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Hesperian Health Guides

Family Planning Methods

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HealthWiki > New Where There Is No Doctor > Family Planning > Family Planning Methods


This book describes several different kinds of common family planning methods. For information about other, less common methods (patch, diaphragm, and others) see chapter 13 of Where Women Have No Doctor, or chapter 17 of A Book for Midwives, both available from Hesperian.

Contents

How to choose a family planning method

The different family planning methods have different advantages and disadvantages. It may be helpful to talk to your partner, other women, or a health worker about the different methods to help you decide which is right for you. Some things you may want to consider when choosing a family planning method are:

  • how well it prevents pregnancy.
  • how well it protects against sexually transmitted infections (STIs).
  • if your partner is willing to use family planning, or if you must hide it from him.
  • if the method is easy to get, and how frequently you must use it.
  • how much the method costs.
  • if there are side effects.
  • if you have other needs and concerns. For example: Are you breastfeeding? Do you have all the children you want?
a priest and a doctor talking to a woman who is thinking.
You have a right to make your own decisions about family planning.


FAMILY PLANNING
METHOD
Protection
from
Pregnancy
Protection
from STIs
How often Other important
information
Condoms

Good Best Every time Most effective when used with a spermicide and a water-based lubricant. A condom needs to be used every time you have sex.
Birth control pill-Combination pill

Very good None Every day Works best if taken at the same time every day. Women who have the health problems listed below should not use this method.
Birth control pill-Minipill

Very good None Every day Will only work if it is taken at the same time every day. Can be used while breastfeeding (start after the baby is 6 weeks old).
Implants

Best None 3 or 5 years Must be inserted and removed by a specially trained health worker and replaced every 3 or 5 years depending on the type.
Injections

Very good None 1, 2, or 3 months Need to be repeated every 1, 2, or 3 months (depending on the type).
IUD

Best None 5 or 12 years Effective for 5 or 12 years (depending on the type). Must be inserted and removed by a specially trained health worker.
Pulling out (withdrawal)

Least None Every time The man needs to withdraw every time you have sex. Even if he pulls out, some liquid from the penis may enter the vagina during sex, which can cause pregnancy or pass STIs.
Breastfeeding (during the first 6 months only) Very good None Several times a day and at night This method is only effective if the woman is feeding her baby only breast milk and if her menstruation has not returned.
Fertility awareness

Good None Every time This method does not work well for women with irregular menstrual cycles.
Sex without intercourse (penis not inside vagina) Best Depends Every time If the penis doesn’t touch the woman’s genitals, she cannot get pregnant. Anal sex can easily pass STIs, oral sex is less likely to pass STIs, and sexual touch rarely passes any.
Sterilization Best None Once Once a man or woman is sterilized, they will never become pregnant or get someone pregnant.


People choose different methods based on their situation.


a woman speaking
I do not want to have to do something every day.
a woman speaking
I do not want to have to put things in my vagina or womb.
You might prefer: Implants, injections, IUD You might prefer: Pills, implants, men’s condom, fertility awareness
You might avoid: Pills, fertility awareness You might avoid: Female condom, IUD
a woman speaking
I don’t want my parents to know I am using birth control.
a woman and a man speaking
I do not want any more children.
Raising 2 children is enough for me.
You might prefer: Injections, condoms You might prefer:Implants, injections, IUD, male or female sterilization
You might avoid: Pills You might avoid: Fertility awareness
a woman speaking
I want to have a child in about a year, but not now.
a man speaking
I have had sex with others and want to protect my wife from HIV.
You might prefer: Condoms, pills, fertility awareness You might prefer: Using a condom each time
You might avoid: Implants, injections, IUD, sterilization You might avoid: Having sex without a condom
The person can use more than one method.
a woman speaking
We use fertility awareness, and on my fertile days, we use condoms to prevent pregnancy.
My girlfriend gets injections and we use condoms to prevent STIs.

Condoms

a man speaking

A condom is a thin latex cover the man wears on his penis during sex. The man’s semen stays inside the condom, so sperm cannot get into the vagina and cause pregnancy. Condoms are safe and have no side effects.

