When discussing contraception with a patient, in may be useful to understand a little about the patient’s cultural and / or religious background.
Obviously, it is not the medical professional’s position to advise on any religious aspects, but only to advise on the medical basis of contraceptive methods, and their use and efficacy, thus that the patient may make their own informed decision.
It can be a difficult decision for patients, when their religious beliefs and personal views on contraception are at odds.
For most religions, the use of contraception is acceptable, although in almost all cases there are different interpretations within the same religious group.
The use of contraception is not discouraged – in many cases it is actively encouraged, as many Hindu’s believe they have a duty not to produce more children than their environment can support
The decision to use contraception is left to individual couples
The use of contraception is generally not discouraged – some Orthodox groups may suggest that contraception should not be used unless there are certain conditions (e.g. the family already has several children, or pregnancy may be dangerous to the woman), whilst other groups often will not discourage the use of contraception. Jews may seek advice from their Rabbi, who will give personalised advice.
In Orthodox Judaism, hormonal methods may be preferred, as they are perceived as more ‘natural’ than barrier methods.
Calendar based methods are discouraged, as they typically co-inside with ‘Niddah’ (days when the women is menstruating).
Generally, the use of contraception is acceptable – although sterilisation may be discouraged.
In some Islamic states (e.g. Iran) contraceptive methods are actively taught to young unmarried people, and to married couples.
The views on contraception grew from the historical use of the ‘withdrawal method’, which was widely accepted in Islam. Thus as newer methods have become available, as contraception was already accepted, so were the new methods.
Generally accepted, except in Roman Catholicism.
Generally, the use of contraception is acceptable to most Protestant groups, and to Anglicans.
The Roman Catholic View
Even within those who would consider themselves Catholic, the uptake for the use of Natural Family Planning (NFP) is very low (one study suggested 1 in 25 Catholics).
The Roman Catholic Church has traditionally forbidden all types of contraception through history. The only acceptable method to the Church, is abstinence.
In light of this, the Church recommends the use of Natural family planning to anticipate when the woman is least fertile.
These methods are sometimes used outside of the Catholic context, in which case it is usually called fertility-awareness based contraception.
Natural family planning can involve:
Symptom analysis – the basal body temperature can be used to measure the time of the cycle. This is the lowest temperature attained by the body during rest. It is best measured as soon as the woman wakes in the morning. It varies between 36.4’ and 36.7’ during the menstrual cycle
This temperature is also often monitored by women when trying to conceive.
It is suggested that pregnancy is unlikely to result after the third day after ovulation – thus the third day after the increase in temperature.
Other symptoms, such as cervical position and cervical mucus may also be measured to help determine the day of the cycle. Once the day of the cycle has been determined, then the couple can chose to only have sexual intercourse during the least fertile period of the cycle.
Typically, for pregnancy to occur, the sperm much reach the egg within 24 hours after ovulation. However, sperm can survive inside the female for up to 7 days.
The calendar method – the woman needs to carefully monitor her cycle length, and can use this to determine the most fertile period, by knowing that this occurs typically 12-16 days before the next predicted menstruation. This means the least fertile period is typically around the time of menstruation.
Efficacy of Natural Family Planning
Studies show that this varies from between 85-95% per year, and that the highest efficacy rates are in Developed countries, suggesting that thorough education of the individuals who wish to use this method, results in increased efficacy.
‘Persona’ – is a brand of urine dipstick, used to analyse hormonal changes in the urine. It costs about £65, and dipstick refills cost £10. With a sample of urine it gives a red or a green light, designed to inform the patient whether pregnancy is likely or unlikely if sex occurs at that time.
If the device is used correctly, the risk of pregnancy during the course of 1 year is around 10%
Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009.
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