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.

  • Blog post
    Tamunotonye Harry is a Nigerian-based digital health advocate who has completed several courses through K4Health’s Global Health eLearning platform.

    Tamunotonye Harry is a Nigerian-based digital health advocate who has completed several courses through K4Health’s Global Health eLearning platform. Photo Credit: Carrot Photography.

    Tamunotonye Harry is a young digital health professional based in Port Harcourt, Nigeria. After learning about the Global Health eLearning Center (GHeL) and taking a course on digital health, Tamunotonye connected with K4Health for information about our Global Digital Health Network. In this lightly edited interview, Tamunotonye explains how discovering GHeL has influenced his career path in a positive way.

    How did your experience in the National Youth Service Corps engage you in mHealth work?

    Tamunotonye Harry: I graduated from the University of Port Harcourt with a degree in Human Physiology in 2015. I had to wait a whole year before I was finally accepted into the National Youth Service Corps (NYSC). The one-year gap was actually a blessing as I used this time to gain work and volunteer experience, which involved building capacity for children with disabilities.

  • Resource

    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. 

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    © 2004 Ahsanul Kabir, Courtesy of Photoshare

    A health worker administers a Somazet injection for family planning at a community health clinic in Islampur union, Rajbari district, Bangladesh. © 2004 Ahsanul Kabir, Courtesy of Photoshare

    Hormonal contraceptives are very effective in preventing pregnancy when used correctly and are an important part of a program's contraceptive method mix. There are many exciting developments in terms of new contraceptive technologies, as well as evidence that the renewed focus on long-acting reversible contraceptives (LARCs), specifically implants, has been quite successful in some countries. The following three come to mind:

    1.)    Injectable contraceptives continue to be one of the world’s most popular methods for preventing pregnancy, offering women safe and effective protection, convenience, and privacy. Until now, however, they have not been widely available outside clinic settings. The introduction of Sayana® Press, a lower-dose formulation and presentation of Depo-Provera®, offers the potential to improve contraceptive access for women worldwide.

    Sayana Press is a three-month, progestin-only injectable contraceptive product packaged in the Uniject™ injection system and administered via subcutaneous injection. It is small, light, easy to use, and requires minimal training, making it especially suitable for community-based distribution. PATH and partners are supporting country-led pilot introduction of Sayana Press in Bangladesh, Burkina Faso, Niger, Senegal, and Uganda, which will continue through 2016. 

  • Blog post

    This blog post originally appeared January 6, 2015 on The Pump, JSI's blog promoting and improving health. 

    In order to achieve FP2020’s goals and ensuring that people have access to a broad range of contraceptives, it is essential that the Standard Days Method® (SDM) be included as part of the family planning (FP) modern method mix in health facilities and community-based family planning (CBFP) programs. On December 9, 2014, Advancing Partners & Communities (APC) launched its series of CBFP related technical consultations. This consultation focused on raising awareness of SDM as part of the method mix. Close to 50 people representing over 20 different organizations, including representatives from USAID as well as country representatives of programs in India, Mali, Nigeria, Rwanda and Uganda, convened to discuss the integration of SDM into CBFP programs.

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    Chelsea Polis and Kavita Nanda were both directly involved in writing the two major documents mentioned: the 2014 WHO guidance and the USAID/PEPFAR briefer on HC-ART. 

    © 2013 Sarah V. Harlan/CCP, Courtesy of Photoshare

    A Health Extension Worker explains the systems she uses to keep track of her patients at the Saadamoo Health Post in the Oromia Region of Ethiopia. Health posts provide preventive care and treatment in a number of areas, including family planning and HIV. © 2013 Sarah V. Harlan/CCP, Courtesy of Photoshare

    Extraordinary gains have been made in the last decade towards increasing access to antiretroviral therapy (ART) for HIV. With an eye towards ending the AIDS epidemic by 2030, UNAIDS recently released bold targets related to HIV diagnosis and treatment. By the year 2020, their aim is to have 90% of all people living with HIV aware of their status, 90% of people diagnosed with HIV receiving sustained ART, and 90% of people on ART achieving viral suppression. As we move closer to these laudable public health goals, we must also consider how expansion of ART may affect and be affected by other health issues, such as prevention of unintended pregnancy among women living with HIV.

