CHAPTER ONE
1:0 INTRODUCTION
Contraceptive use is an effective primary prevention strategy for reducing maternal mortality. It has been estimated that the use of effective contraception could avert 90% of abortion-related and more than 20% of obstetric-related mortality globally. Abortion incidence is inversely associated with the level of contraceptive use, especially where the fertility rates are stable. In addition, comprehensive sex education has the potential to prevent unintended pregnancies that lead to unsafe abortions. In order to meet the increasing demand for contraceptives and to ensure the sexual and reproductive health and rights of women, including the right to Planned Parenthood, intensified efforts are urgently needed.
CONTRACEPTIVES METHODS
Protection against STIs, It is important to practice safer sex, as well as to prevent an unplanned pregnancy. Not all methods of contraception provide protection against STIs. The best way to reduce your risk of STIs is to use barriers such as male and female condoms
Implants and injections – hormonal contraception
Hormonal contraception for women is also available as implants and injections. Male inject able contraceptives are currently being trial led.
Implants. There is a hormonal, rod-shaped implant that is inserted under the skin at the inner side of the upper arm. It contains etonogestrel, a progesterone-like hormone that prevents ovulation and stops sperm from entering the cervix by changing cervical mucus.
The contraceptive implant lasts for three years. Injections (Depo). There is a hormonal injection containing progesterone that is administered every 12 to 14 weeks. These injections, known as Depo prevent ovulation and block sperm by thickening the mucus made by the cervix.
Intrauterine devices (IUDs) The IUD is a small plastic device with added copper or hormones that is inserted into the uterus by a doctor. These can stay in place for five to 10 years, depending on the type used. The IUD can be easily removed earlier if you want to become pregnant or if you are experiencing problems
Emergency contraception
Sometimes, it is necessary to prevent pregnancy after having sex, rather than before, for example, when a pill is forgotten or a condom breaks, or in the case of rape. Emergency contraception, also known as the ‘morning after pill’, is a hormonal method of contraception that prevents or delays ovulation for that cycle. It prevents 85 per cent of pregnancies that would have otherwise occurred.

There are different types of emergency contraception available. The most commonly used form, a single pill containing the hormone progestogen, can be prescribed by a doctor or purchased over the counter at most pharmacies. It is best to take emergency contraception as soon as possible, ideally within 24 hours of having sex, but it still works well within 96 hours (4 days). You can take it within 96 to 120 hours (5 days), but it will not be very effective.
Pills and vaginal rings – hormonal contraception

Hormonal contraception for women is also available by prescription in the form of a pill (oral contraception) or a vaginal ring. These methods are highly effective (99.7 per cent) if used correctly, however, allowing for missed pills or forgetting to put a new ring in on time, may only be 91 per cent effective. Pills and vaginal rings may produce side effects and do not protect against STIs.
Combined pill

This is made of synthetic forms of the hormones oestrogen and progesterone. The combined pill prevents ovulation and thickens cervical mucus to prevent sperm from entering the uterus.

There are many types of combined pills with different dose and hormone combinations. This form of contraception is generally not recommended for women who are at risk of heart disease, such as smokers who are aged over 35 years.
Mini pill

This contains a synthetic form of a single hormone, progesterone. It makes the cervical mucus thicker, preventing sperm from entering the uterus. The mini pill is not as effective as the combined pill and needs to be taken every day at the same time. It is usually suitable for women who either experience side effects from oestrogen or should not take oestrogen for health reasons.
Vaginal ring

This contains similar hormones to the combined pill and works in the same way. A ‘one size fits all’ ring is inserted into the vagina and stays in place for three weeks. During this time, it slowly releases hormones that pass from the vagina into the bloodstream. It is then removed and a new ring is inserted one week later.

