La planificación de la familia: el Mundial de Referencia para proveedores

How can this book help? By enabling health care providers to give better care to

more people. In a straightforward, easily used way, this book translates scientific

evidence into practical guidance on all major contraceptive methods. This

guidance reflects the consensus of experts from the world’s leading health

organizations. With this book in hand, a provider can confidently serve clients

with many different needs and knowledgeably offer a wide range of methods.

The World Health Organization (WHO) appreciates the many contributions

to this book made by people from around the world. The collaboration to

develop, by consensus, an evidence-based book of this scope and depth is a

remarkable achievement. WHO would like to thank particularly the Johns

Hopkins Bloomberg School of Public Health/Center for Communication

Programs for its invaluable partnership in the preparation of this book. WHO

also appreciates the commitment of the many organizations—United Nations

agencies, members of the Implementing Best Practices Consortium, and many

others—that are adopting this handbook and disseminating it to health care

providers throughout the world with the financial support of a wide range of

government agencies and other development partners. These concerted efforts

attest that the job of improving the world’s health lies in good hands.

Paul F.A. Van Look, MD PhD FRCOG

Former Director, Department of Reproductive Health and Research

World Health Organization

Forewords v

From the United States Agency for International Development

The practical, up-to-date guidance in this new handbook will help to improve

the quality of family planning services and maximize people’s access to them.

It can help family planning providers to assist clients choosing a family planning

method, to support effective use, and to solve clients’ problems. Managers and

trainers can use this book, too.

While this handbook covers many topics, 4 overall themes emerge:

1. Almost everyone can safely use almost any method, and providing most

methods is usually not complicated. Thus, methods can be made widely

available and offered even where health care resources are quite limited.

This book defines and explains the many opportunities for people to

choose, start, and change family planning methods appropriately.

2. Family planning methods can be effective when properly provided. For

greatest effectiveness some methods, such as pills and condoms, require

the user’s conscientious action. The provider’s help and support often can

make the difference, such as discussing common possible side effects. Some

methods require the provider to perform a procedure correctly, such as

sterilization or IUD insertion. Short of giving instructions on performing

procedures, this handbook offers the guidance and information that

providers need to support effective and continuing contraceptive use.

3. New clients usually come for services with a method already in mind, and

this is usually the best choice for them. Within the broad range of methods

that a client can use safely, the client’s purposes and preferences should

govern family planning decisions. To find and use the most suitable method,

a client needs good information and, often, help thinking through choices.

This book provides information that client and provider may want to

consider together.

4. Many continuing clients need little support, and for them convenient access

is key. For ongoing clients who encounter problems or concerns, help

and support are vital. This handbook provides counseling and treatment

recommendations for these clients.

With the collaboration of the World Health Organization and many organizations,

many experts worked together to create this book. The United States Agency

for International Development is proud to support the work of many of the

contributors’ organizations and the publication of this book, as well as to have

participated in developing its content. Together with the providers of family

planning who use this book, we all endeavor to make the world a better place.

James D. Shelton, MD

Science Advisor, Bureau for Global Health

United States Agency for International Development

vi Family Planning: A Global Handbook for Providers

Vera Zlidar, Ushma Upadhyay, and Robert Lande of the INFO Project,

Center for Communication Programs at Johns Hopkins Bloomberg School

of Public Health were the principal technical writers and led the handbook

development process, together with Ward Rinehart from the INFO Project

and Sarah Johnson of the World Health Organization, who also served as

editors. Other contributors to the research and writing from the INFO

Project include Fonda Kingsley, Sarah O’Hara, Hilary Schwandt, Ruwaida

Salem, Vidya Setty, Deepa Ramchandran, Catherine Richey, Mahua Mandal,

and Indu Adhikary.

Key technical advisors throughout the development of the book include

Robert Hatcher, Roy Jacobstein, Enriquito Lu, Herbert Peterson, James

Shelton, and Irina Yacobson. Kathryn Curtis, Anna Glasier, Robert Hatcher,

Roy Jacobstein, Herbert Peterson, James Shelton, Paul Van Look, and Marcel

Vekemans conducted final technical review of this book.

