Hesperian Health Guides

Methods for preventing pregnancy

In this chapter:

Women who want to prevent pregnancy can make better decisions about using birth control when they can choose from several methods. They also need correct and clear information about how to use each method and how well the method prevents pregnancy if used correctly. Men are also more supportive of family planning when they know about different methods and how to use them.

In order to use birth control methods correctly, women and men both need to understand their bodies and their sexuality.
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The first step is learning how women’s and men’s genital organs work, how women’s fertility is related to monthly bleeding, and what happens during intercourse. For more information, see Chapter 4: Sexuality and Sexual Health, and Where Women Have No Doctor, Chapter 4.

Any woman who has started monthly bleeding can use contraception. Different women prefer different methods for different reasons at different times in their lives. For example, a woman may prefer one method when she is younger and before she has any children, another method while she is "spacing" the children she wants to have, and another method when she has decided not to have any more children.

Unfortunately, many women are unable to prevent pregnancy when they want to because they do not have correct information about family planning, or they cannot get services that provide methods of birth control.

Different methods for different needs

The best family planning method is one that is effective and is the one a woman is most comfortable using. The information on the next section shows the different types of methods to help a woman decide which one might be best for her.

All birth control methods are more effective when they are used correctly the entire time a woman wants to prevent pregnancy. This can mean using a condom correctly each time she has sex, or always taking a pill at the same time every day. An experienced health worker can help a woman decide which method to use.

Different methods prevent pregnancy in different ways

Barrier methods block a man’s sperm from reaching a woman’s egg. These methods are used each time a woman has sex. They do not cause any changes in a woman’s fertility or monthly bleeding.

Condoms are the only method that both prevent pregnancy and also provide good protection against STIs including HIV. You can combine condoms with hormonal or other more effective methods of birth control.

Family planning method Protection from pregnancy Other important information
for men
Good Most effective when used with spermicide and a water-based lubricant. Available in most places at low or no cost.
Condom for women
Good Do not use together with a male condom.
Diaphragm, cervical cap
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Good Most effective when used with spermicide. Effective only when using the correct size. Requires health worker examination. With regular use, will need replacement after about 5 years.

Hormonal methods temporarily stop a woman’s ovaries from releasing eggs. When a woman stops using a hormonal method, her ovaries will produce eggs again, and she can get pregnant unless she starts using a different method. Hormonal methods can help with irregular bleeding and pain during a woman’s monthly bleeding. Talk with an experienced health worker about how to use correctly and possible side effects.

Family planning method Protection from pregnancy Other important information
Best Effective for 3 to 5 years. Must be inserted and removed by a trained health worker.
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Very good Effective for 1, 2, or 3 months, depending on the type.
Birth control pills
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Very good Most effective when taking 1 pill each day at the same time without missing any pills.

IUDs (intrauterine devices) are small plastic devices inserted in a woman’s womb. IUDs prevent a man’s sperm from fertilizing (joining with) a woman’s egg. An IUD can stay in place for years. When it is removed, the woman will be able to get pregnant.

Family planning method Protection from pregnancy Other important information
Best Effective for 5 to 12 years, depending on the type. Must be inserted and removed by a specially trained health worker.

Permanent methods are operations that make it impossible for a woman’s egg to be fertilized by a man’s sperm. The operation for a man is called "vasectomy." The operation for a woman is often called "sterilization" or "tubal ligation."

Family planning method Protection from pregnancy Other important information
Best A woman or man will never be able to have babies after these operations, but these operations do not affect a man’s or a woman’s sexuality, pleasure, or ability to have sex.
(tubal ligation)

Natural methods are ways of avoiding intercourse (penis inside the vagina) when a woman may be fertile. Sex without intercourse always prevents pregnancy.

Family planning method Protection from pregnancy Other important information
Sex without intercourse (penis not inside vagina at all)
Best Sexual touch rarely passes any STIs. Oral sex is less likely to pass STIs. Anal sex easily passes HIV and other STIs. Always use a condom with anal sex.
Breastfeeding (during the first 6 months only)
Very good To use this method, a woman must give her baby only breast milk, not even water, for the first 6 months, and her monthly bleeding must not have returned yet.
Fertility awareness
Good A woman must know when she is fertile, and she must not have sex with intercourse during her fertile time. Some women use a condom or diaphragm on their fertile days instead of avoiding sex.
Pulling out (withdrawal)
Least Can be hard to do effectively. Even if the man pulls out, some liquid from the penis may enter the vagina during sex, which can cause pregnancy.

