Good day, reader! How are you doing? Take a moment to check in with yourself.

What’s been weighing on your mind lately? What would make your day just a little better? Life gets busy and it’s important to pause and reconnect sometimes. We all need moments of self-care now and then.

Here’s a question for you: when was the last time you had a pregnancy scare? You know, that heart-stopping moment when you think, “Why is my period delaying? Am I pregnant?” “Did we do everything right?” Pregnancy scares are crazy! If you’ve ever had that scare, you would know what I’m talking about. I don’t know anyone who enjoys dealing with it. It’s a stressful experience that can leave you feeling frustrated, uncertain, and even anxious about the future.

Let’s be real, leaving pregnancy prevention to chance is rarely a good idea. In this day and age, it is not the wisest thing to do because we are so fortunate to have access to contraception that gives us control over our bodies, our plans and our futures. Several contraceptive methods exist and in this guide, I will tell you all you need to know about them.

By the end, you’ll have a toolkit of information to help you make empowered decisions about your sexual and reproductive health. For more, check out my website amisdiaries.com for all things sexual health, or listen to my podcast Sex and Sanity (https://linktr.ee/sexandsanity) for conversations on sexual and reproductive health. Plus, my book Hot Sex Everyday dives into how to boost your sexual health and get the most out of your sexual experiences.

The History of Contraception

It might surprise you, but people have been trying to prevent pregnancy for thousands of years. Ancient Egyptians used honey, acacia leaves, and lint that they inserted into the vagina to block sperm from fertilizing an egg. The Greeks used pessaries made from various herbs, while early condoms were made from animal bladders and were primarily used for disease prevention. Over time, contraception evolved slowly, with the first rubber condoms appearing in the 1800s.

In the 1960s, the introduction of the birth control pill marked a major turning point, giving people, especially women, an unprecedented level of control over their reproductive choices.

Today, contraceptive options have further developed, with different methods to suit a range of needs, lifestyles, and health considerations. The goal remains the same: giving people the freedom to decide when and if they want to have children. Before you make a choice, it’s important to understand what each contraceptive method does, how effective it is, and what challenges or side effects you might deal with when you use it.

Types of Contraceptives:

Here’s a closer look at the types of contraception, along with what you can expect from each:

1.  Barrier Methods: Physical Protection

• Male and Female Condoms: These are great for preventing both pregnancy and STIs, making them an essential tool in sexual health. Male condoms, often made of latex or polyurethane, have an approximately 85% effectiveness rate with typical use. They are worn over the penis during sex to prevent sperm from entering the vagina. Female condoms, worn internally, offer a similar level of protection but aren’t as well-known. They are inserted into the vagina before sex to prevent sperms from reaching the egg. While condoms are generally affordable and accessible, some people experience allergies to latex or complain that condoms reduce sensation. Non-latex condoms like Skyn exist for people with latex allergies.
• Diaphragms and Cervical Caps: These are reusable silicone cups that cover the cervix to block sperm during sexual intercourse. They are less common and require fitting by a healthcare provider. They are moderately effective as contraception, but their effectiveness improves significantly when used with spermicides (chemicals that kill sperm). They don’t protect against STIs. Here’s a breakdown of their effectiveness:
  • Diaphragms: When used with spermicide, diaphragms are about 88% effective in preventing pregnancy. This means that about 12 out of 100 people using this method over the course of a year might experience an unintended pregnancy. Without spermicide, the effectiveness drops to around 60-80%.
  • Cervical Caps: Cervical caps are slightly less effective than diaphragms. For people who have never given birth, they are around 80% effective with spermicide. However, for those who have given birth, the effectiveness can be as low as 60-70%. Without spermicide, the effectiveness can be as low as 40-60% for people who haven’t given birth before, and even lower (about

30-40%) for those who have.

Both methods require proper use, including applying spermicide each time they are inserted and ensuring they are placed correctly over the cervix. They should also be left in place for at least six hours after intercourse to maximize effectiveness. Many people find them inconvenient because they need to be fitted by a healthcare provider and require precise placement.

• Spermicides: These are chemicals that kill or immobilize sperm, applied inside the vagina before sexual intercourse. They are 71% effective when used alone and are often paired with barrier methods to make them more effective. Available in various forms, including gels, foams, creams, films, and suppositories, spermicides are inserted into the vagina, near the cervix, before intercourse and usually need 10-15 minutes to activate. They must be reapplied before each round of intercourse to maintain effectiveness. While spermicides are convenient, they do not protect against sexually transmitted infections (STIs) and can sometimes cause irritation.

