In the last issue, we looked at the permissibility of birth control in Islam as well as the process of fertilization. The thumb rule is: any method that prevents fertilization of a mother’s egg and father’s sperm is allowed, whereas a method that destroys a fertilized Zygote (Nutfah) or is an irreversible process is not permitted.
With this perspective, let us now analyze the options available to us.
Common Methods of Contraception
1) Natural methods
An egg can be fertilized only during the day or so after ovulation. Sperm can live in the female reproductive tract for up to 6 days. So intercourse that takes place more than 5 days before or 2 days after ovulation is unlikely to lead to pregnancy. Abstinence during this period is called the rhythm method. Women need to know exactly, when they ovulate, by measuring their body temperature and/or levels of hormones by a urine test.
Withdrawal method (Azl)
The husband withdraws from the wife’s vagina before the release of sperm. This method was practiced during the time of the Prophet (sa).
2) Chemical methods
They are also known as spermicidal chemicals. Chemicals such as nonoxynol 9 are inserted in the vagina – these are all acidic and inactivate the alkaline sperm. They are usually available in the form of soaps, foams or jellies.
3) Mechanical barriers
These prevent husband’s sperm from entering the wife’s vagina.
This is a sheath of thin flexible material (such as latex) worn by the husband. They are highly effective and are the most commonly used form of contraception in Pakistan.
This is a rubber dome placed at the upper end of the vagina. They may be used alongside spermicidal chemicals.
This is an impermeable cap fitted over the wife’s cervix. It may be left in place until menstruation.
4) Hormonal methods
Oral combined pill
This is also called an oral contraceptive pill (OCP). It contains a combination of two synthetic hormones: estrogen and progestin. The estrogen works in the ovaries to prevent ovulation (release of egg) by giving negative feedback. The two most commonly prescribed OCPs in Pakistan are Nordette (by Wyeth) and Marvelon (by Organon).
Oral progesterone only pill (POP pill)
This is also known as the mini pill. It contains a very low dosage of the hormone progestin. It does not inhibit ovulation but creates local changes, which interfere in either fertilization or implantation of the fertilized zygote. This type of pill is not currently available in Pakistan.
5) Intrauterine devices (IUD)
For centuries camel drivers in northern Africa inserted a stone in the uterus of their female camels before starting on a long trek. This prevented the animal from becoming pregnant on the journey.
The intrauterine device (IUD) accomplishes the same purpose. It must be inserted by a physician. A variety of materials (usually containing some copper) and shapes are used. Coils (Cu 7 & CuT) and Lippes Loop are commonly used. Research indicates that it is the presence of a foreign body within the uterus that makes conditions unfavorable for implantation of the fertilized zygote.
IUDs have caused such bad side effects (e.g., infections of the uterus and fallopian tubes) that only two types remain on the U.S. market! They are used in Pakistan as well. One is Mirena® – it releases a progestin and can be left in place for up to 5 years.
These are irreversible processes.
A woman’s fallopian tubes (both of them!) are cut and tied, so that no egg can be fertilized. It requires incision(s) and must be done under anesthesia.
A man’s reproductive tubules in the testes are cut near the top of the scrotum. It can be done in the doctor’s office with a local anesthetic in 30-40 minutes.
We need to educate ourselves and spread awareness about the various types of contraception options. Otherwise, there are chances of getting pressurized by family planning workers or ‘well-meaning’ gynecologists to use a particular method increases, if we have no idea how it works. It is mostly lack of awareness that leads women and families to make unwise birth control choices or none at all. Sterilization and IUDs are recommended by doctors, who themselves are most probably not aware of their consequences.
Having identified the permissible methods available to us, the choice of method of contraception is ultimately a personal one. We must consult a medical practitioner to determine that it is a safe way.
Permissible Birth Control Methods
|Method||Why permissible?Intervention before fertilization|
|Rhythm||No artificial intervention|
|Withdrawal||No artificial intervention|
|Combined pill||No egg release|
|Condom||No sperm entry|
|Diaphragm||No sperm entry|
|Cervical cap||No sperm entry|
|Spermicidal chemicals||Inactivates sperm|
Non-Permissible Birth Control Methods
|Method||Why not permissible?Intervention after fertilization or irreversible process|
|Intra Uterine Devices (IUDs) e.g. coil||Egg and sperm present – kills zygote|
|Progestin only pill: POP pill||Egg and sperm present – kills zygote|
|Vasectomy (male sterilization)||Irreversible process|
|Tubal ligation (female sterilization)||Irreversible process|