Family planning:

Family planning allows individuals and couples to anticipate and attain their desired number of
children and the spacing and timing of their births. It is achieved through use of contraceptive
methods and the treatment of involuntary infertility. A womans ability to space and limit her
pregnancies has a direct impact on her health and well-being as well as on the outcome of each
pregnancy.

Key facts

An estimated 225 million women in developing countries would like to delay or stop
childbearing but are not using any method of contraception.

Some family planning methods, such as condoms, help prevent the transmission of HIV
and other sexually transmitted infections.

Family planning / contraception reduces the need for abortion, especially unsafe abortion.

Family planning reinforces peoples rights to determine the number and spacing of their
children.

By preventing unintended pregnancy, family planning /contraception prevents deaths of

mothers and children.

Family planning allows people to attain their desired number of children and determine the
spacing of pregnancies. It is achieved through use of contraceptive methods and the treatment of
infertility (this fact sheet focuses on contraception).
Benefits of family planning / contraception

Promotion of family planning and ensuring access to preferred contraceptive methods for
women and couples is essential to securing the well-being and autonomy of women, while
supporting the health and development of communities.
Preventing pregnancy-related health risks in women

A womans ability to choose if and when to become pregnant has a direct impact on her health
and well-being. Family planning allows spacing of pregnancies and can delay pregnancies in
young women at increased risk of health problems and death from early childbearing. It prevents
unintended pregnancies, including those of older women who face increased risks related to
pregnancy. Family planning enables women who wish to limit the size of their families to do so.
Evidence suggests that women who have more than 4 children are at increased risk of maternal
mortality.

By reducing rates of unintended pregnancies, family planning also reduces the need for unsafe
abortion.
Reducing infant mortality

Family planning can prevent closely spaced and ill-timed pregnancies and births, which
contribute to some of the worlds highest infant mortality rates. Infants of mothers who die as a
result of giving birth also have a greater risk of death and poor health.
Helping to prevent HIV/AIDS

Family planning reduces the risk of unintended pregnancies among women living with HIV,
resulting in fewer infected babies and orphans. In addition, male and female condoms provide
dual protection against unintended pregnancies and against STIs including HIV.
Empowering people and enhancing education

Family planning enables people to make informed choices about their sexual and reproductive
health. Family planning represents an opportunity for women to pursue additional education and
participate in public life, including paid employment in non-family organizations. Additionally,
having smaller families allows parents to invest more in each child. Children with fewer siblings
tend to stay in school longer than those with many siblings.
Reducing adolescent pregnancies

Pregnant adolescents are more likely to have preterm or low birth-weight babies. Babies born to
adolescents have higher rates of neonatal mortality. Many adolescent girls who become pregnant
have to leave school. This has long-term implications for them as individuals, their families and
communities.
Slowing population growth

Family planning is key to slowing unsustainable population growth and the resulting negative
impacts on the economy, environment, and national and regional development efforts.
Who provides family planning / contraceptives?

It is important that family planning is widely available and easily accessible through midwives
and other trained health workers to anyone who is sexually active, including adolescents.
Midwives are trained to provide (where authorised) locally available and culturally acceptable
contraceptive methods. Other trained health workers, for example community health workers,
also provide counselling and some family planning methods, for example pills and condoms. For
methods such as sterilization, women and men need to be referred to a clinician.
Contraceptive use

Contraceptive use has increased in many parts of the world, especially in Asia and Latin
America, but continues to be low in sub-Saharan Africa. Globally, use of modern contraception
has risen slightly, from 54% in 1990 to 57.4% in 2014. Regionally, the proportion of women

aged 1549 reporting use of a modern contraceptive method has risen minimally or plateaued
between 2008 and 2014. In Africa it went from 23.6% to 27.6%, in Asia it has risen slightly from
60.9% to 61.6%, and in Latin America and the Caribbean it rose slightly from 66.7% to 67.0%.
Use of contraception by men makes up a relatively small subset of the above prevalence rates.
The modern contraceptive methods for men are limited to male condoms and sterilization
(vasectomy).
Global unmet need for contraception

An estimated 225 million women in developing countries would like to delay or stop
childbearing but are not using any method of contraception. Reasons for this include:

limited choice of methods;

limited access to contraception, particularly among young people, poorer

segments of populations, or unmarried people;

fear or experience of side-effects;

cultural or religious opposition;

poor quality of available services;

users and providers bias

gender-based barriers.

