Navigating the Landscape of Emergency Contraception and Unplanned Pregnancy

Insights from a South African Survey**

 

Authors: Mrs Yashmita Naidoo CEO of HIV SA, Dr Venessa Timmerman (PhD) and Mr Siraaj Adams (MBA, MPH).

HIVSA is an NGO that commissioned the national survey.

 

Introduction

Studies have reported that students between 18 and 24 years have one of the highest rates of unplanned pregnancies. The lack of effective knowledge concerning contraceptive use results in an increase in unplanned pregnancies (Bryant 2009:12; Trieu et al. 2011:431).

In a study amongst 15 to 24-year-old South African women, it was estimated that only 52.2% of sexually experienced women are using contraceptives (MacPhail et al. 2007:3). Because of the fact that 80% of undergraduate students at higher educational institutions are sexually active, it is vital that they have access to safe, accessible and adequate contraceptive services (Bryant 2009:12). Dreyer (2012:6) suggests that the main reasons for women not utilising or discontinuing the use of contraceptives are side effects, lack of knowledge about different methods available, or lack of interest in utilising it.

In the study amongst students in Durban, South Africa, Roberts, Moodley and Esterhuizen (2004:441) suggested that an increase in the use of emergency contraceptives might reduce the number of unplanned pregnancies.

In our recent survey conducted in South Africa, we embarked on a comprehensive examination of emergency contraception and unplanned pregnancy among 469 female respondents aged between 20 and 35. This survey sought to uncover the prevailing landscape surrounding the use of emergency contraception, experiences with unplanned pregnancies, and the evolving attitudes toward contraceptive accessibility. The data gathered provides crucial insights into the reproductive health dynamics of young women in South Africa.

 

Understanding Emergency Contraception Practices

Our survey captured the experiences and choices of a diverse group of women,469 respondents from all 9 provinces, offering a comprehensive view of emergency contraception practices. The respondents provided valuable insights into the frequency of morning-after pill usage and the prevalence of unplanned pregnancies.

 

Key Survey Findings

  1. Morning After Pill Usage

A significant 49.3% of respondents reported having used the morning-after pill, highlighting the concerning high utilisation of emergency contraception in managing reproductive health.

  1. Repetitive Morning After Pill Usage:

Over 21% of respondents revealed using the morning-after pill more than 2 to 3 times, indicating a recurring reliance on emergency contraception among a notable portion of the surveyed population.

  1. Unplanned Pregnancies on Hormonal Contraception

Alarmingly, 18.6% of respondents reported falling pregnant while on some form of hormonal contraception. This finding underscores the need for further exploration into the effectiveness of existing contraceptive methods or whether or not non-compliance by patients is a factor.

  1. Incidence of Unplanned Pregnancies

Nearly 45% of respondents disclosed experiencing unplanned pregnancies, verifying the concerningly high prevalence of unexpected reproductive outcomes among young women in South Africa.

  1. Termination of Pregnancy

A significant 19% of respondents confirmed having undergone a termination of pregnancy, primarily at public health facilities. This highlights the crucial role these facilities play in addressing reproductive health needs.

  1. Preference for Online Morning After Pill Purchase

Almost half of the respondents, approximately 47%, expressed a willingness to purchase the morning-after pill online. This inclination reflects a growing demand for convenient and discreet avenues for accessing emergency contraception.

Implications and Considerations

These survey findings carry substantial implications for reproductive health policies, healthcare providers, and the broader community. The prevalence of unplanned pregnancies, the repetition of morning-after pill usage, and the occurrence of pregnancies while on hormonal contraception warrant careful consideration.

 

Conclusion

The prevalence of contraceptive use by sexually active students in previous research was high at 79%. However, inconsistent use of contraceptives is a major challenge. Females were aware of the benefits of contraceptives in preventing unplanned pregnancies; however, they used contraceptives inconsistently as a result of being afraid of possible side effects. Overall, there was limited awareness and use of emergency contraceptives. Consistent use of regular contraceptives and condoms should be emphasised to reduce not only unplanned pregnancies but also sexually transmitted diseases (Brunner Huber & Ersek 2009:1069).

In a study among students in Durban, South Africa, Roberts et al. (2004, p. 441), suggested that an increase in the use of emergency contraceptives might reduce the number of unplanned pregnancies. However, due to the lack of knowledge and awareness thereof, the family planning services were underutilised (Roberts et al. 2004, p. 441).