2.  Hormonal Methods: Regulating Fertility from Within

• Birth Control Pills: The birth control pill has been around for decades and comes in two forms: combination pills (estrogen and progestin) and progestin- only pills. With typical use, it is 91% effective. It works by preventing ovulation and thickening the cervical mucus to stop sperms from reaching the egg for fertilization. The pill is taken daily, but missing a day or more can increase the risk of pregnancy. It also has side effects, including nausea, mood changes, weight gain and changes in libido. Some women use it to regulate their menstrual cycle or reduce acne, but it requires daily discipline.
• Injections (Depo-Provera): This method involves receiving an injection every three months. It also works by preventing ovulation and thickening cervical mucus. It’s around 94% effective with typical use, but some people find the need to schedule regular appointments inconvenient. Depo-Provera can lead to side effects like weight gain and mood swings, and it may disrupt your menstrual cycle.
• Implants (e.g., Nexplanon): A small rod is placed under the skin of the arm and it can last up to three years in preventing pregnancy. It’s over 99% effective, providing long-term protection with minimal maintenance. However, some people experience irregular bleeding when they use it, and the insertion and removal can be uncomfortable.
• Patches and Vaginal Rings: The patch is a small adhesive worn on the skin and changed weekly, while the vaginal ring is inserted internally and changed monthly. Both are around 91% effective and release hormones to prevent ovulation. The patch needs to be replaced weekly for three weeks, with a patch- free week afterward. The ring is also inserted in the vagina and left in place for three weeks and removed for one week. Some users experience skin irritation with the patch or infections with the ring, but they offer an option for those who don’t want to use a daily pill.

3.  Intrauterine Devices (IUDs): Long-Lasting Protection

IUDs are over 99% effective in preventing pregnancy They are convenient, long-term contraception options that do not require daily attention, making them an appealing choice for people seeking reliable, hassle-free birth control. However, they do not protect against STIs, so additional protection, like condoms, may be recommended for STI prevention.

There are two types:

• Copper IUD (e.g., ParaGard): This non-hormonal IUD is a small, T-shaped device that is inserted into the womb/uterus to release copper ions, which are toxic to sperm. The copper creates a hostile environment that prevents sperm from reaching and fertilizing the egg. It can prevent pregnancy for up to 10 years and can also serve as emergency contraception if inserted within five days of unprotected sex. However, some users report side-effects like heavier periods and increased cramps. The device can also occasionally expel or shift, causing discomfort.
• Hormonal IUDs (e.g., Mirena and Skyla): These IUDs release a small amount of progestin hormone, which thickens cervical mucus to block sperm from

entering the uterus, and may also prevent ovulation. The progestin IUD is effective for 3-7 years, depending on the specific type.

Insertion and Maintenance: A healthcare provider inserts IUDs during a short office visit. Once in place, IUDs require minimal maintenance, though it’s recommended to have periodic check-ups to ensure the IUD remains properly positioned.

Finally, some women report issues with the IUD “thread” hanging out, which can be irritating or noticeable during sex.

4.  Natural Methods: Tracking and Timing

• Fertility Awareness Methods (FAM): These involve tracking signs of fertility to identify the days in a menstrual cycle when pregnancy is more likely. This is done by monitoring basal body temperature, cervical mucus, and cycle timing. With typical use, FAM is around 76% effective, meaning that 24 out of 100 people may experience unintended pregnancy in a year. For those who use FAM perfectly, the effectiveness can increase to about 95%. Various apps can assist with tracking these signs, like Period Calendar and Flo, but FAM requires a high level of commitment, accuracy, and consistency to be effective. Importantly, this method does not provide protection against sexually transmitted infections (STIs).
• Withdrawal Method: This method, also known as “pulling out,” relies on the male partner withdrawing the penis from the vagina before ejaculation to prevent sperm from entering. This method is about 78% effective with typical use, which means that roughly 22 out of 100 people using this method over the course of a year may experience an unintended pregnancy. While it can be slightly more effective with perfect use, withdrawal has a high risk of failure due to pre-cum or pre-ejaculate, which may contain sperm. The success of the withdrawal method depends on the male partner’s control and timing, and it requires clear communication between partners. Like FAM, it does not protect against STIs.

Natural methods can be effective when used consistently and accurately, but they require high commitment and offer no STI protection, making them best suited for those in monogamous relationships where both partners are STI-free.

5.  Permanent Methods:

These are highly reliable choices for people who are certain they do not want more or any children. They are permanent solutions that require little maintenance once completed, but do not protect against sexually transmitted infections (STIs). There are two types:

• Tubal Ligation (for Females): Tubal ligation is a highly effective permanent contraception method, with a success rate of over 99%. This surgical procedure involves closing, cutting, or blocking the fallopian tubes, which transport eggs from the ovaries to the uterus. By sealing the tubes, tubal ligation prevents sperm from reaching and fertilizing an egg. The procedure is usually performed in a hospital or clinic and is considered permanent, though reversals may sometimes be possible, with limited success rates. Tubal ligation does not impact hormone

levels or menstrual cycles, making it a reliable option for those certain about not wanting future pregnancies.

