"Family Planning”: An Online Evidence-based Course 2022

Raqibat Idris, MBBS, DO, MPH

Geneva Foundation for Medical Education and Research
Contraceptive methods: overview
Outline
• Definitions
• Key facts about contraception / family planning
• Benefits of family planning and contraception
• Contraceptive methods
• Comparing effectiveness of family planning
methods
• Contraceptive use by method

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Definitions
What is contraception?
Contraception is the intentional prevention of pregnancy by artificial
or natural means.
What is family planning?
Family planning allows individuals and couples to anticipate and attain
their desired number of children and the spacing and timing of their
births. It is achieved through use of contraceptive methods and the
treatment of involuntary infertility.
What is an unmet need for family planning?
An unmet need for family planning is the number of women that want
to stop or delay childbearing but are not using any method of
contraception to prevent pregnancy, including also pregnant women
whose pregnancies were unwanted or mistimed at the time of
conception, and postpartum amenorrhoeic women who are not using
family planning and whose last birth was unwanted or mistimed.
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Training Resource Package for Family Planning – Benefits of Family Planning.
United Nations, Department of Economic and Social Affairs, Population Division. Contraceptive Use by Method 2019: Data Booklet (ST/ESA/SER.A/435). United Nations; 2019.
 Key facts about contraception /
family planning
Among the 1.9 billion Women The proportion of the need
of Reproductive Age group for family planning satisfied
(15-49 years) worldwide in by modern methods, Use of contraception
2019, 1.1 billion have a need Sustainable Development prevents pregnancy-related
for family planning; of these, Goals (SDG) indicator 3.7.1, health risks for women,
842 million are using was 75.7% globally in 2019, especially for adolescent
contraceptive methods, and yet less than half of the need girls.
270 million have an unmet for family planning was met
need for contraception. in Middle and Western Africa.

Contraception offers a range

of potential non-health
Only one contraceptive
Use of contraception benefits that encompass
method, condoms, can
advances the human right of expanded education
prevent both a pregnancy
people to determine the opportunities and
and the transmission of
number and spacing of their empowerment for women,
sexually transmitted
children. and sustainable population
infections, including HIV.
growth and economic
development for countries.
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WHO. Family planning/contraception methods. World Health Organization; 2020.
 Increased risk of having problems during
pregnancy and delivery
Some women have an increased risk of having problems during
pregnancy and delivery. They are women who:
• Are under the age of 18, or over age 35
• Become pregnant less than 2 years after a previous live birth
• Become pregnant less than six months post-abortion or post-
miscarriage
• Have too many children (high parity)
• Have certain existing health problems
• Do not have access to skilled health care

Problems are more likely in those with multiple risk factors.

Training Resource Package for Family Planning – Benefits of Family Planning. 5
Benefits of family planning and
contraception
Reduces unsafe
Prevents maternal Reduces newborn
abortion from
morbidity and and infant
unintended
mortality mortality
pregnancies

Empowers people
Helps to prevent Reduces adolescent
and enhances
HIV/AIDS pregnancies
education

Secures the well-

Contributes to being and
Economic Growth autonomy of
women
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WHO. Contraception: Evidence brief. World Health Organization; 2019.
Contraceptive methods

There are different types of contraception. They can be

short acting or long acting, reversible or permanent.

The different methods of contraception have varying rates

of effectiveness depending on correct usage. (See next few
slides)

Health care providers play an important role in helping

people find and use a method that is both effective and
acceptable.

