Taking risks with contraception

GIRLS Aloud singer Nadine Coyle has hit the headlines. The 28-year-old recently announced she was pregnant and had no idea how it had happened.

Surely most women know that using an approved form of contraception is essential if they don’t want a baby? Or do they? Nadine may not have used a reliable contraceptive method and she’s not the only one. Other celebrities who have had shock pregnancies include Kim Kardashian, January Jones from Mad Men and former Spice Girl Mel B.

According to the Irish Contraception and Crisis Pregnancy Study (ICCP) 2010, one-in-three women who get pregnant didn’t plan on doing so.

Why are women taking such risks? A recent British survey may have some of the answers. Of 3,000 women interviewed, two thirds said they had not been given enough information when choosing contraception. Most had opted for what their doctor recommended, which in the vast majority of cases was the contraceptive pill. They had never even heard of long-lasting reversible contraceptives such as implants, injections or intra uterine devices/coils.

Fertility experts now believe different contraceptive methods are more suitable for women at different stages of their lives. But women aren’t aware of the range of options available and as a result, most don’t make the right choices.

There are also more complex issues to consider. If a recent debate on www.mumsnet.com is anything to by, some women are choosing the risky withdrawal method over the much more reliable contraceptive pill. Because this relies on the man withdrawing at exactly the right moment and ignores the pregnancy risk of pre-ejaculate, it’s something of a Russian roulette approach for women to take to their fertility. But some women seem to think the risk is worth it, especially compared with the dangers associated with taking the pill long term — dangers such as weight gain, loss of libido, mood swings, vaginal dryness and disruption of the fertility cycle.

The ICCP Study involved more than 3,000 participants aged between 18 and 45. It revealed that condoms and the contraceptive pill were the most commonly used contraceptives in Ireland, with 62% of people using condoms and 43% using the pill.

Despite being so popular, there was a growing unease about the contraceptive pill. 55% of 18 to 25 year-olds, 67% of 26 to 35 year-olds and 77% of 36 to 45 year-olds expressed worry about taking it in the long term.

The study also found an increase in the use of other forms of contraception. Eight per cent used either the contraceptive ring, patch, injections or implanted capsules (up from 3% in 2003) and 11% used long- acting reversible contraceptives (up from 6%).

More unexpectedly but entirely in keeping with British trends, 22% admitted not using contraception consistently and these people were more likely to be older and married than young and single.

The Irish Family Planning Association has seen evidence of this and in particular has seen women relying on withdrawal as their only method of contraception.

“Our sexual health clinics see lots of women using this as their only method of contraception, which is concerning,” says IFPA Medical Director Dr Caitriona Henchion. “These women usually present for emergency contraception when the withdrawal method has failed or if they regret taking the risk. Many simply do not know the risks involved.”

However, this is not something they link to a growing resistance to using the pill. “We occasionally encounter a fear of weight gain and the fear of perceived damage to fertility in later life is also common. Mostly what we see is that many women simply do not know the risks associated with less reliable contraceptive methods and simply do not have the time to address their contraceptive needs,” says Dr Henchion.

Holly Grigg-Spall, a British writer in her 30s and now living in California, is one of a growing number of women to turn against the contraceptive pill. She describes her personal experience in her new book Sweetening the Pill. “I’d been on the pill for 10 years when I started having problems,” she told Feelgood over the phone from Los Angeles. “At one stage, I would bleed whenever I had sex and when I went to the doctor I was told it was a side effect of my pill so I was moved to another. I was on a merry-go-round, pushed from one pill to the other, never offered anything else. I didn’t realise I had a choice. I thought it was the pill or nothing — the pill or pregnancy.”

She eventually came off the pill and started practicing sympto-thermal fertility awareness, a method that involves tracking a woman’s fertility cycle by taking body temperature, monitoring cervical mucus and keeping an eye on the calendar.

“Before, I was under the vague impression women were fertile all the time and could get pregnant whenever they had sex but now I know there are times you are fertile and times you are not,” she says. “You learn how to tell when you are and take precautions at those times.”