Here are some examples of situations and methods that women might prefer:

pairs of women speaking, followed by suggestions for each of them.
I want to keep having normal monthly bleeding.
I do not want to have to do something every day.
You might prefer: Barrier methods, IUD

You might avoid: Implants, injections
You might prefer: Implants, injections, IUD

You might avoid: Pills, natural methods
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I don’t want my parents to know I am using birth control.
I do not want to put things in my vagina or my womb.
You might prefer: Injections, barrier methods

You might avoid: Pills, implants
You might prefer: Hormonal methods, men’s condom, natural methods

You might avoid: Diaphragm, female condom, IUD
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I want to be able to have sex anytime without interruption.
I do not want any more children.
You might prefer: hormonal methods, IUD

You might avoid: Barrier methods, natural methods
You might prefer: Sterilization, implants, injections, IUD

You might avoid: Natural methods, barrier methods, pills
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I want to have a child within a year.
I think my partner has sex with others and may infect me with an STI.
You might prefer: Barrier methods, pills, natural methods

You might avoid: Implants, injections, IUD, sterilization
You might prefer: Male or female condom

You might avoid: Having sex without a condom
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I am breastfeeding my baby. I do not want to have another child for at least 2 years.
My partner does not want to be involved in using a family planning method.
You might prefer: Male or female condom, diaphragm, implants, IUD, mini-pill, progestin-only injection

You might avoid: Combined pill, monthly injections until baby is 6 months old or your monthly bleeding returns
You might prefer: Female condom, diaphragm, hormonal methods, IUD

You might avoid: Male condom, natural methods

Emergency contraception

A woman can use emergency contraception (also called EC and in some places by the brand name, Plan B) to prevent pregnancy after having intercourse without using a birth control method, or if the method was used incorrectly. For example, EC can be used if a condom package has a small hole or tear that might have damaged the condom. Or if the condom broke during sex. Or if a woman forgot to take her pill for more than one day.

Plan B is a high dose of the same hormones in birth control pills, taken once, up to 5 days after having intercourse. It is also possible to take a certain number of some kinds of regular birth control pills if Plan B is not available. The other EC method is an IUD inserted by a specially trained health worker within 5 days after having intercourse.

All women should know about EC and be able to use it if they need to. Many women — especially adolescents — are pressured or forced into having sex without their consent or any kind of planning. EC can also help a woman prevent pregnancy after being raped. Unfortunately, information about EC is not available in many places. If information about EC is not well known in your community, talk with health workers, teachers, and community leaders who are interested in preventing unintended pregnancies, especially among adolescents.

For more information about emergency contraception, see Other Resouces and Chapter 13: Family Planning in Where Women Have No Doctor.

a woman speaking.
We made an action plan to make sure all women in the community, and health workers who may treat women after rape, know how to safely use regular birth control pills for emergency contraception.

Facts and myths about family planning

Myths, rumors, or false information about some types of birth control may make people too afraid to try them, even if they want to. People need correct information so they can choose a method and use it with confidence. You can use examples like the ones here to create skits, role plays, or games that help people sort out the truth from the rumors they hear.

myth: Some people say that birth control pills make women sick.
fact: Many women never feel sick because of their birth control pills, but some women get headaches or feel nauseous when they first start taking pills. This feeling usually goes away after taking pills for 2 months. A woman can often change to another kind of pill that does not cause any feeling of illness.
myth: Some people say family planning methods make women less able or unable to get pregnant later, after they stop using them.

fact: The only family planning method that makes women sterile (permanently unable to get pregnant) is an operation that "closes the tubes" or that removes the womb. Most women can get pregnant right away after they stop using any other kind of birth control. Some women may not be fertile for a few months after they stop taking a hormonal method.

myth: Some people say women cannot get pregnant during their monthly bleeding.

fact: Women can get pregnant any time during their monthly cycle, especially if their monthly bleeding does not happen regularly every 28 days.

myth: Some people say rinsing out the vagina, taking hot baths or showers right after having sex, or having sex standing up can prevent pregnancy.

fact: None of these work at all to prevent pregnancy.
myth: Some people say that a having a vasectomy makes a man weak and unable to please his partner when they have sex.
fact: A vasectomy only stops the man from releasing sperm. It does not affect his feelings or his ability to have sex.

