Which contraception is best for you? Your guide to birth control in South Africa

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It would be best to speak with a healthcare provider to determine which birth control option is best for you.
It would be best to speak with a healthcare provider to determine which birth control option is best for you.
Getty Images/JLco-Julia Amaral
  • More than 850 million women worldwide are using some form of birth control.
  • In South Africa, most women use contraception, although equitable access to options remain challenging.
  • Many options are available, ranging from hormonal to non-hormonal and long-acting reversible contraception.

The world has witnessed significant progress in the provision of a wide range of safe contraceptives for women. 

The contraceptive pill, for example, is one of the most revolutionary inventions of the last 60 years. It liberated women sexually and socially and finally gave them the freedom to choose control. 

For the first time, women were free to pursue tertiary education and a career – no longer stymied by untimely motherhood, says Nicole Jennings, spokesperson for Pharma Dynamics.

READ MORE | A baby was born holding his mother's IUD

The number of women using a modern contraceptive method increased from 663 million in 2000 to 851 million in 2020, notes the World Health Organization (WHO). Sadly, there is also a  continuing battle for access to them - more than 160 million women are unable to get the contraception they need.

Similarly, the use of contraception among South African women is high (64%). Still, quality contraceptive service delivery, equitable access, and women’s ability to correctly and consistently use contraceptive methods of their choice remain problematic, especially among young and rural women, says Jennings.

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There are several types of birth control, also known as contraception. The type of birth control you choose depends on many factors, including your health, your desire to have children now or in the future, and your need to prevent sexually transmitted infections. 

Knowing the different options will help you decide which will work best for you. We look at hormonal, long-acting reversible contraception (LARC) and non-hormonal options available in South Africa.

HORMONAL

1. The pill

This hormonal contraceptive is available in tablet form. It works by inhibiting the body’s natural cycle by preventing the monthly release of an egg from the ovaries (ovulation), thickening the cervical mucus so sperm can’t swim through it, and changing the lining of the uterus to prevent the egg from implanting, explains Jennings.

The standard way to take the pill is to take one every day at the same time for 21 days, then wait seven days (you will have your period during this week).

However, not all birth control pills are the same as they come with different hormones (oestrogen and progesterone, or progesterone alone) and can affect your periods differently, notes Huffington Post.

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“The pill is amongst the most prescribed contraceptives in the world,” says Jennings. “Women describe it as easy to use, convenient and discreet since you don’t have to negotiate with your partner as in the case of a condom. It’s also 99% failure-proof when used correctly and has few side effects.”

2. The patch

A birth control patch is a thin piece of plastic that looks like a square bandage, explains Harvard Health. Like combined birth control pills, it contains the hormones oestrogen and progesterone. It prevents ovulation in most women, and the progesterone also thickens the mucus in your cervix, which stops sperm from entering the uterus. 

A birth control patch releases hormones through your skin notes the Cleveland Clinic. It has to be replaced once per week, either on your upper outer arm, lower belly, buttocks, or upper chest.

3. Vaginal ring

The birth control ring is a flexible circle of plastic that is placed inside your vagina. It gradually releases the hormones oestrogen and progestin and prevents ovulation in most women. Additionally, the progesterone thickens the mucus in your cervix, preventing sperm from entering the uterus.

The vaginal ring is inserted once a month.

LARC

1. Intrauterine devices (IUDs)

The IUD is a small, flexible, T-shaped device inserted into your uterus to prevent pregnancy. There are two types of IUDs: an IUD made of copper and an IUD made of plastic containing hormones (progestin). 

These IUDs work by causing your cervical mucus to become thicker so sperm can’t reach an egg, explains the Cleveland Clinic. Depending on which IUD you opt for, they can last 3-10 years.

2. Birth control implant

This implant is a small rod (the size of a matchstick) placed under the skin of your upper arm. It delivers the hormone progestin and prevents ovulation. 

The implant lasts about three years before it needs to be removed or replaced.

3. Birth control shot or Depo

The birth control shot involves an injection of Depo-Provera, a form of progesterone, that is injected into your upper thigh or arm. Each injection provides protection against pregnancy for around 12 weeks (or three months). 

Another option available in SA is Noristerat. It is given during the first one to five days of your monthly period and protects against pregnancy for around eight weeks (or two months).

NON-HORMONAL CONTRACEPTIVES

1. Female condom

The condom for women is a tube with a flexible ring at the open and closed ends. It is made of synthetic rubber and covered in a silicone-based lubricant.

Condoms are the best way to prevent STIs but are not the most effective at preventing pregnancy. For this reason, they work best when used with another type of birth control.

2. Diaphragm 

Also known as a ‘barrier’ method, the diaphragm is a dome-shaped silicone cup placed inside the vagina to block sperm from entering the womb. You will need to use spermicide with the diaphragm to help prevent pregnancy.

Diaphragms are inserted approximately one to two hours before sex and must be removed six to 24 hours after having sex.

3. The cap

The cervical cap is a thimble-shaped cup made out of silicone or soft rubber and fits snugly over your cervix. It blocks your cervix, and the spermicide paralyses the sperm. 

The cap can be inserted up to six hours before sex, and you shouldn’t remove it for at least eight hours after sex. It can be kept in place for up to 48 hours. Like the diaphragm, you need to use spermicide with the cap to help prevent pregnancy.

READ MORE | Birth control pill for men 99% effective in early study – human trial expected this year

Jennings stresses that the efficacy of each contraceptive method varies and that it should be taken into consideration. “To determine which contraception will work best for you depends on your lifestyle, personal preferences and any medical conditions you may have.

“Taking contraception reduces unintended pregnancies and the need for unsafe abortions. Talking to your doctor about the different types of birth control, listing the pros and cons of each is a good place to start,” she says.

Held each year on 26 September, World Contraception Day aims to improve awareness of all available contraceptive methods and to enable people to make informed choices about their sexual and reproductive health.


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