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.
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.
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.
|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.|