From emergency contraception to longer-lasting implants and future contraceptives for men, the World Health Organization (WHO) is recommending a wider range of safe and effective options so people can choose contraception that meets their needs.
An estimated 164 million women who want to delay or avoid pregnancy are not using contraception, underscoring the urgent need for better and expanded access to contraceptives.
With the new publication, "WHO guidelines on expanding contraceptive options" , WHO aims to help countries broaden access to methods supported by the best available evidence.
This can help ensure that people have a wider range of options so they can make informed decisions about whether to use contraception, which method is right for them, and when to change or stop it.
The new guidelines offer people alternative ways of using existing methods. To this end, WHO recommends that combined oral contraceptive pills can be taken for extended periods of up to six months or continuously for up to one year, as alternatives to cyclical use. WHO supports use of contraceptive implants for up to five years, potentially reducing the need for replacement procedures, clinic visits and associated costs.
WHO recommends mifepristone as an additional emergency contraception option, taken as soon as possible and within five days of unprotected sex. The evidence shows that mifepristone at doses of 10 – 50 mg is likely to be as safe and effective as other emergency contraceptive methods.
"Choice is a gender equality issue," said Pascale Allotey, Director of WHO's Department of Sexual, Reproductive, Maternal, Child and Adolescent Health and Ageing. "Contraception isn't one-size-fits-all. Men and women both need a range of options that reflect what science and innovation can now offer, weighed against convenience, invasiveness, behaviour, reliability and accessibility. Real choice means the confidence and control to choose a method, change it, or stop it."
Expanding access also means being clear about which methods are not yet supported by sufficient evidence. In this regard, WHO has called for more research around ormeloxifene before inclusion in family planning programs because the current evidence on safety is limited. The new guideline further recommends against adding quinestrol-containing contraceptive pills to national contraceptive programmes due to limited evidence and reports of serious adverse events.
While the new guideline expands the evidence base for existing contraceptive methods, WHO is also working to broaden the range of contraceptive choices available in the future. Today, men have relatively few methods under their control – principally condoms, withdrawal and vasectomy. Yet even with those limited choices, around 30% of couples rely on a male method.
WHO research challenges a longstanding assumption that men would not use new contraceptives. More than 75% of couples surveyed said they would be willing to use a new male contraceptive, while more than 85% of women said they would trust their male partners to take responsibility for contraception.
To help turn that demand into new products, WHO has developed its first Target Product Profile for male contraceptive methods, setting out the characteristics future methods should aim to meet, including safety, effectiveness, acceptability and affordability. The aim is to give researchers, funders and developers clearer direction and help shape a market that better reflects what people want and need.
Several hormonal and non-hormonal male methods are being researched, and several promising candidates are in advanced clinical trials, suggesting that new reversible male contraceptives may be in the market within the next 5-10 years.
WHO aims to support countries in updating their policies and plans to support family planning backed by the best available science.
