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Family Planning Methods.
Introduction
Women, men, or couples can choose from many contraceptive methods to
help them plan their family and prevent an unplanned pregnancy. They need
to know that if they are having sex regularly and do not use a contraceptive
method, about 8 of every 10 women will become pregnant during the next
12 months.
Different people want different things from a
contraceptive method. Some want a method
that guarantees there is no chance of
pregnancy. Some want a quick return to
fertility so they can get pregnant soon after
stopping a contraceptive method. Some do
not want to think about contraceptives
every time they have sex. Some do not
want to depend on their partner for the
success of the method. Some women do
not want to remember to take a daily
pill, while others find that is easy.
And there are still other factors that
influence method choice. Some may
need protection from STIs and will
choose condoms to be used alone or
in addition to another contraceptive
method. Some people want a method.
they can always get easily whenever they need more. Some people prefer
fertility awareness methods because of religious beliefs, because they are
worried about side effects, or do not like other methods. Some women want
a method that their partner will not know they are using. A few may have a
medical condition that could affect the safe use of a particular method.
For many people, the effectiveness of a family planning method is important.
The chart below compares the effectiveness of methods as commonly used.
The most effective methods are grouped at the top, and less effective methods
are at the bottom.
Providers can help women, men, and couples think about their preferences
and their situations and choose the method that best suits them. Many
women seeking family planning services already know which method they
want, and counselors should provide this method along with accurate and
complete information, either themselves or through a referral. It is the
provider’s job to ensure that a client makes an informed voluntary choice and
is not denied a method. In rare cases, a client may have a medical condition
that will affect which method they can safely use.
Supporting Information
Fact 1.
Hormonal contraceptive methods include oral contraceptives pills,
injectables, and implants. They all prevent pregnancy mainly by
stopping a woman’s ovaries from releasing eggs. Hormonal methods
contain either one or two female sex hormones that are similar to the
hormones naturally produced by a woman’s body.
Hormonal methods are highly effective in preventing pregnancies, and nearly
all women can use them. All hormonal methods work by preventing the
woman’s ovaries from releasing an egg every month. Without an egg, there is
nothing for sperm to join with — known as fertilizing the egg — so pregnancy
cannot occur. They also cause the mucus produced by the cervix to become
very thick which prevents sperm from entering the uterus.
Hormonal methods include oral contraceptive pills, injectables, and implants.
Each is used differently, has somewhat different side effects, and has slightly
different advantages and limitations. It is helpful if a woman talks with a
health care provider to make sure she has no health conditions that may make
a method unsuitable, to learn the
specifics about the method, and
to choose one that is right for her.
Some hormonal methods are shortacting, and some are long-acting.
The short-acting hormonal methods
require either taking a pill every
day or getting repeat injections as scheduled. They are very effective when
used correctly. They are somewhat less effective when women forget to take a
pill or to return for an injection on time. Implants are long-acting hormonal
methods, and they are highly effective because, once inserted in the woman’s
arm, the woman will not require further action for 3 to 5 years depending on
the implant being used.
Fact 2
Oral contraceptive pills should be taken one pill every day. They are
most effective when no pills are missed, the pill is taken at the same
time every day, and each new pack of pills is started without a delay.
Combined oral contraceptives (COCs). The most commonly used oral
contraceptive pills combine two synthetic hormones — estrogen and
progestin. These oral contraceptives are often referred to as
combined pills or simply “the Pill.” If a woman
remembers to take the Pill every day, the method
is close to 100% effective in preventing pregnancy.
However, since some women forget, on average over
the course of a year, 8 pregnancies will occur among
every 100 women taking the Pill.
Some women experience side effects when first taking the Pill, such as nausea
or mild headaches, but the side effects are not dangerous and usually go away
after the first few months. Breastfeeding women should delay starting the Pill
until the baby is at least 6 months old because the estrogen in the Pill might
reduce the amount of breast milk.
Progestin-only pills (POPs). Another type of oral contraceptive pills contains
only one synthetic hormone — progestin. These pills are often called
progestin-only pills or the “mini-pill.”
Progestin-only pills are recommended for breastfeeding women because,
unlike estrogen, progestin will not reduce the production of breast milk.
Also, progestin-only pills are more effective in breastfeeding than in nonbreastfeeding women. For women who are not breastfeeding, the mini-pill
may not be as effective as the combined estrogen and progestin pill.
The effectiveness depends on taking the mini-pill at about the same time every day.
