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Family Planning Methods

Family planning (FP) is the intentional planning of when to have children, the healthy timing and
spacing of pregnancies, and the ability of couples and individuals to freely choose to use birth
control (or contraceptive) methods and other approaches to implement these plans. While FP is
often used as a synonym for birth control, FP includes a range of approaches including education
on sexuality and reproduction, promotion of good health and nutrition, reproductive health care
and prevention and treatment of sexually transmitted infections (STIs), pre-conception, antenatal,
and postpartum counseling, and management of infertility.
FP methods by category with details on effectiveness and risks and benefits:

Barrier methods
include the male condom and female-controlled methods (spermicides, the
female condom, diaphragm and cervical cap
). The methods can be used alone, in
combination, or with non-barrier types of contraception. Barrier methods are safe with correct
use, have no systemic effects, and are relatively effective for preventing pregnancy. Some offer
varying degrees of protection from STIs when used consistently and correctly. Only the
diaphragm and cervical cap require a clinic visit for proper fitting. Latex condoms (male and
female) provide the best protection against STIs, including HIV. Barrier methods must be used
correctly during every act of intercourse to be effective, and counseling and training can help
facilitate successful use. Condoms in particular require partner participation and communication.
Hormonal Methods include oral contraceptive (OC) pills, Nuvaring, injectables (DMPA and
Net-En), and implants (Norplant)
. OCs and Nuvaring (a vaginal ring that lasts one month)
contain estrogen and progestin and are very effective at preventing pregnancy when used
consistently and correctly. They also provide other health benefits, such as regular menses and
protection against ectopic pregnancy, ovarian and endometrial cancer, and pelvic inflammatory
disease (PID). Progestin-only pills (minipills or POPs) are slightly less effective at preventing
pregnancy and more likely to cause breakthrough bleeding. Pills can be used without the male
partner's knowledge or cooperation. These methods do not offer protection against STIs, and
providers should recommend that women at risk of STIs also use condoms.
Two widely-used progestin-only injectables are DMPA (depot-medroxyprogesterone acetate),
taken every 3 months, and NET-EN (norethisterone enanthate), taken every 2 months. These
methods provide excellent protection against pregnancy but do not protect against STIs. They are
quite safe for young people and, like the pill, have long-term, non-contraceptive benefits,
including decreased risk of PID, ectopic pregnancy, and ovarian and endometrial cancers.
A progestin-only implant, Norplant, is effective for up to five years and is a good method for
women and couples who know they do not want children for several years. Norplant requires a
simple surgical procedure for insertion and removal. Injectables and implants do not require
daily action as OCs do, making them easier to use, especially for young adults. They require a
periodic visit to a clinic or pharmacy, and with no supplies at home, a male partner does not need
to know that a woman is using it. However, the medical visit may be a barrier to access. These
methods often result in irregular bleeding, spotting or amenorrhea and can delay return to
fertility, which may be a source of concern for women and couples.
Intrauterine Devices (IUDs) may be safely used by women who have had proper medical
screening. It is important to counsel women to check for the IUD string regularly, to ensure the
IUD has not been expelled. Women under age 20 who have not borne children may have an
increased risk of expulsions and complications with IUD use. IUDs do not protect against STIs,
and are not recommended for women at increased risk of STIs. The insertion process can
increase the risk of infection in the upper genital tract, leading to PID, and possible infertility.
IUDs are very effective at preventing pregnancy, can last up to 10 years, and are not expensive.
The lactational amenorrhea method (LAM) is a 98% effective method for postpartum family
planning when the three following criteria are met: (1) the mother’s period has not returned; (2)
the baby is fully or nearly fully breastfed and is fed often, day and night; and (3) the baby is less
than six months old. When any of these criteria are not met, the woman is likely to become
fertile again and immediate transition to another method is needed.
Surgical (or non-surgical) sterilization including tubal ligation for females and vasectomy for
males, is a permanent procedure that should be considered irreversible and is only recommended
when individuals or couples have completed having their desired number of children or if there
are medical reasons for preventing further pregnancies. Reversibility is possible but is not always
successful, and such services are not available in many locations.
Abstinence is the most certain way to prevent pregnancy and the transmission of STIs. It should
be discussed as an option for young adults who have not initiated sexual intercourse and for
those who have already begun sexual activity. Abstinence requires commitment, motivation and
self-control, making it difficult for many young adults to achieve. Counseling should focus on
gaining skills to cope with peer and partner pressure, and providers should ensure that youth
have information and access to contraceptive options.
Fertility Awareness and Natural FP methods may be the only options available for some
couples and young adults. In order to use periodic abstinence or withdrawal (coitus
interruptus) successfully, couples must have high motivation, self-control, and good knowledge
of the menstrual cycle, which many couples and young adults do not have. In the months
immediately after menarche, the menstrual cycle is not regular, making periodic abstinence
difficult to practice. Also, periodic abstinence and withdrawal have very high pregnancy rates
compared to other methods of contraception, and neither protects against STIs.
Emergency contraception (EC) requires the use of a regimen of oral contraceptives. Higher
doses of pills should be taken, the first within 72 hours after unprotected intercourse and the
second dose 12 hours later. The dosage is achieved by taking multiple pills, typically four or two
pills depending on the strength. Used correctly, EC prevents about 75 % of pregnancies that
would otherwise occur. EC is an option when couples forget to use a method or use it
incorrectly, experience condom breakage or slippage, have unplanned sex with no method
available, or if a woman is raped. It is not designed or safe to be used as a regular method.


Reading group questions

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