Contraceptive Methods

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.

  • Publications & Resources

    Facts for Family Planning presents a comprehensive collection of key information and messages that anyone can use who communicates to others about family planning. Although a variety of individuals and groups can use Facts for Family Planning, it is primarily designed for those who communicate with men and women who are seeking information about family planning and help in selecting a family planning method.

  • Publications & Resources

    One of K4Health's flagship publications, Family Planning: A Global Handbook for Providers offers clinic-based health care professionals in developing countries the latest guidance on providing contraceptive methods. Originally published by K4Health's predecessor the INFO Project, the book was prepared through a unique collaboration between editorial staff at the Johns Hopkins Bloomberg School of Public Health and technical experts from the World Health Organization, the United States Agency for International Development, and other organizations around the world.

  • Blog post

    Hot on the heels of a partnership agreement to reduce the price of the long-acting, contraceptive implant Jadelle by half (see my blog of February 22), comes  an announcement by Merck (MSD) and partners to reduce the cost of IMPLANON® and its next generation IMPLANON NXT® by 50% for the next six years in 70 of the poorest countries around the world.Implanon® is the only single-rod, long-acting reversible contraceptive implant (Jadelle has two rods). It offers three years of pregnancy protection through a one-time single insertion by a trained health care worker. “Notably, IMPLANON and its next generation IMPLANON NXT® are pre-packaged and fully sterilized, making them easy and convenient to insert, including in settings with limited health care infrastructure,” according to the announcement. (Learn more about Implanon and two other hormonal implants, Jadelle and Sino-implant (II), at K4Health’s Implants Toolkit.)

    Woman displays contraceptive implant in Thailand

     

    A family planning client in Kampong Thom, Cambodia, displays her contraceptive implant insertion site.

    © 2012 Marcel Reyners, Courtesy of Photoshare

    MSD and the Bill & Melinda Gates Foundation are direct parties to the agreement. Other facilitating parties include the Clinton Health Access Initiative, the governments of Norway, the United Kingdom, the United States, and Sweden, the Children’s Investment Fund Foundation, and the United Nations Population Fund (UNFPA).

    According to a USAID press release about the earlier Jadelle price reductions, about 600 million women in the developing world use some form of contraception, but only 1% to 2% of them are using long-acting, contraceptive implants. Surveys show that as many as 20% would prefer them, if they were available.  An article published in the Global Health: Science and Practice Journal (co-published by USAID and the K4Health Project) explains that if 1 of 5 women in sub-Saharan Africa who were currently using pills or injectables switched to the more effective contraceptive implants, more than 1.8 million unintended pregnancies would be averted in 5 years, resulting in 10,000 fewer maternal deaths and almost 600,000 fewer abortions.

    Now with the cost of all three implants on par at about US$8 per set, there is a tremendous opportunity to provide modern contraceptives at low cost to the 222 million women—73% of whom live in developing countries—who want, but don’t have access to, them.

  • Event
    August 26, 2013 (All day) to August 31, 2013 (All day)
    Busan, Republic of Korea

    In conjunction with the International Union for the Scientific Study of Population (IUSSP). Over 2000 scientific papers presented in 270 regular sessions, 4 poster sessions, and 4 plenary sessions on topics in 21 themes including reproductive health, mortality, longevity and health, population ageing, migration, union formation and marriage, as well as themes addressing the interrelationship between population, development and the environment. 

  • Publications & Resources

    From the "Background Information" section: "The key aim of the guide is to pull together, in one place, key resources for Family Planning (FP) programming and advocacy at the country level. The guide provides an array of widely referenced resources in FP. Included are documents that explain the rationale and benefits of investing in FP, as well as more detailed programmatic and policy resources."

  • Blog post

    About 600 million women in the developing world use some form of contraception, but only 1% to 2% of them are using long-acting, contraceptive implants. Surveys show that as many as 20% would prefer them, if they were available, according to a USAID press release.

