MEANS OF SPACING BETWEEN PREGNANCIES
(Family Planning Means)

Umm Iman : There are some ladies who prefer to have close pregnancies. What is preferable: close pregnancies of spaced ones ?

Dr Ahmad :

Information about the means to distance between pregnancies is as old as history itself. All the known societies have tried to instaure some control on the numerical size of their population as well as on some of  its traits like the ratio between the males and the females. Some of the papyri from Ancient Egypt contain medical prescriptions for preventing pregnancy. Amongst the various artifacts found in the country are surgical tools used in ancient times to cause abortion. The same obtains for the  early muslim doctors' writings, where one can find prescriptions for preventing pregnancy and foetal abortion side by side with prescriptions  for treating any illness starting from the common cold to leprosy.

Umm Iman : What are the ways to space between pregnancies ?

Dr Ahmad :

There are many ways to space between pregnancies. There are also many ways to subgroup them [i.e the ways]. One subgrouping is chronological in nature, e.g.: traditional (or ancient) means, modern (or recent) means.  Another one is to subgroup them in terms of the means used, e.g.: the hormonic means; behavioural means; mechanical means. The behavioural means (or the societal means) are many. An example of these is refraining from having sexual intercourse (abstinence), since, in some African societies, there is a belief that the sperm contaminates the mother's milk. These societies practice abstinence for a period ranging from two to three years, during the breastfeeding of the child.

Another example of societal behavioural means is to extend the breastfeeding period since, in many cases, this extention delays getting pregnant. There are other types of behavioural means, like external ejaculation (withdrawal), the use of "thigh coition", the manual closing -by the man- of the  spermal duct of the male organ immediately before ejaculation (by finger pressure on the penis). Some ladies use some violent body movements after coition like jumping, and the extensive cleaning of the vagina, in the belief that these actions prevent the maintenance of the sperm in it. It is better to use the modern ways because they are the safest and the most efficient ones.

There are also some country folk (or old folk) ways and prescriptions (most of them harmful) for preventing pregnancy, like: putting an aspirin tablet in the vagina; drinking some herbal perfusions; putting inside the vagina some chemical substances like alum, which is a costive and astringent chemical substance. In addition, there are very harmful ways which use the delays in the menstruation period to provoke the menses (even though this is considered abortion), like: putting sticks from some plants (jew's mallow, hene, cotton) inside the uterus in the belief that they are provoking menstruation while they are actually causing an abortion.

Umm Iman : Are they modern ways that are safe ?

Dr Ahmad :

Yes, amongst them are the uterine devices (Intra-uterine devices):

They are of many types and of various sizes. They are made up of  velvety plastic material cast in various forms. When a copper wire is added to them, their efficiency increases. The same holds when  (wires  made up of) other minerals are added, e.g. silver, platinum. To some types is added a slow to absorb progesterone hormone so as to increase their efficacy and limit their complications.

Umm Iman : How do they work ?

Dr Ahmad :

There are a number of theories about how the intra-uterine device  works, the most important of which are the following :

- It makes the uterus and the Fallopian tubes contract further, since it is a foreign body. This brings about an increase in the speed with which the non-fertilized ovum travels towards the outside, which deprives it of the opportunity to get integrated with the spermatozoa. This increase in travel speed towards the outside also prevents the fertilized ovum from sheltering in the lining of the uterine wall. The copper of the wire induces the production of some enzymes in this lining.

- As for the progesterone hormone, which is contained in some types of intra-uterine devices, it endeavours to make the inside lining of the uterine wall develop and reach the size it does in the case of pregnancy.     

Umm Iman : What is the percentage of its efficacy ?

Dr Ahmad :

The percentage of its efficacy reaches 98%. This efficacy starts immediately after installation and coition can take place very shortly after this latter.        

Umm Iman : Are there any contraindications for its use ?

Dr Ahmad :

Yes. These contraindications are as follows :

1. Pregnancy or the suspicion that conception has taken place.

2. Inflammations of the reproductive apparatus.

3. Abundant menses.

4. Presence of lymph swelling (abscesses).

5. Absence of previous pregnancy.

6. Antecedent of extra uterine pregnancy.

Umm Iman : For how long can it be used ?

Dr Ahmad : 

Duration of Use : The period during which the Intra-uterine device can be used ranges from two and a half years to ten years, in the case of  recent types like the copper intra-uterine device 380. This period is for  the rest of the woman's life, in the case of other types like the one  called "Lyps".

