Community Forum

RH Resources

Program Examples by Region



Site Map

Adolescent Reproductive Health

Cervical Cancer

Family Planning

Gender and Sexual Health

Harmful Traditional Health Practices



Men and Reproductive Health

Refugee Reproductive Health

Reproductive Tract Infections

Safe Motherhood

Family Planning

 Overview/Lessons Learned | Contraceptive Methods | Key Issues
Annotated Bibliography | Program Examples | Links | Presentations

Annotated Bibliography

This is page 2 of the Family Planning Annotated Bibliography. This page contains:

To access more bibliographic entries, visit page 1, page 3, or page 4, or return to the complete list of topics covered in the Family Planning Annotated Bibliography. Be sure to use the Glossary if you are unfamiliar with any of the terms on this page.


Emergency contraception

American College of Obstetricians and Gynecologists (ACOG). Practice Pattern #3: Emergency Oral Contraception. (December 1996).
Based on studies published from 1974 to 1996, ACOG evaluated the safety, efficacy, effects on menstrual cycle, mechanism of action, contraindications, and potential teratologic effects associated with the Yuzpe regimen of emergency contraceptive pills (ECPs). ACOG concluded that there is good evidence to support the use of ECPs. The report concludes that ECPs can be offered with the assurance that they are at least 75% effective, and indicates that while nausea and vomiting may be associated with treatment, use of antiemetic agents prior to administration of each dose will decrease the risk of these effects.

Bellagio Conference on Emergency Contraception. Consensus statement on emergency contraception. Contraception 52 (1995).
This statement reports the outcome of an international meeting on emergency contraception.

Consortium for Emergency Contraception. Emergency Contraceptive Pills: A Resource Packet for Health Care Providers and Programme Managers. Seattle: PATH (1997).
This resource packet contains an extensive array of materials on emergency contraceptive pills (ECPs) including: suggestions for how to adapt resource packet materials for local use; a framework outlining key issues that should be considered before introducing ECPs through family planning, reproductive health, and other delivery systems; questions and answers for decision makers; prototype client brochures that describe in simple language what ECPs are and how they are used; and selected references on key studies that address ECP safety, efficacy and use. Online versions of packet materials are available on the
Consortium website (www.path.org/cec.htm).

Farrell, B. et al. Emergency Contraceptive Pills: A Comprehensive Training Course. Watertown: Pathfinder International Medical Services, Training Module Number 5 (May 1997).
Although well-documented and safe, emergency contraceptive pills (ECPs) have not received significant attention or use until recently. ECPs can play a crucial role in family planning programs, providing a safe method of avoiding unwanted pregnancy after unprotected intercourse, as well as a bridge to continuing contraception. This training module will prepare providers to offer ECP services to family planning clients.

Glasier A, Baird D. The effects of self-administering emergency contraception. New England Journal of Medicine 239(1):1-4 (July 2, 1998).
The authors compared the use of emergency contraceptive pills (ECPs) in 553 women who were provided with a replaceable supply of hormonal emergency contraceptive pills to be taken at home (the treatment group), and 530 women who could obtain ECPs through a doctor (the control group). The study found that the women in the treatment group were no more likely to use emergency contraception repeatedly than the women in the control group, and that nearly all women used emergency contraception correctly. The authors conclude that making emergency contraception more easily obtainable does not pose any risks or increase the likelihood of repeat use. Furthermore, because the efficacy of ECPs decreases over time since unprotected intercourse, increased availability of emergency contraception may reduce the rate of unwanted pregnancies.

International Planned Parenthood Federation (IPPF). International Medical Advisory Panel Statement on Emergency Contraception. IPPF Medical Bulletin 28(6) (December 1994).
This statement on emergency contraception, developed by the International Medical Advisory Panel (IMAP) in 1994, describes the need for emergency contraception and recommends two standard methods: the Yuzpe method of oral contraceptives and the use of copper-releasing intrauterine devices (IUDs). The importance of appropriate counseling and appropriate follow-up are stressed. The IMAP statement also describes various methods of emergency contraception under investigation (in 1994), including levonorgestrel alone and antiprogestins. The IMAP statement recommends that family planning associations should advocate the availability of emergency contraception and, where available, they should advertise it widely so health providers and public will know in advance that it is an option for avoiding pregnancy.

PATH (Program for Appropriate Technology in Health). Emergency contraceptive pills: safe and effective but not widely used. Outlook 14(2) (September 1996) (Available online at www.path.org/outlook/html/14_2.htm).
This article discusses the effectiveness, safety, mode of action, correct use, and service delivery considerations of two of the most commonly used hormonal emergency contraception regimens.

