a contraceptive method. However, your method might fail unless you are aware of the limitations of each method and unless you fully comply with all the instructions.

First and foremost, it is your responsibility to inform your doctor regarding any health risks or medical history before he or she can prescribe either the birth control pill or the intra-uterine device, also known as the coil or IUD.

You need to tell your doctor about any episodes or breast, liver or cardiac disease, about any serious blood pressure problems or migraine-type headaches and about any unusual vaginal bleeding. You should also mention whether or not you are a cigarette smoker and how many you smoke, and also whether your lifestyle includes a frequent change of sexual partner or any risk of acquiring a sexually-transmitted disease. Complete honesty is crucial for the sake of your health, and all information will be treated with complete confidence.

The hormonal methods, such as the pills, injections and implant, all rely on your body steadily absorbing a measured amount of one or more chemicals, any interruptions, such as taking your pill late (even by a few hours) can cause your method to fail if you continue to be sexually active that month. Missing your pill by as little as 12 hours (or by three hours in the case of the mini-pill) will cause enough of a drop in the birth control hormones so that you could get pregnant during the following two weeks if you are not aware of the risk. It doesn't matter that you might have been taking your pills for months, or years, as there is no build-up of the pill in your body to stop you from ovulating after a missed pill. The really important thing to know is what to do if you do miss a pill. Ideally, you should abstain from intercourse during the following 14 days, or if you do not already practise "safe sex'' now is the time to make sure that you use a reliable barrier method, such as a condom or vaginal spermicide or, even better, use both. Even if you do take all your pills on time, your body may not be absorbing them if you have any episodes of vomiting or diarrhoea, or if you are taking certain antibiotics.

Again, you should rely on another method other than your pill if this happens, for the next 14 days, while you continue to finish up the pills left in your packet. This information is actually written on the leaflet inside your packet of pills but if you ever have any concerns about what to do, then you should speak to your pharmacist or doctor or clinic nurse for the best advice.

Sometimes, asking your friends or relatives for advice on these matters can be unwise, because they may not be fully informed.

In the case of the injection method of birth control, it is unwise to miss the deadline for your shot, for the same reason as above. If you know that you cannot keep the appointment for your injection on the appropriate date, have it earlier rather than later. At this time of year, we are often planning vacations and may not be on the island when we thought we would. If this causes you to miss your shot, you should make sure to use another method of birth control at least until you can get your missed injection and for 14 days after that, too.

The IUD is a very good method of contraception for a lot of women. Your responsibility is to try to check for the fine thread which you can feel in the upper vagina, and usually the best time to do this is after you have finished your period each month. You might want to combine this with checking your breasts for lumps, as this is a very appropriate time to do that, too. Of course, a breast exam is a good health habit, whether or not you have an IUD or even whether or not you have ever been sexually active. Do you know the expiry date of your IUD and how it functions? If you don't then you need to ask your health-care professional for this information, in order to protect yourself against an unexpected pregnancy and to know what to recognise as a side-effect or complication.

If you are a diaphragm user, then you should know what size to buy and this can only be determined accurately by a doctor's exam. Moreover, if you gain or lose weight in excess of 10lbs. then you should be refitted for size as this might have changed enough to make your old diaphragm unreliable. You should also be aware that it is unwise to rely on any diaphragm after it is six months old. Please read the written instructions enclosed with the diaphragm, make sure that you always use contraceptive jelly and leave it in place for six to eight hours after use. Make sure that you keep your diaphragm clean and dry when not in use, away from contact with oils or talcum powder.

Condoms, especially when used in conjunction with a vaginal spermicide, can be a reliable method of birth control only if they are used carefully and on every occasion of intercourse. Both you and your partner should be in agreement on this. Check for expiry dates before use and always store in a cool place. Nowadays, everyone should be aware of the prevalence in our community of virulent sexually-transmitted diseases and of the need to use some form of barrier/spermicide method as a precaution. Not all infections show up on testing immediately after exposure, perhaps not for months, so you should always be aware that many different types of infection can be present even without symptoms or any apparent problems. Other methods of family planning, such as the fertility-awareness or calendar methods, often known as natural family planning or the "rhythm'' method require such specific and personal instruction that it would not be appropriate to include them in a general article such as this.

Remember, it is your job to be well-informed about your choice of contraceptive method, so you should never hesitate to ask for advice or instruction. Your doctor, nurse or pharmacist will be more than willing to help.

MARY B. BOORMAN Family Planning Nurse Department of Health Victoria Street Clinic HEALTH HTH