Collaborating and Supporting Organizations Abt Associates, Private Sector Partnerships One Project (PSP-One) Academy for Educational Development American College of Obstetricians and Gynecologists (ACOG) Association for Reproductive and Family Health (ARFH), Nigeria Centre for African Family Studies (CAFS) The Centre for Development and Population Activities (CEDPA) CONRAD Constella Futures East European Institute for Reproductive Health EngenderHealth, ACQUIRE Project Family Health International Family Health Options Kenya (FHOK) Family Planning Association of India (FPA India) Family Planning Organization of the Philippines Federation of Family Planning Associations, Malaysia Fundación Mexicana para la Planeación Familiar, A.C. (MEXFAM) Georgetown University, Institute for Reproductive Health Guttmacher Institute Gynuity Health Projects Hesperian Foundation Ibis Reproductive Health Implementing Best Practices (IBP) Consortium International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) International Consortium for Emergency Contraception IntraHealth International, Inc. JHPIEGO John Snow, Inc. (JSI) Johns Hopkins Bloomberg School of Public Health London School of Hygiene and Tropical Medicine Management Sciences for Health Marie Stopes International Minnesota International Health Volunteers (MIHV) National Family Planning Coordinating Board (BKKBN), Indonesia Pan American Health Organization (PAHO) PATH Pathfinder Plan International Planned Parenthood Federation of Nigeria (PPFN) Population Council Population Reference Bureau Population Services International Princeton University, Office of Population Research Tulane University School of Public Health and Tropical Medicine University of the Witwatersrand, Reproductive Health and HIV Research Unit University of North Carolina School of Public Health University Research Co., LLC Family Planning A GLOBAL HANDBOOK FOR PROVIDERS Evidence-based guidance developed through worldwide collaboration A WHO Family Planning Cornerstone World Health Organization Johns Hopkins Department of Bloomberg School of Public Health Reproductive Health and Research Center for Communication Programs INFO Project United States Agency for International Development Bureau for Global Health Office of Population and Reproductive Health 2007 Family Planning A GLOBAL HANDBOOK FOR PROVIDERS Contents Forewords ..............................................................................................iv Acknowledgements .................................................................................vi What’s New in This Handbook? .............................................................. viii How to Obtain More Copies of This Book ................................................ x World Health Organization’s 4 Cornerstones of Family Planning Guidance .....xi 1 Combined Oral Contraceptives ..................................................... 1 2 Progestin-Only Pills .................................................................... 25 3 Emergency Contraceptive Pills .................................................... 45 4 Progestin-Only Injectables .......................................................... 59 5 Monthly Injectables .................................................................... 81 6 Combined Patch .......................................................101 7 Combined Vaginal Ring ..............................................105 8 Implants ..................................................................................109 9 Copper-Bearing Intrauterine Device ............................................131 10 Levonorgestrel Intrauterine Device .............................157 11 Female Sterilization ...................................................................165 12 Vasectomy ...............................................................................183 13 Male Condoms .........................................................................199 14 Female Condoms .....................................................................211 15 Spermicides and Diaphragms ......................................................221 16 Cervical Caps ...........................................................237 17 Fertility Awareness Methods ......................................................239 18 Withdrawal .............................................................255 19 Lactational Amenorrhea Method ................................................257 20 Serving Diverse Groups Adolescents .......................................................................267 Men ..................................................................................270 Women Near Menopause ....................................................272 21 Sexually Transmitted Infections, Including HIV ..............................275 22 Maternal and Newborn Health ...................................................289 ii Family Planning: A Global Handbook for Providers 23 Reproductive Health Issues Family Planning in Postabortion Care ...................................297 Violence Against Women ...................................................300 Infertility ..........................................................................304 24 Family Planning Provision Importance of Selected Procedures for Providing Family Planning Methods .................................................307 Successful Counseling ........................................................308 Who Provides Family Planning? ...........................................310 Infection Prevention in the Clinic .........................................312 Managing Contraceptive Supplies .........................................316 BACK MATTER Appendix A. Contraceptive Effectiveness .....................................319 Appendix B. Signs and Symptoms of Serious Health Conditions ......320 Appendix C. Medical Conditions That Make Pregnancy Especially Risky .................................................................322 Appendix D. Medical Eligibility Criteria for Contraceptive Use ........324 Glossary..................................................................................335 Index ......................................................................................343 Methodology ...........................................................................355 JOB AIDS AND TOOLS Comparing Contraceptives Comparing Combined Methods ..........................................358 Comparing Injectables .......................................................359 Comparing Implants ..........................................................360 Comparing Condoms ........................................................360 Comparing IUDs ...............................................................362 Correctly Using a Male Condom ................................................363 Female Anatomy and the Menstrual Cycle ....................................364 Male Anatomy ..........................................................................367 Identifying Migraine Headaches and Auras ....................................368 Further Options to Assess for Pregnancy .....................................370 Pregnancy Checklist ..................................................................372 If You Miss Pills .....................................................Inside back cover Effectiveness Chart ........................................................ Back cover Searchable online at www.fphandbook.org Contents iii Forewords From the World Health Organization The job of family planning remains unfinished. Despite great progress over the last several decades, more than 120 million women worldwide want to prevent pregnancy, but they and their partners are not using contraception. Reasons for unmet need are many: Services and supplies are not yet available everywhere or choices are limited. Fear of social disapproval or partner’s opposition pose formidable barriers. Worries of side effects and health concerns hold some people back; others lack knowledge about contraceptive options and their use. These people need help now. Millions more are using family planning to avoid pregnancy but fail, for a variety of reasons. They may not have received clear instructions on how to use the method properly, could not get a method better suited to them, were not properly prepared for side effects, or supplies ran out. These people need better help now. Moreover, the job of family planning never will be finished. In the next 5 years about 60 million girls and boys will reach sexual maturity. Generation after generation, there will always be people needing family planning and other health care. While current challenges to health throughout the world are many and serious, the need to control one’s own fertility probably touches more lives than any other health issue. It is crucial to people’s well-being, particularly that of women—and fundamental to their self-determination. How can this book help? By enabling health care providers to give better care to more people. In a straightforward, easily used way, this book translates scientific evidence into practical guidance on all major contraceptive methods. This guidance reflects the consensus of experts from the world’s leading health organizations. With this book in hand, a provider can confidently serve clients with many different needs and knowledgeably offer a wide range of methods. The World Health Organization (WHO) appreciates the many contributions to this book made