Contraception: Meaning, Importance and Myths

1Why this matters

Every family in Rwanda has an opinion about family planning, and not all of those opinions are based on facts. You will hear that the pill makes women infertile, that a girl cannot get pregnant the first time, or that washing after sex prevents pregnancy. None of these is true. This unit gives you accurate biology, so that as an adult you can make informed decisions, and so that you can correct myths when you hear them.

For you as a secondary school student, the key fact is simple: abstinence is the only method that is 100% effective at preventing pregnancy, and it also protects you from sexually transmitted infections.

2How pregnancy begins: a quick reminder

1. About once a month, one ovary releases an egg into the oviduct (fallopian tube). This is ovulation. The egg survives for only about 12 to 24 hours.
2. During sexual intercourse, semen containing millions of sperm is deposited in the vagina. Sperm swim through the cervix and uterus into the oviducts, and can survive there for up to about five days.
3. If a sperm meets the egg in the oviduct, it fertilises it, producing a zygote.
4. The zygote divides as it moves down the oviduct and then implants in the thick lining of the uterus. Pregnancy has begun.

3What contraception is

Contra means "against", so contraception means "against conception": any method used to prevent pregnancy. Each method breaks the chain above at one point: it stops an egg being released, stops sperm reaching the egg, or stops a fertilised egg implanting. Methods are grouped as:

• natural methods (avoiding intercourse on fertile days), lesson 2;
• barrier methods (condoms, diaphragm) and hormonal methods (pill, injection, implant), lesson 3;
• intra-uterine devices (IUDs) and permanent methods (sterilisation), lesson 4.

4Why contraception is important

• Family planning: couples can decide how many children to have and when, so that each child can be fed, cared for and educated.
• Health of mothers and babies: waiting at least two years after a birth before the next pregnancy gives the mother's body time to recover and improves the baby's chances of good health.
• Preventing unplanned and teenage pregnancies, which can harm a young mother's health and end her education.
• Protection from infection: condoms also prevent sexually transmitted infections, including HIV.

5How effective is a method? Reading a failure rate

A method's failure rate is the number of women out of 100 who become pregnant during one year of using it. Typical use rates include ordinary human mistakes such as forgetting a pill, so they are higher than perfect use rates.

Worked example: using a failure rate

In a sector, 300 women use the pill and 300 use an implant for one year. Estimate the number of pregnancies in each group, and explain the difference.

1. Pill: 8 per 100, so 8 × (300 ÷ 100) = 8 × 3 = 24 pregnancies.
2. Implant: fewer than 1 per 100, so fewer than 1 × 3 = fewer than 3 pregnancies.
3. Explain: the pill must be taken correctly every day, so forgotten or late pills cause most of its failures. Once an implant has been placed under the skin, it works for years with nothing to remember, so typical use is almost the same as perfect use.

6Myths and facts

Practice