Our survey provides a comprehensive snapshot of the current landscape of emergency contraception and unplanned pregnancy among young South African women. The findings underscore the importance of accessible and effective reproductive health services. Efforts should be directed towards enhancing awareness, ensuring the availability and education around use of reliable contraceptive methods, and exploring innovative solutions, such as online access to emergency contraception. By addressing these needs, we can empower women to make informed choices about their reproductive health, contributing to a healthier and more equitable future. This survey serves as a catalyst for ongoing discussions and actions aimed at fostering reproductive well-being among South African women.

 

References

Bryant, K.D., 2009, ‘Contraceptive use and attitudes among female college students’, Journal of ABNF 20(1), 12-16. PMID: 19278182.

Dreyer, G., 2012, Contraception: A South African perspective, Van Schaik Publishers, Pretoria.

MacPhail, C., Pettifor, A.E., Pascoe, S. & Rees, H.V., 2007, ‘Contraception use and pregnancy among 15-24-year-old South African women: A nationally representative cross-sectional survey’, BMC Medicine 5, 31. PMID: 17963521, http://dx.doi.org/10.1186/1741-17015/5/31

Roberts, C, Moodley, J & Esterhuizen, T 2004, Emergency contraception: knowledge and practices of tertiary students in Durban, South Africa, Journal of Obstetrics and Gynaecology, vol. 24, no. 4 pp. 441-445, doi:10.1080/0144361040001685619

Failure of the emergency contraceptive levonorgestrel and the risk of adverse effects in pregnancy and on fetal development: an observational cohort study”: https://www.sciencedirect.com/science/article/pii/S0015028205008861

Contraception Q&A: Part 2

You’ve probably read part one, and as promised, here’s part two of me answering some more common contraceptive questions I’ve received in my DMs and on AskChoma.

Question: What are the side effects of contraceptives?

Depending on which contraceptive method you’re on, you might experience similar or different side effects. The most common side effects associated with contraceptives are:

Weight gain

Headaches

Sore breasts

Irregular periods

Mood changes

Decreased sexual desire

Acne

Nausea

All these side effects depend on how your body reacts to the contraceptive and it’s not the same for everyone. If you do have side effects, they should go away on their own after a few months (usually three months). It’s advisable to visit your healthcare provider if you have any concerns.

Question: Do I have to tell my parents about taking a contraceptive?

If you decide to tell your parents or guardian that you’re taking or considering being on a contraceptive, you’ll want to put some thought into how to tell them. They may assume you’re sexually active, which may result in them asking you questions that might make you feel uncomfortable. Their reaction might also make you re-consider, but remember to think about what is best for you, depending on your sexual status.

Although it may seem scary, an advantage of speaking to your parent/caregiver about such topics is that is creates open communication between you and them. This’ll enable you to feel more comfortable to discuss any matters openly in future, and create a more supportive environment at home.

If you’re 16 or older, you can usually be given the contraceptive (without parental consent) at your local clinic, depending on its safety for you. If you’re under the age of 16, the process will be slightly different. It’s best to get some guidance from an adult you trust or a healthcare provider before starting a contraceptive.

Question: What’s the morning after pill?

If you have sex without using any contraceptive, or the contraceptive method failed (eg. the condom broke during sex), you can use the morning after pill to prevent pregnancy. It should ONLY be used in an emergency and not for regular prevention. It’s most effective when taken as soon as possible after having unprotected sex.

Question: Where can I get the morning after pill?

You can get the morning after pill at any local pharmacy without a prescription. You can also get them at your local clinic for free.

Question: Is the morning after pill a termination (abortion) pill?

The morning after pill won’t work if you’re already pregnant, so it cannot terminate a pregnancy in any way. It’s also not a good idea to use this pill if you’re already pregnant.

Question: Can Coke and Disprin be used to terminate a pregnancy?

Coke and Disprin does NOT work in terminating a pregnancy, but instead pose a health risk the same goes for other dangerous DIY contraceptive methods. Don’t compromise your health, rather go to your nearest clinic or pharmacy if you need emergency contraceptives.

If you have more questions about contraceptives, or need help accessing contraceptives, feel free to send me a DM. It’s advisable to always check in with your healthcare provider if you have any concerns.

If you or a friend need advice or help, you can contact me here on Ask Choma, send me a Facebook Messagea Twitter DM, or a WhatsApp Message (071 172 3657).