Condoms are also the most effective way to prevent sexually transmitted infections (STIs), including HIV. Even if you are using another method of birth control, you can also use a condom to protect you and your partner from STIs.

Condoms are the only family planning method that is effective at both preventing pregnancy and sexually transmitted infections. But the man must be willing to use one every time he has sex.

Squeeze the tip of the condom and unroll it all the way over the hard penis. The loose condom tip will hold the man’s sperm. (If you do not leave space for the sperm, the condom might break.)

After climaxing, while the penis is still hard, hold the rim of the condom to keep it on your penis while you pull out of the woman’s vagina. Then take the condom off the penis. (Put the condom in the trash – do not just throw it where others will come across it!) Use a new condom each time you have sex.

Female Condom

Inner ring goes inside the vagina.
Outer ring stays outside the vagina.

A female condom fits into the vagina and covers the outer lips of the woman’s vulva. It is bigger than a male condom and less likely to break. Female condoms protect against HIV and other STIs. Do not use a male and female condom together.

Spermicide

Spermicides are foam, tablets, cream, jelly, or flat strips that dissolve in the vagina and kill sperm so they cannot fertilize an egg.

Applicator


Spermicide is put into the vagina just before having sex. It does not work well by itself, but gives extra protection against pregnancy when used along with a condom. Spermicide does not protect against STIs or HIV.

Birth control pills

Birth control pills contain hormones that are similar to the natural hormones in women’s bodies. They prevent pregnancy by stopping the woman’s ovaries from releasing an egg. There are 2 main types of birth control pills: combination pills which contain two hormones, estrogen and progestin, and minipills which contain only progestin. Some common brand names are shown in the section on Oral Contraceptives. Birth control pills do not protect against HIV or other sexually transmitted infections (STIs). To protect yourself, also use a condom.

Some women choose to take the pill because it helps make their cycles more regular, so they know exactly when they will have their period. The pill also lessens the amount of menstrual blood, and reduces cramping and pain.

Birth control pills do not cause cancer.

Combination pills (pills that have estrogen and progestin)

Different brands of combination birth control pills have different doses of these two hormones. There are common combinations for standard dose pills such as is 1 milligram (mg) or less of progestin and 30 or 35 micrograms (mcg) of an estrogen called ethinyl estradiol, or 50 mcg of an estrogen called mestranol.

The minipill is not a combination pill and contains only progestin.

The pill is very effective if taken every day at the same time. It is safe for most women.

How to take the combination pill

woman taking birth control pill.

If you are sure you are not pregnant, you can start taking the pill any time. Pills will not prevent pregnancy until you have been taking them for about a week. So during the first 7 days after starting birth control pills, use condoms or avoid sex.

You must take 1 pill every day to prevent pregnancy, even if you do not have sex on that day. Try to take it at the same time each day. If you keep the pills where you sleep, it may help you remember to take one each night before bed. Most combination pills come in packets of 28 or 21 pills.

Possible side effects of the combination pill

The side effects are not dangerous but some can be annoying. They usually lessen or disappear after about 3 months. Sometimes it helps to try a different brand of pills.

Changes in mood such as being sad or irritable Headaches Unexpected light bleeding between normal bleeding times
Swollen, tender breasts Nausea

Combination pills can be used 3 ways

28-day use: Take the pills with hormones for 21 days and then for 7 days take the reminder pills (the extra pills in the packet that have no hormones) or take no pills. You will have bleeding each month during those seven days like a normal period.

woman taking birth control pill.
If you have a 28 day packet, take 1 pill every day. The last 7 pills are reminder pills that have no hormones – they are there to help you remember to take a pill each day. The last 7 pills in the packet will be a different color than the others.
If you have a 21 day packet, take 1 pill every day for 21 days – the whole packet. Then do not take a pill for 7 days. Then start a new packet.


Extended use: Take the pills with hormones for 84 days in a row and then take a 7 day break. Sometimes pills come in packets with 91 pills (84 with hormones and 7 which are reminder pills that have no hormones). During those 7 days, you will have normal bleeding like a period but only once every 3 months. Spotting (very light bleeding) may occur but should go away after a few months.

Continuous use: Take the pills with hormones every day without taking breaks. If bothered by irregular bleeding, stop taking pills for 3 or 4 days in order to have a few days of regular bleeding, and then start taking the pill again every day.

