Closing the Effectiveness Gap
June 2007 Issue No. 13	The INFO Project • Johns Hopkins Bloomberg School of Public Health • Center for Communication Programs • 111 Market Place, Suite 310 • Baltimore, Maryland 21202, USA • 410-659-6300 • 410-659-6266 (fax) • www.infoforhealth.org • infoproject@jhuccp.org

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

Key Points

In Botswana members of the Bolokang Matshelo Support Group demonstrate how to put on a female condom correctly using a model. For methods that require user action, contraceptive effectiveness depends not only on the method’s inherent effectiveness but also on the extent to which the user follows the method’s rules for correct and consistent use. © 2006 Sean Blaschke

The most effective contraceptive method for any individual is usually the one that the person uses correctly and consistently. Family planning clients can ensure the greatest protection against unintended pregnancy if they choose a contraceptive that combines the greatest inherent effectiveness—that is, its biological ability to protect against pregnancy—with their own ability to use it correctly and consistently.

Two standard measures of contraceptive effectiveness are perfect-use and typical-use pregnancy rates. The best indicators of the inherent effectiveness of a method are perfect-use pregnancy rates, which measure unintended pregnancies when methods are used correctly and consistently. Typical-use pregnancy rates indicate contraceptive effectiveness as the average person uses a method. They measure unintended pregnancies among users who make contraceptive use mistakes as well as among those who use the method correctly and consistently.

The gap between perfect-use and typical-use pregnancy rates differs by method. Some long-acting contraceptives, such as sterilization, intrauterine devices, and implants, require little or no user action to ensure the greatest effectiveness possible with the method. For these methods, typical-use pregnancy rates are nearly the same as perfect-use rates. For most methods, however, typical-use rates are higher than perfect-use rates, and much higher for some methods, because many people do not use them correctly and consistently.

Contraceptive users themselves have primary responsibility for closing the gap between typical-use and perfect-use effectiveness, by following the rules for effective use of their chosen methods. Many clients have poor knowledge about contraceptive effectiveness, however, or what they should do to achieve maximum protection against unintended pregnancy.

Family planning providers and programs, too, have a responsibility for closing the effectiveness gap. Providers and programs can help their clients use contraception more effectively if they:

• Compare the effectiveness of methods during typical use. Such comparison can give clients a basis for deciding on the general level of pregnancy risk they are prepared to accept. Providers can compare risks of pregnancy by grouping methods in order of their effectiveness, ranked from the more effective to the less effective.
• Counsel clients to use their chosen methods properly. Counseling about the gap between the typical-use and perfect-use pregnancy rates of the client’s method and what the client can do to close this gap can encourage correct and consistent use. Providers can emphasize the most important behavior for effective use of the client’s chosen method and offer tips on how to continue with that behavior.
• Prepare clients in advance about common side effects. Contraceptive side effects often interfere with correct and consistent use, especially of hormonal methods. Side effects are the most commonly reported method-related reason—and sometimes the most common reason overall—that women discontinue a contraceptive method.
• Provide convenient access to a range of methods. The more contraceptive methods that a family planning program offers, the more clients will be able to choose a method that suits their individual needs—one that they will be able to use effectively. Programs also can provide clients with an adequate supply of their chosen method right at the start or offer supplies in the community so that clients do not interrupt use of their methods because they have difficulty returning to the clinic.

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