Birth Control: The In’s and Out’s (How It works and When To Stop If You Want To Get Pregnant)

Birth control or “family planning” is a way to stop unwanted pregnancies from happening. There are many forms of contraceptive measures that are effective, easy to use, and readily available. Contraceptives can range from the use of medications to devices that prevent unintended pregnancy.

The main groups of contraceptives are hormonal and non-hormonal:

Hormonal contraception involves the release of hormones (progesterone and oestrogen) into a woman’s body to suppress ovulation, thicken the cervical mucus, and thin the uterine lining.

Non-hormonal contraception does not change hormones in a woman’s body to prevent pregnancy. Non-hormonal contraceptives usually physically prevent sperm from reaching the egg.

Types of hormonal contraception

The contraceptive pill

The birth-control pill is an oral contraceptive that is taken at the same time each day and alters reproductive hormones to prevent pregnancy.

The contraceptive patch

The contraceptive patch is a patch that looks like a plaster, is stuck to the skin, and releases hormones to the skin to prevent pregnancy.

The contraceptive implant

The implant is a flexible plastic rod that is inserted under the skin of a woman’s upper arm to prevent pregnancy.

Types of non-hormonal contraception

Condoms (male and female)

Male condoms are worn by a man on his penis to provide a barrier during sexual intercourse. Female condoms are inserted into the woman’s vagina before intercourse to form a barrier during sexual intercourse. The barrier formed by both the female and male condoms prevents the sperm from reaching and fertilizing the egg.

Copper intrauterine device (IUD)

This form of contraception is a T-shaped device that is inserted into a woman’s uterus by a healthcare provider. The copper IUD is a non-hormonal contraceptive that releases a small amount of copper into the uterus. The copper changes the cervical mucus and makes fertilization more difficult. Once used, it can prevent unwanted pregnancy for 5 to 10 years, depending on the type.

Start of contraception

Starting birth control can be daunting if you are not sure which method to choose. It’s always advisable to see a healthcare provider to discuss which option is best for your lifestyle.

Condoms are the only contraceptives that can protect you from HIV and STIs. Remember to always use condoms until you and your partner have been tested for STDs and HIV.

Trying to get pregnant? When to stop using birth control.

Contraceptives do not affect your fertility. Most women can get pregnant within a year of stopping contraceptives. However, when you should stop using birth control depends on which birth control method you choose,

  1. Condoms: you can get pregnant as soon as you have sexual intercourse without using them.
  2. IUD or the Implant: It’s possible to get pregnant right after the doctor removes it from your body.
  3. Contraceptive patches and the pill: Ovulation should return to normal within 1-3 months after you stop using them.

Remember to always check in with your healthcare provider if you are unsure or struggling to fall pregnant.

If you or a friend need advice or help, you can contact me here on Ask Choma, send a Facebook message, an  Instagram message or a Twitter DM, or a WhatsApp Message (071 172 3657).

 

How does chronic medication affect contraceptives

A lot of people have chronic conditions they take treatment for, but may not be aware of how this treatment may interact (become affected by) their chosen contraceptive method. If you have a chronic illness and are thinking of getting a long or short contraceptive, but worried about how your medication may affect your chosen method, here are a few things to keep in mind.

What is chronic medication?

Firstly, it’s important to understand what a chronic illness is. A chronic illness is a long-term health condition. Examples of chronic illnesses are Diabetes, TB, Heart disease, HIV/AIDS, and mental health illnesses such as bipolar and depression. Chronic medication or treatment is used to treat these long-lasting illnesses. Chronic medication needs to be taken routinely, over a long period of time to control the effects of the chronic illness on your body.

Can it affect your contraception?

The pill and other types of contraceptives (like the patch, ring, or injections) usually contain the hormones estrogen and progestin. These stop the eggs from leaving the ovaries, preventing pregnancy. However, some chronic medication reduces the effectiveness of contraceptives.

Antibiotics like those taken to treat acne, a sore throat, UTIs (Urinary Tract Infections) and vaginal infections can usually be taken with hormonal contraceptives. But others, like an antibiotic called rifampicin, which is used to treat tuberculosis or meningitis, can affect how effective the contraceptive is.

Some antiviral drugs used to treat HIV are also known to make hormonal birth control less effective. Luckily, there are some antiretroviral drugs that don’t interfere with the pill’s effectiveness, so it’s important to discuss your options with your healthcare provider.

