Contraception: Everyone’s responsibility
Contraception and fertility planning should form part of every consultation, as it is key to reducing maternal mortality and morbidity associated with unplanned pregnancy. It also prevents pregnancy in women who are medically unfit for pregnancy until their condition has been optimised. This is only the tip of the iceberg compared with the social and economic burden of unintended pregnancy. The South African (SA) National Department of Health has recognised the importance of contraception and fertility planning. A national policy and guideline have been formulated that promote this agenda. In the past, the commonest contraceptives used in SA were the combined oral contraceptive and the injectable contraceptive. Long-acting reversible contraceptives (LARCs) offer the most benefit, and have efficacy comparable to permanent contraception. Their failure rates are the same for typical and perfect use. In addition, continuation rates after one year of use remain high. The intrauterine contraceptive device, the levonorgestrel intrauterine system and the injectable progestogen contraceptives form part of this group of contraceptives. The most recently launched LARC is Implanon NXT. A comprehensive guideline to assess suitability of the various contraceptive methods in various medical conditions is the World Health Organization Medical Eligibility Criteria for contraceptive use. Counselling is key to choice and suitability of contraceptive methods. Compliance, in part, is dependent on adequate discussion of side-effects, availability and acceptance of the method.