Birth Control, Contraception & Medical Termination of Pregnancy | Biology Class 12 - NEET PDF Download

Better healthcare and living conditions led to more people being born and living longer. For example, in India, the number of people went from 350 million to over a billion by 2000 because of better healthcare and more people able to have children. Even though programs like the Reproductive Child Health (RCH) program tried to slow down the population growth, it wasn't enough. With more and more people being born, there was a risk of not having enough food, houses, and clothes for everyone, so the government had to step in to help.

What is Birth Control?

Birth control is the use of certain devices, drugs or surgical procedures in both males and females, to prevent conception. Population explosion means that the number of people in the world or a country is growing super fast in a short time.

In 1900, the world had about 2 billion people. By 2000, it reached around 6 billion, increasing three times in just 100 years. Then, by 2011, it jumped to 7.2 billion. In India, at independence, there were about 350 million people. By 2000, it hit 1 billion, and by 2011, it was 1.2 billion.

The reasons for this explosion include:

• Better healthcare and living conditions.
• Fewer people dying, especially mothers and babies.
• More people reaching reproductive age.
• Medical help for couples struggling to have children.

Ways to control this growth are:

• Encouraging smaller families by promoting birth control methods and giving rewards.
• Educating people about the importance of having fewer children, like the "Our Two, Our Two" slogan.
• Encouraging families to have only one child.

What is Contraception?

Contraception is an artificial method or other techniques, mainly used to prevent pregnancy as a consequence of sexual intercourse. When a sperm reaches the ova in women, she may become pregnant. 

Contraception is a method that prevents this phenomenon by:

• Stopping egg production.
• Keeping the egg distinct from the sperm.
• By stopping the fertilized egg from attaching to the lining of the womb.

Types of Contraception

They are ideal if they are user-friendly, easily available, effective, reversible with no side effects, and non-interfering with the sexual drive, desire, and sexual act. There are several methods of birth control.

These are categorized mainly as follows:

(a) Natural Methods

The natural method of birth control involves avoiding chances of sperm and ovum meet.
It can be achieved by:

1. Periodic abstinence in which couples avoid coitus from day 10-17 (Fertile period) of the menstrual cycle. In this period, ovulation is expected to occur and chances of fertilization are very high. Also called the rhythm method or natural family planning.

2. Coitus interrupts also called the ‘rejected sexual intercourse’ or ‘pull-out method or withdrawal. In this method, the penis is withdrawn, from the vagina just before ejaculation.

3. Lactational amenorrhea refers to the absence of menstruation during the period of lactation following parturition. Because ovulation does not occur in this period, the chances of conception are none. This method is reliable for a maximum period of six months after delivery.

(b) Barrier Method

These are based on the prevention of ovum and sperm from physically meeting with the help of barriers. Barriers may be chemical or mechanical.

• Mechanical methods
  (a) Condoms are mechanical barriers made of thin rubber or latex sheath to cover the penis in males or vagina and cervix in females which prevent the meeting of sperm and ova. Condoms also provide protection against sexually transmitted diseases. They are disposable and can be self inserted and thereby gives privacy to the user.
  (b) Diaphragms, cervical caps, and vaults are also mechanical barriers, made of rubber that are inserted into the female reproductive tract to cover the cervix during coitus. They are reusable.
  

Chemical methods

Usually spermicidal chemical substances are used along with or without barriers like diaphragms, cervical caps, and vaults. They can be only used if the user is non-allergic to the substance.

• Spermicidal creams, jellies, and foams: Used along with reusable barriers to increase their contraceptive capability. Consists of spermicides like lactic acid, citric acid, potassium permanganate, etc.
• Sponge: Foam suppository or tablets that contain spermicide like nonoxynol inserted in the reproductive tract of the female.

(c) Intra-Uterine Devices (IUDs)

• Non-medicated IUCDs: S-shaped plastic wire that increases phagocytosis of sperms by immune cells. E.g. Lippes’ loop.
• Hormone-releasing IUCDs: Contains hormones that alter the hormonal balance of the female’s body making the uterus unsuitable for implantation and the uterus hostile for sperms. E.g. Progestasert, LNG-20.
• Copper-releasing IUCDs: These IUCDs release Cu ions that suppress sperm motility and fertilization capacity. E.g. CuT, Cu7, Multiload 375, etc.

Placement of IUD in the Uterus

IUDs prevent contraception in the following ways:

• Increase phagocytosis of sperms within the uterus.
• Some IUDs suppress sperm motility and fertilizing ability of sperm by releasing copper ions.
• The hormone-releasing IUDs make the uterus unsuitable for implantation and make the cervix hostile to sperms.

  IUDs are ideal contraceptives for females who want to delay pregnancy. It is one of the most widely accepted contraception methods in India.

(d) Oral Contraceptives

Oral contraceptives are hormonal preparations in the form of pills.

• Pills are small doses of either progestogens or progesterone-estrogen combinations.
• Oral pills alter/inhibit ovulation and implantation and also modify the quality of cervical mucus to prevent/retard entry of sperms.
• Oral pills have to be taken daily for a period of 21 days starting within the first five days of the menstrual cycle.
• Saheli an example of an oral contraceptive developed by scientists at Central Drug Research Institute (CDRI) Lucknow, contains a non-steroid called centchroman. It is a once-a-week pill, with very few side effects.

(e) Replants or Injections

(f) Emergency Contraceptives

Both of these techniques are highly effective but poorly reversible. 

2. Surgical Methods

Sterilisation or surgical methods are used by male/female partners as a terminal method to prevent any more pregnancies. These methods block the transport of gametes and prevent contraception.

• Vasectomy is applied in the case of males. In this method, a small portion of vas deferens is removed or tied up through an incision on the scrotum.
  
  Vasectomy in males
• Tubectomy is applied in females, where a small part of the Fallopian tubes is removed or tied up through a small incision in the abdomen or through the vagina.
  
  Tubectomy in Females

Medical Termination of Pregnancy

MTP, short for induced abortion, is the deliberate ending of a pregnancy before its natural completion. Each year, approximately 45 to 50 million induced abortions are carried out globally, which accounts for roughly one-fifth of all pregnancies worldwide. In India, MTP was legalized in 1971 with strict regulations to prevent misuse. The procedure is considered relatively safe during the first trimester, up to 12 weeks of pregnancy, but becomes significantly riskier during the second trimester.

Induced abortion serves various purposes:

• Preventing unwanted pregnancies resulting from situations like rape, casual relationships, or unprotected intercourse.
• Avoiding pregnancies that could pose serious health risks to the mother, fetus, or both.
• Contributing to population control efforts.

However, there are notable concerns associated with induced abortions:

• A large number of abortions are performed illegally by unqualified individuals, increasing the risk to women's health.
• Instances of misuse, such as gender-based selective abortions, perpetuating issues like female foeticide.