Family Planning Methods

Once you have decided to use family planning, you must choose a method. To make a good decision you must first learn about the different methods, and their advantages and disadvantages.

There are 5 main types of family planning methods:

1. Barrier methods, which prevent pregnancy by keeping the sperm from reaching the egg.

Barrier methods prevent pregnancy by blocking the sperm from reaching the egg. They do not change the way the woman’s or man’s body works, and they cause very few side effects. Barrier methods are safe if a woman is breastfeeding. Most of these methods also protect against STIs, including HIV. When a woman wants to become pregnant, she simply stops using the barrier method.

The most common barrier methods are the condom, condoms for women, the diaphragm, and spermicides.

2. Hormonal methods, which prevent the woman’s ovary from releasing an egg, make it harder for the sperm to reach the egg, and keep the lining of the womb from supporting a pregnancy. These includes injections, pills and implants which are put into a woman's arm.

Hormonal methods work by preventing the woman’s ovaries from releasing an egg. The hormones also make the mucus at the opening of the womb very thick, which helps stop the sperm from getting inside the womb.

Most birth control pills and some injections contain both estrogen and progestin. These are called ‘combination’ pills or injections. The two hormones work together to give excellent protection against pregnancy. However, some women should not use pills or injections with estrogen for health reasons, or because they are breastfeeding (see Who should not take combined pills).

Progestin-only pills (also called mini-pills), implants, and some injections contain only one hormone—progestin. These methods are safer than combined pills or injections for women who should not use estrogen, or are breastfeeding.

These women should avoid ANY kind of hormonal method:
» Women who have breast cancer, or a hard lump in the breast. Hormonal methods do not cause cancer. But if a woman already has breast cancer, these methods can make it worse.

» Women who might be pregnant or whose monthly bleeding is late.

» Women who have abnormal bleeding from the vagina during the 3 months before starting hormonal methods. They should see a health worker to find out if there is a serious problem.

Note: Some medicines for seizures (“fits”), for tuberculosis (TB), or for HIV make hormonal methods less effective. A woman taking these medicines should use another family planning method or combine it with a second method such as a condom or a diaphragm.

Some hormonal methods are harmful for women with other health problems. Be sure to check each method to see if it is safe for you. If you have any of the health problems mentioned and still wish to use a method, talk to a health worker who has been trained in hormonal methods of family planning.

3. IUDs, which prevent the man’s sperm from fertilizing the woman’s egg.

*The IUD (IUCD, Copper-T) is a small object or device that is inserted into the womb by a specially trained health worker or midwife. Once in the womb, the IUD prevents the man’s sperm from fertilizing the woman’s egg. The IUD can stay in the womb for up to 10 or 12 years (depending on the kind of IUD it is) before it must be removed and replaced. An IUD can be used without the man knowing you are using it (although sometimes a man can feel the strings).

The most common IUDs are made of plastic, or plastic and copper.

*Progestin IUD (Mirena, Levonova) This kind of IUD also contains the hormone progestin and is available in some countries. Progestin decreases the pain and bleeding that some women have with the IUD. It protects against pregnancy for 5 years.

4. Natural methods, which help a woman know when she is fertile, so that she can avoid having sex at that time.

There are also 3 methods to avoid pregnancy that do not require any devices or chemicals (as with barrier methods) or medicines (as with hormonal methods). The methods are:

»breastfeeding for the first 6months
»the mucus method
»the counting days method

¤ Traditional Methods ¤
Every community has traditional methods to prevent or stop pregnancy. Many of these can be very useful in limiting the number of children a couple has, although they are usually not as effective as modern methods. But some traditional methods are not effective at all, and some can even be very harmful.

Traditional methods that work

* Withdrawal or pulling out (coitus interruptus). With this method, a man pulls his penis out of the woman and away from her genitals before he ejaculates. This method is better than no method, but it does not always work. Sometimes a man is not able to pull out before he ejaculates. Even if the man pulls out in time, some liquid that contains sperm can leak out of his penis before ejaculation and cause pregnancy.

* Separating partners after childbirth. In many communities, couples do not have sex for months or years after the birth of a baby. This allows the mother to give more time to the care of the new baby and to regain her strength without fear of pregnancy.

* Sex without intercourse. There are also ways to have sex that do not cause pregnancy. Oral sex (mouth on genitals) and sexual touch (touching the genitals or other parts of the body) are both sexual activities that many couples enjoy. They have very low risk of passing HIV and other STIs. Anal sex also cannot cause pregnancy, although HIV and other STIs can pass very easily this way.

Avoiding all sexual intercourse (the man’s penis inside the woman’s vagina) is the surest way to prevent pregnancy, although it may be difficult to practice for a long time.

Traditional methods that do not work or can be harmful:
»Omens and magic do not prevent pregnancy.
» Putting grasses, leaves, pods, and dung in the vagina can cause infection and irritation.
» Washing out the vagina (douching) with herbs or powders does not prevent pregnancy. Sperm move very fast and some will reach the inside of the womb before they can be washed out.
» Urinating after sex does not prevent pregnancy. (But it can help to prevent infections of the urine system.)

5. Permanent methods. These are operations which make it impossible for a man or a woman to have any children.

Sterilization (the operation for no more children) for men is called vasectomy while that done for women is called tubal ligation
There are operations that make it almost impossible for a man or a woman to have any children. Since these operations are permanent, they are only good for those women or men who are certain that they do not want any more children.

To have one of these operations, you must go to a health center or hospital. The surgery is fast and safe, and does not cause side effects.

Reference: Hesperian Health Guides (2014). Family Planning