FAMILY PLANNING

Family
planning/Contraception
8 February 2018

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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

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

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.

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

Effectiveness to
Method Description How it works Comments
prevent pregnancy

Prevents the >99% with correct

Combined oral Contains two and consistent use Reduces risk of
release of
contraceptives hormones
eggs from the endometrial and
(COCs) or “the (estrogen and
ovaries 92% as commonly ovarian cancer
pill” progestogen)
(ovulation) used

99% with correct

Thickens and consistent use
cervical
Progestogen- Contains only mucous to Can be used while
only pills progestogen block sperm breastfeeding; must
(POPs) or "the hormone, not and egg from 90–97% as be taken at the same
minipill" estrogen meeting and commonly used time each day
prevents
ovulation
Implants Small, flexible rods Thickens >99% Health-care provider
or capsules placed cervical must insert and
under the skin of mucous to remove; can be used
 Effectiveness to
Method Description How it works Comments
prevent pregnancy

the upper arm; block sperm for 3–5 years

contains and egg from depending on implant;
progestogen meeting and irregular vaginal
Thickens
Injected into the cervical >99% with correct Delayed return to
muscle or under mucous to and consistent use fertility (about 1–4
months on the
Progestogen the skin every 2 or block sperm
average) after use;
only injectables 3 months, and egg from
depending on meeting and 97% as commonly irregular vaginal
used bleeding common, but
product prevents
not harmful
ovulation

Monthly >99% with correct

Prevents the
injectables or Injected monthly and consistent use
release of Irregular vaginal
combined into the muscle,
eggs from the bleeding common, but
injectable contains estrogen
ovaries not harmful
contraceptives and progestogen
(ovulation) 97% as commonly
(CIC)
used
The patch and the
CVR are new and
research on
Continuously
Combined effectiveness is The Patch and the
releases 2
contraceptive Prevents the limited. CVR provide a
hormones – a
patch and release of Effectiveness comparable safety and
progestin and an
combined eggs from the studies report that it pharmacokinetic
estrogen- directly
contraceptive ovaries may be more profile to COCs with
through the skin
vaginal ring (ovulation) effective than the similar hormone
(patch) or from the
(CVR) COCs, both as formulations.
ring.
commonly and
consistent or correct
use.
Copper Longer and heavier
Small flexible
component periods during first
Intrauterine plastic device
damages months of use are
device (IUD): containing copper
sperm and >99% common but not
copper sleeves or wire that
prevents it harmful; can also be
containing is inserted into the
from meeting used as emergency
uterus
the egg contraception
Intrauterine A T-shaped plastic Thickens >99% Decreases amount of
device (IUD) device inserted into cervical blood lost with
 Effectiveness to
Method Description How it works Comments
prevent pregnancy

levonorgestrel the uterus that mucous to menstruation over

steadily releases block sperm time; Reduces
small amounts of and egg from menstrual cramps and
levonorgestrel each meeting symptoms of
Forms a 98% with correct
Sheaths or Also protects against
barrier to and consistent use
coverings that fit sexually transmitted
Male condoms prevent sperm
over a man's erect 85% as commonly infections, including
and egg from
penis used HIV
meeting
Sheaths, or linings, 90% with correct
Forms a
that fit loosely and consistent use Also protects against
barrier to
inside a woman's sexually transmitted
Female condoms prevent sperm
vagina, made of 79% as commonly infections, including
and egg from
thin, transparent, used HIV
meeting
soft plastic film
>99% after 3 3 months delay in
months semen taking effect while
Permanent
evaluation stored sperm is still
contraception to Keeps sperm
Male present; does not
block or cut the vas out of
sterilization affect male sexual
deferens tubes that ejaculated
(vasectomy) 97–98% with no performance;
carry sperm from semen
semen evaluation voluntary and
the testicles
informed choice is
essential

Permanent Eggs are

Female Voluntary and
contraception to blocked from
sterilization >99% informed choice is
block or cut the meeting
(tubal ligation) essential
fallopian tubes sperm

Temporary 99% with correct

contraception for and consistent use
Prevents the A temporary family
new mothers
Lactational release of planning method
whose monthly
amenorrhea eggs from the based on the natural
bleeding has not 98% as commonly
method (LAM) ovaries effect of breastfeeding
returned; requires used
(ovulation) on fertility
exclusive or full
breastfeeding day
 Effectiveness to
Method Description How it works Comments
prevent pregnancy

and night of an
infant less than 6
Emergency If all 100 women
contraception Pills taken to used progestin-only
Does not disrupt an
pills (ulipristal prevent pregnancy Delays emergency
already existing
acetate 30 mg or up to 5 days after ovulationcontraception, one
pregnancy
levonorgestrel unprotected sex would likely
1.5 mg) become pregnant.
Can be used to
identify fertile days
by both women who
want to become
Women track their Prevents
95% with consistent pregnant and women
fertile periods pregnancy by
and correct use. who want to avoid
(usually days 8 to avoiding
Standard Days pregnancy. Correct,
19 of each 26 to 32 unprotected
Method or SDM consistent use
day cycle) using vaginal sex
requires partner
cycle beads or during most
cooperation.
other aids fertile days.
88% with common
use (Arevalo et al
2002)

99% effective with

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

Traditional methods

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