• Vasectomy (for Males): Vasectomy is a simple, minor surgical procedure that offers over 99% effectiveness in preventing pregnancy, making it one of the most reliable forms of permanent contraception. The procedure involves cutting or blocking the vas deferens, the tubes that carry sperm from the testicles to mix with semen. By preventing sperm from entering the ejaculate, vasectomy effectively blocks fertilization. This quick, 15-30 minute procedure is performed in a clinic or doctor’s office and is generally permanent, although reversals are sometimes possible with varying degrees of success. Following a vasectomy, sperm remains in the system for about 8-12 weeks, so additional contraception is recommended until a doctor confirms a zero sperm count.

6.  Emergency Contraception

Emergency contraception is a method used to prevent pregnancy after unprotected sex or contraceptive failure, and it is most effective when taken as soon as possible. The primary form of emergency contraception available is emergency contraceptive pills (ECPs), also called morning-after pills or postpills (e.g., Postinor 2). ECPs reduce the risk of pregnancy by 75-89% if taken within 72 hours (3 days) of unprotected intercourse. Some types of ECPs remain effective up to 5 days after sex, though their efficacy decreases the longer one waits (e.g., Lydia postpill)

ECPs work by delaying or preventing ovulation. By altering the hormonal environment, these pills make it less likely for the ovary to release an egg, thus reducing the chance of fertilization. It’s important to note that ECPs do not interrupt an established pregnancy. So, if you are already pregnant, they won’t work.

While emergency contraception is a valuable option for preventing unintended pregnancy, it is designed for occasional use and should not replace regular contraception methods. They also do not offer protection against sexually transmitted infections (STIs), so they may be best combined with other precautions for comprehensive sexual health.

• Copper IUD as Emergency Contraception: Like I mentioned earlier, the copper IUD can also work as emergency contraception, with an effectiveness rate of over 99% when inserted within five days after unprotected sex. Once inserted, the copper IUD provides continuous contraception for up to 10 years if desired.

How Effective Are Contraceptives, Really?

Effectiveness can vary widely between methods, especially depending on typical use (real-world use) versus perfect use (used exactly as intended). For example:

• Condoms are about 85% effective with typical use but can go up to 98% with perfect use.
• Birth Control Pills are 91% effective with typical use due to missed doses, while IUDs and implants, which require minimal upkeep, can exceed 99%.

No contraceptive is 100% effective, unless you choose to abstain from sexual intercourse.

Common Issues with Contraceptives

Different contraceptives come with their own set of challenges. Here are a few commonly experienced issues:

• Physical Side Effects: Many experience hormonal side effects like mood swings, weight gain, nausea, and acne.
• Insertion Discomfort: IUD and implant insertion can be painful, and some IUD users find the “thread” bothersome.
• Health Risks: Some methods, such as the pill, patch, and vaginal ring, carry a higher risk of blood clots, particularly for individuals who smoke or have certain medical conditions (e.g., pulmonary embolism, thrombophilia, obesity, hypertension, diabetes, or heart disease).
• Emotional Reactions: Hormonal methods may affect mental health, with some users reporting mood swings or increased anxiety.

Reasons Why Some People Avoid Contraceptives

For some people, the idea of contraception doesn’t sit well. Common reasons include:

• Cultural or Religious Beliefs: Many cultures and religions have reservations about contraception.
• Fear of Side Effects: For people wary of hormonal changes, natural methods feel like a safer choice.
• Misinformation: Myths around infertility or misconceptions about effectiveness can drive people away from using contraception.

Accessing Contraceptives in Ghana and Beyond

In Ghana, access to contraceptives varies:

• Health Clinics and Hospitals: They provide a range of options, along with counseling.
• Pharmacies: You can get over-the-counter options like condoms and emergency contraception.
• NGOs like Marie Stopes and Planned Parenthood Association of Ghana (PPAG): They provide affordable contraceptive services.

Globally, similar services exist, from Planned Parenthood and Marie Stopes to government-run programs that make contraception affordable.

Busting Myths and Misconceptions

Some myths about contraceptives include the belief that contraception leads to infertility or that condoms reduce sexual pleasure. Another common misconception is that hormonal contraception, like birth control pills, is only suitable for women who have already had children. In reality, most modern contraceptives are safe, do not

cause infertility, and are suitable for a wide range of individuals regardless of their parental status.

Additionally, some believe that using emergency contraception is the same as having an abortion, which is inaccurate. Emergency contraceptive pills work by preventing ovulation and do not affect an existing pregnancy. There’s also a misconception that intrauterine devices (IUDs) are only for older women or those who’ve had children, while in fact, many types of IUDs are safe and effective for young women, including those who haven’t given birth.

Education and access to reliable information can help combat these myths.

Taking Control: Don’t Leave Pregnancy Prevention to Chance

If you’re feeling overwhelmed, that’s okay. Contraception is a big topic, and making the right choice can feel daunting.

Contraception is about much more than preventing pregnancy. It’s a means of taking control, making choices, and owning your health. Whether you’re in high school, university, or an adult navigating relationships, understanding your contraceptive options empowers you to make informed decisions for your life.

Don’t leave it to chance. Find what works for you, ask questions, seek out credible resources, and feel confident in your choices. Sexual health is a journey, and you deserve to be informed, empowered, and in control every step of the way.