1/28/2020 Family planning/Contraception

Family
planning/Contraception
8 February 2018

Key facts
214 million women of reproductive age in developing countries who want to avoid
pregnancy are not using a modern contraceptive method.
Some family planning methods, such as condoms, help prevent the transmission of HIV
and other sexually transmitted infections.
Family planning / contraception reduces the need for abortion, especially unsafe
abortion.
Family planning reinforces people’s rights to determine the number and spacing of their
children.
By preventing unintended pregnancy, family planning /contraception prevents deaths of
mothers and children.

Family planning allows people to attain their desired number of children and determine the
spacing of pregnancies. It is achieved through use of contraceptive methods and the treatment of
infertility (this fact sheet focuses on contraception).

Benefits of family planning / contraception

Promotion of family planning – and ensuring access to preferred contraceptive methods for
women and couples – is essential to securing the well-being and autonomy of women, while
supporting the health and development of communities.

Preventing pregnancy-related health risks in women

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A woman’s ability to choose if and when to become pregnant has a direct impact on her health
and well-being. Family planning allows spacing of pregnancies and can delay pregnancies in
young women at increased risk of health problems and death from early childbearing. It prevents
unintended pregnancies, including those of older women who face increased risks related to
pregnancy. Family planning enables women who wish to limit the size of their families to do so.
Evidence suggests that women who have more than 4 children are at increased risk of maternal
mortality.

By reducing rates of unintended pregnancies, family planning also reduces the need for unsafe
abortion.

Reducing infant mortality

Family planning can prevent closely spaced and ill-timed pregnancies and births, which
contribute to some of the world’s highest infant mortality rates. Infants of mothers who die as a
result of giving birth also have a greater risk of death and poor health.

Helping to prevent HIV/AIDS

Family planning reduces the risk of unintended pregnancies among women living with HIV,
resulting in fewer infected babies and orphans. In addition, male and female condoms provide
dual protection against unintended pregnancies and against STIs including HIV.

Empowering people and enhancing education

Family planning enables people to make informed choices about their sexual and reproductive
health. Family planning represents an opportunity for women to pursue additional education and
participate in public life, including paid employment in non-family organizations. Additionally,
having smaller families allows parents to invest more in each child. Children with fewer siblings
tend to stay in school longer than those with many siblings.

Reducing adolescent pregnancies

Pregnant adolescents are more likely to have preterm or low birth-weight babies. Babies born to
adolescents have higher rates of neonatal mortality. Many adolescent girls who become pregnant
have to leave school. This has long-term implications for them as individuals, their families and
communities.

Slowing population growth

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Family planning is key to slowing unsustainable population growth and the resulting negative
impacts on the economy, environment, and national and regional development efforts.

Who provides family planning /

contraceptives?
It is important that family planning is widely available and easily accessible through midwives and
other trained health workers to anyone who is sexually active, including adolescents. Midwives
are trained to provide (where authorised) locally available and culturally acceptable contraceptive
methods. Other trained health workers, for example community health workers, also provide
counselling and some family planning methods, for example pills and condoms. For methods
such as sterilization, women and men need to be referred to a clinician.

Contraceptive use
Contraceptive use has increased in many parts of the world, especially in Asia and Latin
America, but continues to be low in sub-Saharan Africa. Globally, use of modern contraception
has risen slightly, from 54% in 1990 to 57.4% in 2015. Regionally, the proportion of women aged
15–49 reporting use of a modern contraceptive method has risen minimally or plateaued between
2008 and 2015. In Africa it went from 23.6% to 28.5%, in Asia it has risen slightly from 60.9% to
61.8%, and in Latin America and the Caribbean it has remained stable at 66.7%.

Use of contraception by men makes up a relatively small subset of the above prevalence rates.
The modern contraceptive methods for men are limited to male condoms and sterilization
(vasectomy).

Global unmet need for contraception

214 million women of reproductive age in developing countries who want to avoid pregnancy are
not using a modern contraceptive method. Reasons for this include:

limited choice of methods;

limited access to contraception, particularly among young people, poorer segments of
populations, or unmarried people;
fear or experience of side-effects;
cultural or religious opposition;
poor quality of available services;
users and providers bias
gender-based barriers.