What should you do?

If you’re on a form of chronic medication, be sure to consult with your healthcare provider on which contraceptive method would work best for you. You may have to consider some non-hormonal birth control options, such as the copper IUD. Like all birth control methods, it has some risks, but overall, it’s really safe. Visit your nearest clinic to find out whether they have the copper IUD or talk to a healthcare provider to find out if it’s right for you.

Finding the right birth control method can take some time, especially if you’re on chronic medication. Talking through your options with your healthcare provider is a good first step, though, so I advise you to do this. Remember, to use a condom along with whichever contraceptive method you choose to use. This will help you prevent unwanted pregnancy and stay protected against STIs.

Remember if you or a friend need advice or help, you can contact me here on Ask Choma, send me a Facebook Messagea Twitter DM, or a WhatsApp Message (071 172 3657).

How to Take the Pill Properly

If you’re sexually active and want to prevent unwanted pregnancy Choma, then contraceptives are definitely recommended. I’ve spoken to you about the various contraceptive options before, which you can still read about here and here, but in this article I’ll be focusing on The Pill. The Pill is 99% effective at preventing pregnancy when you use it correctly. If you’ve just started taking the pill, or are thinking about it, then you might be worried about what it means to take the pill correctly and what happens when you don’t.

Well, to help ease your mind about taking the pill Choma, here’s a bit of advice on how to take the pill properly to make sure that it’s effective.

About the Pill

First off, there are actually a few reasons why young women take the pill. So you might be taking the pill for a reason that has nothing to do with pregnancy, such as:

  • Regulating your periods
  • Controlling Acne
  • To treat Polycystic Ovary Syndrome (PCOS)
  • To treat Endometriosis (which is a condition that occurs when tissue similar to the inside lining of the uterus is found outside of its normal location)
  • To treat menstrual cramps or PMS (Premenstrual Syndrome)

How the pill works

The pill usually works by preventing ovulation (the release of an egg during your monthly cycle). If you don’t ovulate then you won’t get pregnant because there isn’t an egg to be fertilised.

The pill also works by thickening the mucus around your cervix, which makes it harder for sperm to enter you uterus and reach any eggs that may have been released, preventing pregnancy.

How the pill should be taken

Most birth control pills come in either a 21-day or 28-day pack.

With the 21-day pack, you would take the pill once a day (every day for 21 days) and then stop taking the pill for 7 days (around this time you would get your period).

With the 28-day pack, you would take the pill once a day, every day. For the first 21 days you would take the hormone pills and then for the remaining 7 days take pills without the hormone (around this time you would get your period). Taking the 7 “non-hormone” pills is simply a way to keep you in the habit of taking the pill every day.

What about the best time to take the pill?

Well Choma, the pill works best when taken every single day and at the same time every day – regardless of whether you have sex or not. Taking the pill at the same time every day also helps you to remember to take the pill. The best thing to do would be to consider the best time for you and then set your alarm to go off every day at that time.

You can also time it around the same time that you do other regular activities, such as right before or after you brush your teeth.

What happens if I forget?

If you skip the pill or forget to take the pill (even if it’s just one pill), then keep in mind that this puts you at risk of falling pregnant. You should use a back-up form of contraceptive, such as the condom, to prevent pregnancy.

You might need to contact your healthcare provider on what to do if you miss the pill, because this sometimes depends on what type of birth control pill you’re using. But usually Choma, all you need to do is take the pill as soon as you remember and then keep taking your pills as normal. Some say you should take the pill twice (the missed pill and the pill scheduled for that day) but you should definitely check with your healthcare provider before you do this.

If you find that you’re always forgetting to take the pill, then perhaps you should consider another form of contraception Choma.

Different types of birth control pills

There are a few different types of birth control pills available to choose from Choma. They might differ slightly in how they work or how they affect your body. The most popular birth control pills you’ll find in clinics are:

  • Ovral
  • Nordette
  • Triphasal
  • Hyan

Speak to your healthcare provider about the general side effects of each and about which one would work best for you.

