1. The European Journal of Contraception and Reproductive Health Care, April 2010;15:65–66
EDITORIAL
Non-hormonal methods of
contraception
Istvan Batar
´ ´
Family Planning Centre, Department of Obstetrics and Gynaecology, University of Debrecen, Debrecen, Hungary
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K E Y W O R D S Non-hormonal contraception; Female sterilisation; Male sterilisation; Intrauterine
contraception; IUD; Mechanical barrier methods; Spermicides; Natural family planning
...........................................................................................................................................................................................................
Non-hormonal contraception encompasses a wide training programmes in family planning must include
variety of modalities from the ‘natural’ methods to the even the less effective methods while, for the benefit
most reliable ones, sterilisation and intrauterine of the clients, education at all levels should focus on
devices. They are resorted to worldwide; however, up-to-date information.
some of them are not well known or correctly Helping a given person to choose the most
For personal use only.
perceived by lay people and health care providers. appropriate method is not always easy and depends
Clinical observations, randomised longitudinal on the person’s lifestyle, cultural background, religious
trials, evidence-based reviews and meta-analyses show values and other characteristics. Young people,
that the contraceptive methods concerned differ nulliparous women, the poor and the poorly educated
greatly with regard to their effectiveness and overall have specific needs and expectations which must be
performance (in terms of ease of use, side effects, direct taken into account. Even the same couple’s needs
and indirect costs, continuation rates, etc.) and that for change with time and circumstances, and efficacy is not
each method, depending on specific features, differ- necessarily the most important criterion during the
ences are noted. whole duration of their relationship.
Available and reliable evidence allows us to rank The regularly updated Medical Eligibility Criteria
contraceptive modalities on one or another scale for Contraceptive Use of the World Health Organisa-
according to their effectiveness, continuation, asso- tion (WHO)1 provides evidence-based recommenda-
ciated adverse effects, cost or benefits, but we cannot tions concerning the safety of use of various methods
unambiguously consider them as good or bad, since in interaction with specific physiological (e.g., nulli-
each method has a role to play in the prevention of parity, lactation) or medical conditions. The WHO
unwanted pregnancy in accordance to the user’s medical eligibility categories are intended for world-
wishes and needs. Consequently, conclusions based wide use with emphasis on developing countries. A
on effectiveness observed during typical use can serve, modified version of the criteria has been compiled for
at best, only as very broad guidelines. use in the United Kingdom2 and may readily be
Contraceptive advice and practice must be tailored applied in other developed countries.
to the client’s needs and characteristics. Service Methods of non-hormonal contraception including
providers therefore must be knowledgeable of all ‘natural’ family planning have been re-evaluated in
modalities and must help the client identify the one recent years. Thanks to new and continuing research
that is most appropriate for him or her. To achieve that, they have been improved. Innovative changes have
Correspondence: Dr Istvan Batar, Poroszlay 11, 4032-Debrecen, Hungary. Tel: þ36 30 9282074. E-mail: batar0705@t-online.hu
´ ´
ª 2010 European Society of Contraception and Reproductive Health
DOI: 10.3109/13625180903560160

2. Non-hormonal contraception Batar
´
increased their effectiveness, sometimes diminished trials with different methods, and published nearly 200
their side effects, and widened or restricted the papers, most of them on intrauterine devices (IUDs).
indications for use. Rob J. C. M. Beerthuizen practised as a gynaecolo-
A series of review articles appearing in this issue of the gist/obstetrician in the Queen Beatrix Hospital in
European Journal of Contraception and Reproductive Health Winterswijk, The Netherlands, until 1997. He
Care under the common title ‘State-of-the-art of non- presently heads the Dutch Foundation for Contra-
hormonal methods of contraception’ summarises the ception. He participated in several multicentre trials
history, clinical experience and research on mechanical on IUDs and subdermal implants. Professor Gunter ¨
barrier methods3, spermicides4, intrauterine contracep- Freundl of the Heinrich-Heine-University in Dussel- ¨
tion (excluding hormone-releasing systems)5, natural dorf, Germany, was the principal investigator of
family planning6 and female and male sterilisation7–8. research projects on natural family planning in that
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The articles are a product of the Expert Group on country. Irving Sivin, senior scientist at the Population
Non-hormonal Methods of Contraception, which is Council in New York, USA, has published over 120
one of the five expert groups of the European Society peer-reviewed articles on development and evaluation
of Contraception and Reproductive Health. The task of contraceptives, particularly IUDs, contraceptive
assigned to these groups consists of following advances implants and vaginal rings.
in their domain, summarising the results and publish- In the editorial phase of this series, the original group
ing the updated conclusions from time to time. The of authors was extended to include a sixth colleague
group members are acknowledged experts in their invited by the Editor-in-Chief of the Journal: Dirk
field of scientific and/or clinical interest. Michielsen, a staff member of the Department of
These articles and their authors represent a rather Urology of the University Hospital Brussels in
wide range of research activity. Group coordinator, Belgium, and he is the senior author of the last article
For personal use only.
Associate Professor Istvan Batar was Head of the
´ ´ of the series, on male sterilisation8.
Family Planning Centre at the Debrecen University, The authors hope that, with this project, they
Hungary between 1973 and 2006. He conducted contribute to the updating of knowledge on non-
many national and international contraceptive clinical hormonal contraception.
REFERENCES
1. World Health Organization. Medical eligibility criteria for 5. Sivin I, Batar I. State-of-the-art of non-hormonal
´
contraceptive use, 3rd edn. 2004. http://whqlibdoc.who. int/ methods of contraception: III. Intrauterine contra-
publications/2004/9241562668.pdf (Accessed July 2009) ception. Eur J Contracept Reprod Health Care 2010;
2. Faculty of Family Planning and Reproductive Health Care 15:96–112.
Clinical Effectiveness Unit. UK Medical Eligibility Criteria for 6. Freundl G, Sivin I, Batar I. State-of-the-art of non-
´
Contraceptive Use. 2005/2006. http://www.ffprhc. org.uk/ hormonal methods of contraception: IV. Natural family
admin/uploads/298_UKMEC_200506.pdf (Accessed July planning. Eur J Contracept Reprod Health Care 2010;
2009) 15:113–23.
3. Batar I, Sivin I. State-of-the-art of non-hormonal
´ 7. Beerthuizen RJCM. State-of-the-art of non-hormonal
methods of contraception: I. Mechanical barrier contra- methods of contraception: V. Female sterilisation. Eur J
ception. Eur J Contracept Reprod Health Care 2010; 15:67– Contracept Reprod Health Care 2010;15:124–35.
88. 8. Michielsen D, Beerthuizen RJCM. State-of-the-art of
4. Batar I. State-of-the-art of non-hormonal methods of
´ non-hormonal methods of contraception: VI. Male
contraception: II. Chemical barrier contraceptives. Eur J sterilisation. Eur J Contracept Reprod Health Care 2010;
Contracept Reprod Health Care 2010;15:89–95. 15:136–49.
66 The European Journal of Contraception and Reproductive Health Care