WHO expands list of recommended birth control options

The World Health Organization on Monday added a series of long-acting, hormonal contraceptives to the list of globally recommended birth control methods, which will significantly reduce mothers’ risk of dying during childbirth, experts say.

The WHO’s guidelines relax restrictions on the use of hormonal methods for breastfeeding women who are less than six weeks postpartum, according to researchers at the John Hopkins Bloomberg School of Public Health.

The guidelines are welcome in many poor countries, where the researchers hope policymakers and health industries will adopt the updated recommendations to battle high maternal death rates.

More than half of women in low- and middle-income countries (defined as nations with a gross national income less than $12,615 per capita) become pregnant within two years of a first birth, despite their desire to postpone pregnancy or not have another baby, according to a study in Contraception, a reproductive health journal. Pregnancies that occur within that interval are at higher risk of resulting in maternal, newborn or child death, according to the researchers.

Experts writing on Global Health Now, a blog affiliated with John Hopkins Bloomberg School of Public Health, called the move “bold” and “overdue” — one that increases women's chances on accessing safe reproductive healthcare worldwide.

Every year, 87 million women become pregnant unintentionally due to the underuse of modern methods of contraception, according to a 2014 study in 35 low- and middle-income countries published in Human Reproduction, an Oxford University journal. An estimated 222 million girls and women who want to avoid another pregnancy are not using any method of contraception, according to the WHO. 

While more than 92 percent of mothers do not wish to give birth again soon after a pregnancy, 61 percent of postpartum women in low- and middle-income countries do not use family planning methods, according to the Contraception study.

At least half of these women give birth again within an interval that’s deemed unsafe to the mother’s health, according to the same study. Even when a mother is using contraceptives, the study found, she is relying on short-acting methods rather than long-acting ones such as implants.

Previously, medical practitioners were discouraged from prescribing hormonal birth control such as patches and implants to women who are less than six weeks postpartum. Many women rely on barrier methods, such as condoms, or believe that practicing breastfeeding prevents pregnancy, fueling many unwanted births that put mothers’ health at risk, according to the John Hopkins Bloomberg School of Public Health's researchers.

"The support for postpartum family planning contained in the revised MEC [WHO recommendations] should usher in a wave of policy changes that make the FP2020 commitment an attainable goal rather than a lofty target," the researchers added, referring to the Bill and Melinda Gates Foundation's public health target of reaching 120 million more women and girls with voluntary family planning options.