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The unmet need for contraception remains too high. This inequity is fuelled by both a growing
population, and a shortage of family planning services. In Africa, 24.2% of women of reproductive
age have an unmet need for modern contraception. In Asia, and Latin America and the
Caribbean – regions with relatively high contraceptive prevalence – the levels of unmet need are
10.2 % and 10.7%, respectively (Trends in Contraception Worldwide 2015, UNDESA).

Contraceptive methods
Modern methods

How it Effectiveness to
Method Description Comments
works prevent pregnancy
Prevents
Combined >99% with correct and
the release
oral Contains two consistent use Reduces risk of
of eggs
contraceptives hormones (estrogen endometrial and
from the
(COCs) or and progestogen) 92% as commonly ovarian cancer
ovaries
“the pill” used
(ovulation)
Thickens
cervical
99% with correct and
mucous to
consistent use
Progestogen- Contains only block Can be used while
only pills progestogen sperm and breastfeeding; must
(POPs) or "the hormone, not egg from be taken at the same
minipill" estrogen meeting time each day
and 90–97% as commonly
prevents used
ovulation
Thickens
cervical Health-care provider
Small, flexible rods mucous to must insert and
or capsules placed block remove; can be used
under the skin of the sperm and for 3–5 years
Implants >99%
upper arm; contains egg from depending on implant;
progestogen meeting irregular vaginal
hormone only and bleeding common but
prevents not harmful
ovulation
Progestogen Injected into the Thickens Delayed return to
>99% with correct and
only muscle or under the cervical fertility (about 1–4
consistent use
injectables skin every 2 or 3 mucous to months on the
months, depending block average) after use;
on product sperm and irregular vaginal
egg from

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How it Effectiveness to bleeding common, but

Method Description Comments
not harmful
works prevent pregnancy
meeting
and
97% as commonly
prevents
used
ovulation
Monthly Prevents >99% with correct and
injectables or Injected monthly into the release consistent use Irregular vaginal
combined the muscle, contains of eggs
bleeding common, but
injectable estrogen and from the
97% as commonly not harmful
contraceptives progestogen ovaries
(CIC) (ovulation) used

The patch and the

CVR are new and
Continuously
Combined research on The Patch and the
releases 2 Prevents
contraceptive effectiveness is limited. CVR provide a
hormones – a the release
patch and Effectiveness studies comparable safety
progestin and an of eggs
combined report that it may be and pharmacokinetic
estrogen- directly from the
contraceptive more effective than the profile to COCs with
through the skin ovaries
vaginal ring COCs, both as similar hormone
(patch) or from the (ovulation)
(CVR) commonly and formulations.
ring.
consistent or correct
use.
Copper
Longer and heavier
component
Small flexible plastic periods during first
Intrauterine damages
device containing months of use are
device (IUD): sperm and
copper sleeves or >99% common but not
copper prevents it
wire that is inserted harmful; can also be
containing from
into the uterus used as emergency
meeting the
contraception
egg
Decreases amount of
blood lost with
A T-shaped plastic Thickens
menstruation over
device inserted into cervical
time; Reduces
Intrauterine the uterus that mucous to
menstrual cramps and
device (IUD) steadily releases block >99%
symptoms of
levonorgestrel small amounts of sperm and
endometriosis;
levonorgestrel each egg from
amenorrhea (no
day meeting
menstrual bleeding) in
a group of users
Forms a 98% with correct and
Sheaths or barrier to Also protects against
consistent use
Male coverings that fit prevent sexually transmitted
condoms over a man's erect sperm and infections, including
85% as commonly
penis egg from HIV
used
meeting

