Brief overview
Ensuring access for all people to their preferred contraceptive methods advances several human rights including the right to life and liberty, freedom of opinion and expression and the right to work and education, as well as bringing significant health and other benefits. Use of contraception prevents pregnancy-related health risks for women, especially for adolescent girls, and when births are separated by less than two years, the infant mortality rate is 45% higher than it is when births are 2-3 years apart and 60% higher than it is when births are four or more years apart [4]. It offers a range of potential non-health benefits that encompass expanded education opportunities and empowerment for women, and sustainable population growth and economic development for countries.
The number of women desiring to use family planning has increased markedly over the past two decades, from 900 million in 2000 to nearly 1.1 billion in 2020. Consequently, the number of women using a modern contraceptive method increased from 663 million to 851 million and the contraceptive prevalence rate increased from 47.7 to 49.0 per cent. An additional 70 million women are projected to be added by 2030 [5].
The proportion of women of reproductive age who have their need for family planning satisfied by modern contraceptive methods (SDG indicator 3.7.1) has increased gradually in recent decades, rising from 73.6 per cent in 2000 to 76.8 per cent in 2020 [5] .Reasons for this slow increase include: limited choice of methods; limited access to services, particularly among young, poorer and unmarried people; fear or experience of side-effects; cultural or religious opposition; poor quality of available services; users’ and providers’ bias against some methods; and gender-based barriers to accessing services. As these barriers are addressed in some regions there have been increases in demand satisfied with modern methods of contraception
Contraceptive methods
Methods of contraception include oral contraceptive pills, implants, injectables, patches, vaginal rings, Intra uterine devices, condoms, male and female sterilization, lactational amenorrhea methods, withdrawal and fertility awareness based methods. These methods have different mechanisms of action and effectiveness in preventing unintended pregnancy. Effectiveness of methods is measured by the number of pregnancies per 100 women using the method per year. Methods are classified by their effectiveness as commonly used into: Very effective (0–0.9 pregnancies per 100 women); Effective (1-9 pregnancies per 100 women); Moderately effective (10-19 pregnancies per 100 women); Less effective (20 or more pregnancies per 100 women)
Mechanisms of action and effectiveness of contraceptive methods [6]
| Method | How it works | Effectiveness: pregnancies per 100 women per year with consistent and correct use | Effectiveness: pregnancies per 100 women per year as commonly used |
|---|---|---|---|
| Combined oral contraceptives (COCs) or “the pill” | Prevents the release of eggs from the ovaries (ovulation) | 0.3 | 7 |
| Progestogen-only pills (POPs) or "the minipill" | Thickens cervical mucous to block sperm and egg from meeting and prevents ovulation | 0.3 | 7 |
| Implants | Thickens cervical mucous to blocks sperm and egg from meeting and prevents ovulation | 0.1 | 0.1 |
| Progestogen only injectables | Thickens cervical mucous to block sperm and egg from meeting and prevents ovulation | 0.2 | 4 |
| Monthly injectables or combined injectable contraceptives (CIC) | Prevents the release of eggs from the ovaries (ovulation) | 0.05 | 3 |
| Combined contraceptive patch and combined contraceptive vaginal ring (CVR) | Prevents the release of eggs from the ovaries (ovulation) | 0.3 (for patch) 0.3 (for vaginal ring) | 7 (for patch) 7 (for contraceptive vaginal ring) |
| Intrauterine device (IUD): copper containing | Copper component damages sperm and prevents it from meeting the egg | 0.6 | 0.8 |
| Intrauterine device (IUD) levonorgestrel | Thickens cervical mucous to block sperm and egg from meeting | 0.5 | 0.7 |
| Male condoms | Forms a barrier to prevent sperm and egg from meeting | 2 | 13 |
| Female condoms | Forms a barrier to prevent sperm and egg from meeting | 5 | 21 |
| Male sterilization (Vasectomy) | Keeps sperm out of ejaculated semen | 0.1 | 0.15 |
| Female sterilization (tubal ligation) | Eggs are blocked from meeting sperm | 0.5 | 0.5 |
| Lactational amenorrhea method (LAM) | Prevents the release of eggs from the ovaries (ovulation) | 0.9 (in six months) | 2 (in six months) |
| Standard Days Method or SDM | Prevents pregnancy by avoiding unprotected vaginal sex during most fertile days. | 5 | 12 |
| Basal Body Temperature (BBT) Method | Prevents pregnancy by avoiding unprotected vaginal sex during fertile days | Reliable effectiveness rates are not available | |
| TwoDay Method | Prevents pregnancy by avoiding unprotected vaginal sex during most fertile days, | 4 | 14 |
| Sympto-thermal Method | Prevents pregnancy by avoiding unprotected vaginal sex during most fertile | <1 | 2 |
| Emergency contraception pills (ulipristal acetate 30 mg or levonorgestrel 1.5 mg) | Prevents or delays the release of eggs from the ovaries. Pills taken to prevent pregnancy up to 5 days after unprotected sex | < 1 for ulipristal acetate ECPs 1 for progestin-only ECPs 2 for combined estrogen and progestin ECPs | |
| Calendar method or rhythm method | The couple prevents pregnancy by avoiding unprotected vaginal sex during the 1st and last estimated fertile days, by abstaining or using a condom. | Reliable effectiveness rates are not available | 15 |
| Withdrawal (coitus interruptus) | Tries to keep sperm out of the woman's body, preventing fertilization | 4 | 20 |
[1] Kantorová V, Wheldon MC, Ueffing P, Dasgupta ANZ (2020) Estimating progress towards meeting women’s contraceptive needs in 185 countries: A Bayesian hierarchical modelling study. PLoS Med 17(2):e1003026. https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003026
[2] United Nations, Department of Economic and Social Affairs, Population Division. Family Planning and the 2030 Agenda for Sustainable Development. New York: United Nations. https://www.un.org/en/development/desa/population/publications/pdf/family/familyPlanning_DataBooklet_2019.pdf
[3] Family Planning Can Reduce High Infant Mortality Levels. Guttmacher Institute. https://www.guttmacher.org/sites/default/files/report_pdf/ib_2-02.pdf[4] Family Planning Can Reduce High Infant Mortality Levels. Guttmacher Institute. https://www.guttmacher.org/sites/default/files/report_pdf/ib_2-02.pdf
[5] United Nations Department of Economic and Social Affairs, Population Division (2020). World Family Planning 2020 Highlights: Accelerating action to ensure universal access to family planning (ST/ESA/SER.A/450).
[6] Family Planning: A Global Handbook for Providers. 2018 World Health Organization and Johns Hopkins Bloomberg School of Public Health. https://apps.who.int/iris/bitstream/handle/10665/260156/9780999203705-eng.pdf?sequence=1