The unmet need for contraception remains too high. This inequity is fuelled by both a growing
population, and a shortage of family planning services. In Africa, 23.2% of women of
reproductive age have an unmet need for modern contraception. In Asia, and Latin America and
the Caribbean regions with relatively high contraceptive prevalence the levels of unmet need
are 10.9 % and 10.4%, respectively (World Contraceptive Reports 2013, UNDESA).
Contraceptive methods
Modern methods

Method

Description

How it works

Effectiveness to
prevent
Comments
pregnancy

Combined

Contains two

Prevents the

>99% with

Reduces risk of

Method

Description

oral
hormones
contraceptive
(estrogen and
s (COCs) or
progestogen)
the pill

How it works

Effectiveness to
prevent
Comments
pregnancy

correct and
release of
consistent use
eggs from the
ovaries
92% as
(ovulation)
commonly used
99% with correct
and consistent
use

Progestogenonly pills
(POPs) or "the
minipill"

Contains only
progestogen
hormone, not
estrogen

Thickens
cervical
mucous to
block sperm
and egg from
meeting and 9097% as
commonly used
prevents
ovulation

Implants

Small, flexible
rods or capsules
placed under
the skin of the
upper arm;
contains
progestogen
hormone only

Thickens
cervical
mucous to
block sperm
>99%
and egg from
meeting and
prevents
ovulation

Progestogen
only
injectables

Thickens
cervical
Injected into the
mucous to
muscle every 2
block sperm
or 3 months,
and egg from
depending on
meeting and
product
prevents
ovulation

Monthly
injectables or
combined
injectable
contraceptive

Injected
Prevents the >99% with
monthly into the release of
correct and
muscle,
eggs from the consistent use
contains
ovaries
estrogen and

>99% with
correct and
consistent use

97% as
commonly used

endometrial and
ovarian cancer

Can be used while

breastfeeding;
must be taken at
the same time
each day

Health-care
provider must
insert and remove;
can be used for 3
5 years depending
on implant;
irregular vaginal
bleeding common
but not harmful
Delayed return to
fertility (about 14
months on the
average) after
use; irregular
vaginal bleeding
common, but not
harmful
Irregular vaginal
bleeding common,
but not harmful

Method

s (CIC)

Description

progestogen

How it works

(ovulation)

Effectiveness to
prevent
Comments
pregnancy
97% as
commonly used

The patch and

the CVR are new
and research on
Continuously
effectiveness is
Combined
releases 2
limited.
contraceptive
Prevents the
hormones a
Effectiveness
patch and
release of
progestin and
studies report
combined
eggs from the
an estrogenthat it may be
contraceptive
ovaries
directly through
more effective
vaginal ring
(ovulation)
the skin (patch)
than the COCs,
(CVR)
or from the ring.
both as
commonly and
consistent or
correct use.

The Patch and the

CVR provide a
comparable safety
and
pharmacokinetic
profile to COCs
with similar
hormone
formulations.

Small flexible
Copper
plastic device
component
Intrauterine
containing
damages
device (IUD):
copper sleeves sperm and
>99%
copper
or wire that is
prevents it
containing
inserted into the from meeting
uterus
the egg

Longer and
heavier periods
during first
months of use are
common but not
harmful; can also
be used as
emergency
contraception

A T-shaped
plastic device
Suppresses
inserted into the
the growth of
Intrauterine
uterus that
the lining of
device (IUD) steadily releases
>99%
uterus
levonorgestrel small amounts
(endometrium
of
)
levonorgestrel
each day

Decreases amount
of blood lost with
menstruation over
time; Reduces
menstrual cramps
and symptoms of
endometriosis;
amenorrhea (no
menstrual
bleeding) in a
group of users

Male condoms Sheaths or

Forms a

98% with correct Also protects

Method

Female
condoms

Description

How it works

Effectiveness to
prevent
Comments
pregnancy

and consistent
barrier to
coverings that
prevent sperm use
fit over a man's
and egg from 85% as
erect penis
meeting
commonly used

against sexually
transmitted
infections,
including HIV

Sheaths, or
90% with correct
linings, that fit
and consistent
Forms a
loosely inside a
use
barrier to
woman's
prevent sperm
vagina, made of
and egg from 79% as
thin,
meeting
commonly used
transparent, soft
plastic film

