We are fortunate to live in a country where we have some of the most liberal sexual and reproductive health rights in the world. This means that we generally have the ability to access contraceptive options and make our own decisions about our reproductive health, our sexual identity, orientation and behaviour. Unfortunately, even though there are many options available, many women do not have access to contraceptives or the knowledge about them to find one that suits them best or use them effectively. A lot of women aren’t even sure what contraceptive option are available in South Africa, how much they cost, or how they work.
Contraceptives are available in hormonal and non-hormonal methods, and there is generally something out there to suit everyone. Here’s a run down of the most readily available and used contraceptives in SA.
The Condom (Non-hormonal, barrier method)
The condom is the most widely used contraceptive in the world. A condom is a sheath made out of latex that creates a barrier between the penis and vagina/ anus. We all more commonly know about the male condom, but you can also get female condoms in South Africa. If you would like more information on the female condom please get in touch with me here. The male condom usually comes in a square foil condom, with two serated edges. These serated edges are so you don’t have to use your teeth to open the wrapper (and you never should)! Before opening, check the expiry date. To ensure condoms last, keep them in a cool, dry place out of sunlight – one in your wallet is a good idea. Once open, find the “right side up” of the condom – this is when the condom comes from the inside and the ring on the outside. Hold the teet of the condom and place over the penis with one hand. Using your other hand, roll the condom down the penis. Once it is rolled out fully, release the teet and adjust. You do this so as to stop an air lock forming which could lead the condom to burst. All condoms have some lubrication on them, but if you feel you need more, only ever use water- or silicone-based lubricants as any oil based product (Vaseline) will cause micro-tears and infection for her. With perfect use, meaning that you use it perfectly as instructed, then it is 98% effective, but it’s typical use, meaning according to how it is generally used, is only 82%.
It is possible that either a man or woman may suffer from a latex allergy, and then you would need to buy condoms made out of an alternative substance, such as polyurethane. Durex does sell latex-free condoms but they can sometimes be hard to find.
Condoms are the only contraceptive that protect you against STIs and unwanted pregnancy! It’s important to be responsible for your own sexual health, and I hate hearing people say “we didn’t have a condom…” Petrol stations, pharmacies, supermarkets and adult stores all sell condoms; and petrol stations are open 24/7 so you have no excuse!
Cost: anywhere from R20 and R200 depending on brand and amount of condoms per pack
Advantages: Easy, accessable, cheap, no prescription needed, protects against STIs AND unwanted pregnancy, can be used in conjuction with hormonal contraceptives, can help prolong sex if male ejaculates quickly
Disadvantages: Allergy to latex, incorrect use can lead to slippage or breaking, decreased sensation, you can only use it once, requires male’s penis to be erect, can be difficult to negotiate condom use
The pill (combined oral contraceptive) (Hormonal)
Probably the more commonly known of all the contraceptives, the pill is a combination of oestrogen and progestogen. Generally, you get a pack of 28 pills (21 ‘active’ and 7 ‘inactive’). The 21 ‘active’ pills alter the hormone levels in your body and supresses ovulation (when your ovaries release an egg to be fertilised) and thicken cervical mucus. Once you have taken the 21 pills, you take the 7 ‘inactive’ pills which are in actual fact sugar pills. This is an indication to your body that it’s time to menstruate, and generally a woman’s period would start after the 2nd pill and end before the final one. You should generally take it around the same time every day, and never longer than 12 hours after your usual time. With perfect use, meaning that you take it at the same time, everyday, every month, then it is 99.7% effective, but it’s typical use is 91%. This form on contraceptive only protects against unwanted pregnancy, and not STIs. Once you stop taking the pill, you should be able to fall pregnant within a month, but some woman report falling pregnant immediately, and other’s say it took quite some time.
On the Pill, you can skip you period entirely, or move it a week forward/ back. There is no harm is skipping it entirely as many women may think. If doing so, you may experience some breakthrough bleeding or spotting although not having your period will not cause you any health concerns or affect your fertility at all. On the pill you are at higher risk of developing DVT (deep vein thyrombosis) but overall the risks are low.
