Contraceptive methods available in South Africa include hormonal oral pills, injectables, the implant, patch and the hormone based intra-uterine device (IUD). The non-hormonal option is the Copper IUD. There are also common barrier methods such as male and female condoms which also help prevent sexually transmitted infections if worn correctly. If you’re looking to permanently prevent pregnancy then sterilisation or tubal ligation is an option.
According to General Practitioner, Dr Thabile Vezi, all contraceptives are effective and have an efficacy of around 99% if used correctly. When choosing which one will work for you, Marie Stopes South Africa advises thinking about your needs first. These considerations include how long you want to stay pregnant free; how often you can access a clinic; if you are forgetful with medication and if you mind your period getting disrupted. There is also cost to consider. Most contraceptives are available for free at public health centres and at a certain fee at private facilities.
How it all works
There are short term and long-acting reversable contraception choices depending on how long you want to stay pregnant- free for. And hormonal and non-hormonal options depending on what you need.
How do hormonal contraceptives work? Dr Vezi explains: “Every cycle, the ovaries release the eggs–this is called ovulation. The lining of the womb gets thick to prepare it for pregnancy. The hormones found in contraceptives work by preventing ovulation. They also change the lining of the womb to prevent pregnancy from developing and change the mucus at the cervix (opening of the uterus) to prevent sperm (male reproductive cells) from entering.”
- The pill:
The different types of contraceptive pills contain both Oestrogen and Progestin hormones (and some contain only progestin) to prevent the egg from being released. The pill is to be taken at the same time each day.
“If you are forgetful, I’d advise against taking the pill because it will not be effective if you forget. If you are sick and get prescribed medication, please always mention it to the Dr that you are on contraception because some medication, like antibiotics, displaces the pill in your system and you could get pregnant,” Dr Vezi says, adding, “However, the pill can also help with clearing the skin, acne. And it can make your periods lighter and help with period pains. The government offers certain brands of the pill for free, and it costs between R90 and R350 at private facilities.
Injectables
- Injectable contraceptives contain the hormone Progestin and are given as a shot every two or three months, depending on the brand you go for. Depo-Provera works for three months and Nuristerate for two months. “The injection takes about two weeks to be effective in your blood, if it’s your first shot or your first one in a long while,” Dr Vezi warns. In this case, it’s advisable to also use a condom. The injection is free at any government hospital or clinic and costs between R90 and R250 at any private facilities.
- The Patch
Dr Vezi likes to call the patch the “middle child” of contraceptive methods because not a lot of women know about it as it is not available in the public sector. It works in the same way as the pill but the hormones are secreted through a patch.
“It is a thin, square patch that sticks to the skin and releases hormones through the skin into the bloodstream to prevent pregnancy. It is to be put on the first day of the menstrual cycle or the first Sunday after the menstrual cycle begins. The patch should be applied and changed every week for three weeks on the abdomen, buttocks, upper outer arm or upper torso – except for the breasts. On the fourth week, no patch is worn, and periods should start during this time,” Dr Vezi explains.
You can do regular activities like exercise. The patch is not affected by water from bathing, swimming or showering. It should not be applied over makeup, creams, lotions and other skin products however, as these may prevent it from sticking well. The Patch is available by prescription and ranges between R200 to R400.
- Condoms
Male and female condom made from latex or plastic (for those allergic to latex) work as barriers to prevent fertilisation with the efficacy of about 95 – 98% if used correctly. The female condom is also called the Internal condom and can be worn in the vagina or the anus and used by any gender. Condoms are free at any government facility and range between R60 and R300 for different brands and quantities.
The above are considered short term contraceptives. For long-acting reversable contraception which are inserted into your body, lasting for three, five and ten years, the following are your options:
- The implant
This is a rod the size of a matchstick which is inserted (by a health worker) under the skin of your upper arm where it secretes small doses of progestin. It is active for three to five years and can be removed at any time you want to get pregnant. According to Marie Stopes South Africa the once off cost for the implant is between R1800 to R2100.
- Intra-Uterine Devices (IUDs)
Considered the most effective form of contraception, IUDs, also called coils or loops, are inserted into your uterus and can last for up to five and 10 years. There are two types: Non hormonal such as Copper T and more recently Pearl Balls; and Hormonal such as Mirena and Kyleena which secrete Progestin. According to Dr Novikova, “hormonal IUDs stop menstrual periods in 70% of women and non-hormonal IUDs may make menstrual periods a littler heavier and more painful.”
Mirena or Kyleena IUDs may cost around R3700 in South Africa’s private sector; R2800 for the non-hormonal pearl balls and R800 for the Copper T. This excludes the amount to insert the device which can get up to R4600 alone. To insert the loop at Marie Stopes clinics is much less expensive.
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Read more about the efficacy of contraceptives
Possible side effects
All medications may have side effects and potential risks and it’s important to discuss these with your prescribing doctor. Side effects from hormonal contraceptives differ from woman to woman. “Minor side effects include nausea, headaches (and migraines), breast tenderness, vaginal discharge. Injectables sometime give you what we call breakthrough bleeding. Sometimes you don’t get your periods at all. Weight gain is possible with injectables. Hormonal contraceptives may also cause a decrease in or no sexual desire.” Mild depression is also possible but if it’s extreme, please see a healthcare professional and cease taking it.
Serious side -effects include an increase in high blood pressure and blood clots so if you are predisposed to these conditions or have them in your family, then consider your options carefully and make sure to have regular health checkups. “If you have a history of high blood pressure or history of clots, you shouldn’t take hormonal contraceptives,” Dr Vezi adds.
Smoking is not advisable while on the pill. Although the risk is quite small, the pills are associated with increased risk of some cancers like breast cancer and cervical cancer,” Dr Vezi says.
Who shouldn’t take hormonal contraceptives?
Sister Ntombikayise Patience Tlali is a private nurse practitioner who specialises in sexual reproductive health. She says, “women with cardiovascular disease, who have a history of stroke or other medical conditions like Epilepsy or migraines and those who are on treatment for TB or HIV should speak to their doctors about other contraceptive options.”
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