The following people provided their expertise during expert meetings in

Baltimore in October 2004, Geneva in June 2005, or both: Yasmin Ahmed,

Marcos Arevalo, Luis Bahamondes, Miriam Chipimo, Maria del Carmen

Cravioto, Kathryn Curtis, Juan Diaz, Soledad Diaz, Mohammad Eslami, Anna

Glasier, John Guillebaud, Ezzeldin Othman Hassan, Robert Hatcher, Mihai

Horga, Douglas Huber, Carlos Huezo, Roy Jacobstein, Enriquito Lu, Pisake

Lumbiganon, Pamela Lynam, Trent MacKay, Olav Meirik, Isaiah Ndong,

Herbert Peterson, John Pile, Robert Rice, Roberto Rivera, Lois Schaefer,

Markku Seppala, James Shelton, Bulbul Sood, Markus Steiner, James Trussell,

Marcel Vekemans, and Wu Shangchun.

The key contributors to this handbook, who are listed above, declared no

conflicts of interest.

The following organizations made extraordinary technical contributions to

the creation of this handbook: The Centre for Development and Population

Activities, EngenderHealth, Family Health International, Georgetown

University Institute for Reproductive Health, JHPIEGO, Management

Sciences for Health, Population Council, and the United States Agency for

International Development.

Many others also contributed their expertise on specific topics and

participated in the development of consensus on technical content.

Contributors include Christopher Armstrong, Mark Barone, Mags

Beksinska, Yemane Berhane, Ann Blouse, Julia Bluestone, Paul Blumenthal,

Annette Bongiovanni, Débora Bossemeyer, Nathalie Broutet, Ward

Acknowledgements

Acknowledgements vii

Cates, Venkatraman Chandra-Mouli, Kathryn Church, Samuel Clark, Carmela

Cordero, Vanessa Cullins, Kelly Culwell, Johannes van Dam, Catherine

d’Arcangues, Barbara Kinzie Deller, Sibongile Dludlu, Mary Drake, Paul

Feldblum, Ron Frezieres, Claudia Garcia-Moreno, Kamlesh Giri, Patricia

Gómez, Pio Iván Gómez Sánchez, Vera Halpern, Robert Hamilton, Theresa

Hatzell, Helena von Hertzen, John Howson, Carol Joanis, Robert Johnson,

Adrienne Kols, Deborah Kowal, Jan Kumar, Anne MacGregor, Luann Martin,

Matthews Mathai, Noel McIntosh, Manisha Mehta, Kavita Nanda, Ruchira

Tabassum Naved, Francis Ndowa, Nuriye Ortayli, Elizabeth Raymond,

Heidi Reynolds, Mandy Rose, Sharon Rudy, Joseph Ruminjo, Dana Samu, Julia

Samuelson, Harshad Sanghvi, George Schmid, Judith Senderowitz, Jacqueline

Sherris, Nono Simelela, Irving Sivin, Jenni Smit, David Sokal, Jeff Spieler, Kay

Stone, Maryanne Stone-Jimenez, Fatiha Terki, Kathleen Vickery, Lee Warner,

Mary Nell Wegner, Peter Weis, and Tim Williams.

Family planning providers in Bangladesh, Brazil, China, Ghana, India, Indonesia,

Kenya, Pakistan, the Philippines, and Zambia offered comments on draft

covers and chapters of the book in sessions organized by Yasmin Ahmed,

Ekta Chandra, Miriam Chipimo, Sharmila Das, Juan Diaz, Carlos Huezo,

Enriquito Lu, Isaiah Ndong, Samson Radeny, Mary Segall, Sarbani Sen, Nina

Shalita, Bulbul Sood, and Wu Shangchun.

John Fiege, Linda Sadler, and Rafael Avila created the layout of the book.

Mark Beisser created the cover and initial design along with Linda Sadler, the

staff at Prographics, and John Fiege. Rafael Avila managed the photographs

and illustrations. Ushma Upadhyay, Vera Zlidar, and Robert Jacoby managed

the book’s production. Heather Johnson managed printing and distribution of

the handbook along with Mandy Liberto, Tre Turner, Roslyn Suite-Parham, and

Quan Wynder.

© 2007, 2008, 2011 World Health Organization and Johns Hopkins Bloomberg School of

Public Health/Center for Communication Programs

ISBN 13: 978-0-9788563-7-3

ISBN 10: 0-9788563-0-9

Suggested citation: World Health Organization

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