This means Grigg-Spall takes her basal body temperature before getting up every morning; checks her cervical mucus and uses condoms if she has sex while fertile. “It works for me,” she says. “It allows me to control my own fertility.”

It’s proven effective too. A 20-year survey of 900 women in Germany showed it to be just as effective as the pill at preventing pregnancy, although it must be said that, used by itself, it provides no protection against sexually transmitted diseases or infections and is best used by those in long-term relationships.

In many ways, it’s a more scientific version of the traditional Catholic rhythm method. The rhythm method is also based on women learning to identify their fertile phases; the difference being that it recommends avoiding sex during these times. The Catholic marriage care service Accord maintains it’s up to 98% effective when used by motivated couples taught by experienced teachers.

Popular period tracker mobile phone apps are based on a similar approach. But because they only follow the calendar, they are not reliable enough for Griggs- Spall. “The fact women are using them shows they are interested in a more natural approach but they are not the same as the fertility awareness method,” she says. “They tell you when you’re supposed to be ovulating. They don’t teach you to recognise when you are.”

Sex therapist Emily Power Smith has also witnessed a backlash to the contraceptive pill. She believes it is over prescribed, particularly to young girls with problem periods.

“The pill, along with other forms of contraception based synthetic hormones, like implants and injections, causes some women problems with extended use,” she says.

She sees particular issues with condoms. “Women absorb the message that sex is not enjoyable with condoms and as a result, make poor decisions in the heat of the moment,” she says.

There’s a certain perception of girls who carry condoms too. 24% of those surveyed for the ICCP study had a negative attitude towards women who carried condoms in case of unanticipated sexual encounters.

Power Smith believes such problems could be addressed by better sex education.

The pill may have given women freedom but it has its drawbacks too.

“Should the pill be the standard response to the question of contraception,” asks Grigg-Spall. “We need to give women information and confidence to make the right choices.”

How we got to work it out

Gemma Crowley, 30, from Clonakilty Co Cork understands why so many women are willing to take the risk of using the withdrawal method.

She started to take the contraceptive pill when she was 18. “It seemed the most common and normal thing to do,” she says. “Other options were available but it was what I tried first and I had no major side effects.”

She continued using the pill until she broke up with her boyfriend at the age of 24.

“It took time for my periods to settle down, ” she says. “It was always in the back of my mind to have kids so I was happy to give the pill a break.”

She met her current partner when she was 26 and they used condoms at the start but then switched to the withdrawal method.

“I use a fertility monitor that tells me when I’m fertile and, on those days, he has to pull out,” she says. “We agree before sex. And on safe days, he can come inside me. We have the best of both worlds and it’s 100% natural.”

Because she and her partner are committed and have discussed starting a family in two to three years’ time, she doesn’t worry about pre-ejaculate or a miss-timed withdrawal causing an unplanned pregnancy.

“My man knows when to withdraw but if we were 17 or 18, there’s no way I’d chance it,” she says. “As we’re planning on a baby in a few years’ time, it wouldn’t be the end of the world if I got pregnant.”

Nicole McBride, 23, from Dublin, weighed up all her options when it came to contraception. She started using condoms but soon wanted something more permanent.

“I knew I wouldn’t be able to take the pill due to a sensitive gag reflex,” she says. “I also wanted something I wouldn’t have to remember to take every day and the Implanon implant seemed perfect. It lasted for three years, was effective and out of all the possibilities, it seemed the best for me.”

Nicole found having the implant put in — a 20-minute procedure under local anaesthetic — only slightly uncomfortable. She soon got used to having a bar in her arm.

She had her first implant fitted in Britain for free but her second one was removed and replaced in Ireland, costing €300.

“When you break that down, it works out at around the same as the pill,” she says.

She hasn’t experienced any negative side effects. “I was told I could have a six-month cooling off period but I’m on my second one now and happier than ever with it,” she says.

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