Family planning

Family planning allows individuals to attain their desired number of children and determine their spacing of pregnancies. Access to safe, voluntary family planning is a human right and the woman or the couples have the right to choose the contraceptive method which best suits them.

In Cameroon, family planning includes:

  • Birth control
  • Treating sexually transmitted infections
  • Ensuring that contraceptive methods are available to all, in order to reduce and avoid maternally, infant and child mortality and morbidity, especially those related to HIV/AIDS, unwanted pregnancies and unsafe abortions
  • Ensuring personal and family well-being.

Family planning saves lives by raising awareness about the risk of poorly spaced pregnancies on women’s health and lives; it reduces child mortality and prevents HIV/AIDS. As a result of family planning, the population is able to make better decisions with respect to sexuality and birth control. Family planning empowers women and also has economic benefits.

In Cameroon, like other developing countries, insufficient contraceptive uptake is likely due to:

  • Limited access to modern contraceptive methods,
  • Fear of side effects,
  • Sociocultural beliefs,
  • Poor quality of family planning service delivery.

Contraceptive methods

Contraceptive Methods

Contraceptive methods are grouped into two main categories, modern and natural methods.

Modern Methods

These refer to barrier methods, hormonal methods and surgical methods. The barrier methods create a barrier between the genital secretions of the man, the sperm, and the genitals of the woman thereby preventing the sperm from pouring into the woman’s genitals and meeting the ovule.

Barrier methods refer to the male and female condom, the diaphragm, and the cervical cap. There are also spermicidal agents that destroy the sperms in the vagina.

  • Condoms, male or female, is the only method of contraception that protects against HIV-AIDS and sexually transmitted infections (STIs).

Male condom

Sheaths or coverings that fit over a man’s erect penis. 
Forms a barrier to prevent sperm and egg from meeting.

Effectiveness to prevent pregnancy:

  • 98% with correct and consistent use
  • 85% as commonly used

Comments: Also protects against sexually transmitted infections including HIV.

Female condom

Sheaths or linings that fit loosely inside a woman’s vagina, made of thin transparent soft plastic film. Forms a barrier to prevent sperm and egg from meeting.

Effectiveness to prevent pregnancy:

  • 90% with correct and consistent use
  • 79% as commonly used

Comments: Also protects against sexually transmitted infections including HIV

The diaphragm, cervical cap

Local means, they slip into the vagina, in contact with the cervix, must be systematically placed before each intercourse (or a few hours before), and as a precaution, be jointly used with spermicides.

Effectiveness to prevent pregnancy:

  • 91 % per year for nulliparous women (women who have never given birth)
  • 74 % per year for parous women

Comments: The diaphragm and the cape are reusable, but must be thoroughly washed and stored.

 

Emergency contraception (Levonorgestrel 1.5mg)

Progestogen-only pills taken to prevent pregnancy up to 5 days after unprotected sex. Prevents ovulation.

Effectiveness to prevent pregnancy:

  • 1 in 100 chance of becoming pregnant.

Comments: Does not disrupt an already existing pregnancy.

IUD Intrauterine device: copper-containing

A small flexible plastic device containing copper sleeves or wire that is inserted into the uterus. Copper component damages sperm and prevents it from meeting the egg.

Effectiveness to prevent pregnancy:

  • 99%

Comments: Longer and heavier periods during the first months of use are common but not harmful.

IUD Levonorgestrel

A T-shaped plastic device inserted into the uterus that steadily releases small amounts of Levonorgestrel each day. Suppresses the growth of the lining of the uterus (endometrium).

Effectiveness to prevent pregnancy:

  • 99%

Comments: Reduces the amount of blood loss with menstruation over time; Reduces menstrual cramps and symptoms of endometriosis; amenorrhoea in some users.

Progestogen-only pills (POP) or “the minipill”

Contains only progestogen hormone. Thickens cervical mucus to block sperm and egg from meeting and prevents ovulation.

Effectiveness to prevent pregnancy:

  • 99% with correct and consistent use
  • 90-97% as commonly used

Comments: Can be used while breastfeeding; Must be taken at the same time each day.

Combined oral contraceptives (COC) or “the pill”

Contains two hormones (estrogen and progestogen) Prevents ovulation (release of eggs from the ovaries)

Effectiveness to prevent pregnancy:

  • Contains two hormones (estrogen and progestogen)
  • Prevents ovulation (release of eggs from the ovaries)

Comments: Reduces the risk of endometrial and ovarian cancer

Monthly injectable or combined injectable contraceptives (CIC)

Injected monthly into the muscle, contains estrogen and progestogen.

Prevents ovulation.

Effectiveness to prevent pregnancy:

  • 99% with correct and consistent use
  • 90-97% as commonly used

Comments:  Irregular vaginal bleeding common, but not harmful.

Progestogen-only injectable

Injected into the muscle every 2 or 3 months, depending on the product.

