World Health Organisation (WHO) has called for an expansion of contraceptive options globally, a move that could have significant implications for Nigeria and other African countries grappling with unmet family-planning needs.
The global health agency, in its latest Guidelines on Expanding Contraceptive Options, said an estimated 164 million women who want to delay or avoid pregnancy are not using contraception.
According to WHO, broadening access to safe and effective methods would give individuals and couples greater opportunity to choose contraceptives based on their needs, circumstances and preferences.
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The organisation said the new guidance is intended to help countries expand access to contraceptive methods supported by the best available evidence.
Under the new recommendations, WHO supports the use of contraceptive implants for up to five years, potentially reducing the frequency of replacement procedures, health-facility visits and associated costs.
The agency has also recommended alternative ways of using combined oral contraceptive pills, saying they can be taken for extended periods of up to six months or continuously for up to one year, instead of conventional cyclical use.
The recommendations could be particularly relevant to countries such as Nigeria, where access to healthcare services and family-planning commodities varies considerably across communities.
WHO has further recommended mifepristone as an additional emergency contraceptive option, stating that it should be taken as soon as possible and within five days of unprotected sex.
The organisation said available evidence indicates that mifepristone at doses ranging from 10 to 50mg is likely to be as safe and effective as other emergency contraceptive methods.
Pascale Allotey, Director of WHO’s Department of Sexual, Reproductive, Maternal, Child and Adolescent Health and Ageing, described contraceptive choice as a gender-equality issue.
“Contraception isn’t one-size-fits-all. Men and women both need a range of options that reflect what science and innovation can now offer, weighed against convenience, invasiveness, behaviour, reliability and accessibility,” she said.
According to her, “Real choice means the confidence and control to choose a method, change it, or stop it.”
While encouraging wider access, WHO also cautioned countries against introducing contraceptive methods without adequate evidence on their safety and effectiveness.
The organisation called for more research into ormeloxifene before it is considered for inclusion in family-planning programmes, citing limited evidence on safety.
It also recommended against adding quinestrol-containing contraceptive pills to national contraceptive programmes because of limited evidence and reports of serious adverse events.
The WHO initiative also signals growing attention to male-controlled contraception.
At present, men have relatively few contraceptive options, principally condoms, withdrawal and vasectomy. Despite this, WHO estimates that approximately 30 per cent of couples rely on a male contraceptive method.
Research cited by the organisation suggests considerable potential demand for new male contraceptives.
More than 75 per cent of couples surveyed said they would be willing to use a new male contraceptive, while more than 85 per cent of women surveyed said they would trust their male partners to take responsibility for contraception.
To accelerate research and development, WHO has developed its first Target Product Profile for male contraceptive methods.
The framework identifies key characteristics that future products should meet, including safety, effectiveness, acceptability and affordability.
Several hormonal and non-hormonal male contraceptive candidates are currently being researched, with some promising methods already in advanced clinical trials.
WHO said new reversible male contraceptives could potentially become available within the next five to 10 years.
For Nigeria, the expansion of contraceptive options could provide additional tools for addressing unmet family-planning needs and improving access to methods that suit different circumstances.
However, the availability of new methods alone may not resolve the challenges confronting family planning.
Effective implementation will also depend on affordability, consistent availability of commodities, trained healthcare personnel, access to health facilities and reliable information to enable individuals to make informed choices.
WHO said it would continue supporting countries as they update their policies and programmes to ensure that family-planning services are guided by the best available scientific evidence.
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