Contraceptive Mechanism of Action: In the Womb Where It Happens

Drawing on his experiences as an OB/GYN, professor, and advisor, Dr. Hathaway’s presentation will help participants learn more about and better understand: a) the basics of the female reproductive system, b) how to be reasonably certain a woman is not pregnant, and c) her contraceptive method options, none of which cause abortion.

Participants will leave the presentation with a more complete understanding of the types of family planning methods available. One barrier facing women around the world is lack of access to modern contraceptive options. We’re fighting for universal access to appropriate family planning options for people around the world in our field and advocacy work.

**This presentation is appropriate for a general audience and is not intended for practical application.

About the Speaker

Dr. Mark Hathaway, Senior Technical Advisor for Reproductive Health at Jhpiego

Dr. Hathaway is Senior Technical Advisor for Reproductive Health at Jhpiego, and an obstetrician-gynecologist. He has served on several national-level work groups and committees, including the Institute of Medicine Standing Committee on Family Planning and the National Contraceptive Metrics Workgroup. He holds appointments at Johns Hopkins University as Adjunct Professor of OB/GYN and at George Washington University as Associate Clinical Professor of Health Care Sciences. Dr. Hathaway is also a member of Population Connection’s Board of Directors.

Q+A

What parts of the world have made the most progress with family planning services? Also what organizations provide family planning services.

Marian Starkey, PopConn’s VP of Communications answer: High-income, developed countries have historically been the ones that have made the most progress in providing voluntary family planning services to their people. But because of donor countries and foundations providing family planning assistance to aid-recipient countries for the past half-century, many low- and middle-income countries have also been able to increase contraceptive prevalence.

The major world regions that have made the most progress in the last few decades are Latin America and Asia, where fertility rates (a proxy for how widely a population practices contraceptive use) have declined by 3.4 and 3.6 children per woman, respectively, since the late 1960s.

Hidden within that, though, are large fertility declines at the country level, many in places that might surprise you! Here are the ten countries whose fertility rates have declined by the largest amount since the late 1960s:

1. Libya (-5.74)
2. United Arab Emirates (-5.35)
3. Maldives (-5.34)
4. Kuwait (-5.30)
5. Jordan (-5.22)
6. Qatar (-5.09)
7. Saint Lucia (-5.03)
8. Bahrain (-4.97)
9. Honduras (-4.93)
10. Saudi Arabia (-4.92)

Population Connection partners with organizations including WINGS Guatemala, Family Health Options Kenya, the Turimiquire Foundation (Venezuela), and Conservation Through Public Health (Uganda) to improve access to contraceptives among the populations they serve. Although we advocate for the full spectrum of reproductive healthcare for all people, we are not a direct service provider.

Other organizations that provide family planning services in less developed countries include International Planned Parenthood Federation, Marie Stopes International, UNFPA, the Bill and Melinda Gates Foundation, and many more.

What methods are most appropriate for those women in the Sahel region, or in immigration camps, etc., basically primitive conditions?

Dr. Mark Hathaway’s answer: This is very complicated because it depends so much on access to any care, providers who know and understand contraceptive methods, and then, of course, are methods/supplies/commodities even available. MSF (Doctors w/o Borders) and several humanitarian organizations provide health care in many sites around the world and are sometimes better positioned than governments to provide contraceptive services.

Do religious groups who oppose abortion also oppose contraception?

Marian Starkey, PopConn’s VP of Communications answer: Some religious leaders oppose both abortion and contraception, but it’s also true that many who practice those religions do not share the same views. Catholicism is a good example: The Church officially condemns abortion and contraception, but 99% of Catholics in the U.S. who have had sex at least once have used contraception. And Italy and Spain—both Catholic-majority countries—have two of the lowest fertility rates in the entire world.

Many imams argue that Islam doesn’t forbid contraception for spacing births farther apart, because doing so is beneficial to the health of women and their children. And, of course, many imams do condemn contraception.

The point is that, regardless of what religious dogma tells people, many will do what’s best for themselves even if it goes against their religious ideology.

I am interested in data on the use and access to the morning-after pill in the USA or any other after-the-fact birth control method.

Dr. Mark Hathaway’s answer: Check out the Emergency Contraception website. It’s managed out of Princeton. There’s also good info on the Guttmacher.org website. websites.

How can the use of contraceptives reduce the chance of getting sexually transmitted diseases?

Dr. Mark Hathaway’s answer: Condoms are really the only methods that will reliably reduce exposure to STIs. There’s some evidence that progesterone methods that thicken the cervical mucus may reduce transmission, but not reliably. Of note, getting women and in particular, adolescents to see a provider for regular care, including contraceptive care, indirectly reduces STIs, since screening often happens at these visits. There are also more and more self-care self-testing methods becoming available.

Is it true taking emergency contraception after day 14 may not prevent fertilization?

Dr. Mark Hathaway’s answer: Yes, that’s true. The main way that hormonal EC works is by shutting down ovulation. It probably has an impact on the sperm and egg is released as well, but if ovulation has occurred all bets are off…still good to use the method, however. The copper IUD is also very effective for EC, as well, but much less utilized.