Contraceptives, and where you can find them! - by Anjila

Contraceptives, and where you can find them!

I bet you’ve heard the term 'family planning' often, but you might not know that currently, the term is being phased out by 'contraception.' The transition from the term 'family planning' to 'contraception' signifies a broader societal acknowledgment that not everyone using contraceptive methods is necessarily planning for a family. Knowledge about safe sex and access to contraception has made it possible for individuals engaging in sexual intercourse, irrespective of their marital status, to practice without the fear of pregnancy. Previously promoted with the concept of population control, the world has gradually shifted to promoting its use as an individual choice and freedom, as a method to design the life they believe is ideal for themselves. Broad categorization includes temporary and permanent contraceptives. Temporary means that there is a regain of fertility (ability to reproduce) after stopping the use of the methods, whereas permanent methods put an end to the ability for good. Temporary devices can then further be divided into barrier methods, intrauterine devices, and hormonal methods. We will focus on the different types of contraceptive devices available in Nepal and where to find them.

A barrier method is used to denote devices that act as a literal barrier, preventing skin-to-skin contact and sperms from entering into the uterus. The most commonly used barrier method is the external condom, commonly known as the male condom. Condoms can also be used for vaginal, anal, or oral sex. Other less commonly used barrier methods include the internal condom, commonly known as female condoms or femidom, cervical cap, and diaphragm. The most easily available barrier method is the condom. Condoms (both internal and external) also minimize the risk of transmission of Sexually Transmitted Infections such as HIV from one person to another. They are made accessible free of cost in all government health facilities in the country, from health posts to provincial-level hospitals. They are also available for purchase from local pharmacies and department stores. Condoms are made available in a universal size. One thing to pay attention to is any allergic reactions that the user or their partner may develop to the condom. Other barrier methods are not available for free, nor is publicly accessible information easily available regarding their correct use.

Hormonal methods include a variety of ways to administer hormones (estrogen and progesterone) externally to a person assigned female at birth to prevent the monthly release of eggs from the ovary (ovulation), ultimately preventing fertilization and pregnancy. The methods available in Nepal include taking oral pills, commonly known as OCPs (such as Nilokan White, a popular brand of OCPs in Nepal) every day, a three-monthly shot in the outer arm, commonly known as Depo or colloquially referred to as 'Tin Mahine Sui,' and a five-yearly administration of a hormone-releasing implant, commonly known as Norplant. All three of these methods are available in every single hospital in the country, with services being free of cost in government health facilities. Proper counseling is required regarding when to start taking the pills, proper intake of the pills, and what to do when a pill is missed. It is also necessary to be informed about the common side effects of using these methods, such as hormonal acne, skin changes, weight gain, headaches, occasional mood swings, and intermenstrual spotting (bleeding between two periods). These effects might be especially concerning to some users, and it is best to seek advice from health service providers regarding alternative contraceptive methods.

Intrauterine devices refer to the contraceptives that are inserted inside the uterine cavity through the vagina, commonly known as Copper-T. These devices are usually made of copper and prevent fertilization and pregnancy. The device must be inserted by a trained health care worker, and once inserted, it can be kept for 8 years. After 8 years, it must be removed in a health care center, and the return of fertility is almost immediate. The advantages are the absence of hormonal side effects and its prolonged usage. There might be lower abdominal pain and spotting (light bleeding), which needs to be checked out by a health service provider if it is proving to be a concern. Once again, IUDs are free at government health care centers but need to be paid for at private or semi-government centers.

The final tier of contraceptive services provided by the Government of Nepal is permanent sterilization. There are separate procedures for males and females. In females, the fallopian tubes that carry the eggs are cut and tied, a procedure called Minilap. In males, the tubes that carry the sperms released from the testes are cut and tied, a procedure called vasectomy. This prevents fertilization and pregnancy. The methods are permanent but can be reversed via another operation. Both services are provided free in government hospitals, with males being given financial incentives for opting to get a vasectomy. The recovery time and intensity of complications are much lower in a vasectomy in comparison to minilaps.

A wide variety of contraceptive methods are available in Nepal, and the most basic of choices are supposed to be made available by the government in public health facilities. In addition to government and private health facilities, contraception is also available at the clinics of the Family Planning Association of Nepal and Marie Stopes Nepal. However, there are frequent stock outages that narrow down the choices. Not every contraceptive would be ideal for an individual, which is why it is important to hold the government accountable for delivering the promise of making multiple contraceptives available to everyone for free. Also, the disparity in access between public and private health care facilities calls for a more thorough investigation of socioeconomic variables and how they relate to reproductive health services.

The complex aspects of contraceptive choices can be highlighted by an intersectionality lens, which takes accessibility, gender, and socioeconomic status into account. Promoting inclusive and comprehensive reproductive health policy guarantees people the freedom to make decisions that suit their unique needs and goals. It is also imperative to examine how these choices intersect with gender dynamics, considering the disproportionate burden placed on individuals assigned female at birth.