Please note: This archive was last updated in 2005.

RHO archives : Topics : Contraceptive Methods

Overview: Meeting Needs Through the Life Cycle

Introduction

Research results and experience worldwide provides clear evidence that family planning benefits the health of women and children (WHO 1994; FHI 1998). Family planning offers freedom from fear of unplanned pregnancy and can improve sexual life, partner relations, and family well-being.

Many contraceptive methods are available, including methods that are short- or long-acting, permanent or reversible, hormonal or nonhormonal, and for use by women or men. When properly provided and used, currently available contraceptives are safe and effective for the vast majority of users. The World Health Organization (WHO), in consultation with medical experts around the world, has developed eligibility criteria for contraceptive use to ensure that women and men have access to safe and high-quality family planning services. (Please see the WHO Eligibility Criteria page for more information.)

Family planning providers play a crucial role when they help clients select an appropriate method from the range of methods supplied by their program. Clients benefit from being offered a choice because they are more likely to find a method that meets their needs. In addition, when clients are given complete information and counseled about their method, they will be better able to use the method effectively and feel confident about its safety. By giving clients appropriate choices, providers help guarantee each couple's right to freely determine the number and spacing of their children. (Please see the Method summaries page for detailed information on each of the various methods.)

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Meeting contraceptive needs through the life cycle

Most healthy women are eligible to use any method of contraception and can select a method that best meets their needs. As a woman moves through the stages of her reproductive life, her contraceptive needs and her health status may change. Not all methods are equally acceptable at each stage of a woman's life. Adolescents, postpartum and postabortion women, breastfeeding women, and women over the age of 35 are groups with special contraceptive and counseling needs. A helpful resource when counseling about the needs of any of the special populations listed below is the Pocket Guide for Family Planning Service Providers (Blumenthal and McIntosh 1996).

Adolescents

Adolescents who are sexually active need access to safe and effective contraception. Many adolescents use no contraception or use a method irregularly, so they are at high risk of unwanted pregnancy, unsafe abortion, and sexually transmitted infections. In general, adolescents are eligible to use any method of contraception. There is some concern, however, that adolescents under age 16 should not use long-acting progestin methods such as Depo Provera or Norplant unless no other acceptable methods are available. (See Table 3 in RHO's Adolescent Reproductive Health section for more information on bone density and other contraceptive options for adolescents.) Adolescents need access to family planning services regardless of their marital status. Services should avoid unnecessary procedures that might discourage or frighten teens, such as requiring a pelvic exam when requesting oral contraceptives.

For more information about providing services to adolescents, please see RHO's Adolescent Reproductive Health section.

Postabortion Women

Women who recently have had an abortion have special health needs that influence their contraceptive options. Providers should be aware of these health issues so they can provide appropriate counseling. Most important, postabortion women may face immediate, acute, and possibly life-threatening medical problems. Women with abortion-related complications need immediate medical attention as well as appropriate information and counseling with respect to family planning once their condition has stabilized.

Postabortion women also experience a rapid return to fertility. WHO has developed a practical guide for program managers to address the needs of these women (WHO 1997). For more information, please see Table 1, which presents information about clinical issues and postabortion contraceptive methods, and Table 2, which includes factors to consider when integrating postabortion family planning into existing systems.

Postpartum Women

Women who recently have given birth also have special health needs that influence their contraceptive options. In postpartum women, return to fertility is influenced by whether the woman is breastfeeding. In women who are not breastfeeding, the first postpartum ovulation may occur anywhere from day 30 to day 90 after delivery. Women who are not breastfeeding or who have weaned their infants are eligible to use any contraceptive method, provided that there are no delivery-related complications and they are screened for existing health conditions.

Breastfeeding women also have special health needs and concerns. They should not use a contraceptive method that will affect breast milk or the health of the infant, such as a combined oral contraceptive or injectable. These methods should be delayed until after six months, unless another, more appropriate method is not available. Progestin-only methods should be delayed until after six weeks, and an IUD may be inserted either within 48 hours of delivery, or after 6 weeks postpartum. For more information, see the article, "Contraception during Breastfeeding" (Anonymous 1998).

Women Over Age 35

Although many women achieve their desired family size by the time they reach 30 years, women remain fertile until menopause, which generally occurs between the ages of 45 and 55 years. Contraception is recommended until one year after menses cease. In addition, women over age 35 may need protection against STIs, including HIV. Access to appropriate and acceptable contraceptives is important for women in their later reproductive years because pregnancy after age 35 carries increased health risks for both the woman and her child. A woman's choice and use of contraceptives during this time may be influenced by whether she wants more children, has existing disease conditions (such as diabetes, hypertension, anemia, or genital tract disorders) or smokes, as well as by her previous experience with contraceptives. For women who are experiencing uncomfortable menopausal symptoms, estrogen-containing hormonal methods may be good choices, as they can alleviate some symptoms. For more discussion of this issue, see Outlook, Volume 14, Number 4.

Because older women are more likely to have pre-existing conditions, family planning programs should provide careful screening and counseling for these women when providing contraception. For more complete information on these recommendations, please refer to WHO's Medical Eligibility Criteria for Contraceptive Use. For information about menopause and aging, see RHO's Older Women section.

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Services for people with chronic health problems

Women and men with chronic or serious health problems still need access to safe and effective contraception. Providing an appropriate contraceptive method for these clients can be complicated since their health condition may limit their contraceptive choices. Providers must know about possible interactions been medical conditions, drugs, and contraceptives, and must be able to provide appropriate counseling. Women who have chronic or serious medical conditions may need medical follow-up and monitoring more often than other women. In balancing the needs and desires of the client, providers need to consider that, for women with serious health conditions that make pregnancy dangerous, providing no contraceptive method would be even more dangerous than providing a method with some health risks.

For more detailed information about providing contraceptives to clients with chronic or serious health conditions, see the section on the WHO eligibility criteria, the 1999 Network issue on contraception and chronic conditions, or the October 1999 IPPF IMAP statement on contraception for women with medical disorders.

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Contraception for HIV-infected women

Women infected with HIV face a variety of reproductive health decisions involving their desire for pregnancy, their contraceptive practice, and choices and decisions if an unintended pregnancy occurs (FHI 2001; IPPF 2001). HIV-infected women should be allowed to make these decisions freely. In both resource-poor and resource-rich countries, women who learned through voluntary testing and counseling programs that they were HIV-positive reported lower levels of desired fertility than did women in the general population. Their knowledge about contraception and access to family planning services may be limited, however. Interventions to offer voluntary family planning can offer these women more control over their reproductive lives and serve as a strategy to prevent perinatal HIV infection.

Male condoms, used consistently and correctly, are effective in preventing HIV transmission within HIV-discordant couples. Female condoms also offer significant protection from STIs, but their use has been limited by cost factors and user acceptability. Other methods of contraception such as hormonal contraceptives and IUDs are effective in preventing unplanned pregnancies, but do not prevent HIV transmission. Recent studies of IUD use by HIV-infected women has not been associated with increased risk of either infection-related complications or HIV cervical shedding (IPPF 2001).

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Related issues

Issues related to the programmatic aspects of contraceptive services are discussed in RHO's Family Planning Program Issues section, which addresses topics such as interpersonal communication and counseling and infection prevention.

For more information about prevention of sexually transmitted infections, see RHO's Reproductive Tract Infections section. For information about particular populations, be sure to visit RHO's Adolescent Reproductive Health, Gender and Sexual Health, Men and Reproductive Health, and Refugee Reproductive Health sections.

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