    Jadelle package plus trocar

    Jadelle ® levonorgestrel contraceptive implants

    Availability is now less of a problem thanks to a new partnership agreement between the government of Norway and other partners and the manufacturer of one of three implants, Jadelle, to reduce the current price, from US$18/set to around $8.50/set, in return for a commitment to assure funding for at least 27 million contraceptive devices for women and girls in low-income countries over the next six years.

    The partnership agreement is expected to prevent almost 30 million unwanted pregnancies by 2018 and will save an estimated US$250 million in global health costs. When fully implemented, the agreement will avert more than 280,000 child and 30,000 maternal deaths due to improved birth spacing and by avoiding other problems such as preterm births. According to the WHO, waiting at least 2–3 years between pregnancies reduces infant and child mortality and benefits maternal health.

  • Blog post

    National Condom Day in the United States is February 14th. We at the MCHIP Program are celebrating the occasion by sharing eight fast facts about this simple invention that continues to save lives around the world! Answer the questions below to determine if you are a condom expert or a condom novice – and in the process, learn more about this reversible birth control method, which can be used by all couples, including breastfeeding women, without the assistance of a health care provider.

    Female condom
    Female condom. © 2006 David Alexander, Courtesy of Photoshare

    1. What role do condoms have as a family planning option?

    Condoms are the only family planning item on the market that has the dual purpose of protecting against sexually transmitted infections (STIs) and offering protection from pregnancy.

    2. Who buys more condoms, men or women?

    Women worldwide purchase 40-70% of all condoms (with men purchasing 30-60%).[i]

  • Blog post

    This past October, K4Health/JHU·CCP launched the Improving Contraceptive Method Mix (ICMM) Project in two provinces of Indonesia:  East Java and West Nusatenggara (NTB). The main goal of ICMM is to improve maternal health in Indonesia by conducting evidence-based advocacy and knowledge management (KM) activities that support the availability of a broader range of contraceptive methods for women and couples. It is being implemented by K4Health/JHU·CCP – working with the Cipta Cara Padu Foundation (Cipta), the Center for Health Research at the University of Indonesia (CHR-UI), and the Indonesian Ministry of Health – and it is funded jointly through USAID and AusAID.

    So why focus on FP in Indonesia? If you have scanned Indonesia’s FP data recently, you may be pleasantly surprised. Comparing FP indicators between the 1970s and today, it is obvious that the country has made real progress. The total fertility rate (TFR) – more than 4 children per woman in the 1970s – is now estimated at 2.6. The contraceptive prevalence rate (CPR) is over 62%, and the use of modern contraceptive methods is 58%.[1]

  • Blog post

    This blog was originally posted on Impatient Optimists on January 8, 2013. Authors Holly Blanchard, Senior Reproductive Health Family Planning Advisor, and Elizabeth Sasser, Senior Program Coordinator, work with Jhpiego in the Maternal and Child Health Integrated Program (MCHIP)For both mothers and infants, there are many benefits to preventing another pregnancy for at least two years after a previous birth. In this blog, they talk about the opportunity to introduce modern family planning methods immediately after delivery, such as the postpartum intrauterine contraceptive device (PPIUCD). 

    This year, 222 million women worldwide will have an unmet need for modern contraception. And as more women are encouraged to deliver in facilities, there is greater opportunity for immediate postpartum  intrauterine contraceptive device (IUCD) services. 

    Abdela Abdosh, a midwife working in Ethiopia, can offer a testament of what this service can mean in a woman’s life. He tells the story of 30-year old Shumba Berisso, a mother who arrived at an MCHIP-supported facility in Ethiopia in labor with her eighth baby. After the delivery, she turned her head away from her newborn and sobbed silently, saying she had no means to care for the baby.

    “If only I could have prevented this pregnancy,” Shumba lamented, adding that her other seven children had never set foot in a classroom, instead spending their days toiling on neighboring farms.

  • Event
    May 22, 2013 (All day) to May 25, 2013 (All day)
    Copenhagen, Denmark

    The conference will focus on empowering women and all aspects of sexual and reproductive health. 

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