Thickens cervical mucus to block sperm and egg from meeting and prevents ovulation.

Effectiveness to prevent pregnancy:

  • 99% with correct and consistent use
  • 90-97% as commonly used

Comments: Delayed return to fertility (about 1-4 months on the average) after use; Irregular vaginal bleeding common, but not harmful.

Implants 

Small, flexible rods or capsules placed under the skin of the upper arm; contains progestogen-only.

Thickens cervical mucus to block sperm and egg from meeting and prevents ovulation.

Effectiveness to prevent pregnancy:

  • More than 99% 

Comments: Health care provider must insert and remove; Can be used for 3 – 5 years depending on the implant; Irregular vaginal bleeding common but not harmful.

Male sterilization (vasectomy)

Permanent contraception to block or cut the vas deferens tubes that carry sperms from the testicles. Keeps sperm out of ejaculated semen.

Effectiveness to prevent pregnancy:

  • 99% after 3 months of semen evaluation
  • 97%-98% with no semen evaluation

Comments: 3 months delay in taking effect while stored sperm is present; does not affect male sexual performance; the voluntary and informed choice is essential.

Female sterilization (tubal ligation)

Permanent contraception to block or cut the fallopian tubes. Eggs are blocked from meeting sperm.

Effectiveness to prevent pregnancy:

  • 99% 

Comments: Voluntary and informed choice is essential

Natural methods

These are methods that do not require the use of substances external to the woman’s body. These methods are based on perfect control of the menstrual cycle and abstinence. These include methods based on mastering of one’s fertility, withdrawal method and lactational amenorrhea method (MAMA)

The fertility-based or symptom-thermal method

Mastery of the fertile period, in other words, refers to having exact knowledge of the beginning and end of the period during which the woman may become pregnant. This method is sometimes referred to as periodic abstinence or natural family planning method. Fertility-based methods require the cooperation of the partner. Couples must be determined to abstain from sex or use another method during the fertile period. The woman must pay attention to changes in her body or follow the days according to the instructions of the specific method. These methods have no side effects or health risks.

This method combines the use of several signs that can occur at the same time when the woman is in her fertile period.  These signs are the normal temperature of the body, monitoring of the cervical mucus, or the calendar method.

Effectiveness in preventing pregnancy:

There are about 25 pregnancies per 100 women who practice periodic abstinence, which means that when this method is used 75 women who apply it correctly will not become pregnant.

The risk of pregnancy is higher when couples have sex on fertile days without using another method. In general, it is more effective to abstain.

It is worth noting that fertility-based methods:

·           Can be very effective if used correctly and regularly,

·           Do not require that the user be able to read,

·           Do not’ harm individuals who can abstain from sex,

·           Do not work if a couple does not know how to determine the fertile period.

Withdrawal method

Withdrawal is the fact that the man withdraws from his partner during sexual intercourse and ejaculates outside the vagina, and so the sperm does not enter the woman’s genitals. This method is also called “interrupted coitus.” This is a method that can be used in any situation. It can be used as a primary method or as a backup method. There is no need for acquiring material or products or going to a health centre. The method can be used at any time. This method works by preventing sperm from entering the woman’s body.

Effectiveness in preventing pregnancy: This is one of the least effective contraceptive methods. Considering how it is used currently, there are about 27 pregnancies per 100 women whose partners use withdrawal, meaning that 73 out of 100 women whose partners use withdrawal will not become pregnant. This method provides no protection against sexually transmitted infections or HIV.

Worthy of note: Withdrawal encourages a man’s involvement in contraception and communication within the relationship. There are no side effects or health risks with this method. All men can use the withdrawal method. No pathology contraindicates its practice.

The lactational amenorrhea method (MAMA)

It is a temporary method of family planning based on the natural effect of breastfeeding on fertility, notably that intensive and optimal breastfeeding temporarily prevents the release of natural hormones, which cause ovulation.

The lactational amenorrhea method is based on three conditions that must be achieved:

·           The mother has not yet had her menses,

·           The baby is exclusively breastfed, i.e. not receiving other liquids or foods, not   

            even water, other than breastmilk.

·           The baby is less than 6 months old.

Effectiveness in preventing pregnancy: As practised currently, approximately 2 pregnancies per 100 women using MAMA during the first six months after delivery.

  • 99% with correct and consistent use
  • 98% as commonly used

Worth noting: All breastfeeding women can safely use this method. MAMA helps protect against the risk of pregnancy. It also encourages the best breastfeeding habits that benefit both the health of the mother and child.

Lactational amenorrhoea (LAM)

Temporary contraception for new mothers whose monthly bleeding has not returned; requires exclusive or fully breastfeeding day and night of an infant less than 6 months old.
Prevents ovulation.

Effectiveness to prevent pregnancy:

  • 99% with correct and consistent use
  • 98% as commonly used

Comments: A temporary family planning method based on the natural effect of breastfeeding on fertility.

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