Family planning and the benefits of contraception

The right to have a family goes well beyond just submitting to biological necessity. It involves the right to decide freely and responsibly how many children to have and the spacing between two pregnancies, as well as the right to have access to information, education and the means through which these rights can be exercised.

The responsibilities that women assume when they decide to have and raise children have an impact on their access to education, employment and other activities relating to their self-development. Being able to plan the number and spacing of children will have a direct impact on the life and health of women; it will reduce the need to resort to abortions, and in particular dangerous abortions when confronted with an unwanted pregnancy; and reduces the mortality rate of women and girls.

It is estimated that in developing countries some 225 million women who would like to delay or stop childbearing do not use any form of contraception.

Some forms of birth control, such as condoms, may also prevent the spread of HIV and other sexually transmitted diseases.

What is family planning?

Family planning allows individuals to determine the number of children they want and the spacing and timing of their births. This can be achieved through the use of contraceptive methods which gives women them the freedom to make informed and autonomous choices regarding their sexual and reproductive health.

This increases their independence and improves their quality of life. At the same time, it benefits the development of communities due to the fact that the possibility of deciding their own future allows women to play a greater role in public life, to gain access to paid employment and to fully develop their potential.

Preventing 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.

Adolescent pregnancies

Women’s and girls’ access to family planning education reduces the number of unintended pregnancies. Pregnant adolescents are more likely to have preterm or low birth-weight babies. Furthermore, babies born to adolescents have higher rates of neonatal mortality. On the other hand, many adolescent girls who become pregnant have to leave school. This has long-term implications for them as individuals, their families and communities.

The need for access to contraception

Millions of women throughout the world would like to plan their pregnancies but are not using any form of contraception because they don’t have information about methods and they lack quality health services. They may also face cultural or religious opposition from their families or communities. Men’s refusal to use condoms, particularly in countries where there is gender inequality, is not only perpetuating a cultural attitude that is harmful to women, it is also harmful to men themselves since they can be infected by sexually transmitted diseases.