Also protects
against sexually
transmitted
infections,
including HIV

>99% after 3
months semen
evaluation

Male
sterilization
(vasectomy)

Permanent
contraception to
block or cut the
vas deferens
tubes that carry
sperm from the
testicles

Keeps sperm
out of
ejaculated
semen

3 months delay in
taking effect while
stored sperm is
still present; does
not affect male
9798% with no sexual
performance;
semen
voluntary and
evaluation
informed choice is
essential

Female
sterilization
(tubal
ligation)

Permanent
contraception to
block or cut the
fallopian tubes

Eggs are
blocked from
meeting
sperm

>99%

Voluntary and
informed choice is
essential

Lactational

Temporary

Prevents the

99% with correct A temporary

Method

Description

How it works

contraception
for new mothers
whose monthly
bleeding has not
returned;
release of
amenorrhea requires
eggs from the
method (LAM) exclusive or full ovaries
breastfeeding
(ovulation)
day and night of
an infant less
than 6 months
old
ProgestogenEmergency
only pills taken
contraception to prevent
Prevents
(levonorgestr pregnancy up to ovulation
el 1.5 mg)
5 days after
unprotected sex

Women track
their fertile
periods (usually
Standard
days 8 to 19 of
Days Method
each 26 to 32
or SDM
day cycle) using
cycle beads or
other aids

Effectiveness to
prevent
Comments
pregnancy
and consistent
use

98% as
commonly used

If all 100 women

used progestinonly emergency
contraception,
one would likely
become
pregnant.

95% with
Prevents
pregnancy by consistent and
correct use.
avoiding
unprotected
vaginal sex
during most
fertile days.
88% with
common use
(Arevalo et al
2002)

family planning
method based on
the natural effect
of breastfeeding
on fertility

Does not disrupt

an already
existing
pregnancy

Can be used to
identify fertile
days by both
women who want
to become
pregnant and
women who want
to avoid
pregnancy.
Correct, consistent
use requires
partner
cooperation.

Method

Description

Woman takes
her body
temperature at
the same time
Basal Body
each morning
Temperature before getting
(BBT) Method out of bed
observing for an
increase of 0.2
to 0.5 degrees
C.

TwoDay
Method

Symptothermal
Method

Women track
their fertile
periods by
observing
presence of
cervical mucus
(if any type
color or
consistency)

Women track
their fertile
periods by
observing
changes in the
cervical mucus
(clear texture) ,
body
temperature
(slight increase)
and consistency
of the cervix

How it works

Effectiveness to
prevent
Comments
pregnancy

99% effective
If the BBT has
with correct and risen and has
Prevents
consistent use. stayed higher for
pregnancy by
3 full days,
75%
with
typical
avoiding
ovulation has
unprotected use of FABM
occurred and the
(Trussell,
2009)
vaginal sex
fertile period has
during fertile
passed. Sex can
days
resume on the 4th
day until her next
monthly bleeding.
96% with correct Difficult to use if a
and consistent
woman has a
use.
vaginal infection
Prevents
or another
pregnancy by
condition that
avoiding
changes cervical
unprotected
mucus.
86%
with
typical
vaginal sex
Unprotected coitus
during most or common use. may be resumed
(Arevalo, 2004) after 2
fertile days,
consecutive dry
days (or without
secretions)
Prevents
pregnancy by
avoiding
unprotected
vaginal sex
during most
fertile

98% with correct May have to be

and consistent
used with caution
use.
after an abortion,
around menarche
Reported 98%
or menopause,
with typical use and in conditions
(Manhart et al,
which may
2013)
increase body
temperature.

Method

Description

How it works

Effectiveness to
prevent
Comments
pregnancy

(softening).

Traditional methods

Traditional
Methods
Women monitor
their pattern of
menstrual cycle
over 6 months,
Calendar subtracts 18 from
method or shortest cycle
rhythm
length (estimated
method
1st fertile day) and
subtracts 11 from
longest cycle length
(estimated last
fertile day)

91% with
The couple
correct
prevents
May need to delay or
and
pregnancy by
use with caution when
consistent
avoiding
using drugs (such as
use.
unprotected
anxiolytics,
vaginal sex during
antidepressants,
the 1st and last
NSAIDS, or certain
75%
with
estimated fertile
antibiotics) which may
common affect timing of
days, by
use
abstaining or
ovulation.
using a condom.

