Choosing a family planning method

On the following pages we describe different family planning methods. Before recommending a method, find out about the woman's needs.

• Does she want to be sure she will not get pregnant using this method?

• Is she concerned about side effects (uncomfortable and unintended effects)?

• Does she want a method she does not have to think about every day —

or can she use a method that requires keeping charts or taking a pill each day?

• Is the woman's partner willing to cooperate in using family planning?

• How much can this woman spend on family planning?

• Does the woman want a method that she can stop using if she wants to become pregnant — or one that is permanent?

• Does she need a method that prevents sexually transmitted infections (STIs)?

The methods described in this chapter work well to prevent pregnancy. Each of these methods also has disadvantages. The woman and her partner may need instruction on how to use the method. The method may cost something, it may require a medical visit, or it may have certain health risks. Make sure you understand how comfortable, safe, costly, or complicated each method is before you recommend it. Make sure the woman understands too.

Consider STI protection along with pregnancy prevention

When thinking about family planning it is important to also think about HIV and other STIs. Sexual intercourse, which causes pregnancy, is also how STIs are passed. Some family planning methods, like condoms, help prevent pregnancy and protect against STIs. Some, like birth control pills and intrauterine devices (IUDs), only prevent pregnancy.

When you are helping a woman choose a family planning method, you must help her think about her risk of STIs including HIV. See Chapter 18 to learn more about STIs.

f Condoms will I protect me from I infections too?

f Condoms will I protect me from I infections too?

On the next page is a chart that shows how well each method works to prevent pregnancy and to protect against STIs. The chart also shows what the possible side effects are for each method, and other important information about how the method must be used. Each method has stars to show how well it prevents pregnancy for the average user. When a man and a woman use a method correctly every time they have sex, the method will work better.


Protection from pregnancy

Protection from STIs

Possible side effects

Other important information

Condom for

Condom for women ftr


(with spermicide)


Hormonal methods

Birth control pill, patch, injections

Sex without intercourse

(penis not inside vagina at all)


(during the first 6 months only) lps>


Fertility awareness






Pulling out













skin allergy headaches, changes in monthly bleeding

â-, heavy and painful ' UJ'' monthly bleeding y* yeast or /¡V. bladder infections

Most effective when used with spermicide and lubricant.

Less effective when the woman is on top of the man during sex.

Most effective when used with spermicide.

More effective when used with another barrier method like diaphragm or condom.

These methods may be dangerous for women with certain health problems.

This method may be dangerous for women with certain health problems.

Some couples, especially young people, may have a hard time using this method.

To use this method, a woman must give her baby only breast milk, and her monthly bleeding must not have returned yet.

To use this method correctly, a woman must understand when she is fertile.

Women or men will never be able to have babies after this operation.

More effective when used with another method like spermicide or diaphragm.

Less effective for women who have had children.


headaches, changes in monthly bleeding

Condom for men (rubber or prophylactic)

A condom is a narrow bag of thin rubber that the man wears on his penis while having sex. The bag traps the man's sperm (seed) so that it cannot get into the woman's vagina or womb. Condoms work well to prevent pregnancy. Condoms also help prevent sexually transmitted infections (STIs), including HIV.

The most effective condoms are made from latex or polyurethane — not sheepskin.

A new condom must be used each time a couple has sex.

Lubricant can make sex feel better for both the woman and the man. It can also keep the condom from breaking. Use a water-based lubricant like saliva (spit), K-YJelly, or spermicide. Do not use oils, petroleum jelly (Vaseline), skin lotions, or butter. They can make the condom break. A drop of lubricant inside the tip of the condom makes it more comfortable on the penis. A little lubricant can also be rubbed on the outside of the condom after the man puts it on.

Condom for women (female condom)

A female condom fits into the vagina and covers the outer lips of the genitals. Each condom should be used only once, because it may break if it is reused. But if a woman does not have any other condoms, she can clean it and reuse it up to 5 times. The female condom should not be used with a male condom.

The female condom is the most effective of the methods controlled by women in preventing pregnancy and protecting against STIs, including HIV.

Female condoms can be expensive and take time to learn to use. They work best when the man is on top and the woman is on the bottom during sex.

3 types of female condoms are now available. The newest are less expensive. The VA female condom fits more closely to the woman's body, so it is more comfortable and makes less noise during sex.

How to use a male condom

A new condom should come rolled up inside a small packet that has not been opened. Be careful not to tear the condom as you open the packet. If the condom is stiff, hard or feels sticky, throw it away. It will not work.

