The decision of a couple to decide the number of children they have is influenced by many cultural, social and religious factors. Keeping a family size small involves use of birth control techniques to prevent unwanted pregnancies.

A small family has many advantages. It has a positive influence on a woman’s health. Repeated pregnancies and deliveries increase  demand of iron, calcium and other nutrients in the woman. This tends to cause chronic anemia and osteoporosis.   Trauma during child birth can lead to urinary incontinence, i.e. inability to hold back urine. Prolapse of the uterus is   often the result of multiple pregnancies,   and leads to repeated urinary and vaginal infections. Women also tend to develop   hernia due to weakening of abdominal muscles caused because of frequent pregnancies. Sometimes unwanted pregnancy is aborted illegally   which endangers the life of women

Every pregnancy causes some emotional stress due to impact of hormonal changes and anxiety for the forthcoming delivery. Some women go into depression following delivery. Brunt of the economic and social stress of a large family always falls on the woman. 

Family size also affects the health of the children. Family planning is  about limiting the number of children and also space them. It is seen that when one child is feeding on breast and another arrives, the first child  is neglected, because the new born gets priority. This is one of the major reasons for malnutrition in children of poor communities. There should be a reasonable interval, minimum two years or more, between the children. 

Women are very much open to the idea of a small and planned family, because they are the ones to suffer most due to multiple pregnancies and child birth.  But most of the men world over are careless in this regard. There are many cultural, religious and other factors involved. Some people think that it is a sin to prevent pregnancies as it is forbidden in their religion. But they should realise the fact that thousands of years before when religions had originated, there was no problem of population crunch in the world. Diseases and wars consumed many lives, therefore more numbers were needed. But today, times have changed.

In the rural sector and families engaged in manual work, it is thought that more children will provide more working hands and hence more money. But instead of more money, there comes in more   sickness and misery.

There are many myths related to contraceptive or birth control methods. Men do not like to use   condoms , because they think that it is an offence against their masculinity. Therefore the onus of limiting family size usually falls on the woman.

Intrauterine devices (I.U.D) in women are good for spacing pregnancies. Inserted in proper centres by trained personnel, they are very safe. Only risk associated with I.U.D is that sometimes infection can occur if proper aseptic precautions are not observed during its insertion. Pelvic infection can block the fallopian tubes, thus causing secondary sterility. 

Cervical caps and diaphragms are like a female condom and provide a barrier for entry of sperms. If used correctly, they  are very effective in preventing unwanted pregnancy.

Hormonal contraceptives are available in forms of pills or implants. Women are scared of the possible adverse effects of  hormonal contraceptives like cancers, heart attacks, e.t.c. But compared to their usefulness, side effects are few. Side effects develop over months or years of use in most of the cases. Users are educated about possible side effects of pills, when prescribed.  Choice of the pill or implants,   is decided as per the medical condition of the woman. 

If a couple does not want to use any of the contraceptives at hand, they  out to exercise   enough restraint. Withdrawing and ejaculating outside the vagina ( coitus interruptus) is also very useful to  prevent pregnancy.

Dr Rachna Pande, Specialist, internal medicine

rachna212002@yahoo.co.uk