Types of Family Planning Methods in Kenya

  • The reality out there is that not every woman wishes to have a child and equally, not every man is ready to become a father.

    If you are sexually active, you should talk to your partner about the different family planning methods in order to enjoy a healthy sex life without fearing the consequences.

    One should, however, note that the efficiency of each method depends on how well the instructions are followed and also how timely the use of a method is.

    It is also worth noting that there is no single choice of a family planning method that is effective or safest for all couples.

    This article will help you figure out clearly which type of contraceptives best suits you.

    What is family planning?

    Family planning refers to the practice of controlling the number of children a family has, as well as the intervals between the births of these children by means of voluntary sterilization or contraception.

    This is achieved through the use of contraceptive methods and the treatment of infertility.

    What are the benefits of family planning?

    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.

    Here are the benefits:

    1. Preventing pregnancy-related health risks in women

    A woman’s ability to choose if and when to become pregnant has a direct impact on her health and well-being.

    Family planning allows the 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 four children are at increased risk of maternal mortality.

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

    2. Reducing infant mortality

    Family planning can prevent closely spaced and ill-timed pregnancies and births, which contribute to some of the world’s 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.

    3. 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 Sexually Transmitted Infections (STIs) including HIV.

    4. 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.

    5. 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.

    6. 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?

    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.

    Who uses contraceptives?

    Both men and women can use contraceptives. However, the 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).

    According to WHO, contraceptive use by women has increased in many parts of the world, especially in Asia and Latin America, but continues to be low in sub-Saharan Africa.

    Globally, the use of modern contraception has risen slightly, from 54% in 1990 to 57.4% in 2015.

    Regionally, the proportion of women aged 15–49 reporting use of a modern contraceptive method has risen minimally or plateaued between 2008 and 2015.

    In Africa it went from 23.6% to 28.5%, in Asia it has risen slightly from 60.9% to 61.8%, and in Latin America and the Caribbean, it has remained stable at 66.7%.

    Why women are opting out of using modern contraceptives

    WHO indicates that 214 million women of reproductive age in developing countries who want to avoid pregnancy are not using a modern contraceptive method.

    Reasons for this include:

    1. Limited choice of methods.
    2. Limited access to contraception, particularly among young people, poorer segments of populations, or unmarried people.
    3. Fear or experience of side-effects.
    4. Cultural or religious opposition.
    5. Poor quality of available services.
    6. Users and providers bias.
    7. Gender-based barriers.

    Types of family planning methods

    • Modern Methods of family planning

    1. Combined oral contraceptives (COCs) or “the pill”

    It contains two hormones (estrogen and progestogen).

    The contraceptive works by preventing the release of eggs from the ovaries (ovulation).

    Its effectiveness to prevent pregnancy is 99 per cent with correct and consistent use, and 92 per cent as commonly used.

    2. Progestogen-only pills (POPs) or "the minipill"

    It Contains only progestogen hormone, not estrogen.

    It works by Thickening cervical mucus to block sperm and egg from meeting and prevents ovulation.

    Its effectiveness to prevent pregnancy is 99 per cent with correct and consistent use, and 90–97 per cent as commonly used.

    3. Implants

    Implants are small, flexible rods or capsules placed under the skin of the upper arm; contains progestogen hormone only.

    They work by thickening cervical mucus to block sperm and egg from meeting and prevents ovulation.

    Implants thicken cervical mucus to block sperm and egg from meeting and prevents ovulation.

    However, a Health-care provider must insert and remove the implant.

    It can be used for 3-5 years depending on the implant.

    A common side effect includes irregular vaginal bleeding but it is not harmful.

    Other side effects include weight gain, mood changes,  acne,  headaches and growth of facial hair.

    Its effectiveness to prevent pregnancy is 99 per cent.

    4. Progestogen-only injectables

    They are injected into the muscle or under the skin every 2 or 3 months, depending on the product.

    The injectables work by thickening cervical mucus to block sperm and egg from meeting and prevents ovulation.

    Side effects include delayed return to fertility (about 1–4 months on the average) after use.

    It also causes irregular vaginal bleeding but its not harmful.

    Its effectiveness to prevent pregnancy is 99 per cent with correct and consistent use, and 97 per cent as commonly used.

    5. Monthly injectables or combined injectable contraceptives (CIC)

    It is injected monthly into the muscle and contains estrogen and progestogen.

    The injectables work by preventing the release of eggs from the ovaries(ovulation).

    A common side effect includes irregular vaginal bleeding but it is not harmful.

    Its effectiveness to prevent pregnancy is 99 per cent with correct and consistent use, and 97 per cent as commonly used.

    6. Combined contraceptive patch and combined contraceptive vaginal ring (CVR)

    They continuously release 2 hormones – a progestin and estrogen- directly through the skin (patch) or from the ring.

    They also prevent the release of eggs from the ovaries (ovulation).

    The patch and the CVR are new and research on their effectiveness is limited.

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

    However, effectiveness studies report that it may be more effective than the COCs, both as commonly and consistent or correct use.

    7. Intrauterine device (IUD): copper containing

    It is a small flexible plastic device containing copper sleeves or wire that is inserted into the uterus.

    The copper component damages sperm and prevents it from meeting the egg.

    It can also be used as emergency contraception

    Its effectiveness to prevent pregnancy is 99 per cent.

    Its side effects are Longer and heavier periods during the first months of use but are not harmful.

    Other side effects include backache and cramping a few hours after placement,  increased menstrual cramps and perforation of the wall of the uterus during insertion.

    8. Intrauterine device (IUD) levonorgestrel

    A T-shaped plastic device inserted into the uterus that steadily releases small amounts of levonorgestrel each day.

