Challenges
to choice

Contraception is the most obvious way to prevent an unintended pregnancy.

And while all methods can fail or be used incorrectly, the biggest issue by far is people not being able to get the contraception that they need, when they need it.

Contraception (n)

the act of intentionally preventing pregnancy, such as through the use of devices, practices, medications or surgical procedures. Contraception can be considered modern or traditional.

Synonym: family planning

?! “family planning” might imply people should want to have a family…?

Globally, around 257 million women who want to avoid pregnancy are not using safe, modern methods of contraception.

Among them, 172 million are using no method at all. Most women who do not want to become pregnant say they do not use modern contraception because of:

  • fear and experience of side effects (26%)
  • infrequent sex or none at all (24%)
  • opposition to contraception (23%)
  • they are breastfeeding or postpartum and not menstruating (20%)

Myths and misinformation are everywhere and peddled by all sources, from teachers to health workers, policymakers or parents.

Myth

Contraceptives cause infertility in women.

Fact

The great majority of contraceptive methods are temporary and do NOT cause infertility. There are two methods (tubal ligation and vasectomy) that are meant to be permanent, but even these can, in some cases, be reversed.

Myth

Contraceptives cause abortions.

Fact

Contraceptives prevent pregnancy; they do not cause abortion.

Myth

Contraceptives cause promiscuity.

Fact

Contraceptives do not cause risky sexual behavior or promiscuity.

Myth

Contraceptives cause cancer.

Fact

Contraceptives can actually reduce the risk of certain cancers.

Myth

Contraceptives make men sterile, impotent or weak.

Fact

Contraceptives have no impact on male fertility, strength or masculinity.

Myth

IUDs move around a woman’s body, or can injure a man during sex.

Fact

IUDs are designed to stay in the uterus. They do not impact or injure men.

Myth

Contraceptives are only for women who have already given birth.

Fact

Contraceptives can be used by people who have not given birth. In fact, some contraceptives may even be prescribed for people who are not having sex at all, such as to address acne or endometriosis.

Many women have concerns about side effects, which can be dismissed by health providers. Their contraceptive needs might also change over time, which health systems aren’t always responsive to, while alternative methods may be in short supply or not available at all.

Yes. Weight gain, acne, nausea, moodiness, headaches, diarrhoea, stomach cramps. USA, 39 years old

Yes, blurry vision and mood swings. No one told me about the side effects beforehand, not the doctor, nor the pharmacist. Jordan, 44 years old

Yes, heavy bleeding and abdominal pain in the first few months. Nigeria, 37 years old

No. India, 62 years old

Yes. Fatigue and decreased libido. Mexico, 38 years old

I had a health insurance plan that made it impossible to access oral contraceptives. USA, 39 years old

Yes, many young people hesitate to access contraceptives because of fear and stigma. Nepal, 23 years old

No, but sometimes doctors were embarrassed to talk about contraception. Ukraine, 39 years old

Yes! When I was 21 years old, the doctor at a health unit scolded me. Mexico, 38 years old

Yes, there are regular stock-outs. Uganda, 35 years old

Many unmarried girls are scared to go for consultations because of a lack of privacy. Doctors might not keep it secret. Tajikistan, 30 years old

I was embarrassed to ask for condoms, because it is believed that only a man should ask for them. Nicaragua, 50 years old

Note: An informal questionnaire elicited about 60 responses from nearly 30 countries at the end of 2021. Responses here have been excerpted and edited for clarity.

Family planning programmes have made huge strides in opening up access to and information on contraceptives – but there’s still far to go. To reach those left behind, these programmes need to tackle stigma, misinformation, health provider training, comprehensive sexuality education and gender inequality head on.

The problem with abstinence-only approaches:

Abstinence from sexual activity is considered by many to be a “fail-safe” method of controlling fertility. But abstinence can be ineffective if it is not reliably practiced.

Surveys show that, among people using periodic abstinence as a method of contraception, about 40 per cent discontinue the method within 12 months. And even people who faithfully adhere to abstinence may experience rape or coercive sex, which are alarmingly pervasive.

We need more research into other kinds of contraceptives, including those with fewer side effects and male contraceptives.

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