All of these ways of using combination pills are safe. Anyone using combination pills should know what to do if you miss one or more pills:

If you forget to take 1 or 2 pills, take 1 pill as soon as you remember. Then take the next pill at the regular time. This may mean that you take 2 pills in one day.

If you forget to take 3 pills, 3 days in a row, take 1 pill right away. Then take 1 pill each day at the regular time. Use condoms until you start your period, or do not have sex until you have taken a pill for 7 days in a row.

If your period does not come on time and you have missed some pills, keep taking your pills, but have a pregnancy test. If you find out you are pregnant, stop taking the pill.

Ending the combination pill

You can stop taking the pill at any time. You could then get pregnant right away, so if you want to avoid pregnancy, use condoms or another method.

Who should not take the combination pill

Some women have health problems that make it dangerous for them to use the combination pill. Do not take combination pills if you have:

  • Severe high blood pressure (160/110 or higher). See Heart Disease (in development) for more on high blood pressure.
  • Diabetes for more than 20 years.
  • If you are over 35 and smoke tobacco.
  • Migraines (severe headaches with nausea) if accompanied by numbness or severe vision problems.
  • Breast cancer, liver cancer, or uterine cancer. See Cancer.
  • Gallbladder disease.
  • History of stroke (an attack causing paralysis).
  • A blood clot in a vein (this usually causes swelling and pain in one leg).
  • Liver disease or hepatitis.


Most women with any of these health problems can safely use the progestin-only minipill or progestin-only birth control implants or injections instead. Women with breast cancer or cancer in the womb should not use family planning methods that have hormones, and instead should use another method.

Medicines that interact with combination pills

Rifampicin (a tuberculosis medicine), ritonavir (an HIV medicine) and some epilepsy medicines make birth control pills less effective. If you take these medicines, use a different family planning method. Women who take insulin for diabetes may need to adjust the amount of insulin after starting birth control pills.

Who should consider other methods if available

There are a few other health problems which make the combination pill not an ideal method. It is safer for women with these problems to use another family planning method:

  • High blood pressure (over 140/90). See Heart Disease (in development) for more on high blood pressure.
  • If you are over 35 and have migraine headaches (severe headaches with nausea).


If a woman with these health problems takes the combination pill, monitor her to make sure the problems are not getting worse. If there is no change, it is OK for her to continue using the combination pill. If the problems worsen, she should stop taking the pill immediately.

The Minipill (Progestin-only pills)

This birth control pill does not contain estrogen, only progestin. It is safe for most women who cannot use combined birth control pills and has fewer side effects than combination pills. The minipill does not lessen the milk supply for breastfeeding mothers. Women taking the minipill may have irregular periods, lighter bleeding during periods, or no periods at all.

All the pills in the minipill packet have the same amount of hormone. Take 1 pill every day.

How to take the minipill

Take your first pill on the first day of your period. Then take 1 pill at the same time every day, even if you do not have sex. When you finish a packet, start your new packet the next day, even if you have not had any bleeding. Do not skip a day. Every pill in the packet has the same amount of progestin.

If you take the minipill even a few hours late, or if you forget 1 day’s pill, you can become pregnant. If you miss a pill, take it as soon as you remember. Then take the next pill at the regular time, even if it means taking 2 pills in one day. Use condoms or do not have sex for 7 days. You may bleed a little if you miss your minipill or take it late.

Possible side effects of the minipill

The most common side effect of progestin-only minipills is changes in monthly bleeding. You may have bleeding when you do not expect it. Your period may go away altogether. This is not dangerous. Other possible effects include weight gain, headaches, and acne (pimples).

Medicines that interact with the minipill

Rifampicin (a tuberculosis medicine), ritonavir (an HIV medicine) and some epilepsy medicines make birth control pills less effective. If you take these medicines, use a different family planning method. Women who take insulin for diabetes may need to adjust the amount of insulin after starting birth control pills.

Ending the minipill

If you want to get pregnant or change methods, you can stop taking the minipill at any time. You might be able to get pregnant as soon as you stop, so if you want to avoid pregnancy, start another method immediately.



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