    It works by thickening the cervical mucus to block sperm and egg from meeting.

    The effectiveness to prevent pregnancy is 99 per cent.

    The side effects include decreasing the amount of blood loss with menstruation over time, reducing menstrual cramps and symptoms of endometriosis; amenorrhea (no menstrual bleeding) in a group of users.

    9. Male condoms

    They are made of Sheaths or coverings that fit over a man's erect penis.

    Condoms form a barrier to prevent sperm and egg from meeting.

    Its effectiveness to prevent pregnancy is 98 per cent with correct and consistent use, and 85 per cent as commonly used.

    Condoms also protect against Sexually Transmitted Infections, including HIV.

    10. Female condoms

    They are made of sheaths, or linings, that fit loosely inside a woman's vagina, made of thin, transparent, soft plastic film.

    Condoms form a barrier to prevent the sperm and egg from meeting.

    Its effectiveness to prevent pregnancy is 90 per cent with correct and consistent use, and 79 per cent as commonly used.

    It also protects against sexually transmitted infections, including HIV

    11. Male sterilization (vasectomy)

    This is a permanent contraception to block or cut the vas deferens tubes that carry sperm from the testicles.

    It works by keeping the sperm out of ejaculated semen.

    Its effectiveness to prevent pregnancy is 99 per cent after 3 months of semen evaluation and 97–98 per cent with no semen evaluation.

    It takes 3 months delay to take effect while stored sperm is still present.

    Note: it does not affect male sexual performance.

    Voluntary and informed choice is essential.

    12. Female sterilization (tubal ligation)

    This is a permanent contraception to block or cut the fallopian tubes.

    It works by blocking the eggs from meeting the sperm.

    Voluntary and informed choice is essential

    Its effectiveness to prevent pregnancy is 99 per cent

    13. Lactational amenorrhea method (LAM)

    LAM is a temporary contraception for new mothers whose monthly bleeding has not returned.

    It requires exclusive or full breastfeeding day and night of an infant less than 6 months old.

    It prevents the release of eggs from the ovaries (ovulation).

    Its a temporary family planning method based on the natural effect of breastfeeding on fertility.

    Its effectiveness to prevent pregnancy is 99 per cent with correct and consistent use, and 98 per cent as commonly used.

    14. Emergency contraception pills (ulipristal acetate 30 mg or levonorgestrel 1.5 mg)

    These are Pills taken to prevent pregnancy up to 5 days after unprotected sex.

    The pills work by delaying ovulation.

    If used  as the only contraception then one would likely become pregnant.

    Note: It does not disrupt an already existing pregnancy.

    15. Standard Days Method or SDM

    Women use this contraception by tracking their fertile periods (usually days 8 to 19 of each 26 to 32-day cycle) using cycle beads or other aids.

    It works by avoiding pregnancy during unprotected vaginal sex on most fertile days.

    It can be used to identify fertile days by both women who want to become pregnant and women who want to avoid pregnancy.

    Note: Correct, consistent use requires partner cooperation.

    Its effectiveness to prevent pregnancy is 95 per cent with correct and consistent use, and 88 per cent as commonly used.

    16. Basal Body Temperature (BBT) Method

    BBT works by the woman taking her body temperature at the same time each morning before getting out of bed observing for an increase of 0.2 to 0.5 degrees C.

    If the BBT has risen and has stayed higher for 3 full days, ovulation has occurred and the fertile period has passed.

    Sex can resume on the 4th day until her next monthly bleeding.

    It avoids pregnancy during unprotected vaginal sex on most fertile days.

    Its effectiveness to prevent pregnancy is 99 per cent with correct and consistent use, and 75 per cent as commonly used.

    17. Two Day Method

    In this method, women track their fertile periods by observing the presence of cervical mucus (if any type of colour or consistency)

    It avoids pregnancy during unprotected vaginal sex on most fertile days.

    It's difficult to use if a woman has a vaginal infection or another condition that changes cervical mucus.

    Unprotected coitus may be resumed after 2 consecutive dry days (or without secretions).

    Its effectiveness to prevent pregnancy is 96 per cent with correct and consistent use, and 86 per cent as commonly used.

    18. Sympto-Thermal Method

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

    It may have to be used with caution after an abortion, around menarche or menopause, and in conditions which may increase body temperature.

    Its effectiveness to prevent pregnancy is 98 per cent with correct and consistent use, and 98 per cent as commonly used.

    It also avoids pregnancy during unprotected vaginal sex on most fertile days.

    B. Traditional Methods of Family planning

    1. Calendar method or rhythm method

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

    The couple prevents pregnancy by avoiding unprotected vaginal sex during the 1st and last estimated fertile days, by abstaining or using a condom.

    A woman may need to delay or use with caution when using drugs (such as anxiolytics, antidepressants, NSAIDS, or certain antibiotics) which may affect the timing of ovulation.

    Its effectiveness to prevent pregnancy is 91 per cent with correct and consistent use, and 75 per cent as commonly used.

    2. Withdrawal (coitus interruptus)

    In this method, a man withdraws his penis from his partner's vagina, and ejaculates outside the vagina, keeping semen away from her external genitalia

    By doing so, the man keeps sperm out of the woman's body, preventing fertilization.

    Withdrawal is considered one of the least effective methods, because proper timing of withdrawal is often difficult to determine, leading to the risk of ejaculating while inside the vagina.

    Its effectiveness to prevent pregnancy is 96 per cent with correct and consistent use, and 73 per cent as commonly used.

    Source: World Health Organization (WHO).