Withdrawal Man withdraws his

(coitus
penis from his
interruptus partner's vagina,
)
and ejaculates
outside the vagina,
keeping semen

Tries to keep
sperm out of the
woman's body,
preventing
fertilization

96% with One of the least

correct
effective methods,
and
because proper timing
consistent of withdrawal is often
use
difficult to determine,
leading to the risk of
73% as

Traditional
Methods
away from her
external genitalia

commonly
used
(Trussell,
2009)
ejaculating while
inside the vagina.

WHO response

WHO is working to promote family planning by producing evidence-based guidelines on safety

and service delivery of contraceptive methods, developing quality standards and providing prequalification of contraceptive commodities, and helping countries introduce, adapt and
implement these tools to meet their needs. WHO is also developing new methods to expand
contraceptive choices for men and women.
Purpose:
family planning helps to prevent unwanted pregnancies,reduced illegal abortion,
reduce the number of infant deaths,reduce over population,enables parents to
decide on the number of children, spacing and timing,reduce hiv and sexually
transmmited diseases when using condoms,

18.7 births/1,000 population

note: this rate results in about 255 worldwide births per minute or 4.3 births
every second (2014 est.)
7.89 deaths/1,000 population
Death rate
note: this rate results in about 108 worldwide deaths per minute or 1.8 deaths
every second (2014 est.)
at birth: 1.07 male(s)/female
0-14 years: 1.07 male(s)/female
15-24 years: 1.062 male(s)/female
Sex ratio
25-54 years: 1.022 male(s)/female
55-64 years: 0.955 male(s)/female
65 years and over: 0.802 male(s)/female
total population: 1.014 male(s)/female (2014 est.)
Total fertility rate 2.43 children born/woman (2014 est.)
HIV/AIDS adult prevalence 0.8% (2009 est.)
rate
HIV/AIDS people living
35.3 million (2009 est.)
with HIV/AIDS
Literacy
definition: age 15 and over can read and write
total population: 84.1%
Birth rate

male: 88.6%
female: 79.7%
note: almost three-quarters of the world's 775 million illiterate adults are found
in only ten countries (in descending order: India, China, Pakistan, Bangladesh,
Nigeria, Ethiopia, Egypt, Brazil, Indonesia, and the Democratic Republic of
the Congo); of all the illiterate adults in the world, two-thirds are women;
extremely low literacy rates are concentrated in South and West Asia and SubSaharan Africa (2010 est.)
Fp programs:

Family planning programs are a key component to comprehensive sexual and reproductive
health. They provide essential and often life-saving services to women and their families. By
enabling women to delay pregnancy, avoid childbearing, or space births, effective family
planning programs are not only fundamental to womens health, they also allow women and
families to better manage household and natural resources, secure education for all family
members, and address each family members healthcare needs. The best programs have also been
found to increase equity between women and their partners and enhance communication and
negotiation skills within couples.
Yet recent data shows that an estimated 225 million women globally have an unmet need for
family planning: in other words, they do not wish to have a child at this time, yet are not using
effective contraception. This lack of access to family planning methods is a major contributor to
the preventable deaths of 290,000 women annually due to pregnancy related causes.

During the 1994 International Conference on Population and Development

(ICPD), donor nations recognized the importance of family planning programs to
broader development goals, and agreed to provide one-third of total funding
needed in order to eliminate the unmet need for contraceptives. More
than 20 years later, this commitment is still unrealized.
Awareness:

Fertility awareness-based methods of family planning are those that

depend upon a woman identifying those days during each menstrual
cycle when intercourse is most likely to result in a pregnancy.
Accurate identification of those potentially fertile days is a skill
that requires a woman to apply knowledge about fertility to herself.

This knowledge is referred to as "fertility awareness."

If a woman can identify her potentially fertile days, a couple can

use this information to time intercourse either to avoid or achieve
a pregnancy. Couples who have a basic understanding about their
fertility may be in a better position to understand how family
planning methods work and to choose the most appropriate method for
their circumstances.

If they are using a barrier method or withdrawal, they will

understand more clearly the importance of using their chosen method
consistently and correctly on potentially fertile days. Also, they
will probably understand that most family planning methods will not
affect their long-term fertility.