Women who are taking progestin-only pill may experience irregular light
bleeding and spotting. This is not harmful, although may be inconvenient for
some women.
All oral contraceptives. There is no delay in returning to fertility after a
woman stops using either combined pills or progestin-only pills. The
Pill is usually readily available at pharmacies as well as clinics, and from
community-based providers.
Fact 3.
Injectable contraceptives are given by injection into a woman’s arm
or buttocks once every 1, 2, or 3 months, depending on the type of
injectable. Injectables are most effective when women remember to
come back for re-injection on time.
Injectable contraceptives are given by injection into
a woman’s arm or buttocks in either the muscle or
under the skin in the fatty tissue, depending on
type of injectable. After the injection, the hormone
is released slowly from the injection site into the bloodstream. Different
injectables require a woman to return for a repeat injection once every 1, 2,
or 3 months.
When women always remember to come for re-injection on time,
injectable contraceptives are close to 100% effective. However, some women
occasionally are late for re-injection. On average, over the course of a year, 3 pregnancies will occur among every 100 women using injectables.
The most common side effects of injectables are bleeding changes. At first, injectables may cause irregular, heavy, or prolonged bleeding, but after several injections many women stop having monthly bleeding altogether. This is especially common with the 2- and 3-month injectables. Having no bleeding pleases many women, but some may worry that something is wrong or that they are pregnant. They should know that having no bleedings is harmless and does not cause permanent damage to a woman’s fertility. It can even be good for some women’s health because the absence of monthly bleedings reduces the risk of anemia (low iron level in the blood). Women need to be aware of these side effects in advance so they know what to expect and do not worry.
Depending on the type of injectable, the return to fertility after a woman’s last injection is often delayed and may take from 4 to 10 months. A family planning counselor can help a couple to consider return to fertility when they are selecting a method for timing or spacing pregnancies. A woman can get an injection at a clinic or health outpost. In many countries, communitybased health workers and pharmacists are able to administer injections.
Fact 4.
Contraceptive implants are inserted under the skin of a woman’s upper
arm and provide continuous, highly effective pregnancy protection for 3
to 5 years, depending on the type of implant. When this time is over, new
implants can be inserted during the same visit that the old set is removed.
Implants are small plastic rods, each about the size of a matchstick.
These rods are placed just under the skin on the inside of a woman’s
upper arm. Implants are almost 100% effective and can provide
3 to 5 years of protection from pregnancy, depending on the
type of implant. Women have found implants to be among the
easiest family planning methods to use. After implants are
inserted, there are no further actions to take or additional
costs until they are removed.
A woman must visit a trained health care provider to have implants put in her arm or to have them removed. To continue being highly effective, they should be removed and replaced promptly, in 3 to 5 years, depending on the type of implant. A woman will become fertile again and able to get pregnant almost immediately after the implants are removed.
If a woman desires to continue to use implants, a new set can be inserted and the old ones do not have to be removed.
Side effects of implants include irregular vaginal bleeding and spotting. Some women’s monthly bleedings stop altogether. This pleases many women, but some may worry that something is wrong or that they are pregnant. It is important to counsel women in advance that they may stop menstruating and that this is harmless.
Fact 5.
Emergency contraceptive pills (ECPs) can help prevent pregnancy if taken within 5 days after unprotected sex. The sooner they are taken, the more effective they are. They are NOT meant to be used for ongoing contraception, in place of a regular method.
Emergency contraceptive pills (ECPs) are sometimes referred to as the “morning-after pill” because they are taken after unprotected sex has taken place. They contain either progestin alone or progestin and an estrogen together, like oral contraceptives. However, the hormone dose in ECPs is higher, and a woman takes only one or two pills.
Emergency contraception works like any other hormonal method by preventing ovulation. There is no evidence that ECPs prevent a fertilized egg from attaching to the uterine lining.
ECPs should not be used in place of regular contraception because they are not as effective as most regular methods. They are 75% to 95% effective in preventing pregnancy depending on the type of ECP and on how soon after unprotected sex the pills are taken. Providers should help women who use ECPs to choose a regular contraceptive method for ongoing protection against pregnancy.
ECPs have no serious side effects. Some women may have headaches, nausea,
or vomiting after taking ECPs, but these go away within several days. The ECPs
that contain only progestin cause fewer side effects and are more effective.
