**7. Types of contraception and the mechanism of action**

Per the views of the World Health Organization [20], contraception is 'a core' issue of public health. It contributes to the reduction of family size as a result of birth spacing and also improves the health of mothers, infants and children. In the same vein, women are able to further their education, secure a career and promote economic growth as well as the lives of families and communities (Ibid).

Contraception is a method used to prevent ovulation, which may intend to prevent unintended pregnancy leading to the reduction of induced abortion [30]. Some women prevent pregnancy as a result of delaying pregnancy, spacing out births and limiting the number of births they want to have. These are the reasons why contraception is used [31]. But then, one needs to consider the following factors while choosing the most suitable contraception. These include:


When these are made known, women would not be influenced when making a decision to use them. There are various types of contraception but when making a decision to use them, one needs to consider their needs and the circumstances involved. The commencement of these procedures can be done when there is no issue with pregnancy. These include:


The natural methods are the calendar, basal body temperature (BBT), cervical mucus and the symptothermal. Traditional methods are coitus interruptus and coitus reservatus which is done to prevent sperm from entering the body for fertilization to commence (Ibid).

Nevertheless, contraception is provided by a doctor or a trained nurse. These are how the various methods of contraception are provided. Short-term hormonal methods include patches, vaginal rings and injections. According to Trussell et al. [32], a hormonal patch is a method worn on the skin, either at the abdomen, buttocks or upper body, far from the breast to release hormones (estrogen and progesterone) into the bloodstream and it works for 3 weeks by changing it every week, and then removed in the fourth week during menstruation. The vaginal ring is a ring placed into the vagina for the release of estrogen and progesterone, then it is taken out in the fourth week to allow the flow of the menses before using it again. The patch and the vaginal ring keep the sperms apart from reaching the egg when estrogen and progesterone are released into the bloodstream.

There is also the hormonal contraceptive injection. The 'Depo-Provera' (150 mg), 'Sayana Press' (104 mg) and Noristerat are mainly progestin-based contraceptives. The Depo Provera is given intramuscular (IM) every 3 months at the buttocks or upper arm, while the Sayana Press is given subcutaneously every 13 weeks at the back of the hand, the front thigh or the abdomen, far from the naval. The Noristerat injection '(NET-EN)' is given IM every 2 months. The progestin-only pill is good for women who cannot take estrogen-based contraceptives. The other contraceptive to consider is the combined injection contraceptive (CIC), which contains estrogen and progestogen and is given IM every month at the buttocks or upper arm [33]. The effectiveness of hormonal-based contraceptives can be reduced with some medications (e.g., Rifampicin/Rifabutin). Its usage ceases ovulation making the ovaries inactive to release eggs to meet the sperm. They are highly effective in preventing pregnancy when the injection is taken consistently and contraception takes up to

*Perspective Chapter: Factors that Influence Young Women's Decision-Making in Contraceptive... DOI: http://dx.doi.org/10.5772/intechopen.103066*

seven (7) days to work effectively. Therefore, there is a need for a backup method during sexual intercourse.

The oral contraceptive pill is made up of the progestin-only pill (POP)/mini pill and the combined oral contraceptive (COC) pill. They are safe and effective when taken at the same time every day starting from the first day of menstruation and will need a backup method or abstain for the first 7 days [34]. It thickens the cervical mucus, ceases ovulation and also makes the uterine lining thin to prevent the passage of sperm for conception to take place. However, it is good to report to a service provider when a pill is missed or forgotten but condoms can be used as a backup method. The POP is good for lactating mothers. The COC pills are made up of 21 estrogen and progestogen pills and seven brown or iron pills per pack/cycle serving as iron supplements. There is a quick return to ovulation after stopping COC; good for the treatment of painful menstruation and gives protection against ovarian cancer [33].

The long-term hormonal IUD is a 'T-shape device' placed into the uterus to prevent pregnancy for 10–12 years. The copper component kills the sperm and thickens the mucus of the cervix preventing sperms from swimming to meet the egg. We also have IUDs that are non-hormonal. However, women eligible for IUD are those with no issue of pelvic infections, those whose uterus sound is more than 6 cm or less than 10 cm and those that are not allergic to copper. It is effective as soon as insertion is done. That's why it is used as emergency contraception (EC) (Ibid).