Things to remember

While taking the pill Choma, there are a few things you need to keep in mind:

 

  • The pill only helps prevent unwanted pregnancy, not Sexually Transmitted Infections (STIs). So it’s important to still use a condom while taking the pill.
  • Certain types of medication, especially antibiotics, can affect the effectiveness of the pill. So if you’re on medication, speak to your healthcare provider who should be able to advise you on what to do.
  • Healthcare providers usually tell you to wait 7 days to 2 weeks for the pill to be completely effective. During this time, you need to be especially careful to use both the pill and a condom.
  • You may or may not experience side effects when you start taking the pill. If you do experience side effects, they usually disappear after some time. However, if you notice persisting problems Choma, speak to your healthcare provider who will then advise you on a different option or check for any other problems that could be causing you to experience these side effects.

The pill is a great option for anyone who wants to prevent pregnancy but it has to be taken properly in order for it to be effective. Do you have any more questions about the pill Choma? Simply ask me in the comments below or on Ask Choma.

All about the contraceptive Implanon

What exactly is Implanon and how does it work?

Implanon is a method of birth control that gets implanted just under your skin, on your upper arm. Once it’s implanted, it works as continuous contraception for up to 3 years. It’s actually been said to be one of the most effective birth control methods to use.

Implanon looks like a tiny, thin, flexible plastic matchstick and the way it works is by releasing a hormone called progestin that prevents pregnancy from taking place. It does this by keeping your eggs from leaving the ovaries. Pregnancy can’t happen if the egg doesn’t join the sperm. The progestin hormone also makes the female’s cervical mucus thicker, making it difficult for the sperm to get to the eggs. So, the implant leaves very little room for any mistake for you to fall pregnant.

How Implanon is inserted

Your doctor or any other health care professional will implant the matchstick-like rod under your skin in your upper arm in a quick procedure. You should both make sure that the Implanon is in your arm, after insertion, and you can check by feeling for it. If neither your doctor nor you can feel the implant immediately, you may need special tests to check if it is in place.

Once the Implanon is placed in your upper arm, it will protect you against falling pregnant for up to three years. Your doctor can remove your implant at any time you want. However, your ability to get pregnant does return quickly after the implant is removed.

Before getting Implanon, talk to your doctor or health care professional about whether or not the implant is right for you. Remember to be open about any health condition or concerns you may have because this could affect your doctor’s decision to recommend Implanon to you.

STI (Sexually Transmitted Infections) Prevention

Implanon does not prevent the spread of STIs such as HIV. Always use a condom along with the implant to help protect yourself.

Side Effects

There might be side effects with Implanon such as:

  • Weight gain
  • Headache
  • Dizziness
  • A pain or an infection in the arm, but only rarely.
  • Pain where it was inserted.
  • Stomach Pain
  • Back Pain
  • There might be some discolouring of the skin over the implant.
  • Tender, sore breasts

But these are the less common ones chomas. The most common side effect, especially in the first 6-12 months is irregular bleeding. Your periods might become lighter and fewer or may be the complete opposite – they may become heavier and longer. You might bleed lightly and have increased spotting in between periods. These side effects are normal chomas.

When do the side effects get serious?

If you:

  • have a pain, bleeding, pus or increased redness at the place where the implant was inserted,
  • suspect a lump in your breast
  • have skin or eyes turning yellow
  • have no period at all after the inserting the implant
  • have heavy or continuous bleeding from your vagina
  • notice that the implant comes out or the place where it was inserted becomes uncomfortable
  • blood clots (the risk increases if you smoke)

Then that means you must visit your doctor almost immediately as these are more serious side effects.

Benefits

  • Your period cramps will ease.
  • You don’t have to take medication on a daily basis.
  • It’s safe, simple and convenient.

If you are thinking about getting the Implanon then visit your nearest Planned Parenthood clinic or doctor as they are there to help. Your health care professional will be able to give you better direction on whether or not you can start using Implanon. The implant does not protect you against any STIs, including HIV, so always use a condom to protect yourself.

Excuses for not condomising

Whether you are experienced or not, you’ve probably heard all kinds of things about condoms and sex. Many guys and girls talk about how much better it is to have sex without a condom – but if you’ve ever heard about unwanted pregnancy, STDs (sexually transmitted diseases) and HIV, then you know that sex without a condom is a huge risk.

Guys will come up with all kinds of excuses about why the two of you should not use a condom when you’re having sex, trying to make a fool out of us smart girls.

Here are some lame ones. If your guy gives you these, tell him to step because you’re WAY smarter than that!

“I’m too big, it won’t fit”

Yeah right. No guy is THAT big that he can’t fit into a condom. So number 1: Condoms come in different sizes, he needs to go out and find one. Number 2: If his ‘manhood’ is too big for a condom, then it’s too big for you. Run girl!