There is no delay in return to fertility after taking ECPs. Because of this, ECPs
prevent pregnancy only after unprotected sex that occurred within the previous
5 days. ECPs will not prevent pregnancy resulting from unprotected sex that
takes place after ECPs have been taken.
ECPs offer women a second chance to prevent pregnancy after unprotected
sex. They do not cause an abortion, and, if taken accidentally by a woman who
is already pregnant, they will not harm the woman or the fetus or disrupt the
course of pregnancy.
Fact 6.
Intrauterine contraceptive devices (IUDs or IUCDs) are small, flexible
plastic devices that are inserted into the woman’s uterus. The most
common IUDs contain copper, and they work by preventing sperm from
reaching an egg. Depending on the type, IUDs can provide protection for
5 to 12 years.
An IUD is a small, often T-shaped plastic device that is wrapped in copper or
contains a progestin hormone. A specially trained health care provider inserts
the IUD into the uterus. A plastic string tied to the end of the IUD hangs down
through the cervix into the vagina. A woman can check that the IUD is in
place by feeling for this string inside the vagina. A health care provider uses the
string to remove the IUD when the woman wants it removed or it eventually
needs to be replaced. Women who are not pregnant can have an IUD inserted
any time. After childbirth, women can have an IUD inserted immediately or
within the first two days. If not, she will need to wait four to six weeks to do so.
IUDs are nearly 100% effective. They are long-acting, too. Once in place, they
can provide 5 to 12 years of protection from pregnancy, depending on the
type of IUD. However, a woman can ask to have the IUD
taken out at any time. When the IUD is removed, a woman
can get pregnant immediately. Women have found the
IUD to be among the easiest family planning methods to
use: after it is inserted into the uterus there are no further
actions a woman must take and no additional costs until
the IUD is removed. Women of all ages can use IUDs,
whether or not they have had children. It does not
cause infertility.
Women living with HIV can safely use IUDs. However, women at very
high risk of STIs or who currently have an active STI, such as gonorrhea or
chlamydia, should not have an IUD inserted. The process of inserting the
IUD could push gonorrhea and chlamydia higher into the reproductive tract
causing a more serious health problem. These infections should be treated
and cured prior to IUD insertion.
Copper-bearing IUD. The copper-bearing IUD works by creating an
environment in the uterus that damages the sperm and keeps them from
uniting with an egg. It is effective for up to 12 years. The most common side
effects of the copper IUD include heavier and longer monthly bleeding, which may be accomplished by increased cramping. For most women, these side effects diminish or disappear in 3 to 6 months of using IUDs.
Hormonal IUD. A hormonal IUD very slowly and continuously releases a
small amount of a progestin hormone. It works by thickening the cervical
mucus, making it hard for sperm to pass from the vagina into the uterus.
It also prevents ovulation in some women and keeps the lining of the uterus
from growing.
Once in place in the woman’s uterus, the hormonal IUD is highly effective and can be used for up to 5 years. The hormonal IUD also changes bleeding patterns, in this case a woman bleeds less and on fewer days, and the bleeding could be irregular. In fact, many women have no bleeding at all after several months of using this method. Lighter bleeding is a benefit to many women, particularly those with anemia.
Fact 7
Barrier methods are either devices (male and female condoms)
that physically block sperm from reaching an egg, or chemicals
(spermicides) that kill or damage the sperm in the vagina. The
effectiveness of barrier methods greatly depends on people’s ability
to use them correctly every time they have sex.
The most common barrier family planning method is the male condom.
Male and female condoms are the only contraceptive methods that provide
protection from STIs, including HIV, in addition to pregnancy. Less common
barrier methods are diaphragms and cervical caps; they are not readily
available in many countries. All of these devices form a mechanical
barrier between the sperm and an egg. Finally, spermicides are chemical
substances placed in the vagina — a foam, a gel, film, or a tablet, for example.
Spermicides work by killing or disabling sperm.
Barrier methods should be used every time a couple has sex. The effectiveness
of barrier methods depends greatly on people’s ability to use them consistently
and correctly. If a woman is fertile and does not use the method consistently
and correctly, she can become pregnant.
Male condom. A male condom is a covering — usually made of thin latex
rubber — that unrolls over a man’s erect penis. It prevents a man’s sperm
from entering the woman’s vagina. It also can keep the small organisms that
cause some STIs/HIV from infecting the partner. When condoms are used
correctly at every sexual act, they are 98% effective in preventing pregnancy.