PATH (Program for Appropriate Technology in Health). Emergency contraception update. Outlook 17(1) (April 1999) (Available online at www.path.org/outlook/html/17_1.htm#ecupdate).
This article reviews recent evaluations of emergency contraceptive pills (ECPs), including the 1998 WHO and Glasier studies. Based on the decreased incidence of side effects, the author concludes that the levonorgestrel-only regimen should be the product of choice where available. The article also recommends that programs inform women of the availability of emergency contraception during routine reproductive health care visits, and provide ECPs in advance of need.

PATH (Program for Appropriate Technology in Health). Tools for expanding ECP access. (Available online at http://www.path.org/resources/ec_tools.htm).
This web page describes the PATH's Collaborative Agreement ECP Pilot Project, which aims to make emergency contraceptive pills more readily available to women in Washington State. The program relies on collaborative drug therapy agreements among pharmacists and other contraceptive care providers, such as physicians, that enable women to receive ECPs directly from a pharmacist. During the first 13 months of the project, 9,333 ECP prescriptions were provided to women directly by pharmacists. In May 1999, PATH hosted a workshop to help U.S. states increase access to ECPs directly through pharmacy providers. Materials created for the workshop were designed to help other states develop and implement similar projects and are available for downloading.

Population Council. New clinical trials aim to simplify and expand emergency contraception. New York: Population Council (1999). (Available online at http://www.popcouncil.org/rhpdev/emergencycontraception.html).
In an effort to facilitate the use of emergency contraception, the Population Council has launched a study to learn if the Yuzpe regimen can be simplified and expanded.
The goals of this two-year trial are to evaluate the effectiveness of the active ingredients of oral contraceptive pills as emergency regimens; the possibility of extending the time limit for taking the pills from three days (72 hours) to five days; the need for a second dose; and the relationship between food and nausea during therapy.

Senanayake, P. Emergency contraception: the International Planned Parenthood Federation's experience. International Family Planning Perspectives 22(2) (1996).
Since 1981, the International Medical Advisory Panel (IMPA) position has been that IPPF should recommend that all affiliates provide emergency contraception. This article describes results from a questionnaire mailed to all 136 IPPF affiliates in 1994 gathering information about service-related factors in providing emergency contraception and characteristics of women who request this method. Overall 43 percent of participating family planning associations reported providing emergency contraception. Several important points for expanding access to emergency contraception are discussed.

Trussell, J. et al. The effectiveness of the Yuzpe regimen of emergency contraception. Family Planning Perspectives 28(2) (1996).
This article reviews the results of ten clinical trials of women treated with Yuzpe emergency contraceptive pill (ECP) regimen. The review showed that estimates of ECP efficacy can be compared only when they are based on expected numbers of pregnancies (computed by matching the cycle day of unprotected intercourse relative to ovulation with conception rates specific to that cycle day). The weighted average of the effectiveness rates of all 10 studies was 74.0%.

Van Look, P.F.A. and von Hertzen, H. Research on the new methods of emergency contraception. International Family Planning Perspectives 22(2) (June 1996).
This article defines an ideal emergency contraceptive and reviews new methods that are currently being tested. Ideal method criteria are: ((1) is highly effective, (2) is as safe as other methods, (3) is free of side effects, ((4) does not disturb the menstrual cycle, (4) is easy to administer and (5) is affordable. Levonorgestrel, Danazol, antiestrogens, GnRH Antagonists, and Progesterone inhibition are discussed. The authors conclude that basic research is unlikely to yield any new methods in the near future.

World Health Organization (WHO). Emergency Contraception: A Guide to the Provision of Services . Geneva: WHO (1998).
Millions of unwanted pregnancies and abortions could be avoided if emergency contraceptives were easily accessible. This booklet provides technical and managerial advice on how to introduce emergency contraception into family planning programs (emergency contraception refers to contraceptive methods that can be used by women within a few days after unprotected intercourse to prevent an unwanted pregnancy). This booklet explains how available methods are effective, easy to use, and safe for the majority of women who may need them.

