Methodology

This handbook, one of the World Health Organization’s family planning cornerstones, provides evidence-based guidance developed through worldwide collaboration. The World Health Organization (WHO) Department of Reproductive Health and Research invited more than 30 organizations to participate in its preparation. The INFO Project at the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs led the handbook development process. This handbook is the successor to The Essentials of Contraceptive Technology (Johns Hopkins School of Public Health, Population Information Program, 1997). While Essentials served as a starting point, new evidence-based guidance has been incorporated and new content has been added (see What’s New in This Handbook?, p. viii). Guidance in this book comes from several similar consensus processes: y The Medical Eligibility Criteria for Contraceptive Use and the Selected

Practice Recommendations for Contraceptive Use. WHO expert Working

Groups developed these guidelines. y For additional questions specific to this handbook, WHO convened an expert Working Group that met in Geneva on 21–24 June 2005. To discuss topics needing special attention, several subgroups met between October 2004 and June 2005. At the June 2005 meeting the full expert Working

Group reviewed and endorsed the subgroups’ recommendations. y Content not addressed in these consensus processes was developed through collaboration between researchers at the INFO Project and technical experts. Then, a group of experts and, finally, representatives of the collaborating organizations had the opportunity to review the entire text. The 2011 Update of the Handbook y This 2011 update incorporates all guidance from the latest expert

Working Group meeting in April 2008 for the Medical Eligibility Criteria and the Selected Practice Recommendations, and two Technical Consultations related to these guidelines in October 2008 and January 2010. y Further guidance has also been incorporated from an expert Working

Group meeting on HIV and infant feeding in October 2009 and a

Technical Consultation on community-based provision of injectable contraceptives in June 2009. y In addition to the new guidance available, this update also corrects any errors and brings up to date available information on brands of contraceptives. Selected members of the expert Working Group that met in 2005, experts who contributed to the handbook, and WHO staff have contributed to and reviewed the update. They include: Mario

Festin, Mary Lyn Gaffield, Lucy Harber, Douglas Huber, Roy Jacobstein,

Sarah Johnson, Kirsten Krueger, Enriquito Lu, Ward Rinehart, James

Shelton, Jeff Spieler, and Irina Yacobson.

Future Handbook Updates y This handbook will be reviewed every 3 to 4 years to determine the need for revisions. New WHO guidance will be incorporated into electronic versions as it becomes available.

Some definitions used in this handbook

Effectiveness: Rates are largely the percentages of US women estimated to have unintended pregnancies during the first year of use, unless noted otherwise. Side effects: Conditions reported by at least 5% of users in selected studies, regardless of evidence of causality or biological plausibility, listed in order of frequency with the most common at the top. Terms describing health risks (percentage of users experiencing a risk): Common: >15% and <45% Uncommon: >1% and <15% Rare: >0.1% and <1% (<1 per 100 and ≥1 per 1,000) Very rare: >0.01% and <0.1% ( <1 per 1,000 and ≥1 per 10,000) Extremely rare: <0.01% (<1 per 10,000)

Sources for WHO guidelines and reports of consultations

Community-based health workers can safely and effectively administer injectable contraceptives. Geneva, WHO, 2010. http://www.who.int/ reproductivehealth/publications/family_planning/WHO_CBD_brief/en/ index.html Guidelines on HIV and infant feeding. 2010. Principles and recommendations for infant feeding in the context of HIV and a summary of evidence. Geneva, WHO, 2010. http://www.who.int/child_adolescent_health/ documents/9789241599535/en/index.html Medical Eligibility Criteria for Contraceptive Use (4th ed.) Geneva, WHO, 2010. http://www.who.int/reproductivehealth/publications/family_ planning/9789241563888/en/index.html Selected Practice Recommendations for Contraceptive Use (2nd ed.) Geneva, WHO, 2004. http://www.who.int/reproductivehealth/publications/family_ planning/9241562846index/en/index.html Selected Practice Recommendations for Contraceptive Use: 2008 Update. Geneva, WHO, 2008. http://www.who.int/reproductivehealth/ publications/family_planning/9241562846index/en/index.html Statement on combined hormonal contraceptive use during the postpartum period. Geneva, WHO, 2010. http://www.who.int/reproductivehealth/ publications/family_planning/rhr_10_15/en/index.html Technical consultation on hormonal contraception use during lactation and effects on the newborn. Geneva, WHO, 2010. http://www.who.int/ reproductivehealth/publications/family_planning/RHR_10_05/en/index.html

(More on processes, sources, selection criteria, and terminology used in this book can be found online at http://www.fphandbook.org/.)

Illustrations by Rafael Avila and Rita Meyer, unless otherwise noted below. All adaptations by Rafael Avila.

p. 5 David Alexander, Center for Communication Programs (CCP), courtesy of Photoshare p. 30 DELIVER p. 34 Cheikh Fall, CCP, courtesy of Photoshare p. 37 Lauren Goodsmith, courtesy of Photoshare p. 46 Francine Mueller, CCP p. 60 David Alexander, CCP, courtesy of Photoshare p. 63 PATH p. 82 Schering AG p. 99 CCP, courtesy of Photoshare p. 102 Ortho-McNeil Pharmaceutical p. 106 David Alexander, CCP, courtesy of Photoshare p. 112 David Alexander, CCP, courtesy of Photoshare p. 113 David Alexander, CCP, courtesy of Photoshare p. 119 Organon USA p. 120 Indonesia Ministry for Population, National Family Planning Coordinating Board p. 121 Indonesia Ministry for Population, National Family Planning Coordinating Board p. 122 JHPIEGO. Source: Bluestone B, Chase R, and Lu ER, editors. IUD Guidelines for Family Planning Service Programs. 3rd ed. Baltimore: JHPIEGO; 2006. (adapted) p. 133 David Alexander, CCP, courtesy of Photoshare p. 142 David Alexander, CCP, courtesy of Photoshare p. 144 JHPIEGO. Source: Bluestone B, Chase R, and Lu ER,editors. IUD Guidelines for Family Planning Service Programs. 3rd ed. Baltimore: JHPIEGO; 2006. (adapted) p.145 JHPIEGO. Source: Bluestone B, Chase R, and Lu ER, editors. IUD Guidelines for Family Planning Service Programs. 3rd ed. Baltimore: JHPIEGO; 2006. (adapted) p. 159 David Alexander, CCP, courtesy of Photoshare p. 175 EngenderHealth (adapted) p. 176 EngenderHealth (adapted) p. 191 EngenderHealth (adapted) p. 212 David Alexander, CCP, courtesy of Photoshare

p. 215 Female Health Foundation (adapted) p. 222 David Alexander, CCP, courtesy of Photoshare p. 238 Francine Mueller, CCP p. 244 Institute for Reproductive Health, Georgetown University (adapted) p. 250 Institute for Reproductive Health, Georgetown University (adapted) p. 251 Institute for Reproductive Health, Georgetown University (adapted) p. 264 LINKAGES Project, Academy for Educational Development p. 268 Helen Hawkings, courtesy of Photoshare p. 270 Bangladesh Center for Communication Programs p. 290 Rick Maiman, David and Lucile Packard Foundation, courtesy of Photoshare p. 291 CCP, courtesy of Photoshare p. 299 CCP, courtesy of Photoshare p. 303 Hesperian Foundation (adapted) p. 312 Lamia Jaroudi, CCP, courtesy of Photoshare p. 314 DELIVER p. 315 CCP, courtesy of Photoshare p. 316 Claudia Allers, FPLM/Johns Snow International, courtesy of Photoshare p. 317 DELIVER