Spotlights on Health and Rights

Key topics in the Heilbrunn Department of Population and Family Health

Reproductive Health

Other Methods

Intrauterine Device (I.U.D)

The Intrauterine Device (I.U.D.) is a small, t-shaped device that is inserted into the uterus to provide reversible and long-term protection against pregnancy. Worldwide, approximately 106 million women use the I.U.D.9

The two most commonly available I.U.D.'s are the:

  • Mirena (which releases progestin, and is also known as the LNG-IUS levonoregestrel-releasing intrauterine system);
  • Copper T 380 (aka Paraguard). Internationally other copper I.U.D.'s are also available (i.e. TCu-220C, TCu-200C, the Nova T, and the Multiload 375).

I.U.D.'s prevent pregnancy by

  • Preventing sperm from fertilizing ova by affecting the way sperm move and inhibiting sperm's ability to reach and join with an ovum.
  • Altering the lining of the uterus, which may make it more difficult for implantation to occur.
  • The Mirena has a method of action that resembles that of other progestin-only hormonal methods. That is, the progestin prevents ovulation and also causes the thickening of cervical mucous, both or which prevent pregnancy.

Method Use

  • I.U.D.'s can be inserted by a medical professional any time during the month, if medical providers are reasonably certain that the woman is not pregnant, and if current or recent upper reproductive tract infections are ruled out.
  • Women must assure correct placement and check for signs of infection by going for medical follow-up six weeks following insertion.


Highly effective with rates ranging from 99.3-98.8%.


  • Not coitus dependent
  • Long term (up to 10 years with the Copper T and five years with the Mirena).


  • Provides no protection against sexually transmitted infections and HIV.
  • Potential cramping and pain with insertion.
  • Menstrual irregularities (i.e. heavier menses with the Cu T380, and irregular but light bleeding or spotting during the first few months with the Mirena)
  • Expulsion (2-10%) of women will expel within the first year.
  • Perforation of uterus (uncommon and usually related to the skill of person inserting device).

Dual Method

Condoms should be used for ongoing STI/HIV prevention.

Withdrawal (Coitus Interruptus)

The withdrawal method for pregnancy prevention refers to when a man pulls his penis out of his partner's vagina before ejaculation so that he does not ejaculate inside his partner.

Withdrawal prevents pregnancy by

Preventing sperm from entering the vagina (and thus the uterus and fallopian tubes) and fertilizing an ovum.


  • In terms of pregnancy prevention, withdrawal effectiveness is similar to that of the male condom. Effectiveness is 96% with perfect use, and 82% with typical use.
  • Consider back-up method such as emergency contraception if ejaculation begins before withdrawal.


Withdrawal requires no money, devices, hormones, or medical provider, making it available to anyone.


  • Provides no protection against sexually transmitted infections and HIV.
  • Requires a great degree of self-control. For some men, it may be difficult to ensure that they withdraw before ejaculation has started.
  • For some people, pleasure may be diminished by the interruption of sexual intercourse.

Permanent Contraception

Surgical sterilization provides permanent contraception to both women and men. It is an important option for persons who are certain that they do not want more children. Effective counseling is crucial to assure that men and women considering these procedures are fully comprehend the permanence. Sterilization does not provide protection against STI/HIV.

Female sterilization is the most widely used contraceptive method. Worldwide, 21% of women aged 15 to 49 use female sterilization11, which is a surgical procedure that involves blocking or cutting the fallopian tubes to prevent fertilization. It is safe, with mortality rates at 1-2 deaths per 100,000 as compared to maternal mortality rates of 7.9 deaths per 100,000 live births.12

Male sterilization (vasectomy) blocks the vas deferens and therefore prevents the passage of sperm into the semen. After having a vasectomy it takes between 15-20 ejaculations to have sperm-free semen. Other forms of contraception should be used until semen is confirmed to be sperm-free.

Vasectomy is simpler and safer procedure than female sterilization and may be reversible, though fertility return is not guaranteed.

Fertility Awareness/Natural Family Planning

Fertility awareness methods rely on understanding the most likely time that ovulation will take place during the monthly cycle, so that intercourse is avoided, or a barrier method is used. Fertility awareness methods include:

  • The Standard Days Methods
  • The Calendar Rhythm Method
  • The Symptothermal Method
  • The Ovulation Method

The effectiveness of fertility awareness methods range from 98% with perfect use, to 78% with typical use. Although an important option for women worldwide, fertility awareness methods overall are less effective than other methods. Male partners must be continuously cooperative. Physiologic changes (i.e. recent childbirth, current breast-feeding, early menstruation, discontinuation of other hormonal methods, approaching menopause) can affect reliability.