Family planning allows women and couples to determine whether and when to have children. The ability to make these choices is fundamental to healthy families and communities worldwide. Family planning programs should offer a well-balanced mix of contraceptive methods, including those that are short- and long-acting, hormonal and non-hormonal, provider-dependent and client-controlled, and natural and clinical.
The methods most commonly available in developing countries include:
- Oral contraceptive pills that women must take daily to prevent pregnancy. Combined oral contraceptives (COCs) contain low doses of the hormones progestin and estrogen while progestin-only pills (POPs), also called minipills, contain low doses of the progestin hormone only, allowing breastfeeding women to use them. COCs work by preventing ovulation—the release of eggs from the ovaries. POPs work mainly by thickening cervical mucus, which blocks sperm from meeting an egg, and they also prevent ovulation. Emergency contraceptive pills (ECPs), or “morning after” pills, can be taken up to five days after unprotected sex to prevent pregnancy. ECPs contain either progestin only or progestin and estrogen and prevent ovulation. ECPs do not work if a woman is already pregnant, and they do not disrupt an existing pregnancy.
- Injectable contraceptives are given by injection into the muscle, slowly releasing a hormone into the woman’s bloodstream. Progestin-only injectables include DMPA, administered every 13 weeks, and NET-EN, administered every 8 weeks. Combined injectable contraceptives (CICs) contain both progestin and estrogen and are administered monthly. Both types of injectables prevent ovulation.
- Hormonal implants are small, flexible rods inserted just under the skin of the upper arm by a clinician. Immediately reversible and very effective for three to seven years depending on the particular type, implants release progestin only, making them safe for breastfeeding women. Implants prevent ovulation and thicken cervical mucus, blocking sperm from meeting an egg.
- Intrauterine devices (IUDs) are small, flexible plastic frames inserted into a woman’s uterus by a clinician. The copper-bearing IUD has copper sleeves or wire around the plastic frame while the levonorgestrel-releasing IUD (LNG-IUD) steadily releases small amounts of the hormone levonorgestrel daily to suppress the growth of the lining of the uterus (endometrium). The copper-bearing IUD is very effective for at least 12 years, and the LNG-IUD for up to five years. Both are immediately reversible when removed from the uterus.
- Sterilization provides very effective, permanent protection against pregnancy. Female sterilization, done by a clinician, involves surgical blocking or cutting of a woman’s fallopian tubes so that eggs released from the ovaries cannot move down the tubes to meet sperm. Male sterilization, also done by a clinician, involves the cutting or blocking of the man’s vas deferens, or the tubes that carry sperm to the penis.
- Barrier methods of male condoms and female condoms provide dual protection against both pregnancy and sexually transmitted infections (STIs), including HIV. Male condoms are sheaths or coverings that fit over a man’s erect penis, forming a barrier that keeps sperm out of the vagina. Female condoms are sheaths or linings with flexible rings at both ends that fit loosely inside a woman’s vagina, forming a barrier that keeps sperm out of the vagina to prevent pregnancy.
- Fertility awareness methods, also referred to as natural family planning, rely on a woman’s ability to tell when she is fertile. Calendar-based methods, such as the Standard Days Method®, involve keeping track of the days of the menstrual cycle to identify the fertile period. Symptoms-based methods, such as the TwoDay Method, require observation of the signs of fertility, which include cervical secretions and basal body
- The Lactational Amenorrhea Method (LAM) is a temporary family planning method for postpartum women that requires women to meet three conditions for effective protection against pregnancy: (1) The mother’s monthly bleeding has not returned. (2) The baby is fully or nearly fully breastfed and is fed often, day and night. (3) The baby is less than six months old.
These contraceptive methods are safe and suitable for nearly all women, yet medical barriers to contraception still exist. To ensure access to family planning for women and couples who wish to prevent pregnancy, health systems must employ up-to-date, evidence-based family planning guidelines that follow the World Health Organization's Medical Eligibility Criteria for Contraceptive Use and Selected Practice Recommendations for Contraceptive Use.
K4Health’s seminal handbook, Family Planning: A Global Handbook for Providers, offers guidance on 20 contraceptive methods, based on the latest WHO family planning guidance. It addresses many facets of contraceptive service delivery, including contraceptive effectiveness, mechanisms of action, correcting misunderstandings, and managing side effects. The companion wall charts, Do You Know Your Family Planning Choices? and Key Reminders About Hormonal Family Planning Methods, provide important but hard-to-remember details on one sheet. Our free interactive mobile application for Android phones, ACE (Application for Contraceptive Eligibility), helps health care workers check whether clients are medically eligible to start using their preferred methods by answering a series of questions about known medical conditions.