Umm Iman : What is the most opportune time to place an Intra-Uterine device ?

Dr Ahmad :

The most opportune time to place an intra-uterine device : It is during the monthly period or immediately after it. This is to ensure that no conception had taken place inside the uterus. In the case of abortion, the intra-uterine device is placed starting from the first post-abortion monthly period. In the case of a woman who has just given birth, the intra-uterine device is placed fourteen days after delivery.

In the case of cesarian delivery, it is preferable to wait for three months. Sometimes, the intra -uterine device is placed immediately after delivery or abortion.

Umm Iman : Does the intra-uterine device have some side effects ?

Dr Ahmad :

Yes. For example, after its placement and until such time that the woman gets used to its presence, she may feel some contractions in her lower belly, some back pains or witness the coming down of a quantity of  blood. Sometimes, during the first three monthly periods, the menses are more abundant than is usual. However, they go back to their normal flow. If these side effects do not diminish or disappear, it is advisable to consult a gynecologist.

Umm Iman : What are the other means  (of contraception) ?

Dr Ahmad :

There are the hormonal means like birth control pills, injections and capsules.

Umm Iman :  What is your opinion, Doctor, concerning birth control pills ?

Dr Ahmad :

There are amongst the safest means of contraception and the most widely used nowadays, since their efficacy reaches 100% when they are taken correctly and regularly. Their mode of action consists in interfering with ovulation since they prevent the ovum from going out into the uterus. They  are made out of a mixture of two hormones (estrogen and progesterone), done in specific dosages, which brings about the arrest of ovulation. Some types, containing only progesterone, also exist.

Birth control pills are taken orally, starting from the fifth day of the coming down of the menses, whether menstruation stops or not. The woman will continuously take one pill a day, at the same time, for twenty one days. When the series (of pills) ends, the woman stops taking birth control pills for seven days. In the eighth day, she starts taking the new series. In principle, the woman must take the pills everyday and regularly. If it happens that she forgets, she must take a pill right away after she remembers and take the next one at its usual time.

Umm Iman : Do birth control pills present side effects ?

Dr Ahmad :

During the first three months, the taking of birth control pills may be accompanied by slight side effects like the following: the flow of blood  secretions or the sporadic drippping of blood drops; nausea; headaches; exhaustion; increase in breast weight; weight gain or loss; the appearance of freckles (or brown spots) on the face or the body. However, these side effects disappear progressively.

Umm Iman : What would prevent the use of birth control pills ?

Dr Ahmad :

The contraindications are : 

1. After the age of 35, for the smoking women; after the age of forty, for the others.

2. Cases of diabetes.                 

3. Cases of blood pressure (high and low pressures).

4. Varicosity.

5. Clinical antecedent attesting to clotting in any organ of the body.

6. Heart diseases.

7. Liver diseases.

8. Kidney diseases.

9. Tumors in the breast.

10. Tumors in the uterus and its annexes.

11. Natural breastfeeding.

Umm Iman : What are the other hormonic means of contraception ?

Dr Ahmad :

- Contraceptive injections : They consist in injecting progesterone, which stops ovulation. There exist a number of types which differ on the basis of the periodicity of their administering: monthly injections; quarterly injections.

- Under skin capsule implants (Norplant) : They are progesterone containing capsules which are implanted by a special syringe, under local anesthesia, underneath the skin in the area located at the top of the arm, towards the body. Their mode of action consists in preventing ovulation as well as changing the nature of cervical secretions and thereby making the cervix unsuitable for spermatozoa penetration. Their effect lasts for five years.There exist other means of contraception that are still at the experimental stage, like the use of ovulation-inhibiting serums, birth control pills and injections for men based on the "josepole" substance.

Umm Iman : What are the local means of contraception ?

Dr Ahmad :

* The male's preservative : Its percentage of efficacy is 80%. It is made out of a thin layer of rubber (latex). It comes in many types, many colors and many shapes. There are ordinary preservatives, granulated ones and those to which spermicides are added.

Umm Iman : How is it used ?

Dr Ahmad :

*  The male's preservative is placed on the male organ (the penis) while in an erection state, and prior to coition, so as to retain the sperm and prevent it from infiltrating into the wife's vagina.

l  After coition, it is recommended to hold the open end (or base) of the preservative tight, during withdrawal from the vagina, so that the sperm does not spill out of it into the vagina.