However, as commonly used, when men sometimes forget or refuse to put a
condom on, condoms are only 85% effective. This means that each year out
of 100 women who rely on condoms, 15 may become pregnant. Condoms
have no general side effects, but a small percent of people may be allergic
to latex. These people can use plastic condoms, which are becoming more
available in many countries.
Female condom. A female condom
is a lubricated pouch made of thin,
soft plastic that fits loosely inside
a woman’s vagina. It prevents
pregnancy by keeping sperm
out of the vagina. In addition to
preventing pregnancy, female
condoms also block transmission of
some STIs/HIV. Female condoms are about as effective as the male condom
if used consistently and correctly every time she has sex, but less effective as commonly used.
Some women need to practice using the female condom correctly. A family
planning counselor can provide clear instructions on how to insert a female
condom into the vagina. While a woman can make a decision to use a
female condom herself, it is better if the man also agrees so that they will
use it correctly every time. Studies have found that most men do not object
to using the female condom to protect against pregnancy and to block
transmission of STIs/HIV.
Spermicides. Spermicides are chemical substances that are inserted deep into
the vagina shortly before sex to kill or disable sperm. They can be used alone as
well as with diaphragms, cervical caps, and condoms. Spermicides are available
as foaming tablets, vaginal suppositories, foam, melting film, jelly, and cream.
Used alone, spermicides are one of the least effective contraceptive methods.
Even when used consistently and correctly, their effectiveness is only about
82%. Thus, 18 in every 100 women who use spermicides may become
pregnant over a year. As commonly used, 29 of every 100 spermicide users
will become pregnant within one year of use. Women and couples who want
reliable protection from pregnancy should consider other contraceptive
methods. Spermicides provide no protection from STIs/HIV and may even
increase the risk of HIV if used several times a day.
Fact 8.
Fertility awareness methods require a couple to know the fertile days of
the woman’s menstrual cycle – the days when pregnancy is most likely
to occur. During these fertile days the couple must avoid sex or use a
barrier method to prevent pregnancy.
Fertility awareness methods are based on understanding the female and the
male reproductive systems. These methods require that couples identify the
days when the woman is fertile and may become pregnant and consistently
abstain from unprotected sex on those days. Couples who use these methods
say they like them because they have no side effects and they do not require
procedures, devices, or hormones.
There are two types of fertility awareness methods that help determine fertile days. One uses the calendar to track fertile days, and
the other observes the
physical signs of fertility.
The Standard Days Method (SDM) is
the most common calendar-based method and is described below.
To successfully use fertility awareness methods to prevent pregnancy requires
a partner’s cooperation; men should be willing to abstain from sex or to use
condoms on fertile days. Thus, for these methods to be effective, men must
become full partners in the decision to use them.
Standard Days Method. To use SDM, the couple avoids unprotected
sex from day 8 through day 19 of every cycle, counting the first day of
monthly bleeding as day 1. These are the days when the woman is most
likely to become pregnant. During that time couples can choose either
to abstain from sex or to use a condom or another barrier method to
prevent pregnancy.
Many women or couples use CycleBeads (see graphic above) to keep track
of their fertile days. CycleBeads are a string of beads that are color-coded to
represent different days of the menstrual cycle. The different colors show the
days the woman is likely to be fertile and get pregnant and the days when it
is safe to have unprotected sex. Others use a calendar to mark those days.
Many couples report that they communicate better with each other as a result
of using this method. A woman can use SDM if most of her menstrual cycles
are 26 to 32 days long. If she has more than two longer or shorter cycles in
a year, SDM will be less effective for her and she should consider another
fertility awareness method or other modern method.
Fact 9.
Breastfeeding provides contraceptive protection for the first 6 months
after delivery if certain conditions are met. This approach is called the
Lactational Amenorrhea Method or LAM.
The natural effect of feeding only breast milk to a baby delays the return of
fertility up to 6 months. For the LAM method to be effective at preventing
pregnancy, three conditions must apply:
- A woman must feed her baby only breast milk
- The baby is younger than 6 months
- The mother’s monthly bleeding does not resume.
For LAM, feeding the baby “only breast milk” means not giving any other
liquids or foods, except for vitamins, medicines, and vaccines. Also, the
woman needs to be breastfeeding
the baby on demand day and night.
If she starts giving any other foods
before her baby is 6 months old or if
her monthly bleeding resumes, the
woman should immediately begin
another family planning method to
prevent a pregnancy. LAM is 98%
effective when practiced correctly
Fred healthcare. 