Contraception: options, methods and obstacles

I. Definition and key figures

Contraception covers all the methods and devices used to prevent unwanted pregnancy. Some methods, such as condoms, also offer protection against sexually transmitted infections (STIs), including HIV, making them an essential public health tool. Its use is particularly necessary in certain regions of the world, such as Africa and the Americas, where STI rates remain high. [1][5]

In this context, contraception contributes to both the control of unwanted pregnancies and the reduction of sexually transmitted infections.

Beyond these aspects, contraception helps to improve maternal health, empower women and promote their reproductive rights.

Key figures:

• In 2022 according to the WHO, an estimated 65% of women aged 15 to 49 worldwide were using a contraceptive method. [2]
• In 2023, every day worldwide, more than a million people aged 15 to 49 contracted a sexually transmitted infection (STI), asymptomatic in the majority of cases and curable, according to the WHO. [3]
• The condom is the only contraceptive method that also protects against sexually transmitted infections, including HIV. [2]
• In Africa, sexual and reproductive health remains a crucial issue. According to the WHO, 47 million women in need of modern contraception still do not have access to it. [4]

II. The different methods of contraception

There are several broad categories of contraceptive methods, each designed to meet different needs. They differ in terms of duration of action, mechanism, efficacy and method of administration.

1. Hormonal methods

These methods use synthetic hormones to block ovulation, densify cervical mucus and/or thin the endometrium, thus preventing fertilization.

• The contraceptive pill: a tablet to be taken daily at regular times for 21 or 28 days. [5][7]
• Patch: this is a patch that is stuck to the skin and releases hormones (progestin and estrogen) to prevent ovulation and thus avoid pregnancy. It must be changed every week. [6]
• Vaginal ring: a small, flexible ring placed in the vagina for 3 weeks. It releases hormones that prevent pregnancy. After 3 weeks, the ring is removed, and there is a one-week break (during which menstruation usually occurs) before a new one is inserted. [6][7]
• Hormonal injection: a contraceptive injection administered by a healthcare professional at regular intervals, offering prolonged protection without daily constraints. [6]
• Implant: a small, match-sized plastic rod inserted under the skin of the arm by a doctor or a midwife. Once positioned, it releases a progestin continuously, blocking ovulation for up to 3 years. To date, it is one of the most effective contraceptive methods, with a failure rate of only 0.05%. [6]

2. Barrier methods

They physically prevent sperm and egg from meeting. [6]

• Male or female condoms: this is a protective device made of latex or synthetic material that is placed on the penis or inside the vagina before sexual intercourse and is used to prevent unwanted pregnancies as well as the transmission of sexually transmitted infections (STIs). [5][6]
• Diaphragm and cervical cap: these small, flexible devices are inserted into the vagina by the woman just before intercourse. They cover the cervix to prevent sperm from entering. They are often used with a sperm-destroying gel, also known as spermicide. [6]

3. Permanent methods

Intended for people who no longer wish to have children, these methods are definitive or difficult to reverse.

• Tubal ligation (for women): this procedure aims to close the tubes that allow fertilized eggs to reach the cavity of the uterus. [7]
• Vasectomy (for men): a procedure performed by a doctor to cut or block the ducts carrying sperm from the testicles. This makes it impossible for sperm to pass from the testicles to the penis. [7]

4. Intrauterine devices (IUDs) for women

Placed in the uterus by a healthcare professional, these devices work for several years.

• Hormonal IUD (or hormonal coil): a small device inserted into the uterus by a doctor or midwife that continuously releases a progestin that thickens cervical secretions, blocking the passage of sperm [6]. It can be effective for 3 to 8 years, depending on the model.
• Copper IUD: a device made of copper and plastic placed in the uterus by a doctor. Copper has a toxic effect on spermatozoa and prevents the implantation of a fertilized egg [6]. It can be effective for 5 to 10 years, depending on the model.

III. Choice of contraceptive method

The choice of a contraceptive method is a personal decision, and will depend on several factors, such as general health, age, frequency of sexual relations, number of sexual partners, whether or not you wish to have children, as well as factors linked to sexual health, such as a history of STIs or protection against them.

Access to all methods of contraception promotes several human rights, including the right to life and liberty, freedom of opinion, expression and choice, as well as the right to work and education. [5]

If several contraceptive options are available to men and women, several data must be considered when choosing one:

1. Factors to consider

• Effectiveness of the device: this is measured by the Pearl index, which indicates the number of pregnancies occurring per 100 women using the method in question for one year. For example, a Pearl index of 2 means that 2 women out of 100 using the contraceptive method analyzed for 1 year became pregnant within the year. [7]
• The duration of action of the device: some methods are short-acting (taken daily), others long (implants, IUDs), or even permanent (tubal ligation, vasectomy). [6]
• Tolerance and medical contraindications: it is important to ensure that there are no contraindications to the contraceptive method chosen. A clinical examination by a health professional is therefore necessary before any prescription. [7]

2. Access and possible obstacles

According to the WHO, in 2022, 77.5% of women aged between 15 and 49 were using a modern contraceptive method, compared with 67% in 1990 [2]. Although this increase shows progress, it remains relatively slow over more than three decades. This is due to numerous obstacles to access to contraception in certain regions of the world, such as [5] :

• The limited choice of contraceptive methods available in some regions.
• Restricted access to contraceptive services, particularly for young people, the poor and the unmarried.
• The presence or fear of side effects associated with certain methods, which can discourage their use.
• Cultural or religious barriers, which have a negative impact on the freedom to use contraception.
• Inadequate quality of services in certain contexts, making the experience of care difficult to access.
• Persistent prejudices or preconceptions about certain contraceptive methods among some users.
• Gender-related obstacles, reducing the autonomy of individuals in making decisions about their reproductive health.

In conclusion, the development and spread of contraceptive methods play an essential role in improving public health worldwide, particularly in some regions such as Africa, where the challenges of reproductive health remain major. By enabling women and couples to better plan their births, these methods help to reduce maternal and infant mortality, empower women and support the socio-economic development of communities. In addition, certain methods, such as condoms, play a crucial role in preventing sexually transmitted infections (STIs), including HIV/AIDS, which is still very prevalent in many parts of Africa. Thanks to the joint efforts of governments, health organizations and local players, access to information, sex education and contraceptive services is progressing, paving the way for a healthier, safer and more equitable future for all.

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Sources

[1] ONU Info – Hausse importante des infections sexuellement transmissibles dans plusieurs régions du monde

[2] OMS – Contraception et planification familiale

[3] OMS – Infections sexuellement transmissibles (IST)

[4] OMS – Santé sexuelle et reproductive des populations vulnérables : dissémination des directives de l’OMS aux parties prenantes

[5] Service-public.fr – Moyens de contraception

[6] Inserm – Dossier sur la contraception

[7] Ameli.fr – La contraception

POI 1079-05/25