The second hormonal method is the implant which is a 'thin rod' and is inserted subdermally into the left upper arm. They are of two types, the Implanon is one rod inserted under the skin of the upper arm for 3 years and Jadelle is a double rod inserted subdermally under the skin of the upper arm for 5 years. It also stops ovulation and makes the cervical mucus thick to prevent the sperm from reaching the egg. They are useful for women who are allergic to the use of estrogen hormones (Ibid). The IUD and the implant are conducted by a trained service provider.

The non-hormonal methods of contraception include the cervical cap (CC) or diaphragm, male and female condoms. The diaphragm or CC are placed inside the vagina to close or cover the cervix to prevent the sperm from reaching the eggs for conception to take place. This can be used in addition to spermicide to kill the sperms and is done before sex. Women who are allergic to spermicides cannot use it. The male and female condoms prevent the eggs from meeting the sperm for fertilization to place. The male condom is a 'thin sheath made of latex rubber', which is worn on an erected penis before inserting it into the vagina. The female condom is a 'soft loose-fitting' rubber sheath with two flexible rings. The inner ring is squeezed into the woman's vagina to cover the cervix and the outer ring at the surface of the vagina. The penis is guided into the condom during sex; and after sex, the outer ring is twisted, squeeze and pulled out from the vagina and discarded into a trashcan or waste bin making sure the sperm does not split (Ibid).

Vasectomy and female sterilization (tubal ligation) is a non-reversible method of contraception. This method follows a 'surgical procedure performed under local anesthesia' on a man or woman preventing him or her from producing additional children. The client is supposed to make an informed decision about the chosen method. The method required a signed consent form from the spouse or a witness before the procedure is being performed. The vasectomy does not allow the spermatozoa to flow into the seminal fluid during ejaculation. The tubal ligation prevents the egg through the fallopian tubes to meet the sperm. It is very safe and effective (Ibid).

The emergency contraceptive (EC) pills and the IUD are the contraceptive methods for emergencies. The EC pills are taken after unprotected sex and they prevent pregnancy from the starting day to 5 days [35].

The natural and traditional methods of contraception include: the lactational amenorrhoea method (LAM), which prevents ovulation through the practice of exclusive breastfeeding for 6 months [33].

The BBT method is used to study a woman's temperature to indicate if ovulation has occurred in order to prevent pregnancy during that period. Here the temperature is taken orally or rectally every morning waking up from bed and before any vigorous activity. The normal BBT to detect if ovulation is over is when 'BBT has risen from 0.2 to 0.5 degrees Celsius' with a constant elevation for 3 days and the readings should be higher than any of the previous days in that particular cycle. The rise in temperature will be constant until the beginning of the next period (Ibid).

The next method is the calendar method, which works like this: it requires the study of the cycle for 6 months to be able to indicate the longest and the shortest of the six cycles. This will help the client to tell which part of the month is fertile. An example is a client with the shortest cycle (SC) of 25 days and the longest cycle (LC) of 32 days. Here 20 will be deducted from the SC (25–20) = 5 and 10 from LS (32–10) = 22. For this reason, sex needs to be avoided from day 5 through to day 22 to prevent pregnancy (Ibid).

The cervical mucus method is a method used to detect when there is a feeling of wetness or mucus at the vulva to be able to tell when one is fertile in order to avoid sex. One can observe the mucus by wiping the vulva with a tissue or when there is wetness in the underpants. There is no sexual relation when mucus is found in the underpants or tissue paper. Consequently, the symptothermal method is the observation of the body temperature and the cervical mucus for the detection of fertile periods. This period ends 4 days after 'peak' mucus from the cervix or 3 days after a sustained rise in temperature. However, when not sure of the fertile period, abstain or use a condom for protection. Also, clients who have problems with the use of one contraception can be provided with a suitable alternative (Ibid). Contraceptive services are given by a practice service provider at the sexual health clinics.

In Ghana, the most available contraceptive methods include: the contraceptive injections (Depo-Provera, Sayana Press and Norigynon), the contraceptive pills (both POP (Microlut) and microgynon (COC), ECP (Postinor 2), implants (Jadelle and Implanon), IUD (10–12 years), vasectomy and female sterilization and condoms, cycle beads and the natural methods.

Recent studies recorded the methods used by women who are married are different from that of unmarried women. The use of modern contraceptives for men is limited to vasectomy and condoms. The prevalence of modern contraceptives among married Women of Reproductive Age as of 2019 is 57.1% [10].