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How it 90% with correct

Effectiveness to and
Method Description consistent use Comments
works prevent pregnancy
Female Sheaths, or linings, Forms a Also protects against
condoms that fit loosely inside barrier to sexually transmitted
a woman's vagina, prevent infections, including
made of thin, sperm and HIV
transparent, soft egg from 79% as commonly
plastic film meeting used
3 months delay in
>99% after 3 months taking effect while
Permanent
Keeps semen evaluation stored sperm is still
contraception to
Male sperm out present; does not
block or cut the vas
sterilization of affect male sexual
deferens tubes that
(vasectomy) ejaculated performance;
carry sperm from the 97–98% with no
semen voluntary and
testicles semen evaluation informed choice is
essential
Eggs are
Permanent
Female blocked Voluntary and
contraception to
sterilization from >99% informed choice is
block or cut the
(tubal ligation) meeting essential
fallopian tubes
sperm
Temporary 99% with correct and
contraception for consistent use
new mothers whose Prevents
A temporary family
monthly bleeding the release
Lactational planning method
has not returned; of eggs
amenorrhea based on the natural
requires exclusive or from the 98% as commonly
method (LAM) effect of breastfeeding
full breastfeeding ovaries used on fertility
day and night of an (ovulation)
infant less than 6
months old
Emergency
If all 100 women used
contraception
Pills taken to prevent progestin-only
pills (ulipristal Does not disrupt an
pregnancy up to 5 Delays emergency
acetate 30 mg already existing
days after ovulation contraception, one
or pregnancy
unprotected sex would likely become
levonorgestrel
pregnant.
1.5 mg)

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How it Effectiveness to
Method Description Comments
works prevent pregnancy
Can be used to
identify fertile days by
Prevents both women who want
Women track their to become pregnant
pregnancy 95% with consistent
fertile periods and women who want
Standard by avoiding and correct use.
(usually days 8 to 19 to avoid pregnancy.
Days Method unprotected
of each 26 to 32 day Correct, consistent
or SDM vaginal sex
cycle) using cycle use requires partner
during most
beads or other aids cooperation.
fertile days.
88% with common use
(Arevalo et al 2002)
If the BBT has risen
Woman takes her 99% effective with and has stayed higher
Prevents
body temperature at for 3 full days,
pregnancy correct and consistent
the same time each ovulation has
Basal Body by avoiding use.
morning before occurred and the
Temperature unprotected
getting out of bed fertile period has
(BBT) Method vaginal sex
observing for an passed. Sex can
during 75% with typical use of
increase of 0.2 to resume on the 4th day
fertile days FABM (Trussell, 2009)
0.5 degrees C. until her next monthly
bleeding.
Difficult to use if a
96% with correct and woman has a vaginal
Prevents
Women track their consistent use. infection or another
pregnancy
fertile periods by condition that
by avoiding
TwoDay observing presence changes cervical
unprotected
Method of cervical mucus (if mucus. Unprotected
vaginal sex 86% with typical or
any type color or coitus may be
during most common use. (Arevalo,
consistency) resumed after 2
fertile days, 2004)
consecutive dry days
(or without secretions)
Women track their 98% with correct and
fertile periods by consistent use. May have to be used
Prevents
observing changes with caution after an
pregnancy Reported 98% with
in the cervical abortion, around
Sympto- by avoiding typical use (Manhart et
mucus (clear menarche or
thermal unprotected al, 2013)
texture) , body menopause, and in
Method vaginal sex
temperature (slight conditions which may
during most
increase) and increase body
fertile
consistency of the temperature.
cervix (softening).

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Traditional methods
Traditional
Methods
91% with May need to delay
Women monitor their pattern The couple prevents
correct or use with caution
of menstrual cycle over 6 pregnancy by
and when using drugs
Calendar months, subtracts 18 from avoiding unprotected
consistent (such as anxiolytics,
method or shortest cycle length vaginal sex during the
use. antidepressants,
rhythm (estimated 1st fertile day) and 1st and last estimated
NSAIDS, or certain
method subtracts 11 from longest fertile days, by 75% with antibiotics) which
cycle length (estimated last abstaining or using a common may affect timing of
fertile day) condom. use ovulation.
96% with
correct One of the least
and effective methods,
Man withdraws his penis from consistent because proper
Tries to keep sperm
Withdrawal his partner's vagina, and use timing of withdrawal
out of the woman's
(coitus ejaculates outside the vagina, is often difficult to
body, preventing 73% as
interruptus) keeping semen away from determine, leading
fertilization commonly
her external genitalia to the risk of
used
ejaculating while
(Trussell,
inside the vagina.
2009)

WHO response
WHO is working to promote family planning by producing evidence-based guidelines on safety
and service delivery of contraceptive methods, developing quality standards and providing pre-
qualification of contraceptive commodities, and helping countries introduce, adapt and implement
these tools to meet their needs.

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