MOH Brief 2 Safe, Effective and Reversible
Publication date: 2003
Extremely safe Millions of women in more than 70 countries throughout the world have safely used the IUCD. When properly inserted in the most appropriate candidate — a woman in a mutually monogamous relationship in which both partners are free of sexually transmitted infections (STIs) — the IUCD is amongst the safest methods of contraception and is much safer than the health risks associated with unwanted pregnancy. The IUCD even confers noncontraceptive health benefits. For instance, research strongly suggests that it protects users against endometrial cancer. The IUCD has very few contraindications and is an option for many women, including those for whom hormonal methods are not recommended. Unlike hormonal methods, the IUCD can be used safely in women who smoke and women who are breastfeeding or immediately or recently postpartum or postabortion. The IUCD is also safe for sexually active women of any age, regardless of whether they have had a child. Highly effective Amongst women who use the IUCD, fewer than 1 percent become pregnant during the first year of typical use. And the cumulative risk of pregnancy over the 10-year service life of the IUCD is less than 3 percent. The IUCD has been compared to female surgical sterilisation in its efficacy, but unlike sterilisation, the IUCD is a completely reversible family planning method. Few side effects or complications IUCDs cause very few side effects. The most common are pelvic cramping and menstrual problems, including heavy and prolonged menstrual bleeding and intermenstrual spotting. Although abnormal bleeding and spotting are the leading reasons for discontinuation of the method, these side effects do not usually affect the health of the user and generally decrease in the first few months after insertion. One potential, though uncommon, complication of IUCD use is device expulsion. Expulsion occurs most often in the first few months after insertion, and it is most common in young women and women who have never given birth. The Safe, Effective, and Reversible KEY POINTS FOR POLICY-MAKERS: ����� The IUCD is a safe and extremely effective contraceptive to include in the national family planning method mix. ����� The IUCD has few contraindications. ����� The IUCD can be used by women of any age. KEY POINTS FOR PROVIDERS: ����� Providers should mention the IUCD to clients when counselling them about method choices. ����� The IUCD is extremely effective. ����� The IUCD has few side effects or contraindications. ����� The IUCD can be used by women of any age. KEY POINTS FOR CLIENTS: ����� Clients can be assured that the IUCD will be a very safe and effective contraceptive. ����� Common side effects of pelvic cramping and menstrual problems usually subside within a few months. IUCD Method Brief No. 2 IUCD can only be expelled outward into the vagina or cervix. It cannot travel to any other part of the body. Expulsion is not dangerous for the user; however, if the IUCD is expelled, the woman is no longer protected against pregnancy because the IUCD’s contraceptive effect is immediately reversible. Several additional IUCD-related complications, including pelvic inflammatory disease, ectopic pregnancy, and uterine or cervical perforation during insertion are possible, but a woman’s risk of them is minimal, especially if she is free of STIs. (See IUCD Method Brief No. 5) Counselling women about these side effects and possible complications — either at the time of insertion or at one-month follow-up visits — can increase client satisfaction and method continuation rates. Summary The IUCD is one of the safest, most effective forms of reversible contraception. If clients are counselled about menstrual side effects and have no medical contraindications, the IUCD can be an excellent contraceptive choice. Women who have multiple partners or are otherwise at risk for STIs should consider an alternative contraceptive or use condoms consistently and correctly, since STIs (at the time of insertion) put women at risk for pelvic infection and other IUCD-related complications. These briefs were produced by the Kenya Ministry of Health and its collaborating partners. This work is supported by the U.S. Agency for International Development (USAID). The contents do not necessarily reflect USAID policy. For more information or additional copies, please contact: Head, Division of Reproductive Health, Kenya Ministry of Health Old Mbagathi Road, P.O. Box 43319, Nairobi, Kenya Telephone: 254-2-2725105 Fax: 254-2-2716814 or Regional Director, Population and Reproductive Health Programs Family Health International, The Chancery, 2nd Floor, Valley Road P.O. Box 38835, Nairobi, Kenya E-mail: email@example.com Telephone: 254-2-2713913-6 Fax: 254-2-2726130 February 2003
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