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It is the most common cause of maternal death. If a mother's life is to be saved it generally requires treatment within two hours at a health facility able to provide blood transfusions and perform other clinical measures.

INFECTION OR SEPSIS (15%)

iIt is a common result of poorly performed abortions and unsterile procedures during delivery. It can also result from a woman's membranes have ruptured and she has not delivered within 24 hours. Serious infection usually results unless prevented by antibiotics;

UNSAFE ABORTION (13%)

Abortion performed with unclean instruments and in unsanitary conditions is the frequent result of unwanted pregnancy. Where abortion is illegal, women are often reluctant to seek medical care even if they begin to hemorrhage or show signs of infection after undergoing the procedure, and consequently may die.

ENCLAMPSIA (12%)

High blood pressure can lead to enclampsia (convulsions) during pregnancy, which can lead to death if not treated in its early stages. It can be detected and its complications prevented by competent prenatal care.

OBSTRUCTED LABOR (8%)

This requires treatment in a hospital or an equivalent facility that can perform operative delivery.

Source; World Health Report 2005, World Health Organization

The Pill - Oral Contraceptives

What are Birth Control Pills?

The Pill is the most popular type of birth control. There are many different brands of The Pill and they come in packs of 21 or 28 pills. One pill is taken every day. The first 21 pills have a combination of synthetic estrogen and progesterone hormones. The Pill stops ovulation, preventing the ovaries from releasing eggs. The Pill also thickens cervical mucus, making it harder for sperm to enter the uterus. The hormones in the Pill prevent fertilization. The last 7 pills of a 28-day pack have no hormones and are called spacer pills. The Pill is 97-99.9% effective as birth control. It does not protect against reproductive tract infections, including HIV/AIDS.

Use

When started within 6 days of the start of a period or within 6 days after an abortion, The Pill is effective immediately. If the Pill is started at other times, it will be effective after one month. To lower the risk of pregnancy and sexually transmitted infections, condoms can be used while taking The Pill.

Starting The Pill:

There are several ways to begin taking The Pill. One common way is to start on the first day of your period or the first day after an abortion. Some women prefer to start on the first Sunday after they begin their period or the first Sunday after an abortion.

Continuing:

Take one pill every day until you finish an entire pack. Try to link taking The Pill with a regular activity that you do at the same time every day, like eating a meal or brushing your teeth. If you have a 28-day pack, start a new pack immediately after you finish the old one. If you have a 21-day pack, take one pill every day for 21 days, no pills for 7 days, then start the new pack immediately.

Cautions

Some women may not be able to take The Pill because of the risk of serious health problems. Women who are over 35 and smoke or who have any of the following conditions should not take The Pill:

History of heart attack or stroke
Blood clots
Unexplained vaginal bleeding
Known or suspected cancer
Known or suspected pregnancy
Liver disease
Women who are under 35 and smoke, have migraines, gallbladder disease, hypertension, diabetes, epilepsy, sickle cell disease, elective surgery, a history of blood clots, liver or heart disease may not be able to take The Pill. Your clinician or doctor can decide.

Women who use The Pill have a higher risk of heart attack and stroke. The effects of The Pill on breast cancer are still unknown. The Pill lowers a woman's chance of developing ovarian cancer, endometrial cancer, and pelvic inflammatory disease.

Side Effects

As the body adjusts to hormonal changes created by The Pill, women often experience some minor side effects, including:

Irregular bleeding or spotting
Nausea
Breast tenderness
Weight gain and/or water retention
Spotty darkening of the skin
Mood changes
Side effects usually disappear after 2-3 cycles. If your side effects are bothersome after 2-3 cycles or if heavy bleeding occurs, continue taking your pills and call the clinic for an appointment to talk about your prescription.

Drug Interactions

The effectiveness of the Pill is lowered when taken with certain medications, including antibiotics, anti-seizure, tuberculosis, and migraine medications. If you are taking any medications, tell your clinician. When taking medications that may interfere with BC, consider adding a backup method of birth control, like condoms and spermicide. As with all drugs, it is useful to inform all your medical providers if you are using hormonal birth control.

Danger Signs

Women who experience any of the following symptoms while taking The Pill should call the clinic immediately:

Abdominal pains (severe)
Chest pain or shortness of breath
Headaches (severe)
Eye problems, such as blurred vision
Severe leg or arm pain or numbness
Missed Pills: Late Start

The most common way women get pregnant while using The Pill is starting late.

1 day late starting the next package: Take 2 pills as soon as you remember and one pill each day after. Use a backup form of birth control for two weeks.
2 days late starting the next package: Take 2 pills per day for 2 days, then continue as usual. Use a backup form of birth control for two weeks.
3 or more days late starting the next package: Call the clinic for instructions.
Missed Pills: During the Cycle

1 pill missed: Take it as soon as you remember and take your next pill at your usual time. This may mean taking two pills in one day.
2 pills missed in a row in the first two weeks: Take two pills on the day you remember and two pills the next day. Finish the rest of the pack as usual. Use a backup form of birth control for one week.
2 pills missed in a row in the third week: Keep taking one pill every day until Sunday. On Sunday, set aside the rest of the pack, including the spacers, and start taking a new pack of pills. Use a backup form of birth control for one week.
3 or more pills missed in a row anytime: Keep taking one pill every day until Sunday. On Sunday, set aside the rest of the pack and start taking a new pack of pills. Use a backup form of birth control for two weeks.
Missing any of the last 7 pills of a 28-day package will not raise your risk of pregnancy. Skip the pills you missed, but be sure you start your next pack on time.

Missed Periods

Missing a period does not always mean that you are pregnant. If you do miss a period, think about how likely a pregnancy is. Also consider the risks related to continuing birth control pills. Pregnancy is more likely:

in the first few months of Pill use
if you missed taking any Pills
if you are taking another medication (especially antibiotics)
if you have been sick (vomiting and/or diarrhea)
If you forgot one or more pills and do not have a period that month, we recommend that you have a sensitive pregnancy test done at a clinic.

If you miss two periods in a row, it could either be normal or a sign of pregnancy. Pregnancy tests are recommended right away. If you become pregnant while on The Pill, there is probably no risk of birth defects.

Future Fertility

Women who want to become pregnant may stop using The Pill at any time. Fertility may return immediately or after a few months.

Advantages

Periods may be lighter or more regular.
Easy to use.
Does not harm future fertility.
Does not interrupt sex play.
May protect against uterine and ovarian cancers.
May reduce acne.
Can be used for Emergency Contraception.
Disadvantages

Does not protect against sexually transmitted infections, including HIV/AIDS.
Must be taken every day.
Less effective when taken with some drugs.
Raised risk of heart attack and stroke.
Requires a prescription.

You can prevent pregnancy after sexual intercourse by taking the Morning After Pill, also called Emergency Contraception pills or EC. The Morning After Pill works by giving the body a short burst of synthetic hormones that disrupt the hormone patterns needed for a pregnancy to start. The most common brand name is Plan B. Also some types of regular birth control pills will work. The Moring After Pill is most effective when taken within 24-48 hours after unprotected sex, but it can work for several days.

(This article only gives out information. This is not meant to prescribe. It is best to consult your OB-Gyn before taking the pill for the first time. - The Editor)