1. A condom should be put on the man's penis when it is hard, and before it touches the woman's genitals. An uncircumcised man should pull his foreskin back. The man should squeeze the tip of the condom and put it on the end of the penis.

2. Unroll the condom until it covers all of the penis. Keep squeezing the tip of the condom while unrolling. Without this extra space at the tip for the sperm, the condom may break.

3. Right after the man ejaculates (comes) and before his penis gets soft, he should hold on to the rim of the condom while he pulls his penis out of the vagina. Then he should carefully take the condom off.

4. Tie the condom shut. Then throw it in the garbage or a latrine

4. Tie the condom shut. Then throw it in the garbage or a latrine

How to use a female condom

1. Carefully open the packet without tearing the condom.

■ inner ring outer ring outer ring

2. Find the smaller inner ring, which is at the closed end of the condom.

3. Squeeze the inner ring together.

4. Put the inner ring in the vagina.

5. Use your finger to push the inner ring up into your vagina and over the cervix. The outer ring stays outside the vagina.

6. Be sure to guide the penis through the outer ring when you have sex.

7. Remove the female condom immediately after sex, before you stand up. Squeeze and twist the outer ring to keep the man's sperm inside the condom. Pull the condom out gently, then bury it or throw it in a latrine. Do not flush it down the toilet.


The diaphragm is a shallow cup of soft rubber that the woman wears in her vagina during sex. The diaphragm covers the cervix so that the man's sperm cannot get into her womb. The diaphragm should be used with spermicide (see page 305). When a diaphragm is used correctly, it is effective in preventing pregnancy and may also give some protection against STIs, like HIV.

Diaphragms come in different sizes. A health worker must help a woman find the right size. Midwives can learn to fit women for diaphragms. It is easy to do once you have been trained.

How to use a diaphragm

1. Squeeze some spermicide into the center of the diaphragm. Then spread a little around the edge of the diaphragm. If you do not have spermicide, you can still use the diaphragm, but it may not work as well.

2. Squeeze the diaphragm in half.

3. Push the M diaphragm into m the vagina, W right over the r ^B cervix. V ]

\lk M Vsià Ki

If the diaphragm is in correctly, the woman can feel her cervix through it.

4. Leave the diaphragm in place for at least 6 hours after sex. If the woman has sex again before 6 hours have passed, she should put more spermicide in her vagina first.

After using the diaphragm, the woman should wash it in mild soap and water. Then she should dry it, dust it in cornstarch if she has any, and store it in a clean, closed container.

Spermicide (foam, jelly, cream, or tablets)

A spermicide is a chemical that kills sperm after it comes out of the penis. Spermicides are fairly good at preventing pregnancy when used alone, and are very effective when used with a condom or diaphragm.

WARNING! A woman should use spermicide only if she knows that her partner does not have HIV.

Most spermicide is made with a chemical called Nonoxynol 9. Nonoxynol 9 irritates the vagina, causing tiny cuts. These cuts allow HIV to pass more easily into the blood. So using spermicide, especially using it very often, may actually make HIV more likely to pass during sex.

How to use spermicide

The woman puts the spermicide in her vagina. Foam or jelly is put in with an applicator. Tablets (suppositories) are put deep in the vagina with the fingers.

Spermicides should be put in the vagina no more than half an hour before having sex. Spermicide must be left in the vagina for at least 6 hours after having sex. A woman needs to put in more spermicide each time she has sex.

Foam Tablets And Jelly

cream or jelly tablets cream or jelly tablets

Hormonal methods

Birth control pills, injections, and implants contain hormones. Hormones are chemicals that a woman's body normally makes. Hormones regulate many processes in a woman's body including her monthly bleeding and her ability to become pregnant. Hormonal methods of family planning prevent pregnancy by stopping the woman's ovaries from releasing eggs into her womb. Some hormonal methods include:

pills injections implants pills injections implants

New hormonal methods are still being invented. Some newer methods are a contraceptive patch, a ring (worn around the cervix), and a hormonal IUD.

Hormonal methods are very effective in preventing pregnancy. But none of them used alone protect women against HIV or other STIs.

Most birth control pills and some injections contain two hormones: estrogen and progestin. Implants, some pills, and some injections contain only progestin.

Some women should not use a method that contains estrogen.

