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The World Health Organisation (WHO) has recommended an expanded range of contraceptive options, including longer use of some existing methods, mifepristone for emergency contraception and the development of new contraceptives for men.
The recommendations are contained in a new publication, “WHO guidelines on expanding contraceptive options”, aimed at helping countries broaden access to contraceptive methods supported by available scientific evidence.
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WHO said the expansion was necessary to give people more options when deciding whether to use contraception, which method to use, and when to change or stop a method.
The global health body estimates that 164 million women who want to delay or avoid pregnancy are not currently using contraception.
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Longer use of existing methods
Under the new guidance, WHO recommends that combined oral contraceptive pills may be taken for extended periods of up to six months or continuously for up to one year, instead of the conventional cyclical use.
The organisation also supports the use of contraceptive implants for up to five years, saying this could reduce the frequency of replacement procedures, clinic visits and associated costs.
WHO also recommends mifepristone as an additional emergency contraceptive option.
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It said mifepristone should be taken as soon as possible and within five days of unprotected sex.
According to the organisation, available evidence indicates that mifepristone at doses of 10 to 50 milligrams is likely to be as safe and effective as other emergency contraceptive methods.
Speaking on the need to expand contraceptive choices, Pascale Allotey, Director of WHO’s Department of Sexual, Reproductive, Maternal, Child and Adolescent Health and Ageing, said contraception should reflect people’s different needs and circumstances.
She said the choice of a contraceptive method should take into account factors including convenience, invasiveness, behaviour, reliability and accessibility.
“Choice is a gender equality issue,” Ms Allotey said, adding that contraception was not “one-size-fits-all”.
She noted that people should have the confidence and control to choose a contraceptive method, change it or stop using it.
WHO cautions against some contraceptive methods
While expanding the range of recommended methods, WHO said there was insufficient evidence to support some contraceptives for inclusion in family planning programmes.
The organisation called for further research into ormeloxifene before it is included in family planning programmes, citing limited evidence on its safety.
It also recommended against adding quinestrol-containing contraceptive pills to national contraceptive programmes because of limited evidence and reports of serious adverse events.
Push for male contraceptives
WHO said expanding contraceptive choices should also include methods that allow men to take greater responsibility for preventing pregnancy.
Currently, the main contraceptive methods under men’s direct control are condoms, withdrawal and vasectomy.
Despite the limited options, WHO said about 30 per cent of couples rely on a male method of contraception.
The organisation said its research challenges the longstanding assumption that men would not use new contraceptive methods.
More than 75 per cent of couples surveyed said they would be willing to use a new male contraceptive, while more than 85 per cent of women said they would trust their male partners to take responsibility for contraception.
To support the development of new methods, WHO has developed its first Target Product Profile for male contraceptives.
The profile outlines characteristics that future male contraceptive methods should aim to meet, including safety, effectiveness, acceptability and affordability.
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WHO said the profile is intended to provide researchers, funders and developers with clearer direction while helping to shape a contraceptive market that reflects users’ needs.
New male contraceptives in development
Several hormonal and non-hormonal male contraceptive methods are currently being researched, with some candidates in advanced clinical trials.
WHO said this suggests that new reversible male contraceptives could reach the market within the next five to 10 years.
The organisation said it would continue supporting countries to update their policies and family planning programmes in line with the best available scientific evidence.
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