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 Contraceptive methods
Hormonal Emergency contraception (EC) or postcoital
contraception
 Progestogen-only contraceptives
1. Progestogen-only pills (POPs) 1. Copper-bearing IUDs (Cu-IUD) for EC
2. Progestogen-only injectable 2. Emergency contraceptive pills (ECPs)
contraceptives (POIs)
3. Progestogen-only implants Intrauterine devices (IUDs)
4. Progesterone-Releasing Vaginal Ring 1. Copper-bearing IUDs (Cu-IUD)
2. Levonorgestrel-releasing IUDs (LNG-IUD)
 Combined hormonal contraceptives
Permanent methods
1. Combined oral contraceptives (COCs)
2. Combined contraceptive patch 1. Female sterilization (tubal ligation)
3. Combined contraceptive vaginal ring 2. Male sterilization (vasectomy)
(CVR) Barrier methods
4. Combined injectable contraceptives
(CICs) 1. Male and female condoms
2. Other barrier methods
Spermicides
Fertility awareness methods
1. Standard Days Method (SDM)
2. Others
Lactational amenorrhea method
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WHO. Contraception. World Health Organization; 2021.
 Mechanisms of action and effectiveness of contraceptive methods - 1
Effectiveness: pregnancies per Effectiveness: pregnancies
Method How it works 100 women per year with per 100 women per year
consistent and correct use as commonly used
Combined oral contraceptives Prevents the release of eggs from the 0.3
7
(COCs) or “the pill” ovaries (ovulation)
Thickens cervical mucous to block
Progestogen-only pills (POPs)
sperm and egg from meeting and 0.3 7
or "the minipill"
prevents ovulation
Thickens cervical mucous to blocks
Implants sperm and egg from meeting and 0.1 0.1
prevents ovulation
Thickens cervical mucous to block
0.2
Progestogen only injectables sperm and egg from meeting and 4
prevents ovulation
Monthly injectables or
Prevents the release of eggs from the
combined injectable 0.05 3
ovaries (ovulation)
contraceptives (CIC)
Combined contraceptive patch 7 (for patch)
Prevents the release of eggs from the 0.3 (for patch)
and combined contraceptive 7 (for contraceptive
ovaries (ovulation) 0.3 (for vaginal ring)
vaginal ring (CVR) vaginal ring)
Intrauterine device (IUD): Copper component damages sperm
0.6 0.8
copper containing and prevents it from meeting the egg
Intrauterine device (IUD) Thickens cervical mucous to block
0.5 0.7
levonorgestrel sperm and egg from meeting
Forms a barrier to prevent sperm and
Male condoms 2 13
egg from meeting
Forms a barrier to prevent sperm and 5
Female condoms 21
egg from meeting

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 Mechanisms of action and effectiveness of contraceptive methods - 2
Effectiveness: pregnancies per 100 Effectiveness: pregnancies per
Method How it works women per year with consistent 100 women per year as
and correct use commonly used
Male sterilization (Vasectomy) Keeps sperm out of ejaculated semen 0.1 0.15
Female sterilization (tubal
Eggs are blocked from meeting sperm 0.5 0.5
ligation)
Lactational amenorrhea method Prevents the release of eggs from the
0.9 (in six months) 2 (in six months)
(LAM) ovaries (ovulation)
Prevents pregnancy by avoiding
Standard Days Method or SDM unprotected vaginal sex during most 5 12
fertile days.
Prevents pregnancy by avoiding Reliable effectiveness rates are not
Basal Body Temperature (BBT)
unprotected vaginal sex during fertile available
Method
days
Prevents pregnancy by avoiding
4
TwoDay Method unprotected vaginal sex during most 14
fertile days,
Prevents pregnancy by avoiding
Sympto-thermal Method unprotected vaginal sex during most <1 2
fertile
Prevents or delays the release of eggs < 1 for ulipristal acetate ECPs
Emergency contraception pills
from the ovaries. Pills taken to prevent 1 for progestin-only ECPs
(ulipristal acetate 30 mg or
pregnancy up to 5 days after unprotected 2 for combined estrogen and
levonorgestrel 1.5 mg)
sex progestin ECPs
The couple prevents pregnancy by
Calendar method or rhythm avoiding unprotected vaginal sex during Reliable effectiveness rates are not
15
method the 1st and last estimated fertile days, by available
abstaining or using a condom.
Tries to keep sperm out of the woman's 4
Withdrawal (coitus interruptus) 20
body, preventing fertilization

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WHO. Family planning/contraception methods. World Health Organization; 2020.
 Comparing Effectiveness of Family Planning Methods

More effective
Less than 1 pregnancy per
How to make your
100 women in one year method more effective
Implants, IUD, female sterilization:
After procedure, little or nothing to do or
remember
Vasectomy: Use another method for first
3 months
Injectables: Get repeat injections on time
Lactational Amenorrhea Method (for 6 months):
Breastfeed often, day and night
Pills: Take a pill each day
Patch, ring: Keep in place, change on time

Male condoms, diaphragm: Use correctly every

time you have sex
Fertility awareness methods: Abstain or use
condoms on fertile days. Standard Days Method
and Two-Day Method may be easier to use.

