WHO updates recommendations to guide family planning decisions

PATTAYA: Today the World Health Organization (WHO) released important updates to its landmark Family Planning Handbook, which provides health workers and policy makers with the most current information on contraceptive options.

Drawing on lessons from recent outbreaks, this new edition details tangible measures for frontline health workers to protect access to family planning services during emergencies, such as wider access to self-administered contraceptives and the use of digital technologies by providers. It also expands guidance for women and young people at high risk of HIV.

“Family planning promotes self actualisation, empowerment, as well as health and wellbeing, and reduces maternal and infant deaths through the prevention of unintended pregnancy and unsafe abortion,” said Dr Pascale Allotey, WHO’s Director for Sexual and Reproductive Health and Rights. “This updated Family Planning Handbook is a vital resource, helping health workers support contraceptive users around the world in making informed choices about the right contraceptive options for them.”

Experience from recent outbreaks shows that family planning services can be severely compromised during emergencies. During the initial phases of the COVID-19 pandemic in 2020, approximately 70% of countries reported disruptions to these vital services - intensifying risks of unintended pregnancies and sexually transmitted infections.

To help avoid such outcomes in the future, the manual details practical measures that support continuity of family planning services during epidemics. These include wider access to self-administered contraceptives, and direct distribution of contraceptives through pharmacies. Health practitioners can also take steps to support ongoing contraceptive access even where physical mobility is reduced, such as providing multi-month supplies.

Self-administered contraceptives include condoms, contraceptive pills, some diaphragms, spermicides and most recently, the option of self-injection of DMPA (a progestin-only contraceptive) since this can now be safely administered just under the skin rather than into the muscle. Many women prefer injectable contraceptives since they are private and non-intrusive, requiring action only every 2-3 months, with the option of self-injection likely to further increase uptake.

“The updated recommendations in this Handbook show that almost any family planning method can be used safely by all women, and that accordingly, all women should have access to a range of options that meet their unique needs and goals in life,” said Dr Mary Gaffield, Scientist and lead author of the Handbook. “Family planning services can be provided safely and affordably so that no matter where they live, couples and individuals are able to choose from safe and effective family planning methods.”

For the first time, the 2022 edition of the Handbook includes a dedicated chapter to guide family planning services for women and adolescents at high risk of HIV, including people living in settings where there is high HIV prevalence, those who have multiple sexual partners, or whose regular partner is living with HIV.

While only condoms protect against HIV and other sexually transmitted infections, all contraceptive options – with the sole exception of nonoxynol-9 spermicide - are now considered safe for women and young people at high risk of HIV, i.e. have not been found to increase risk of HIV transmission or acquisition of infection. For those at high risk of HIV, the manual states that testing, counselling and first-line clinical care and referrals should all be offered as part of family planning services.

In addition, the Handbook incorporates the latest WHO guidance on cervical cancer and pre-cancer prevention, screening and treatment, which can all be provided through family planning services; management of sexually transmitted infections, and family planning in postabortion care.

Now in its fourth edition, WHO’s Family Planning Handbook is the most widely used reference guide on the topic globally, with over a million copies distributed or downloaded to date. It is complemented by the medical eligibility criteria tool for contraceptive use, also downloadable as a dedicated App.

The updated Handbook was released at the International Conference of Family Planning in Pattaya, Thailand. Support for its production and dissemination has been provided through the Johns Hopkins Bloomberg School of Public Health and the United States Agency for International Development (USAID).