These women should use progestin-only methods:

• Women who are breastfeeding, especially in the first 8 weeks after the birth. Estrogen makes the breasts produce less milk. Also, estrogen passes through the breast milk, but after 8 weeks it is safe for the baby.

• Women who have high blood pressure that is not controlled by medicine.

• Women who have diabetes.

• Women who have epilepsy.

• Women who have ever had a stroke, paralysis, or heart disease.

• Women who have hepatitis or liver problems (yellow skin and eyes).

• Women who have ever had a blood clot in the veins (this usually causes a deep and steady pain in one leg or hip). Varicose veins (swollen veins) are usually not a problem.

• Women who get migraine headaches (especially with vision changes). Some women should not use any hormonal method.

• Women who have ever had cancer of the breast or uterus.

• Women who might be pregnant already.

• Women who have very heavy monthly bleeding, monthly bleeding that lasts for more than 8 days, or bleeding from the vagina from an unknown cause.

These women should not use pills, injections, implants, or any other hormonal method.

Side effects

Hormonal methods sometimes have side effects. These effects are not dangerous, but they are often uncomfortable. Hormonal methods can make a woman have:

headaches weight gain headaches weight gain swelling of the breasts changes in monthly bleeding

These effects usually get better after a few months. If they do not get better, the woman can try a different family planning method.

changes in monthly bleeding

Birth control pills (oral contraceptives or "the pill")

Birth control pills have all the benefits and problems of hormonal methods listed on page 306.

When a woman takes a birth control pill at the same time every day, this method is one of the most effective ways to avoid pregnancy.

There are many brands of birth control pills. Pills should be "low-dose." That means they should have 35 micrograms (mcg) or less of estrogen, and 1 milligram (mg) or less of progestin. Women should never use pills with more than 50 mcg of estrogen.

28-day pill packet

28-day pill packet

How to take birth control pills

A woman should take the first pill in a packet on the first day of monthly bleeding. If that is not possible, she should take the first pill anytime in the first 7 days after she starts her monthly bleeding.

Pills come in packets of 21 or 28 tablets. If a woman is using a 28-day packet, she should take one pill every day. Women will usually have light monthly bleeding during the last 7 days of a pill packet. As soon as she finishes one packet, she should begin taking a new one.

(The last 7 pills in a 28-day packet are made of sugar. They have no hormones in them. Women take these pills to remember to take a pill each day.)

If a woman prefers not to bleed every month, it is safe to take only the hormone pills continuously for up to 3 months. When the woman reaches week 4 of her packet (the sugar pills) she can immediately begin a new packet of pills instead of taking the sugar pills. Then continue taking the hormone pills in the usual order.

If a woman is using a 21-day packet, she should take one pill every day for 21 days. She should then wait 7 days before starting a new packet. Usually, a woman will start her monthly bleeding after the 21st day. But even if she does not, she should start a new packet in 7 days.

The pills will not prevent pregnancy immediately. So during the first 7 days on pills, the woman should use condoms or some other backup method to avoid pregnancy.

It is best to take the pill at about the same time every day. Many women take the pill with food, especially if they feel some nausea during the first few months that they take it.

21-day pill packet

21-day pill packet

What if a woman forgets to take her pill?

If a woman forgets to take 1 or 2 pills, she should take 1 as soon as she remembers. Then she should take the next pill at the regular time — even if she must take 2 pills in one day.

If a woman forgets to take 3 pills, 3 days in a row, she should take 1 pill right away. Then she should take 1 pill each day at her regular time.

If she is using a 28-day packet of pills, she should only take the hormonal pills, and should skip the sugar pills. If she is taking a 21-day packet of pills, she should start a new packet as soon as she finishes the one she is taking now.

To prevent pregnancy, she should use condoms any time she has sexual intercourse within 7 days of missing her pills.

^ Remember: Birth control pills will not be effective if they are only taken some of the time. A woman who uses birth control pills must take one pill every day, at the same time of day — even if she is taking other medicine, eating special foods, or is ill.

I took the every day — except when I had a cold!

fl took the piir\ every day — except when l ate pork!

Sometimes I just forgot!

I took my pill every day — no matter what!

fl took the piir\ every day — except when l ate pork!

Sometimes I just forgot!

f forgot one day o l took 2 pills the next day!

I took my pill every day — no matter what!

WARNING! If a woman taking the pill gets any of these signs, she should get medical advice right away:

• chest pain and shortness of breath

• strong headaches

• numbness in arms or legs

For more information about specific birth control pills, see page 490.

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