Having a baby is nothing like buying a TV set or a car and a couple’s urge to produce a baby should ideally be controlled until the man and
woman know they are secure together; that they can cope with the bad times as well as the good; that they want a baby for the baby’s sake only and not to please themselves, to keep up with the Jones’s, improve their own self-esteem and so on; and until they can provide for it without undue sacrifice on their part.
Producing another human being who may well live for eighty or more years is becoming an increasingly awesome undertaking. Most couples are having fewer babies and having them later. This is surely responsible. An increasing proportion of couples (up to 10 per cent) are choosing to have no children at all for various reasons and others are unable to do so because they are infertile.
The ideal way to space a family is not known. Nature’s way, which depends on long-term, unrestricted breastfeeding, ensures that babies are born at intervals of about two and a half to three years. This is not acceptable to most Western couples who do not want a baby every three years throughout their reproductive life, but can be useful between their first and last babies.
If children are born too closely together the mother may be over-taxed, but longer intervals can increase rivalry between the children. Spreading them out with very long intervals means the family is committed to child rearing for years on end, but this suits some women who feel most fulfilled when caring for babies. Longer intervals also reduce the severity of the economic effects of having children on the family. Small families tend to be more favourable to the intellectual development of the children than large ones.
Whatever plan is adopted it has to be related to contraception. One reasonably effective plan is for a highly efficient contraceptive method such as the Pill to be started before the couple first have intercourse. The woman continues taking the Pill until about six months before the couple want to conceive their first baby. At this time the Pill is stopped and a condom or other barrier method used to allow time for the Pill’s effects on the body to wear off. After about three months the couple can start having unprotected intercourse, but it is important to remember that many couples do not conceive at once, whether or not the woman has been on the Pill. A woman having intercourse on an unrestricted basis and not protected by any contraceptive takes an average of 5.3 months to conceive. Twenty-five per cent of couples will have conceived in the first month, 63 per cent by the end of six months, 75 per cent by the end of nine months and 80—90 per cent by the end of one year.
If a couple decides to have a second child but timing is not too important then relatively ineffective methods such as vaginal foams, a diaphragm, or one of the natural methods such as relying on unrestricted breast feeding could be used. If no further children are wanted at all, the Pill can be used again until the woman is about thirty-five years old. Alternatively, one of the partners could be sterilised. After the age of thirty-five less reliable methods can be used, such as the progestogen-only (mini) pill.
Contraception needs to be continued until about a year after the periods end at the menopause, but as fertility is falling rapidly by this age in most women less efficient methods can be used.
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