Family Planning

Providing Combined OralContraceptivesWhen to StartIMPORTANT: A woman can start using COCs any time she wants if it isreasonably certain she is not pregnant. To be reasonably certain she is notpregnant, use the Pregnancy Checklist (see p. 372). Also, a woman can begiven COCs at any time and told when to start taking them.Woman’s situationHaving menstrualcycles orswitching froma nonhormonalmethodWhen to startAny time of the monthóóóIf she is starting within 5 days after the start of hermonthly bleeding, no need for a backup method.If it is more than 5 days after the start of hermonthly bleeding, she can start COCs any timeit is reasonably certain she is not pregnant. Shewill need a backup method * for the first 7 days oftaking pills. (If you cannot be reasonably certain,give her COCs now and tell her to start takingthem during her next monthly bleeding.)If she is switching from an IUD, she can startCOCs immediately (see Copper-Bearing IUD,Switching From an IUD to Another Method,p. 148).Switching froma hormonalmethodFully or nearly fullybreastfeedingLess than 6 monthsafter giving birthóóóImmediately, if she has been using the hormonalmethod consistently and correctly or if itis otherwise reasonably certain she is notpregnant. No need to wait for her next monthlybleeding. No need for a backup method.If she is switching from injectables, she can begintaking COCs when the repeat injection wouldhave been given. No need for a backup method.Give her COCs and tell her to start takingthem 6 months after giving birth or whenbreast milk is no longer the baby’s main food—whichever comes first.*Backup methods include abstinence, male and female condoms, spermicides, andwithdrawal. Tell her that spermicides and withdrawal are the least effective contraceptivemethods. If possible, give her condoms.10 Family Planning: A Global Handbook for Providers