Contraceptive methods

Methods	Description	How it works	Effectiveness to prevent pregnancy	Comments
Combined oral contraceptives (COCs) or “the pill”	Contains two hormones (oestrogen and progestogen)	Prevents the release of eggs from the ovaries (ovulation)	>99% with correct and consistent use 92% as commonly used	Reduces risk of endometrial and ovarian cancer
Progestogen-only pills (POPs) or «the mini-pill»	Contains only progestogen hormone, not oestrogen	Thickens cervical mucous to block sperm and egg from meeting and prevents ovulation	99% with correct and consistent use 90–97% as commonly used	Can be used while breastfeeding; must be taken at the same time each day
Implants	Small, flexible rods or capsules placed under the skin of the upper arm; contains progestogen hormone only	Thickens cervical mucous to block sperm and egg from meeting and prevents ovulation	>99% 97% as commonly used	Health-care provider must insert and remove; can be used for 3–5 years depending on implant; irregular vaginal bleeding common but not harmful
Monthly injectables or combined injectable contraceptives (CIC)	Injected monthly into the muscle, contains oestrogen and progestogen	Prevents the release of eggs from the ovaries (ovulation)	>99% with correct and consistent use 97% as commonly used	Irregular vaginal bleeding common, but not harmful
Combined contraceptive patch and combined contraceptive vaginal ring (CVR)	Continuously releases 2 hormones – a progestin and an oestrogen- directly through the skin (patch) or from the ring.	Prevents the release of eggs from the ovaries (ovulation)	The patch and the CVR are new and research on effectiveness is limited. Effectiveness studies report that it may be more effective than the COCs, both as commonly and consistent or correct use.	The Patch and the CVR provide a comparable safety and pharmacokinetic profile to COCs with similar hormone formulations.
Intrauterine device (IUD): copper containing	Small flexible plastic device containing copper sleeves or wire that is inserted into the uterus	Copper component damages sperm and prevents it from meeting the egg	>99%	Longer and heavier periods during first months of use are common but not harmful; can also be used as emergency contraception
Intrauterine device (IUD) levonorgestrel	A T-shaped plastic device inserted into the uterus that steadily releases small amounts of levonorgestrel each day	Suppresses the growth of the lining of uterus (endometrium)	>99%	Decreases amount of blood lost with menstruation over time; Reduces menstrual cramps and symptoms of endometriosis; amenorrhea (no menstrual bleeding) in a group of users
Male condoms	Sheaths or coverings that fit over a man’s erect penis	Forms a barrier to prevent sperm and egg from meeting	98% with correct and consistent use 85% as commonly used	Also protects against sexually transmitted infections, including HIV
Female condoms	Sheaths, or linings, that fit loosely inside a woman’s vagina, made of thin, transparent, soft plastic film	Forms a barrier to prevent sperm and egg from meeting	90% with correct and consistent use 79% as commonly used	Also protects against sexually transmitted infections, including HIV
Female condoms Male sterilization (vasectomy)	Sheaths, or linings, that fit loosely inside a woman’s vagina, made of thin, transparent, soft plastic film Permanent contraception to block or cut the vas deferens tubes that carry sperm from the testicles	Forms a barrier to prevent sperm and egg from meeting Keeps sperm out of ejaculated semen	90% with correct and consistent use 79% as commonly used >99% after 3 months semen evaluation 97% – 98% with no semen evaluation	Also protects against sexually transmitted infections, including HIV 3 months delay in taking effect while stored sperm is still present; does not affect male sexual performance; voluntary and informed choice is essential
Female sterilization (tubal ligation)	Permanent contraception to block or cut the fallopian tubes	Eggs are blocked from meeting sperm	>99%	Voluntary and informed choice is essential
Lactational amenorrhea method (LAM)	Temporary contraception for new mothers whose monthly bleeding has not returned; requires exclusive or full breastfeeding day and night of an infant less than 6 months old	Prevents the release of eggs from the ovaries (ovulation)	99% with correct and consistent use 98% as commonly used	A temporary family planning method based on the natural effect of breastfeeding on fertility
Emergency contraception (levonorgestrel 1.5 mg)	Progestogen-only pills taken to prevent pregnancy up to 5 days after unprotected sex	Prevents ovulation	Reduces the likelihood of pregnancy to 60% to 90%.	Does not disrupt an already existing pregnancy
Standard Days Method or SDM	Women track their fertile periods (usually days 8 to 19 of each 26 to 32 day cycle) using cycle beads or other aids	Prevents pregnancy by avoiding unprotected vaginal sex during most fertile days.	95% with consistent and correct use. 88% with common use (Arevalo et al 2002)	Can be used to identify fertile days by both women who want to become pregnant and women who want to avoid pregnancy. Correct, consistent use requires partner cooperation.
Basal Body Temperature (BBT) Method	Woman takes her body temperature at the same time each morning before getting out of bed observing for an increase of 0.2 to 0.5 degrees C.	Prevents pregnancy by avoiding unprotected vaginal sex during fertile days	99% effective with correct and consistent use. 75% with typical use of FABM (Trussell, 2009)	If the BBT has risen and has stayed higher for 3 full days, ovulation has occurred and the fertile period has passed. Sex can resume on the 4th day until her next monthly bleeding.
Two Day Method	Women track their fertile periods by observing presence of cervical mucus (if any type colour or consistency)	Prevents pregnancy by avoiding unprotected vaginal sex during most fertile days,	96% with correct and consistent use. 86% with typical or common use. (Arevalo, 2004)	Difficult to use if a woman has a vaginal infection or another condition that changes cervical mucus. Unprotected coitus may be resumed after 2 consecutive dry days (or without secretions)
Sympto-thermal Method	Women track their fertile periods by observing changes in the cervical mucus (clear texture) , body temperature (slight increase) and consistency of the cervix (softening).	Prevents pregnancy by avoiding unprotected vaginal sex during most fertile	98% with correct and consistent use. Reported 98% with typical use (Manhart et al, 2013)	May have to be used with caution after an abortion, around menarche or menopause, and in conditions which may increase body temperature.