Fun ways to share information about family planning

A group discussion about birth control methods can help everyone understand which methods might be best for women in different situations. Sometimes, simply discussing different methods in groups that include youth, elders, or mothers-in-law helps overcome common obstacles to using family planning.

2 women having a conversation.
Well, if a woman is sure she doesn’t want to have any more children, couldn’t she get an IUD? They last for a long time. Or she could get an operation.
I’ve heard it is much easier for the man to get an operation.

An activity such as Sexy bingo can help people feel more comfortable talking about family planning in a group.

Demonstrating different methods

a group of women looking at and touching birth control items on a table.

One way to learn about birth control is to invite a health worker to demonstrate different methods that are available in your community. Everyone can look at and touch all the different items and share what they know about each of them and how they work. The health worker can talk about how each method works to prevent pregnancy and can answer questions. The health worker can also ask the group to think about which type of family planning might be best for specific situations.

For reliable information about family planning methods, see Other Resources and Chapter 13: Family Planning in Where Women Have No Doctor.

Board games

A board game can be a fun way for a group to discuss both the facts about birth control methods and the reasons why different women may prefer different methods. The discussion that happens during the board game will help the group:

  • test what they know about different family planning methods.
  • explore the reasons why women may prefer different methods.
  • practice giving advice to women about birth control options.
  • find out what women want to learn more about.

Activity A family planning board game

To prepare:
The sample board game shown below shows examples of health fact questions and discussion questions. When you make your own health fact questions, be sure to include myths and misunderstandings that are common in your community (see Facts and myths about family planning for ideas).

illustration of the below: 2 women speaking while playing the game.
But what if Zuhir does not want to wait until Hayat finishes school before they have a baby?
Well, my cousin used family planning without even telling her husband! Hayat could use injections or implants and no one would know.

To play:

When a team or player lands on a discussion question (marked with a "?"), ask them to suggest to the whole group 1 or 2 solutions to the situation on the card, and then explain why they think one solution may be better than others. Invite others in the group to make suggestions too. When they land on a fact question (marked with a "✓") have them answer and ask others if they agree.

After playing the board game, invite the players to talk about something they learned from the activity. Ask if there are other questions related to birth control that the group would like to discuss or learn more about. Use their responses to plan other activities.

Questions for the family planning board game

Health fact questions can help the group learn basic information about different methods for preventing pregnancy. (Answers are shown here, but do not put them on your cards. Instead, write them on a separate sheet of paper to help you remember.)
a stack of health fact cards, with a check mark on the back of each.
a stack of discussion cards, with a question mark on the back of each.
sample game board.
Add comments such as, "Unwanted pregnancy, move back 4 squares" or "Talked to partner about condoms, move forward 2 squares."
sample health fact questions.
Which of these family planning methods works better to prevent pregnancy?

Withdrawal or Condom?

(correct answer: Condom)
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A woman cannot get pregnant if she has sex during her monthly bleeding.

True or False?

(correct answer: False)
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Vasectomy (sterilization for men) takes away men’s desire or ability to have sex?

True or False?

(correct answer: False)
sample discussion questions.
Naomy uses a birth control pill. But her clinic ran out of their supply of pills. The health worker told her that from now on the clinic would have only condoms because the aid organization that supports the clinic will provide no other method. Naomy knows that the men in her village do not like to use condoms. She wants to do something about this problem, but does not know where to begin.

What do you think Naomy could do? Why?
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Maria loves her boyfriend Jorge very much. She has been with him for over a year and recently decided to have sex with him for the first time. They used the withdrawal method. Afterwards, Maria tried to ask Jorge about what birth control methods they should use in the future. But Jorge told her it was a woman’s responsibility to use birth control, not a man’s.

What do you think Maria should do? Why?
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Lata and Raj recently married. Before they were married, Raj had sex with many different women. Lata thinks he still has sex with sex workers when he goes out with his friends. Lata has insisted on using condoms with Raj to protect herself from STIs and pregnancy. But now she wants to have a baby with Raj.

What do you think Lata should do now that she wants to have a baby? Why?

Discussion questions describe real-life situations and look at some of the reasons why women might prefer different methods of family planning. There are no right or wrong answers to these questions. The purpose is to discuss the situation as a group.

This page was updated:05 Jan 2024