“I can’t feel anything”

This is a straight up lie ladies. Having sex with a condom isn’t that much different from having sex without one. If he tells you this, then let him know that WITHOUT a condom he will not be feeling anything because you’re not doing anything without one.

“I’m clean, I’ve been tested”

This could also be a lie. Chances are you don’t have proof that he has in fact been tested so you never really know. Apart from not REALLY knowing whether your man has an STD (because they may not have visible symptoms) or HIV, you still risk falling pregnant. Insist on that condom anyway, you don’t have time for his games.

“I don’t have one on me”

Then he should get one. Another thing is if you’re sexually active then at this point you need to pull out one of your own. Guys are not the only ones responsible for carrying condoms. If you know that you’re going to have sex soon, make sure you have a condom on you so that you avoid this situation. If neither of you have one, then put the sex on hold.

“Asking me to wear a condom means that you don’t trust me”

Guys only use this excuse to try and manipulate you so don’t fall for it. Not wanting to use a condom and trying to manipulate you at the same time is just disrespectful. Does he not respect your decision to be safe and to avoid pregnancy? If he doesn’t then no, you shouldn’t trust him.

A guy not wanting to have protected sex is actually something that you should be concerned about. If he hates it that much, then just imagine how many times he’s had unprotected sex with someone else?

You may be afraid of losing him, but if he is not afraid of putting you at risk then maybe you shouldn’t be with him. Your whole life could change in an instant just because you accepted these excuses. Having safe sex gives you a clear conscious because you then have fewer consequences to worry about.

These are just a few excuses guys use for not wanting to wear a condom, there are so many more. What excuses have you heard choma?

Your Contraception Options

By Dr Sindi van Zyl

Contraception is a method of preventing pregnancy. It is also known as family planning or birth control. Pregnancy occurs when a man’s sperm fertilizes a woman’s egg (ovum). Contraception works by preventing fertilization from happening.

It is not always easy to choose a method of contraception because there are quite a few options out there. The decision should be made with one principle in mind – DUAL CONTRACEPTION. This means that even if you choose to use hormonal contraception you should always back that up with barrier contraception – condoms.

Hormonal contraception

Works by releasing artificial hormones into the body. These hormones are very similar to oestrogen and progesterone which women release naturally from their ovaries. The release of these artificial hormones prevents pregnancy from taking place by preventing the release of eggs from the ovaries or by making it difficult for the sperm to reach the egg. 

Combined oral contraception “The Pill”

The Pill consists of 28 tablets in total. 21 of these tablets contain hormones and 7 of these tablets are hormone-free. The 7 tablets allow for menstruation to take place. The Pill is a popular choice for many women but you do need to remember to take it every single day. You also need to take extra precaution when you are on antibiotics and certain medication. The Pill can only be started if you have been assessed by a doctor or nurse because there are certain people that must not use it. 

Hormonal injection

The injection works on the same principles as the Pill – prevention of the release of an egg or blocking sperm. There are two types of injections: Depo Provera which is given every 12 weeks and Nur-Isterate which is given every 8 weeks. Again you need to be assessed by a doctor or nurse before you can start the injection. This is to make sure you do not have any have any medical conditions that will exclude you from being able to use it. 

The implant

The implant – such as Implanon – is fairly new to South Africa but is gaining in popularity. The implant is inserted underneath the skin of the upper arm. The rods contain hormones and these are released into the body – again working by preventing the release of an egg or blocking sperm. The nice thing about the implant is that it lasts for three years. It is inserted and removed by your doctor. 

The intrauterine device IUD

The intrauterine device is also gaining popularity again especially Mirena. It is inserted into the uterus by your doctor and works by preventing the sperm and egg from coming together. The IUD is preferable for older women because it can be kept in for 5 years or longer.

This is a summary of the commonest forms of hormonal contraception on offer in South Africa. Do your research and make your decision based on what will work best for you.

Remember – DUAL CONTRACEPTION is key.

Using the ‘pull-out’ method during sex

Let’s talk about something that not many people are willing to discuss: Pulling Out (i.e. when a guy removes his penis during sex just before he orgasms to avoid impregnating his partner).

Why people choose the pull-out method

Not a lot of girls are willing to admit that they use the pull-out method as a form of contraception, but when you really start talking to girls about their sex lives you realise that quite a lot of them do.

