Closing the Effectiveness Gap

• Key Points
• Achieving Contraceptive Effectiveness
• How Programs Can Improve Contraceptive Effectiveness
• How to Explain Contraceptive Effectiveness
• Figure 2: Comparing Effectiveness of Family Planning Methods
• Figure 3: Counseling Aid: Explaining Effectiveness of Injectable Contraceptives
• Counseling for Effective Use
• Feature: Emergency Contraception: A Second Chance
• Table 2: Client Educational Materials: Tips for Using Contraceptives Effectively
• Subscription and Ordering Information
• Bibliography
• Credits
• Bibliography

Vasectomy

Instructions for Correct and Consistent Use

Tips for Correct and Consistent Use

• Use condoms or another contraceptive method for 3 months after the vasectomy, when it becomes effective.
• If semen analysis is available, return 3 months after the vasectomy to have your semen checked under a microscope.

• If using condoms as your backup method, take enough condoms from your provider to keep you supplied for 3 months.
• Keep extra condoms with you all the time so that you can have them on hand when you need them. But do not keep them in your wallet for more than 1 month.
• Link the 3-month date to a holiday or other event to help you remember it.
• Program a reminder alarm into your mobile phone or pager if you have one.

Injectable Contraceptives

Instructions for Correct and Consistent Use

Tips for Correct and Consistent Use

• Do not massage the injection site.
• Use a backup method for the first 7 days of having your first injection, if directed by your provider, until the injection becomes effective.
• Return on schedule for next injection: Every 3 months (13 weeks) for DMPA, 2 months (8 weeks) for NET-EN, or 1 month (4 weeks) for combined monthly injectables.
• If you cannot return on schedule, you can always have your next injection up to 2 weeks early or 2 weeks late for progestin-only injectables (DMPA or NET-EN), or 7 days early or 7 days late for combined monthly injectables.
• Return for next injection no matter how late you are. But if you are going to be more than 2 weeks late for your next progestin-only injection or more than 7 days late for your next combined monthly injection, use a backup method or abstain from sex until you can get an injection. If you do, you can still have your next injection. Consider using emergency contraceptive pills (ECPs) if you have had unprotected sex, since your injectable may no longer provide protection.

• Link the date for your next injection to a holiday or other event to help you remember it.
• Program a reminder alarm into your mobile phone or pager if you have one.

Lactational Amenorrhea Method (LAM)

Instructions for Correct and Consistent Use

Tips for Correct and Consistent Use

• Begin using another contraceptive method if:
  (1) menstrual bleeding begins,
  (2) your baby is no longer fully or nearly fully breastfeeding frequently, day and night, OR
  (3) your baby reaches 6 months of age.

• Start breastfeeding as early as possible after giving birth to stimulate production of your breastmilk.
• Breastfeed whenever your baby wants to be fed.
• Do not give your baby regular supplemental liquids or foods for the first 6 months of age.
• Join a community breastfeeding support group to help you with breastfeeding.
• Plan ahead with your provider on which contraceptive method to begin when still using LAM or to switch to after LAM stops being effective.

Oral Contraceptives

Instructions for Correct and Consistent Use

Tips for Correct and Consistent Use

• Take one pill each day. Take each pill in the correct order, until the pack is empty.
• Use a backup method for the first few days of starting your pills, if directed by your provider, until they become effective.
• Start the next pack of pills on time.
  • For progestin-only pills and 28-pill combined oral contraceptive packs: When you finish one pack, take the first pill from the next pack on the very next day.
  • For 21-pill combined oral contraceptive packs: After you take the last pill from one pack, wait 7 days—no more—and then take the first pill from the next pack.
• Ask your provider and remember what to do if you forget to take pills.
• Do not skip pills to try to reduce side effects. Skipping pills risks pregnancy and can make some side effects worse.
• There is no reason to take “breaks” or “rests” from pill use. You could get pregnant if you do so.
• If you vomit within 2 hours of taking a pill or have severe diarrhea or vomiting for more than 24 hours, your body might not have absorbed the hormones from the pill. Take a hormonal pill as soon as possible and then keep taking pills one each day at your usual pill-taking time.

• Link pill-taking to a daily activity, such as brushing your teeth or making a pot of coffee in the morning.
• Place brightly colored reminder stickers on calendars or other objects that you use daily to help you remember to take a pill daily.
• Program a daily reminder alarm into your mobile phone or pager if you have one.
• Use an electronic reminder device if available.
• Remember to take your pills with you if you will be away from home when it is time to take your next pill.
• Mark the days on a calendar to help you remember when to start your next pill pack.

Male Condom

Instructions for Correct and Consistent Use

Tips for Correct and Consistent Use

• Use a new condom each and every time you have sex. Do not reuse condoms.
• Before any genital contact, place the condom on the tip of the erect penis with the rolled side out.
• Unroll condom all the way to the base of the erect penis.
• Immediately after ejaculation, hold the rim of the condom in place and withdraw the penis while it is still erect.

• Take enough condoms from your provider to keep you supplied until you can return for more.
• Keep extra condoms with you all the time so that you can have them on hand when you need them. But do not keep them in your wallet for more than 1 month.
• If you are a new condom user, practice putting on and taking off a condom before the next time you have sex. Correct use becomes easier with practice.

Female Condom

Instructions for Correct and Consistent Use

Tips for Correct and Consistent Use

• Use a new condom each and every time you have sex. Reusing female condoms is not recommended.
• Before any genital contact, insert the condom into the vagina. Can be inserted up to 8 hours before sex.
• Make sure that the penis enters the condom—not between the condom and the vaginal wall—and stays inside the condom.

• Take enough condoms from your provider to keep you supplied until you can return for more condoms.
• Keep extra condoms with you all the time so that you have them on hand when you need them.
• If you are a new condom user, practice putting in and taking out a condom before the next time you have sex. Correct use becomes easier with practice.

Fertility Awareness Methods

Instructions for Correct and Consistent Use

Tips for Correct and Consistent Use

• Do not have unprotected sex—either avoid vaginal sex or use another contraceptive method—during fertile time.
• Consider symptoms-based methods (TwoDay Method®, ovulation method, or Basal Body Temperature method) if you have irregular menstrual cycles.
• Consider calendar-based methods (Standard Days Method® or calendar rhythm method) if you have difficulty recognizing the presence of cervical secretions.
• Do not use fertility awareness methods if you are not having monthly bleeding. Use another method until menstrual cycles return.

• If you are using a calendar-based method, use memory aids, such as a calendar or CycleBeads™ (a color-coded string of beads that identifies fertile and non-fertile days of a cycle), to help you identify the start and end of the fertile time during your menstrual cycle.