In addition, a woman who routinely observes her fertility signs,

including bleeding and cervical secretions, is more likely to detect
a change from her usual patterns and may seek health care at an early
stage of a developing health problem.

Not widely available

Fertility awareness can be used effectively with three different

practices during the fertile time: withdrawal, barrier method use,
or abstinence. The term "natural family planning" or NFP is often
used to refer to abstinence during the fertile time.

Some couples prefer to use a barrier method or withdrawal, but only

during the fertile time. For couples at low risk for contacting STDs,
this approach allows them to have unprotected intercourse during part
of the cycle, eliminating the need to use a barrier method during
each act of intercourse. This may be very important in areas where
contraceptives are expensive or the supply is inadequate or
unreliable.

Unfortunately, the majority of family planning programs do not offer

fertility awareness education, which could help couples to use
barrier methods or withdrawal more effectively. For example, many
couples do not use barrier methods or withdrawal consistently. If
couples only needed to use barriers or withdrawal during a few days
of each cycle, their consistent use during those days may improve and
contraceptive effectiveness would improve.

Little scientific information is available about how couples combine

fertility awareness with barrier method use or withdrawal to prevent
pregnancy. Most major surveys worldwide do not collect information
about concurrent use of fertility awareness with barrier methods or
withdrawal. While a few published studies suggest that combining
fertility awareness with the use of barrier methods or withdrawal
during the fertile time is an acceptable alternative to using
barriers or withdrawal all of the time, more research is needed to
test the effectiveness of these approaches.

Better accuracy

In recent decades, it has become possible to identify more accurately

the fertile time, as research using hormonal assays and ultrasound
have demonstrated the relationship between fertility sign patterns
and the start and end of the fertile time.

The main indicators used today are observing cervical secretions,

monitoring basal body temperature, using calendar calculations based
upon cycle length, or using a combination of these indicators.
Research has shown that using a combination of indicators is more
effective than using a single indicator.

As early as the 1800s, researchers recognized the association of

cervical secretions with conception in humans, but it was not until
the 1960s and 1970s that clinical studies were conducted to test the
reliability of using cervical secretions to identify the fertile
time. In the 1920s, researchers observed that a woman's basal body
(resting) temperature rose during the latter part of the menstrual
cycle, but it was not until the 1960s that clinical studies were
conducted to test the accuracy of using basal body temperature to
identify the end of the fertile time.

In the 1930s, researchers discovered that the fertile time occurs for
a few days during the middle of the cycle, and calculations were
developed to identify the fertile time. Since the 1970s, other
"minor" fertility sign indicators have been described ( changes in
the position of the cervix, for example.

New developments

Ways to improve fertility awareness are being developed. For example,

new techniques that do not require daily observation of fertility
signs are being tested to identify the beginning and end of the
fertile time. Newly developed formulas are better able to identify
the fertile time and are easier to use than older calendar rules,
which have existed since the 1930s.

If contraceptive failure rates associated with these new rules can

be shown to be comparable to other user-dependent methods, couples
can be offered a simple and cheap method that does not require
interpreting fertility signs on a daily basis. Field testing must be
done to establish the failure rates of these new rules for
identifying the fertile time. Currently, one of the new rules is
being pilot tested in Brazil.

Home test kits are also being developed to predict ovulation.

Clinical trials are currently under way to evaluate a new home test
device, which determines potentially fertile days by tracking cycle
length and hormone metabolites found in urine. This device, developed
by Unipath, Ltd. in the United Kingdom, features a red and green
light that indicates whether or not a day is potentially fertile.
Although this type of home test kit will introduce new audiences to
fertility awareness-based methods, the cost of the devices may be
prohibitive for many couples in developing countries.

Guidelines need to be developed for combining fertility awareness

with the use of barrier methods or withdrawal. As a first step in

this process, a randomized clinical study is being conducted at the

University of Oxford in the United Kingdom by the authors to
determine the impact of fertility awareness education among condom
users. Patterns of condom use and risk-taking are being evaluated to
determine if fertility awareness education improves the consistent
use of condoms during the highly fertile time in the woman's cycle.

The more options that are available to a couple, the more likely it
is that they will find a method that suits them. If fertility
awareness approaches were more openly discussed in family planning
clinics, couples may be more comfortable about discussing how they
are actually using their methods. Providers would then be in a better
position to counsel couples in how to use their method more
effectively.