The pull-out method, a popular form of birth control because it doesn’t cost anything, can be used anytime and allows you to ditch the condom. Sounds simple, right? So then why are some people shocked when you admit to using the pull-out method? I’ll tell you why, because it’s a HUGE risk.

Why the pull-out method is a bad idea

The pull-out method does NOT protect you from contracting a sexually transmitted disease (STD) such as HIV, and just because he didn’t ejaculate doesn’t mean you can’t fall pregnant!

“I’ve used the pull-out method hundreds of times and I only fell pregnant once.”

I’ve heard women say this before. Think about it like this: You’re with your boyfriend, things get hot and heavy, but then you both realise that you don’t have a condom. The desire to have sex is so strong that he says “Don’t worry, I’ll pull out” and because you also want to be with him really badly, you agree. If your sexual desire is so strong that you can’t put off sex long enough to wait until you have a condom, what guarantee do you have that you will both be able to control your sexual desire DURING sex? What guarantee do you have that your boyfriend will be like “Oh, hold on, I should stop”, if he couldn’t say it before sex? Think about it, Choma.

“He really hates condoms guys, and I don’t want that to keep us from having sex.”

The whole ‘condoms don’t feel good’ excuse is a bit played out, let’s be honest. Some guys only say this because so many others do, as if it is something they are ‘supposed’ to say. We’ve grown up in a society where safe sex sounds like something only adults and teachers talk about to keep us from having sex. So condoms are seen as “uncool”

There’s nothing cool about having a baby, an STI or STD you’re not ready for. Yes, trust is a wonderful thing, but caution with trust is better because it keeps you SAFE.

If anything, using a condom is a good indication of responsibility and respect. When a guy agrees to use a condom he is saying “I respect my body and I respect yours.”

This is not meant to shame anyone for using the pull-out method; you are obviously trying to avoid pregnancy, which is understandable. But you really need to think about the risks involved. Safe sex is a lot more reassuring than simply hoping your partner will have enough self-control to successfully pull out every single time.

Remember if you or a friend need advice or help, you can contact me here on Ask Choma, send me a Facebook Messagea Twitter DM, or a WhatsApp Message (071 172 3657).

Why you – not just your man – should carry condoms

When our moms and their moms where younger, there was a lot of stigma attached to contraception, including the pill and condoms. As far as conservative people were concerned, only “loose women” used that kind of stuff. After all, you weren’t “supposed” to be having sex out of marriage, and if you were married and fell pregnant, that was to be seen as a good thing. Despite the judgement, many women – millions, honestly – continued to use contraception. There were a lot of reasons for this. Some were having sex before marriage, and some didn’t want children.

Contraception, as I’ve said before, choma, is considered an important step towards gender equality because it gives women more control over their own bodies. That’s an amazing thing, not a shameful one!

Fast-forward a couple of decades and there’s still some stigma floating around, unfortunately. Thankfully, it is quite easy to get and take the pill; it is small and discreet. But a girl with condoms is still on the receiving end of some serious side-eye from some people who should know better.

There are too many good reasons for you to take charge when it comes to contraception and protection from STIs, so don’t stop because someone might look at you funny.

Be Responsible

First off, if you are having sex, that’s your decision about your body. So then surely it is your responsibility to look after yourself too?

I’ve heard some women say that carrying condoms is a man’s job, but those men are not having sex by themselves. Don’t be a passive observer of your sexual relationship, choma. Be an active participant.

You can get free condoms from clinics, in some school or public bathrooms, and many other places. And you can buy them too from pharmacies, the big grocery stores and even behind the counter at most petrol station shops.

Be Firm

Sometimes men are resistant to wearing condoms because of the myths that go around about them. I’ve heard guys say “they can’t feel anything” with a condom on. That’s ridiculous! There’s a lot of research on this and there’s just nothing to back up men’s claims here. So, don’t be fooled by this claim, or the “I don’t have any” excuse. If you have condoms in your handbag or wallet, or wherever, then there’s no excuse not to use them. Again, your body = your rules.

Be Prepared

Ok, not all guys are trying to trick you when they say they don’t have any condoms with them. Some guys are just not very responsible. But if things are getting hot and heavy, and he’s forgotten to stock up, then you’ll be very glad you chose to carry condoms too. You will have your own supply close at hand, and you can enjoy consensual safe sex together, instead of hitting the brakes or taking your chances without protection.