    Among all people living with HIV in low- and middle-income countries, 52% are women (57% in sub-Saharan Africa). Most are of reproductive age, and many may wish to use a hormonal contraceptive method to prevent unintended pregnancy, such as oral contraceptive pills, injectables, implants, or hormonal intrauterine devices (IUDs). Access to highly effective contraception has other health benefits as well; it reduces maternal and infant morbidity and mortality, and is a necessary component in ending mother-to-child HIV transmission.

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    © 2008 Virginia Lamprecht, Courtesy of Photoshare

    A mother and her infant at a vasectomy clinic in Rwanda. © 2008 Virginia Lamprecht, Courtesy of Photoshare

    While tragic, the deaths of 13 women in India last week after undergoing female sterilization—possibly attributable to tainted medicine administered after surgery— were highly unusual. In fact, female sterilization is the most widely-used contraceptive method globally, and with good reason. As this  interactive data visualization tool from the New York Times demonstrates, female and male sterilization are among the safest, most effective, and most cost-efficient family planning methods for those who wish to permanently prevent or limit pregnancies. 

    As women have the children they want, if they decide on permanent contraception, they no longer have to spend that money every month or every three months for an injectable [contraceptive] or every three to five years for an implant. They can take on other things with the confidence they won't become pregnant. They can take on jobs and we know that women who have opportunities to do that often do relatively well and are able to contribute income to their families. They have a sense of autonomy, are less subjected to gender-based violence and overall, have a fuller, richer life. –John Townsend, Population Council

    Earlier this week, NPR aired an interview with John Townsend, Population Council’s Director of Reproductive Health, who discussed why so many families around the world rely on sterilization and what constitutes a safe environment for these procedures. Read or listen to the full interview.

    For more information about male and female sterilization, please visit K4Health's Permanent Methods Toolkit

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    FHI 360’s Nicole Ippoliti recently sat down with Judith Bruce, a Senior Associate and Policy Analyst with the Population Council’s Poverty, Gender, and Youth program and a longtime champion for adolescent girls. This concludes our two-part series sharing highlights of their conversation about adolescent pregnancy. Read Part One.

    © 2013 Arturo Sanabria, Courtesy of Photoshare

    A female adolescent in Mbabane, Swaziland. © 2013 Arturo Sanabria, Courtesy of Photoshare.

    There have recently been renewed global monetary commitments to contraceptive and reproductive health services--what is the opportunity for adolescents?

    I am hoping with the new “family planning golden moment” that the vast majority of resources will be devoted to populations under age 24, both married and unmarried. There are many places where two conditions propel high levels of adolescent pregnancy: 1) A high proportion of school-aged girls either out of school or not-at-grade-for-age in places where child marriage is common, and 2) Unmet need for contraception among girls ages 15-19 and 20-24 is higher than the average unmet need across all ages. This means we are doing a poorer job of meeting the needs of younger populations versus older populations.

    An example of how programs can reduce the impact of these two conditions can be seen through The Population Council's Berhane Hewan and Meseret Hiwot programs in Ethiopia. The Council, in collaboration with the Ethiopian government, demonstrated the value of reaching a high proportion of school-aged girls through incentives to parents to keep them in school and community-based girls clubs. Married girls, who are especially isolated, have their own clubs, which are now reaching 250,000 married girls. At the time of the initial intervention, 43 percent of girls were married before the age of 15; in several years, the program was able to increase the age of marriage by two years. More than 65 percent of girls in married-girls clubs use contraception (no new services – just aggregation of demand and building their social connections), which is roughly double the rates in similar communities without any clubs. Most surprising is that the majority of girls using contraception were delaying the first birth.

  • Blog post

    FHI 360’s Nicole Ippoliti recently sat down with Judith Bruce, a Senior Associate and Policy Analyst with the Population Council’s Poverty, Gender, and Youth program and a longtime champion for adolescent girls. We are pleased to share highlights of their conversation about adolescent pregnancy in a two-part series.

    © 2012 Asit Kumar Ghatak, Courtesy of Photoshare

    An adolescent mother with her newborn in Kolkata, India. © 2012 Asit Kumar Ghatak, Courtesy of Photoshare.

