spacing births, as it might have been in the past.

While contraception has been used widely for over 2,000 years, right from coitus interruptus, to herbs, modern methods have evolved as hassle-free, more effective methods – including injectibles, intra-uterine devices, and barrier devices, including condoms, and more recently, hormone-eluting rings.

Gynaecologists adopt what is called a “cafeteria approach” – informing patients of all the devices available in the market and allowing them to make a decision that would be right for them.

The buzzword today is emergency contraception. The use of the pill as effective birth control has been in vogue for a long while, but according to gynaecologists, is gaining popularity among women.

The contraceptive device one uses depends on the situation the woman is in, says Jayashree Gajaraj, gynaecologist. But, by and large, she adds, oral contraceptive pills have been proved largely free of sideeffects and with a very low failure rate.

“With a documented failure rate of 0.2 per cent, it is what you would expect if you are keen on avoiding a pregnancy. But, this is a failure rate if there is 100 per cent compliance with the dosage.” Even if a woman misses one dose, the failure rate jumps pretty high. The pills have changed the scene for women, she adds. As for emergency contraception that is often promoted as a panacea for the sexually-active woman, she says caution is key. “Remember, using a pill will change the menstrual cycle. So we don't want a woman to use the emergency contraception for more than a couple of times in her life. Certainly not after every episode'', Dr. Gajaraj added.

The female condom is not so popular in the country, certainly in domestic settings, doctors say. Priya Selvaraj, of the Fertility Research Centre, GG Hospital, says,

“While Indian women may have issues with the necessity to insert this condom every time, it is undoubtedly the best when it comes to prevention of sexually transmitted infections and HIV. It is the woman's own device of protection when a male partner refuses to use a condom.”

The intra-uterine copper device has been the most popular means of female contraception in India, especially in the public sector, thanks to government support. They help to space births, and are inserted one time to last for between three to five years, K.Saraswathy, former director, Institute of Obstetrics and Gynaecology, says. A recent device also assures protection for upto 10 years. However, unless personal hygiene and sexual hygiene is maintained, the chances of infection with this device are high. Infection can block the (fallopian) tubes, and prevent conception even when the couple is ready for it. Awareness of contraceptive devices is high among patients who come to the private practitioners, according to her.

“We have to coax and cajole women who come to the government hospitals. Even then, some of them remain unwilling to go ahead. We have also started conducting classes for adolescent girls in schools, talking to them about female physiology, contraception and hygiene, as part of the activities of the activities of the Obstetric and Gynaecological Society of Southern India.”

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