Family Planning and Contraception

Many women have at least one pregnancy in their lives, and about half of all pregnancies are not planned. Planning ahead can help you avoid getting pregnant when you don’t want to be, and to be in good health if and when you do decide to become pregnant. Family planning leads to healthier pregnancies, moms, and babies.

There are a number of elements necessary for you to safely and successfully plan out when and how you will (or will not) have children, and you can talk to your midwife or other health care provider about all of them!

What is a reproductive life plan?

Whether to have children is a personal choice that only you can make.

Family planning means developing a reproductive life plan for yourself as you look ahead to having a family. It’s a set of goals about whether or not to have children, when you want to have children, and under what conditions you would like to have them. Your plan can change – in fact, it is a good idea to review your plan every year to make sure you are still on track with your goals as your life changes.

The first step is to decide if you want to have children. Although many people eventually want to have a family, not everyone wants to have children. More and more people are childfree by choice.

If you do want to have children, you may want to consider these questions:

• When would you like to start having children, and at what age would you like to have completed your family or be finished having children? Try to identify the ages when you would like to be pregnant and the ages when you definitely don’t. These are important times in your reproductive life plan.
• How many children do you and your partner, if you have one, want to have? If you want more than one child, how many years apart do you want your children to be? This is called birth spacing. It’s important because babies born too close together (less than 18 months in between births) are slightly more at risk for having problems. Mom’s health is optimal if pregnancies are appropriately spaced as well.
• What is your life like? Ideally, it will be stable and supportive of your desire for children. Think about whether you need to make any changes in your health status, relationships, living situation, finances, job, or anything else that would help you provide the best home for your children.
• If you get pregnant before you are ready, what will you do?
• Who can you talk to about preventing pregnancy until you are ready to have a baby? Your midwife or other health care provider can talk to you about birth control options, and help make sure your pregnancies are planned.

If you do not want to have children, you may want to consider these questions:

• Who can you talk to about preventing pregnancy? Your midwife or other health care provider can help you come up with a plan, and talk to you about birth control options.
• If you get pregnant anyway, what will you do?

After you consider these questions, consider your next steps with the help of your partner or support system, your family, and your midwife or other health care provider.

Family Planning Methods

Natural Family Planning

Natural family planning (or “fertility awareness”) are methods to avoid or achieve pregnancy without using hormones, chemicals, or barriers. There are lots of reasons to choose natural methods of family planning. You can stop anytime, there are no side effects, you don’t have to rely on a health care provider for birth control, and natural family planning is accepted by all religions.

With perfect use, between 2 and 5 out of every 100 women per year will get pregnant using one of the natural family planning methods. With typical use, 24% of women experience unintentional pregnancy using a natural family planning method. You are more likely to have success with natural family planning if you are comfortable touching your body and you have a partner who also wants to use natural family planning. Stress, lifestyle, smoking, and health will all affect the monthly changes in your body.

There are a few different methods, and they all teach you how to track your own body through its monthly changes so you can better predict whether you are likely to get pregnant on a given day. Then, you’ll know when to have sex if you want to get pregnant, or when to avoid it if you don’t. Learn more about natural family planning here.

The signs used by most natural family planning methods are:

• The feel, shape, and position of the cervix
• The texture, color, and amount of mucus in the vagina
• Body temperature
• Feeling of heaviness and breast tenderness, as well as abdominal pain

Some of the most well-known and widely-used methods are:

• The ovulation method (or cervical mucus method, or Billings method), which involves pinpointing when you are most fertile by paying attention to the consistency of your vaginal mucus throughout your cycle.
• The standard days method, which identifies a standard 11-day potentially fertile period (from days 8-19) for women with menstrual cycles that are no shorter than 26 and no longer than 32 days long.
• The sympto-thermal method, which means combining several other methods of natural family planning (for example, charting vaginal mucus while also paying attention to body temperature).
• The lactational amenorrhea method, which only works for people who gave birth less than 6 months ago. You must be giving your baby all its sustenance from your breastmilk only; nursing your baby at least once every 6 hours, even at night; and not having a period.

Contraception

How much do you know about the different types of birth control you could use?

Despite the broad range of options available to women for contraception (also known as birth control), our survey of more than 1200 US women between ages 18 and 45 shows that women do not feel knowledgeable about most of these options and many have harmful misperceptions about their effectiveness. Our survey also found that many women don’t feel they are able to have in-depth conversations with their health care providers to make well-informed decisions on contraception and family planning.

There are several categories of contraception that you can choose from:

• Barrier methods, like male condoms (the ones you can buy at the pharmacy), female condoms, and the diaphragm. These forms of birth control work by creating a physical barrier between sperm and your eggs, so they can’t be fertilized. Barrier methods are some of the lease effective ways to prevent pregnancy, because they are hard to use perfectly. However, male and female condoms are the only forms of birth control that can reduce the risk of sexually-transmitted infections.
• Hormonal methods, like the pill, vaginal rings, patch, and the birth control shot. These forms of contraception work by regulating and controlling the same types of hormones your body already produces to prevent you from ovulating. Hormonal methods are very effective at preventing pregnancy, but become less effective if they are not used perfectly.
• Long-acting reversible contraceptives, like an intrauterine device (IUD) or the implant. IUDs work mainly by affecting the way sperm move so they can’t join with an egg. Some IUDs also use hormones. The implant uses the same hormonal methods as the pill and shot. Long-acting reversible contraceptives are the most effective ways to prevent pregnancy. They last a very long time, and you don’t have to worry about using them perfectly because they do not require action on your part.
• Emergency contraceptives, like Plan B and other “morning after” pills. Emergency contraceptives use higher doses of hormones to prevent eggs from leaving your ovaries for longer than usual. Emergency contraceptives are very effective, but must be used within 5 days (120 hours) after having unprotected sex.
• Permanent sterilization methods, like getting your tubes tied, make it so that you can never get pregnant by closing your fallopian tubes so your eggs can never reach your uterus and sperm can never reach your eggs. Men can have a vasectomy, which prevents sperm from being released. These methods are not meant to be reversed.

Getting Help with Family Planning

Choosing the method of family planning that’s right for you can be complicated. Consider your health and other personal needs, when or if you want to get pregnant, and your partner’s needs and desires.

For example, if you want to get pregnant very soon, you may want to avoid hormonal birth control and consider fertility awareness instead, because it can take some time to get pregnant even after you stop using hormonal contraceptives. Or, if you never want to get pregnant, it is important to make sure you always use very effective birth control, such as an IUD or the birth control implant, or consider sterilization or your partner having a vasectomy.

Your midwife or other health care provider can help you choose the family planning method and/or prescribe you the method of birth control that’s right for you, your partner, and your family.