Female condoms, withdrawal, spermicides:

Use correctly every time you have sex
Less effective
About 30 pregnancies per
100 women in one year

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Family Planning: A Global Handbook for Providers (3rd Edition, 2018)
Contraceptive use by method
Estimated numbers of women of reproductive age (15-49 years) using modern and traditional
contraceptive methods, having an unmet need for family planning and no need for family
planning, worldwide, 2019

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Contraceptive Use by Method 2019: Data Booklet (ST/ESA/SER.A/435). United Nations; 2019.
Contraceptive use by method
Estimated numbers of women of reproductive age (15-49 years) using various
contraceptive methods, worldwide, 2019

13
Contraceptive Use by Method 2019: Data Booklet (ST/ESA/SER.A/435). United Nations; 2019.
Contraceptive use by method
Contraceptive prevalence by method among women of reproductive age (15-49
years), by region, 2019

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Contraceptive Use by Method 2019: Data Booklet (ST/ESA/SER.A/435). United Nations; 2019.
Contraceptive use by method
Trends in contraceptive prevalence by method among women of reproductive age
(15-49 years), by region, 1994 and 2019

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Contraceptive Use by Method 2019: Data Booklet (ST/ESA/SER.A/435). United Nations; 2019.
Contraceptive use by method
Estimated numbers of women of reproductive age (15-49 years) using various
contraceptive methods, 1994 and 2019

16
Contraceptive Use by Method 2019: Data Booklet (ST/ESA/SER.A/435). United Nations; 2019.
Contraceptive use by method
Percentage share of contraceptive use for the most common method among women
of reproductive age (15- 49 years), 2019

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Contraceptive Use by Method 2019: Data Booklet (ST/ESA/SER.A/435). United Nations; 2019.
Contraceptive use by method
Estimated prevalence of individual contraceptive methods among women of
reproductive age (15-49 years), 2019 - I

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Contraceptive Use by Method 2019: Data Booklet (ST/ESA/SER.A/435). United Nations; 2019.
Contraceptive use by method
Estimated prevalence of individual contraceptive methods among women of
reproductive age (15-49 years), by country, 2019 - II

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Contraceptive Use by Method 2019: Data Booklet (ST/ESA/SER.A/435). United Nations; 2019.
Contraceptive use by method
Estimated proportions of contraceptive users among women of reproductive age
(15-49 years) using permanent or long-acting modern methods, short-acting modern
methods and traditional methods in 2019, by country and region - I

20
Contraceptive Use by Method 2019: Data Booklet (ST/ESA/SER.A/435). United Nations; 2019.
Contraceptive use by method
Estimated proportions of contraceptive users among women of reproductive age
(15-49 years) using permanent or long-acting modern methods, short-acting
modern methods and traditional methods in 2019, by country and region - II

21
Contraceptive Use by Method 2019: Data Booklet (ST/ESA/SER.A/435). United Nations; 2019.
Contraceptive use by method
Estimated numbers of women of reproductive age (15-49 years) using various
contraceptive methods, by marital status, 2019

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Contraceptive Use by Method 2019: Data Booklet (ST/ESA/SER.A/435). United Nations; 2019.
Family planning and Human Rights
All individuals and couples have the right:
“…to decide freely and responsibly the number,
spacing and timing of their children and to have the
information, education, and means to do so, and
the right to attain the highest standard of sexual
and reproductive health...”
– ICPD Programme of Action

Training Resource Package for Family Planning – Benefits of Family Planning. 23

 References
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United Nations, Department of Economic and Social Affairs, Population Division. Contraceptive Use
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