WHO Task Force on Postovulatory Methods of Fertility Regulation. Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. Lancet 352: 428-433 (August 8, 1998).
The World Health Organization (WHO) conducted a double-blind, randomized trial of 1,998 women who requested emergency contraception after one unprotected coitus. Approximately half received levonorgestrel-only ECPs (0.75 mg, repeated 12 hours later), and half received the Yuzpe regimen (100 µ
g ethinyl estradiol plus 0.5 mg levonorgestrel, repeated 12 hours later). The crude pregnancy rate was 1.1% with the levonorgestrel-only regimen and 3.2% with the Yuzpe regimen. The incidence of side effects was significantly lower with the levonorgestrel-only regimen, particularly nausea (23.1% vs. 50.5%) and vomiting (5.6% vs. 18.8%). The study also found that the effectiveness of emergency contraception decreased as the interval between administration and intercourse  increased.

Top of page

Female barrier contraceptives

Elias, C.J. et al. Women-controlled HIV prevention methods. In: AIDS in the World II: Global Dimensions, Social Roots, and Responses, The Global AIDS Policy Coalition. Mann, J. and Tarantola, D. (editors), New York: Oxford University Press (1996).
This chapter provides a succinct review of the state of development of female-controlled methods for preventing STD and HIV transmission. It focuses on the need for further development and evaluation of vaginal barrier methods, clarifies the safety and efficacy of currently available spermicides, and describes some of the new microbicidal vaginal products being developed. The authors conclude that while these strategies are important in the short-term effort to reduce the spread of HIV infection, ultimately long-term strategic investments will be needed to increase the status and ability of women in society to define their sexual relationships.

Family Health International (FHI). Study examines N-9 film effect on STDs; N-9 contraceptive film and the risk of STDs; and Selected research involving N-9 and STDs. Network 17(3):4-8 (Spring 1997). (Available online at www.fhi.org/en/fp/fppubs/network/v17-3/nt1731.html)
These three articles from the Adolescent Reproductive Health issue of Network provide an excellent and timely update on the state of knowledge about Nonoxynol-9 (N-9) film and STD prevention. The first article describes the two-year study of condom users (some of whom also used a spermicide) in Cameroon conducted by FHI. The study concluded that vaginal spermicide film was safe but did not confer any additional protection to women from HIV, gonorrhea, or chlamydia infection beyond the protection already provided by condoms. These findings raise doubts about the additional benefits from using N-9 film. The other two articles provide an excellent overview of what is known about N-9.

Feldblum P. and Joanis C. Modern Barrier Methods: Effective Contraception and Disease Prevention. Family Health International (1994).
This publication provides a thorough review of the safety, effectiveness, and acceptability of male and female barrier methods in an easy-to-use format useful for family planning providers and others interested in these products. Topics covered include: pregnancy prevention, disease prevention, user perspectives, and a review of recent developments in male and female barrier methods.

Kreiss, J. et al. Efficacy of nonoxynol-9 contraceptive sponge use in preventing heterosexual acquisition of HIV in Nairobi prostitutes. Journal of the American Medical Association (JAMA) 268(4) (1992).
This articles describes a randomized controlled trial of N-9 contraceptive sponge use among sex workers in Nairobi. Sponge use did not appear to protect against HIV, and sponge users had a three-fold increase in incidence of genital ulcers. However, sponge users had a 60% reduced risk of gonorrhea.

Niruthisard, S. et al. Use of nonoxynol-9 and reduction in rate of gonococcal and chlamydial cervical infections. The Lancet 339 (1992).
This article presents results of a randomized controlled trial in Bangkok, Thailand, on the effects of N-9 film in preventing chlamydia and gonorrhea infection. Infection rates among 186 women who use N-9 film and condoms were compared to rates among 157 women use used condoms and a placebo film. Results indicated that N-9 film use decreased the rate of gonococcal and chlamydial infection by 25%. The rate of infection declined by 40% among women who used N-9 in more than 75% of sexual acts.

PATH (Program for Appropriate Technology in Health). The Female condom: for men and women. Outlook 15(4) (December 1997) (Available online at www.path.org/outlook/html/15_4_fea.htm#femalecondom).
This article provides a brief summary of the effectiveness of the female condom for pregnancy and STD prevention, user perspectives, availability and cost issues, and program implications. A table of selected acceptability studies from African countries also is included.

PATH (Program for Appropriate Technology in Health). Vaginal douching: unnecessary and potentially harmful. Outlook 15(4) (December 1997) (Available online at www.path.org/outlook/html/15_4_fea.htm#vag).
Vaginal douching is a common practice among women from many cultures. Women douche to treat symptoms of infection, for sexual enhancement, and often for a culturally prescribed sense of "cleanliness" before or after intercourse. This article reviews a recent meta-analysis of studies on douching published within the past 30 years that indicate that frequent douching may be linked to adverse health effects. Although data on the effects of douching are limited, it appears that douching may be more harmful than helpful. Frequent douching seems to be associated with a greater likelihood of STDs, PID, and ectopic pregnancy. Women who douche also experience reduced fertility.

