Contraception

What is the same everywhere

The medicine does not change across borders. Hormonal methods — pill, patch, ring, implant, injection — are highly effective when used correctly. The intrauterine device is among the most reliable and cheapest long-term options precisely because it needs no daily action. And only condoms protect against sexually transmitted infections as well as pregnancy; no hormonal method does.

What differs: prescription, price, age

Three things determine real access. First, prescription rules: hormonal methods almost everywhere require one, while emergency contraception is increasingly available over the counter. Second, cost, ranging from full public funding through age-limited schemes to full self-payment. Third, the rules for minors: some systems guarantee confidentiality explicitly, others require a parent's involvement.

Effectiveness compared

Two columns, and it is the gap between them that matters. Perfect use measures the method under ideal conditions; typical use measures what actually happens, missed doses and mistakes included.

Pregnancies per 100 women during the first year of use. International reference figures, rounded.

Hormonal methods

Intrauterine devices

Contrary to a stubborn myth, an IUD can be fitted in a woman who has never given birth or never had penetrative sex: that is no longer a contraindication in current practice.

Barrier methods

Natural methods: how they actually work

Also called fertility-awareness methods, they all rest on one fact: a cycle contains only about six fertile days. Two durations explain it.

• Sperm survive up to five days in the cervix — but only if they find fertile mucus there. Without it they die within hours.
• The egg can only be fertilised for 12 to 24 hours after ovulation.

So the fertile window covers the five days before ovulation and the day itself. That leaves the real difficulty: ovulation does not fall on a fixed day. The second half of the cycle runs fairly consistently at 12 to 16 days, but the first half varies widely — stress, illness, travel or a change of routine can shift it by several days. That is what separates the methods that calculate from those that observe.

The three bodily signs

Hence the hierarchy among natural methods. Those using the calendar alone predict an unpredictable event. Those using a single sign cover one end of the window and not the other. Those that cross mucus and temperature — the symptothermal method — bracket the window from both sides, which is why their effectiveness is of an entirely different order.

What they all require

• Training: allow two to three supported learning cycles (NHS, 2024). It accounts for most of the gap between published figures.
• Daily observation, recorded on the day — an observation reconstructed from memory is worthless.
• A decision as a couple: abstinence or condoms for eight to twelve days a cycle. Settle it before starting.
• Readable cycles: postpartum, breastfeeding, perimenopause, polycystic ovary syndrome, night work or recently stopped hormonal contraception make interpretation hard, sometimes impossible.

Finally, no natural method protects against a sexually transmitted infection, and none removes the need for emergency contraception if there is doubt.

Emergency contraception: earlier is better

It works by delaying ovulation and is not an abortion. Its effectiveness falls with every hour, so the timing matters more than the choice of product. In a growing number of countries it is available without prescription, sometimes including for minors. Ask the pharmacy what is available the same day rather than waiting for an appointment.

Permanent contraception

Sterilisation is open to adults in a growing number of countries, often with no condition as to age, number of children or family situation — contrary to a widespread myth. Where it is allowed, a waiting period is generally imposed between the first consultation and the procedure, and a spouse's consent is not required. It should be treated as permanent: tubal ligation or removal in women, vasectomy in men. Reversal surgery exists but its outcome is never guaranteed.

Clinics and family planning services are usually the best entry point

Where family planning or sexual health services exist, they are typically free, confidential and quicker to reach than a specialist appointment — including for young people. They also know the local funding rules, which change often and are rarely well documented anywhere you could look them up.

One page per method

Each method has its own page: the mechanism in detail, how to use it, effectiveness in figures, the effects to know about and what to do when something does not go to plan.

Fertility-awareness methods

Hormonal, intrauterine and barrier methods

Smoking and the combined pill: an association not to be shrugged off

The risk is heart attack and stroke — rare at that age but serious. It adds to the risk created by hypertension, diabetes, migraine with aura — which on its own contraindicates combined contraception — and a family history of thrombosis.

This is not a dead end: oestrogen-free methods do not carry the problem. The progestogen-only pill, the implant, the hormonal coil and the copper coil remain usable by a smoker over 35, with equal effectiveness — better, in fact, for the long-acting methods, which do not depend on remembering.

Quitting is not the only option — changing contraception is another, and often the simpler one in the short term. But if stopping is on the table, the page Tobacco sets out what actually works, and how fast the vascular risk comes down.

Signs that mean stopping the pill and seeking care the same day

• Pain, heat or swelling in one calf.
• Sudden breathlessness or chest pain.
• An unusual severe headache, visual disturbance, speech difficulty, weakness on one side.

Drug interactions

A pill can be rendered ineffective by another treatment with no visible sign. The main documented interactions are enzyme inducers: several anti-epileptics (carbamazepine, phenytoin, phenobarbital, primidone, high-dose topiramate), rifampicin and rifabutin, some antiretrovirals, bosentan, modafinil, and St John's wort, an over-the-counter herbal product many people never mention because they do not think of it as a medicine. Ordinary antibiotics, contrary to a persistent belief, do not reduce the pill's effectiveness — rifampicin excepted.

In the other direction, combined contraception alters the levels of other treatments — lamotrigine in particular, whose concentration falls, with a risk of seizures. Tobacco itself speeds the metabolism of several medicines, which is why stopping smoking can require an existing treatment to be adjusted.

The practical rule is one sentence: tell every prescriber you use hormonal contraception, dentist and dermatologist included, and tell the prescriber of the contraception about every supplement and herbal product you take.

The law country by country

The legal framework, the procedure, the time limits and the costs differ from one country to another. Each country below has a detailed page: governing texts, key facts, the actual procedure, costs, where to go and the traps to avoid.

Select a country to open its detailed page.

Europe

Western Africa

Middle Africa

Eastern Africa

Southern Africa

Southern Asia

Eastern Asia

South-eastern Asia

Northern America

Caribbean

South America

Oceania

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