Family planning/Contraception

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
release of and consistent use Reduces risk of
contraceptives hormones
eggs from the endometrial and
(COCs) or “the (estrogen and 92% as commonly
ovaries ovarian cancer
pill” progestogen) used
(ovulation)
Thickens 99% with correct
cervical and consistent use
Contains only mucous to Can be used while
Progestogen-only
progestogen block sperm breastfeeding; must
pills (POPs) or
hormone, not and egg from 90–97% as be taken at the
"the minipill"
estrogen meeting and commonly used same time each day
prevents
ovulation
Small, flexible Thickens Health-care
rods or capsules cervical provider must insert
Implants placed under the mucous to >99% and remove; can be
skin of the upper block sperm used for 3–5 years
arm; contains and egg from depending on
 progestogen meeting and implant; irregular
hormone only prevents vaginal bleeding
ovulation common but not
harmful
Thickens >99% with correct
Delayed return to
Injected into the cervical and consistent use
fertility (about 1–4
muscle or under mucous to
months on the
Progestogen only the skin every 2 or block sperm
average) after use;
injectables 3 months, and egg from 97% as commonly
irregular vaginal
depending on meeting and used
bleeding common,
product prevents
but 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,
injectable contains estrogen
ovaries 97% as commonly but not harmful
contraceptives and progestogen
(ovulation) used
(CIC)
The patch and the
CVR are new and
research on
Continuously The Patch and the
Combined effectiveness is
releases 2 CVR provide a
contraceptive Prevents the limited.
hormones – a comparable safety
patch and release of Effectiveness
progestin and an and
combined eggs from the studies report that
estrogen- directly pharmacokinetic
contraceptive ovaries it may be more
through the skin profile to COCs with
vaginal ring (ovulation) effective than the
(patch) or from the similar hormone
(CVR) COCs, both as
ring. formulations.
commonly and
consistent or
correct use.

Copper Longer and heavier

Small flexible
component periods during first
plastic device
Intrauterine damages months of use are
containing copper
device (IUD): sperm and >99% common but not
sleeves or wire
copper containing prevents it harmful; can also be
that is inserted
from meeting used as emergency
into the uterus
the egg contraception
Decreases amount
of blood lost with
A T-shaped plastic
Thickens menstruation over
device inserted
cervical time; Reduces
Intrauterine into the uterus that
mucous to menstrual cramps
device (IUD) steadily releases >99%
block sperm and symptoms of
levonorgestrel small amounts of
and egg from endometriosis;
levonorgestrel
meeting amenorrhea (no
each day
menstrual bleeding)
in a group of users
Sheaths or Forms a 98% with correct Also protects
Male condoms coverings that fit barrier to and consistent use against sexually
over a man's erect prevent 85% as commonly transmitted
 penis sperm and used infections, including
egg from HIV
meeting
Sheaths, or 90% with correct
Forms a
linings, that fit and consistent use Also protects
barrier to
loosely inside a against sexually
prevent
Female condoms woman's vagina, transmitted
sperm and 79% as commonly
made of thin, infections, including
egg from used
transparent, soft HIV
meeting
plastic film
>99% after 3 3 months delay in
Permanent months semen taking effect while
contraception to evaluation stored sperm is still
Keeps sperm
block or cut the present; does not
Male sterilization out of
vas deferens affect male sexual
(vasectomy) ejaculated
tubes that carry 97–98% with no performance;
semen
sperm from the semen evaluation voluntary and
testicles informed choice is
essential

Permanent Eggs are

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

Temporary 99% with correct

contraception for and consistent use
new mothers
A temporary family
whose monthly Prevents the
planning method
Lactational bleeding has not release of
based on the
amenorrhea returned; requires eggs from the
98% as commonly natural effect of
method (LAM) exclusive or full ovaries
used breastfeeding on
breastfeeding day (ovulation)
fertility
and night of an
infant less than 6
months old
Emergency If all 100 women
contraception Pills taken to used progestin-
Does not disrupt an
pills (ulipristal prevent pregnancy Delays only emergency
already existing
acetate 30 mg or up to 5 days after ovulation contraception, one
pregnancy
levonorgestrel unprotected sex would likely
1.5 mg) become pregnant.

Women track their Prevents Can be used to

fertile periods pregnancy by 95% with identify fertile days
Standard Days
(usually days 8 to avoiding consistent and by both women who
Method or SDM
19 of each 26 to unprotected correct use. want to become
32 day cycle) vaginal sex pregnant and
 using cycle beads during most women who want to
or other aids fertile days. avoid pregnancy.
Correct, consistent
use requires partner
cooperation.
88% with common
use (Arevalo et al
2002)

99% effective with If the BBT has risen

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

Women monitor their The couple 91% with

May need to delay
pattern of menstrual prevents correct and
or use with caution
cycle over 6 months, pregnancy by consistent
when using drugs
Calendar subtracts 18 from avoiding use.
(such as anxiolytics,
method or shortest cycle length unprotected vaginal
antidepressants,
rhythm (estimated 1st fertile day) sex during the 1st
75% with NSAIDS, or certain
method and subtracts 11 from and last estimated
common antibiotics) which
longest cycle length fertile days, by
use may affect timing of
(estimated last fertile abstaining or using
ovulation.
day) a condom.
96% with
One of the least
correct and
effective methods,
Man withdraws his penis consistent
Tries to keep because proper
from his partner's vagina, use
Withdrawal sperm out of the timing of withdrawal
and ejaculates outside 73% as
(coitus woman's body, is often difficult to
the vagina, keeping commonly
interruptus) preventing determine, leading
semen away from her used
fertilization to the risk of
external genitalia (Trussell,
ejaculating while
2009)
inside the vagina.
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.