The vaginal ring releases a low dose of hormones and saves having to remember to take a pill every day. It is also as easy to insert as a tampon and, like the combined pill, is 99.7 per cent effective if used correctly.
Barrier methods of contraception

Barrier methods of contraception stop sperm from entering the womb (uterus). Options include the:
• male condom
• female condom
• diaphragm.
Male and female condoms also decrease the risk of STIs. Barrier methods can be very effective if used the right way, but can have high failure rates if not used consistently and correctly.
Male condom

This is a latex (or polyurethane) sheath that covers the erect penis and prevents semen from entering the vagina. The male condom is 98 per cent effective in preventing pregnancy, if used correctly. This means using a condom every time you have sex and putting it on before there is any contact between the penis and vagina.

Male condoms are relatively inexpensive and are available without a prescription from pharmacies, as well as from supermarkets and sexual health clinics.
Female condom

This is a loose polyurethane sheath with a flexible ring at each end that sits in the vagina and collects semen. It can be inserted several hours before having sex and is stronger than the male latex condom, though insertion and use may take some practice. If you use a female condom correctly every time you have sex, the method is 95 per cent effective.

Female condoms are available from Family Planning Victoria (via mail order) and some retail outlets and sexual health clinics.
Diaphragm

This is a soft, shallow, rubber dome that fits in the vagina, covering the cervix and stopping sperm from entering the uterus. The diaphragm needs to stay in place for at least six hours after having sex. If it is used, fitted and positioned correctly, the method is 94 per cent effective.

Diaphragms need to be fitted by a suitably trained doctor or nurse. Although the method may decrease the risk of STIs, it should not be relied on for this purpose.
Sterilization

Sterilization is a permanent, surgical procedure that requires referral to a specialist. Female and male sterilization are very effective methods of contraception, but they do not protect against STIs.
Female sterilisation

This procedure blocks the fallopian tubes, preventing an egg from passing down the tube and being fertilized. The two common surgical methods used are:
• tubal ligation (known as ‘having your tubes tied’) – performed under general an aesthetic
• Essure™ (having small coils inserted) – performed under local an aesthetic.
Vasectomy (male sterilisation)

This involves cutting the tubes that carry sperm. Having a vasectomy stops sperm from passing from the testes to the penis.
Natural methods

Natural methods, known as natural family planning, are based on an understanding of the menstrual cycle. Methods include monitoring cervical mucus changes, body temperature changes and rhythm or cycle calculations to help determine when a woman is most likely to be fertile each month.

The effectiveness of natural family planning varies, depending on which method or combination of methods is used. Natural family planning, however, does not protect against STIs.
1:0:2 Advantages of contraceptives
• No Unplanned Pregnancies
• Family Spacing and Size
• Less Abortion
• Spontaneous Sex
• Using a contraceptive can give you the freedom to enjoy spontaneous sex with your partner, without having to time the menstrual cycle to make sure that you are not having sex during a fertile time.
• STD Protection
CHAPTER TWO
2:0 LITERATURE REVIEW
2:0:1 Level of Awareness and Knowledge On contraceptives use
Some adolescent mothers might perceive contraceptives to be irrelevant or even harmful and these perceptions could result in unplanned pregnancies. Unplanned pregnancies could have serious implications for the physical, psychological and social well-being of adolescents and even for their nuclear as well as extended families. Adolescents should therefore be knowledgeable about contraception and different contraceptives, to enable them to make informed decisions about their own as well as their children’s futures. Adequate information about contraceptives could help adolescents to realize that effective utilization of contraceptives can successfully postpone pregnancies until they have completed their schooling and/or are financially capable of caring for their children. Numerous factors could contribute to the many adolescent pregnancies
In a study in South Africa, Mwaba (2000:32) found that 23% of the adolescents indicated that pregnancy was caused by girls seeking to prove their fertility. This perception might encourage adolescents to engage in unprotected sexual intercourse and avoid using contraceptives so as to prove their fertility. Thus the desire to prove their fertility may have influenced some adolescent mothers’ non-utilization of contraceptives.
Watt (2001:226) found that the belief that condoms are difficult to use and interfere with sexual pleasure was perceived as a barrier to the use of condoms. Adolescents should be educated about contracep