The camel, contraception and West Indian cricket
It’s fair to say that life can hand you bad problems but occasionally even good problems.
Being spoilt for choice is a double-edged sword, but still more preferable than a lack of choice.
For instance, I grew up watching the West Indies play cricket and the team of the ’80s were awesome.
The West Indian coach, though, had a tough time picking a team, especially when it came to fast bowlers.
He had to choose between all-time greats like Andy Roberts, Michael Holding, Colin Croft, Malcolm Marshall, Joel Garner, Courtney Walsh and many others fans could list.
Many quality players were never picked and even played in our Currie Cup, like Sylvester Clarke.
One of the major problems the medical world struggles with is unplanned or unintended pregnancies.
They account for the majority of worldwide maternal deaths through complications of illegal abortions and various other pregnancy-related diseases.
It deprives women of access to education and other opportunities to rise above the oppressive lives they often face.
The economic burden of unplanned pregnancies was estimated to cost SA R3.5bn in 2015.
Our biggest challenge is to provide women of all backgrounds with accessible comprehensive and quality contraceptives.
With thorough non-biased counselling, women can make an informed choice based on their needs regarding the method’s efficacy, user-friendliness and length of action.
The good news is that there has never been a time in SA history where women have had as many affordable options as now.
Unfortunately, we are often reluctant to embrace newly available methods despite a mass of research on them.
Where did contraception start?
One of the ancient stories/myths told is of Arab nomads placing stones in the uterus or vagina of their camels to prevent fertilisation.
The most pertinent question is not about its efficacy but how a feisty camel will allow this!
Through the ages, humans have used a variety of crude methods of contraception including condoms or sheaths made from animal intestines or inserting fruit acids and jelly into the vagina as a chemical spermicide.
When rubber was vulcanised in 1843 by Goodyear it led to the production of rubber condoms and by 1885 the first commercially available vaginal suppository made of cocoa butter and quinine came to market.
The origin of the intrauterine devices so widely used today lies in a ring made of silkworm gut, devised by a Dr Richter in 1909.
A major milestone was the opening of the first dedicated birth control clinic in 1882, by ground-breaking Dutch physician Dr Aletta Jacobs.
She provided the Dutch Cap, a diaphragm made of rubber.
She was also the first woman to attend high school in the Netherlands and to complete her medical studies.
One of the greatest advances in medical history is undeniably the development of the contraceptive pill.
This pill combines two hormones, oestrogen and progestogen, to suppress ovulation and thus prevent fertilisation.
This was the first time in history that a woman had access to an effective method within her own control.
Two leaders in the drive to develop the pill were Margaret Sanger and Katherine McCormick.
Their and others’ work in the 1950s culminated in the first FDA-approved pill, Enovid, being released in 1960.
Interestingly it was initially allowed to be prescribed only to married women in the US.
There were significant complications and side effects to the early pill due to high hormone doses.
The modern pills contain on average a seventh of the hormonal dose compared with those of the ’60s.
Through continued research, we are now at the point of knowing the lowest dose of hormones to reliably block ovulation.
In the last 10 years, the buzzword and focus in contraception have been LARCs: long-acting revisable contraceptives. These include (only those available in SA):
- The injectables nl Depo Provera (3-monthly) and Nur-isterate (2-monthly)
- The implant nl Implanon NXT (3-yearly)
- The copper intrauterine device nl Nova T (5-yearly)
- The intrauterine systems nl Mirena and Kylena (5-yearly)
The major benefit of these are their effectiveness, reliability and reversibility.
They are also very cost-effective.
In the public sector, the injectables historically dominate the contraceptive scene but in private health, the pill is most commonly used.
Unfortunately, the average user under the age of 24 forgets 2.7 pills per month. Regret after sterilisations is another reason LARCs are often advised as an alternative.
Unintended pregnancy remains a major socioeconomic burden and this especially applies to the young (under 24).
Parents need to educate their teens about their contraceptive options or at least refer them to the appropriate health care workers.
We as contraceptive providers/advisers need to be non-judgemental to the user and embrace all the available methods on the market.
To give proper counselling one needs in-depth, up to date knowledge.
Being spoilt for choice should be the new norm for female contraceptive users, unlike more recent West Indian cricket coaches.
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