    Which girls are at the highest risk of adolescent pregnancy?

    Girls at the highest risk of adolescent pregnancy are girls subject to unconsented and/or underage sexual relations, regardless of marital status. We must not forget that the vast majority of adolescent pregnancy takes place within marriage and the needs of married girls are terribly neglected. Until fairly recently, there was a concern that meeting the needs of married girls potentially distracted resources from sexually active unmarried girls. Sexually active unmarried girls, however, are far fewer than married girls, they often have less sex than married girls, and they are often actively avoiding pregnancy but need effective means and bargaining power to do so.

    Suffice it to say that we must protect girls from unsafe and unwanted sexual relations (both in and out of marriage), and confront far more strongly that much of child marriage and unmarried adolescent pregnancy is driven by poverty. In some countries, a very high proportion of girls engage in sexual relations as a result of economic pressures and are often forced to do so with men substantially older, which carries the risk of both pregnancy and elevated STI transmission (including HIV risk, given the age of their partners).

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    © 2012 Akintunde Akinleye/NURHI, Courtesy of Photoshare

    IUDs are displayed on a table at the counseling unit in Yusuf Dantsoho memorial hospital in Nigeria’s northern city of Kaduna. © 2012 Akintunde Akinleye/NURHI, Courtesy of Photoshare.

    The buzz around long-acting reversible contraceptives (LARCs) for teen pregnancy prevention reached a fever pitch in the U.S. last month. First, the American Academy of Pediatrics (AAP) released new guidelines recommending that LARCs be the “first line” of contraceptives for preventing adolescent pregnancy. That is, pediatricians should recommend LARCs such as IUDs and implants before shorter-term contraceptive methods such as condoms and pills for teens.

    Days later, The New England Journal of Medicine published the impressive results of a new study showing that providing adolescent girls in the U.S. with information about, and affordable access to, LARCs can reduce rates of unintended pregnancy and abortion by more than 75 percent.

    These developments deserve our attention. Despite steep declines over the past two decades, the U.S. teen pregnancy rate continues to be one of the highest in the world among high-income countries. While male condoms—currently the most widely used contraceptive method among American teens—are essential to preventing sexually transmitted infections, they have a typical pregnancy-prevention failure rate of 18 percent. Widely popular oral contraceptive pills aren’t far behind at 9 percent. In contrast, both IUDs and implants have failure rates of less than 1 percent.

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    On our last trip to the capitol, we were stopped at a gas station when we heard that USAID staff was also being evacuated. It was March 2009, and Peace Corps was evacuating volunteers from Madagascar due to political unrest. In the months leading up to evacuation, I’d seen increasing limitations on the country’s infrastructure – police checkpoints and fear of riots made it difficult to move freely within major cities and travel within the country; destruction of the main radio towers cut off communication of unfolding events to the majority of the country; and violence in city centers and market areas disrupted commerce and stable livelihoods. 

    © 2008 Micah Albert, Courtesy of Photoshare

    Kikuyus find shelter from the rain at the U.N. High Commissioner for Refugees camp near Eldoret, the largest camp in Kenya during the post-election unrest.© 2008 Micah Albert, Courtesy of Photoshare.

    With USAID pulling out, and other non-governmental organizations being encouraged to do the same, the gravity of the situation hit home. As a Peace Corps volunteer, I’d lived in a rural village four hours south of the country capitol, Antananarivo, and spent most days at the health center providing antenatal care and family planning counseling and conducting refresher trainings for community health workers based in satellite villages. Every Monday, 70 to 90 pregnant women showed up at the clinic for their prenatal checkups. On Friday, another 70 women arrived seeking contraceptives. The folic acid pills, iron supplements, home birth kits,  Depo Provera shots, oral contraceptives, intrauterine devices (IUDS), and other family planning essentials were supplied for free or at a subsidized cost by USAID. With donors pulling funding and non-critical staff being removed, I was concerned that the women in my community would have trouble seeking necessary health services and commodities. My fears were curtailed because although many were evacuated during the humanitarian crisis, there are always individuals who, at great personal risk and discomfort, stay, arrive, or return to play a critical role in mitigating public health risks, including women’s access to health care and contraceptives.