Guest article by Maria José Diniz da Costa, PhD
Maria José Minhoto Diniz-da-Costa, PhD is a reproductive biologist dedicated to women’s health research. After completing her PhD degree at Warwick University in the field of Recurrent Pregnancy loss, Maria worked as a Postdoctoral Associate at Duke University in Fetal-Maternal medicine research. Maria’s passion for community health led her back to grad school where she is currently completing her second Master’s focused on Public Health.
Photos from Women for Conservation’s Family Planning Day in Mapiripán, Colombia in April 2023 which provided women with free access to the Jadelle implant.
At its core, family planning is defined as the process of providing people the opportunity to decide if they want children and how many children to have through access to reproductive healthcare that avoids or delays pregnancy temporarily or permanently. At a broader level, family planning goes beyond the decision of whether to have kids, and has the potential to save the lives of millions of women and infants every year, directly impacting women’s health and empowerment, and ultimately improving a country’s human capital.
Each year, around 295,000 women lose their lives due to pregnancy and childbirth-related complications, with most of these cases concentrated in low and middle-income countries (1). Approximately one-third of maternal deaths could be prevented annually if women were allowed to avoid unintended pregnancies and unsafe abortions, delay motherhood, space out pregnancies, and stop childbearing at their desired family size (2). By gaining greater control over their lives, adolescent girls and women can improve their health and well-being and can pursue opportunities for higher education, profitable employment, and the ability to explore their individual potential.
Thus, satisfying the unmet need for family planning by improving access to appropriate information and reproductive healthcare options is crucial. According to the recent UN report “World Family Planning 2022”, adolescents and women above 30 have less access to family planning compared to other age groups. Additionally, contraceptive options vary between age groups, relationship status, and regions of the globe (3). Current family planning methods are categorized into three subgroups:
- Short-term methods used daily or with every act of intercourse (e.g. the pill, condoms, diaphragm, etc.)
- Long-term methods that can be removed or stopped (implants, injections, and intrauterine devices known as IUDs)
- Permanent methods (vasectomies and tubal ligation).
Short-term and long-term hormonal methods prevent pregnancy mainly by stopping eggs from being released by the ovaries (ovulation). Hormonal methods contain either estrogen or progesterone, similar to naturally produced hormones. They are highly reliable, can relieve period pain, and often lead to lighter periods. The potential side effects include headaches, nausea, sore breasts, mood swings, and reduced sexual desire. There is also a small risk of blood clots forming (thrombosis). This risk is higher during the first year of using the contraceptive, in women over the age of 40, and individuals who are obese, who smoke, or who have a family history of vascular disease (4). Recent data indicated that the thrombotic risk differs between hormonal contraceptives, with levonorgestrel being associated with the lowest risk of blood clots of all combination birth control pills (5). Additionally, none of the hormonal methods can harm a pregnancy or a baby if accidentally taken by a woman who is already pregnant.
Long-term contraceptives, specifically IUDS and implants, are highly effective and cost-effective in preventing pregnancies and are known as long-acting reversible contraception methods (LARCS). IUDs last for several years (3–10 depending on the device) and have become increasingly popular in recent years and do not affect fertility rates after discontinuation. Subdermal contraceptive implants (e.g. Jadelle) deliver a continuous low dose of hormones over a period of 1–5 years and are inserted into the upper arm by a healthcare worker. The contraception injection is delivered into a woman’s arm or buttocks every 3 months and has a strongly inhibitory effect on the release of the egg from the ovary. Permanent methods, such as vasectomies and tubal ligation are appropriate for individuals who are certain they do not want more children. These methods are nearly 100% effective and provide life-long protection against pregnancy. Vasectomies for men are a simpler and safer procedure than tubal ligation for women.
Factors influencing contraceptive choice vary between countries, health clinics, and individuals. Age and stage of life are major determinants of contraceptive choice. Patterns also differ according to education and income, ethnicity and race, partnership status, and fertility intentions. Some people may need protection from STIs and will choose to use condoms, while others with certain medical conditions may be advised towards a particular method. Health professionals should help individuals and couples think about their preferences and walk them through the method that best suits them.
Article by Maria José Diniz da Costa, PhD
Did you know? Women for Conservation in partnership with ProFamilia, a Colombian reproductive healthcare organization, provides women and adolescent girls with free access to the Jadelle implant inserted into the upper arm. The Jadelle implant, which is a safe levonorgestrel-releasing method has been used worldwide since 1983 and is listed on the World Health Organization’s List of Essential Medicines. This safe birth control method is the most effective for our partner communities due to its long-term efficacy (up to 5 years) and ease of insertion. It is also the most appropriate form of birth control due to the remote locations of our partner communities, taking into account cultural sensitivities and the transportation challenges of bringing in healthcare workers. Women for Conservation also responds to the requests and needs of our partner communities, specifically men interested in vasectomies. Since our founding 3 years ago, Women for Conservation has provided women and men in our partner communities with a total of 790 implants, 57 tubal ligations, and 46 vasectomies. Through your donations, we can continue to provide free family planning access to women who would not have access otherwise.
References:
- KFF, “The U.S. Government and International Family Planning & Reproductive Health Efforts”, fact sheet, 2021
- Ahmed S, et al., “Maternal deaths averted by contraceptive use: an analysis of 172 countries,” The Lancet, 2012 (Vol. 30, no. 9837: 111-125)
- UN, “World Family Planning 2022. Meeting the changing needs for family planning: Contraceptive use by age and method”, 2022
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Contraception: Hormonal contraceptives. [Updated 2017 Jun 29]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441576/
- Oedingen C, et al., Systematic review and meta-analysis of the association of combined oral contraceptives on the risk of venous thromboembolism: the role of the progestogen type and estrogen dose. Thromb Res. 2018;165:68-78