Cost: ranging between R60 and R160
Advantages: easy to take, consistent periods and cycle, ability to manipulate cycles, can improve acne and menstrual symptoms, reduces the risk of endometrial and ovarian cancer
Disadvantages: forgetting to take it, possible weight fluctuations and decrease in libido, increased risk of cardiovascular disease, can cause headaches, bloating, tender breasts etc., no STI protection
Nuvaring (the contraceptive ring)
The hormonal contraceptive ring works in the same way as the Pill. It is inserted into the vagina and sits around the entrance of the cervix for 21 days. When it is removed a woman will have a period like she would when she takes the ‘inactive’ pills. The woman and her partner should not be able to feel it during sexual intercourse. With perfect use it is 99.7% effective, but with typical use it is 92% effective.
Advantages: as for the Pill
Disadvantages: forgetting to remove the ring, partner or woman feeling it during sexual intercourse, incorrect insertion, side effects similar to the pill, no STI protection
The morning after pill (Emergency contraception)
The morning after pill is widely available and does not require a script from a doctor. It shocks your body with a high dose of Levonogesterel, which delays or stops ovulation. It can be taken up to 72 hours after unprotected sex, but the sooner after the incident the more effective.
The morning after pill should in no way be used as a regular form of contraception! It should only be used in the case of an emergency. It can be used more than once, but not no woman should ever rely on it as a form of preventing unwanted pregnancy, and I cannot stress this enough!
Advantages: effective emergency contraception, one dose, readily available
Disadvantages: can cause nausea, dizzyness, headache etc, does not prevent against pregnancy in same menstrual cycle, no STI protection
Mirena (IUD; Intrauterine device)
In my opinion, this is the best contraceptive out there at the moment. It is a small, T-shaped plastic device that is inserted into your uterus by a gynaecologist or sexual health physician. It sits inside your uterus for up to 5 years, and during this time it releases small amounts of Levonogesterel which inhibits the sperm and egg from meeting and forming an embyro. As the lining of the uterus thickens, you will gradually stop having your period from 6-12 months after insertaion, with some spotting here and there. As the hormones are localised to your uterus, there are few side-effects on your body/ sex drive/ breasts etc. With perfect use (and it can only be used perfectly), it is 99.8% effective. After insertion you will be able to feel the very end of the string coming out of your uterus. If this string is left too long it might scratch the tip of your partner’s penis which may lead to some discomfort. This can be easily resolved at your doctor. Your ability to fall pregnant will return as soon as the device is removed.
Cost: Device costs around R2000 once off (lasts up to 5 years) and then you need to pay your doctor’s fee for the insertion +- R1500. Your doctor will also need to write you a script for the device. Some doctors use conscious sedation, others use local anasthetic and pain killers. It may feel similar to having a pap smear.
Advantages: complete protection against unwanted pregnancy, little to no menstruation, relief of severe period pains and heavy menstruation (great for women who struggle with this), ease of use as inserted once and lasts for 5 years (effective and long-acting), can be used during breastfeeding
Disadvantages: some women don’t like that they won’t get their periods, risk of ectopic pregnancy (formation in the fallopian tubes and therefore need to abort), discomfort of insertion/ removal, expulsion, expensive upfront, no STI protection
Brand new to SA (thank goodness!), the Implanon is a small rod, which is inserted into the inside of your upper arm, next to your bicep. It delivers progestogen to your body for up to 3 years. It works by preventing ovulation and thickening the lining of the cervix, which prevents sperm penetration. It can only be used perfectly and is 99.9% efffective – the most effective hormonal method of preventing unwanted pregnancy. This is a great alternative to the Mirena!
Cost: +- R1000 plus the doctor’s insertion fee
Advantages: Minimal action and long acting (3 years), immediately effective, ‘invisible’, safe to use breastfeeding or can’t take oestrogen, fertility returns immediately, cost-effective, can improve acne
Disadvantages: No STI protection, period pattern will change (unpredictable/ irregular bleeding), only inserted/ removed by professional – can cause bruising or pain and possible scarring
Depo-provera (injectable contraceptive)
The injection is a progestogen-only, long-acting (12 week) hormonal contraceptive. It prevents unwanted pregnancies by preventing ovulation and thicken the cervical mucus. With perfect use it is 99.8% effective and with typical use (i.e. forgetting to get your next shot according to schedule) it is 94% effective.
Advantages: Non-oral method, minimal action, carries no increased risk of failure, stops your period, safe to use when breastfeeding, ‘invisible’
Disadvantages: No STI protection, remember to have another injection every 12 weeks, can take months for fertility/ periods to return to normal, may produce irregular menstrual patterns