| Abstract: | It is important that health visitors have a basic grasp of the main contraceptive methods, how they work, and the extent of family planning services available, for they will then be in the best position to advise and support patients. National Health Service (NHS) facilities are outlined and details are provided about the following main methods of contraception: combined oral contraceptive (OC) pill; progestogen only or minipill; IUD; diaphragm or cap and spermicide; condom and spermicide; "safe period;" and female and male sterilization. Motivation is a key factor in the successful use of birth control. Couples require information and guidance before they decide on a method and help if they are ambivalent about continuing with a method or concerned about possible side effects. Couples frequently will require continuing support to ensure that they are happy with their chosen method and using it correctly. As up to 2 million women in the UK use no regular or reliable contraception and are at risk of an unplanned pregnancy, much work remains to be done. The range of free NHS services includes: confidential advice; choice of birth control method; free supplies; male and female sterilization; postcoital contraception; special sessions for young persons; treatment for subfertility; psychosexual counseling; pregnancy testing and counseling; rubella screening; smear tests and breast checks; help for menopause problems; advice on premenstrual tension; and artificial insemination by husband and artificial insemination by donor. Although OCs have some possible risks and side effects, few women actually have serious problems. For most women the benefits outweigh the possible disadvantages. The more serious side effects, such as thrombosis, strokes, or raised blood pressure are rare, but the risks are greated in diabetics, cigarette smokers, those with high blood pressure, and those who have close relatives who have had heart attacks or strokes. The progestogen only or minipill can be used by women for whom estrogen containing pills are unsuitable. They are slightly less reliable than the combined pill, but are still approximately 98% effective. IUDs are 96-98% effective. The IUD is particularly useful for older women and for women who have already had children. Side effects such as irregular bleeding and heavy periods may occur in the 1st few months after insertion, and patients may require support and reassurance. If used carefully with a spermicide each time intercourse takes place, the diaphragm is 97% effective. Smaller devices which only cover the cervix are also available: the cervical cap; vault cap; or vimule cap. The condom, a reliable contraceptive method, is about 97% effective provided it is used with spermicide. In addition the condom provides some protection against sexually transmitted diseases. To use the "safe period" it is necessary to try to pinpoint ovulation, and the 4 ways to do this are outlined. The sympto-thermal method can be 85-93% effective if it is used carefully. Sterilization involves the cutting or blocking of the fallopian tubes in a woman or of the vas deferens in a man. The operation in either sex must be regarded as irreversible. |
