Which is the best family planning method
A lot of choices are available to couples when it comes to family planning. But what works how? The new family series from Dr. med. Katrin Kämmerzell helps couples to make a decision and also deals with ethical questions.
This is not supposed to be about contraception. Family planning methods is the more appropriate term because we are not talking about preventing a calamity, we are talking about directing a blessing.
Each method has its advantages and disadvantages. If you take a closer look at it, you quickly notice that the perfect one doesn't even exist. A detailed consultation on all variants at the gynecologist would make perfect sense, because this is about a crucial setting of the course, which in ﬂ uences the future, the health and the relationship. But our health system does not allow that much time in the consulting room. However, there is no simple solution for everyone, because couples and their living conditions are too different for that. This series of articles is not intended to and cannot replace advice from a gynecologist, but it does provide the basis for starting a conversation.
How do you find the right family planning method? In any case, women shouldn't deal with this question with themselves, because a couple is mutually fruitful and together they have the task of dealing with it responsibly. A suitable family planning method should cover the security needs of both partners, do not harm either health or mental health and enable fulfilling sexuality. Serious problems can arise if a couple does not weigh this carefully. For example, a divorced woman said that her ex-husband was against the pill. As a couple, however, they could not talk about good alternatives either. Result: The woman felt completely overwhelmed and deeply hurt by two pregnancies in quick succession immediately after the wedding. Another woman reported how much she suffered from the pill due to sexual listlessness and constant headaches. But her partner found all other methods unacceptable.
A couple should inform themselves intensively about the effectiveness, safety and advantages and disadvantages of the individual methods and then make a joint decision - and question them again from time to time. It is important to remember that no method offers 100 percent security and that sex can never be decoupled from responsibility for a child. Fertility is a gift and not something that can be taken for granted. It should therefore also be cultivated until the desire to start a family is there.
How do contraceptives work?
Countless factors have to work in perfect harmony to see the miracle of pregnancy. In order for a small new life to implant itself in the uterus, there must be ovulation, fertilizable sperm must reach the fallopian tube at the right time and penetrate the egg cell (which can only be fertilized for about eight hours!), The fertilized egg cell must not be too early and not reach the uterus too late and must also find a well-prepared “nest” there. Every contraceptive intervenes at one or more points in this very complex process. This can either prevent fertilization from occurring or prevent the fertilized egg cell from implanting in the uterus. Depending on the definition of the beginning of pregnancy, one is dealing either with the prevention of a pregnancy or with an early abortion and thus also with an ethical conflict that Christians in particular want to include in their considerations when choosing a method of contraception.
|attackpoint||Group of contraceptives|
|Sperm cannot get into the fallopian tube||Barrier methods (e.g. condom, diaphragm)|
|Sperm only enter the fallopian tube at a time when the egg is unable to fertilize||Time selection methods (e.g. natural family planning)|
|Sperm are killed / damaged||Chemical methods, copper systems, hormonal contraception|
|Inhibition of ovulation||Hormonal contraception|
|Changes in the secretion on the cervix (cross-linking of the mucus components, which like a dense network prevents the sperm from passing through)||Hormonal contraception|
|Effects on the ability of sperm to fertilize (biochemical changes that make it difficult for sperm to enter the egg)||Hormonal contraception and copper systems|
|Inhibition of the natural movement of the fallopian tubes: This means that a fertilized egg cannot be transported into the uterus or cannot be transported into the uterus in time and dies||Hormonal contraception|
|Effect on the lining of the uterus so that a fertilized egg cannot implant||Hormonal contraception and copper systems|
Due to a transmission error, the table in the print version was only partially reproduced. Please excuse the mistake!
When is a person a person? From a medical point of view, there is no longer any limit to be drawn after fertilization, as humans develop continuously and not in stages. All other definitions are of a philosophical, but not of a medical nature. In the fertilized egg cell everything is already present and fixed, until death in old age only the number of cells and the di erentiation of the cells change. The German Embryo Protection Act for artificial insemination therefore protects the embryo from fertilization. Paragraph 218 of the Criminal Code on termination of pregnancy, on the other hand, was amended in 1976 to the extent that removal of the pregnancy prior to implantation of the fertilized egg cell in the uterus does not count as termination of pregnancy. That coincided with a time when copper spirals were pushing their way onto the market and would otherwise have been punishable by law. And this redefinition of the beginning of a pregnancy has resulted in the fact that in the package inserts of contraceptives formulations such as “has no in ﬂ uence on an existing pregnancy” can be used. It becomes difficult for users and their doctors to determine the exact mode of action. In addition, hormonal contraceptives and contraceptives containing copper are not clearly applied before or after fertilization, as their effect is based on several mechanisms. The table provides an overview of the possible effects of various family planning methods; further details as an aid to ethical assessment can be found in the following articles in this series of articles on each group of methods.
Take a moment to talk about how satisfied you are with the family planning method you are currently using and answer the following questions for yourself:
- Was it an informed decision that we made together and with God?
- Have we dealt with the mode of action and have peace about it?
- Are both of them doing well or are there any undesirable side effects?
- Can both experience sexuality without fear of an unplanned pregnancy?
It is worth taking stock as a couple! If you can answer “yes” to all of the questions, you have already found the right method for you. If not, further study of family planning will be of great value to you
Dr. med. Katrin Kämmerzell lives with her husband and three children near Stuttgart and works in a gynecological practice.
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