*   Its efficacy increases to 90% when the woman uses a foaming vaginal  suppository at the same time.

Umm Iman : Does it have any drawbacks ? If  so, what are they ?

Dr Ahmad :

Its drawbacks can be reduced to three main ones : (a) it can tear  during coition, (b) it can be punctured, thereby allowing for the  seeping of sperm into the vagina, (c) its use prevents direct  traction, which reduces the spasmic sensation of sexual intercourse.

Umm Iman : What are its advantages ?

Dr Ahmad :

Amongst its advantages is that it prevents the transmission of venerial diseases from one partner to the other. This holds particularly true for the AIDS disease.

Dr Ahmad : 

Amongst other local contraceptives, we have the following:

2. The female's preservatives(11) :  Its form resembles that of the  male's preservative; however, it is larger and possesses an internal ring  which permits its sure holding inside the vagina. We also have the diaphragm (or vaginal protective wheel): this device is made out of a rubber envelope held together by a metalic ring. It comes in various sizes; its efficacy reaches 80%

Umm Iman : How is it used ?

Dr Ahmad : 

*   At their first use, the doctor choses the size that is required by  the woman's vagina and trains her in the technique of placing the diaphragm so that she becomes able to do it herself.

*  The diaphragm is placed in such a way that its rubber part covers the cervix, thereby preventing the spermatozoa to reach the uterus.

* It is recommended to put some spermicide cream on the sides of the  device and on its front surface in order to increase the contraceptive efficacy of this means.

* The diaphragm is placed a quarter of an hour before coition. It must  be maintained in place eight hours, at least, after coition, during which no rinsing or cleaning of the vagina with water is to take place.

* The diaphragm is to be cleaned with water, dried and kept in a thin  layer of talc powder. There exist also some foaming tablets whose contraceptive efficacy attains 60%. When used along with a male's preservative, this efficacy  reaches 95%.

Umm Iman : How are they used ?

Dr Ahmad :

The way they are used is as follows :

 *   The tablet is placed in the vagina at least ten to fifteen minutes before sexual intercourse. Its effect lasts half an hour. If coition goes over this period, another tablet must be put in. In case of repeated coition, a new tablet must be placed in the vagina.

* In the event that foam does not spread after the tablet had been placed (in the vagina), this means that it has lost its efficacy. In this case, a new good tablet must be used.

*   The woman must not undertake any rinsing for eight hours after  intercourse.

There are also contraceptive creams the efficacy of which reaches 65%. They are chemical substances which stop the effect of the spermatozoon. They come in long tubes equipped with special syringes.

Umm Iman : How are they used ?

Dr Ahmad :

*   The syringe is placed on the opening of the tube. The woman presses on the tube so that cream gets into the syringe. Once this latter is filled with the required quantity, it is detached from the tube and  its content is injected into the vagina immediately before coition.

*    If coition is repeated, cream must be put anew, following the same steps.

*   The woman must not undertake any vaginal douche for eight hours after coition.

*   The contraceptive cream can be used along with the diaphragm and the male's preservative.

Umm Iman : Are there any other contraceptive means ?

Dr Ahmad : 

Yes. There are surgical means, which are:

*    Sterilization : it is a definitive means of pregnancy prevention and is irreversible except in very rare cases. Its reversal requires a  highly precise and delicate surgical operation. Another way is to resort to test-tube procreation.

1. Ways to sterilize women :

*    The severing of the Fallopian tubes and their tying through a  little surgical operation in the belly.

* The placement of a plastic staple or ring, with the help of  abdominal fibroscopy.

* The injection of a sterilization substance into the uterus, with the help of uterine endoscopy, 

* Through one of the aforementioned surgical means, during a cesarian operation, for an aged woman with many deliveries.

2. Men's sterilization (Vasectomy) : It is achieved through a small surgical operation involving the severing and tying of the sperm carrying cords (or ducts) or through the injection of a substance in the spermal duct bringing about its obstruction.

Umm Iman : I would like to thank you, Doctor Ahmad, for these  (very valuable) pieces of information and promise you that I will convey them to my daughter and to whomsoever ask me questions about them.

Dr. Ahmad : I would like to draw your attention to the fact that sterilization is prohibited by Islam.