Unplanned pregnancies

More often than I would wish, a woman comes into my office distressed because she is pregnant and it was not planned. Often, she does not feel that she can cope with another child. I usually acquaint her with her legal options.

Unplanned pregnancy is a worldwide problem. According to some estimates, about 38 per cent of pregnancies are unplanned and more than one-fifth of pregnancies end in abortion. Abortion is currently illegal in Jamaica. Whether or not a woman chooses to continue her pregnancy, an unplanned pregnancy can be a heavy burden to bear.

But, for the most part, an unwanted pregnancy can be avoided. World Contraception Day was marked on September 26. This campaign, which started three years ago, aims to 'raise the awareness of contraception and the need to reduce high levels of unplanned pregnancy'.

Oral contraceptives

There are a number of safe and effective contraceptive options available in Jamaica. Perhaps one of the most popular methods of contraception or birth control is the oral contraceptive pill (OCP), and various brands are sold locally. All of them contain ethinyl estradiol, an oestrogen, but the progestin formulations vary. This is the reason that different pills are tolerated differently.

One of the most common reasons that I am given by women for not taking the oral contraceptive pills are concerns about weight gain. However, a number of studies of the newer formulations of combined oral contraceptive pills do not support this notion. Although there are some risks with taking OCPs, such as an increased risk of deep venous thrombosis, they have a number of health benefits including prevention of both ovarian and endometrial cancer, treatment of dysmenorrhoeal (painful periods), acne, as well as regulation of abnormal menstrual cycles.

The contraceptive patch

The contraceptive patch has similar ingredients to the combined oral contraceptive pill and it is believed that its benefits are similar. It offers an advantage to women who have difficulty remembering to take a pill each day.

Depo-Provera

Depot medroxyprogesterone acetate (DMPA), commonly sold as Depo-Provera, is a long-acting injectable progestin that is administered every three months. Its clear advantage is that it requires much less frequent dosing that either the patch or OCPs. Other benefits include a decreased risk of endometrial cancer, pelvic inflammatory disease and ectopic pregnancy and the treatment of endometriosis and heavy menstrual bleeding. It is a good choice for breastfeeding mothers because it may increase milk supply.

Unfortunately, women may experience irregular bleeding with DMPA, especially during the first few months of use. However, this can be treated and usually improves if she continues with this method. After a while, many women on DMPA stop having menses, a side effect some women really enjoy. Some women also gain weight on this method, but a healthy diet and exercise can potentially reduce or even eliminate this side effect.

There are a number of other methods which I will discuss further in my next article.

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.

'According to some estimates, about 38 per cent of pregnancies are unplanned and more than one-fifth of pregnancies end in abortion.'