PATH (Program for Appropriate Technology in Health). Vaginal barrier methods: underutilized options? Outlook 11(4) (December 1993).
This article presents current information on the effectiveness, safety, protective effects, and service delivery/use requirements of various vaginal barrier methods. It also describes current efforts to learn more about the effectiveness and acceptability of these methods in developing country settings.

World Health Organization (WHO). Barrier Contraceptives and Spermicides: Their Role in Family Planning Care. Geneva: WHO (1987). Cost: Sw.fr. 15-/US$13.50. Orders from developing countries: Sw.fr. 10.50.
This 80-page book provides practical information on how barrier contraceptives and spermicides can be successfully incorporated into a family planning program. The book outlines the advantages and disadvantages of available barrier methods. Emphasis is placed on information that helps users select the most appropriate and acceptable method, use it correctly and safely; and recognize and address side-effects. Key potential user groups are defined according to factors such as reproductive status, age, current contraceptive method use, and STD risk. Information about sources of supply and quality control also are provided.

World Health Organization (WHO). Barrier Methods: What Health Workers Need to Know. Geneva: WHO (in preparation).
Barrier methods can be an important part of a family planning program's contraceptive method mix. They can help prevent unwanted pregnancy as well as protect against sexually transmitted diseases. Barrier methods may be particularly appropriate for women who cannot or do not wish to use hormonal methods or an IUD and for young women. Method effectiveness varies widely, primarily due to user issues. This booklet focuses on the importance of consistent and correct use, the need for careful client counseling, and the support required for sustained use.

World Health Organization (WHO). The Female Condom: A Review. Geneva: World Health Organization, WHO/HRP/WOM/97.1, (1997)
This paper reviews what is known about the safety, effectiveness, and acceptability of the female condom and explores the public health rationale for considering its introduction. The paper proposes a strategy for introducing the female condom, especially in developing countries, and examines questions of cost and availability.

Top of page

Injectable contraceptives

Lande, R. A new era for injectables. Population Reports K(5) (August 1995) (Available online at www.jhuccp.org/pr/k5edsum.stm).
This issue provides an extensive review of injectable contraception (including the three-month injectable, DMPA (Depo Provera); the two-month injectable, NET EN; and the one-month injectables, Cyclofem and Mesigyna). Topics include research and regulatory approval, effectiveness and reversibility, side effects and complaints, non-contraceptive health benefits, and the user's perspective on injectables. About 12 million couples throughout the world use injectable contraceptives. DMPA is the most widely used.

PATH (Program for Appropriate Technology in Health). Cyclofem: A new once-a-month injectable contraceptive. Outlook 9(4) (January 1992).
This article describes Cyclofem, its use and development, and reports the findings of clinical studies to date. It also discusses how the characteristics of Cyclofem may impact service delivery.

PATH (Program for Appropriate Technology in Health). DMPA: Now More Widely Available. Outlook 10(3) (December 1992).
Since it was first developed as a contraceptive in the early 1960s, more than 30 million women have used DMPA and over 100,000 have taken it for more than 10 years. This article presents a summary of DMPA's effectiveness, acceptability, and safety.

World Health Organization (WHO). Injectable Contraceptives: Their Role in Family Planning Care. Geneva: World Health Organization (1990). Cost: Sw.fr. 21-/US$18.90. In developing countries Sw.fr. 14.70.
This 117-page book presents a comprehensive guide for family planning program mangers considering introducing or expanding access to injectable contraceptives in their program. Emphasis is placed on use of depot-medroxyprogesterone acetate (DMPA) and norethisterone enanthate (NET-EN), the most widely used injectables. The book presents both research results and practical experience and is designed to help service managers understand the service delivery requirements of offering injectable contraceptives, as well as the health benefits to clients. The book provides explicit instructions for sterilization of needles and syringes, the correct technique for performing injections, and the safe disposal of needles and syringes.

World Health Organization (WHO). Injectable Contraceptives: What Health Workers Need To Know. Geneva: World Health Organization (1990)
This booklet reviews injectable contraceptives and the major points health workers need to know. Topics covered include: what injectable contraceptives are and how they work; their effectiveness; client concerns about injectables; appropriate use; and basic elements of high-quality injectable contraceptive services.

Top of page

Copyright 1997-2000, PATH.

Home | About RHO | Topic Areas | RH Resources | Search | Contact