An estimated 164 million women worldwide who want to delay or avoid pregnancy are not currently using contraception, according to the World Health Organization (WHO), which has issued new guidance aimed at expanding contraceptive choices.

‎The recommendations, released as the world marks World Contraception Day, include support for the extended use of certain contraceptive implants for up to five years and the addition of mifepristone as an emergency contraceptive option that can be taken within five days of unprotected sex.

‎The WHO said the updated guidance is intended to give people a wider range of evidence-based options and greater flexibility in deciding whether to use contraception, which method to choose, and when to change or stop using it.

‎“Contraception isn’t one-size-fits-all,” said Dr Pascale Allotey, director of the WHO Department of Sexual, Reproductive, Maternal, Child and Adolescent Health and Ageing.

‎“Men and women both need a range of options that reflect what science and innovation can now offer,” she said, adding that “choice is a gender equality issue”.

Five-year contraceptive implants

‎One of the key changes in the new guidance is WHO support for the extended use of etonogestrel-releasing contraceptive implants for up to five years.

‎The agency said extending the duration of use could reduce the need for replacement procedures and clinic visits, while also lowering associated costs.

‎The recommendation concerns the duration for which certain implants can be used and does not mean that all contraceptive implants have a five-year duration.

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‎Five-day emergency contraception option

‎The WHO has also recommended mifepristone as an additional option for emergency contraception.

‎‎It can be taken as soon as possible and within 120 hours, or five days, after unprotected sex.

‎According to WHO, available evidence indicates that mifepristone at doses of 10mg to 50mg is likely to be as safe and effective as other emergency contraceptive methods.

‎The agency’s recommendation does not mean that mifepristone is the only emergency contraceptive option. Rather, it adds another evidence-based option to the range of methods available.

‎Changes to contraceptive pill use

‎The updated guidance also addresses how some existing combined oral contraceptive pills can be used.

‎WHO recommends that certain combined oral contraceptives may be taken for extended periods of up to six months or continuously for up to one year, offering an alternative to conventional cyclical use.

‎The appropriate method and regimen can vary depending on individual circumstances, so the guidance is intended to support informed choices rather than prescribe a single approach for everyone.

‎Why millions still lack contraception

‎WHO said the challenge extends beyond the availability of contraceptive methods.

‎Barriers can include limited access and choice, concerns about side effects, cultural or religious opposition, poor-quality services and gender-related obstacles.

‎For the estimated 164 million women with an unmet need for contraception, expanding the range of methods therefore needs to be accompanied by access to safe, quality and affordable information and services, the agency said.

WHO looks to male contraception

The new recommendations also extend to the development of male contraceptive methods.

‎WHO has developed its first Target Product Profile for male contraceptive methods, designed to guide researchers and developers working on reversible male contraception.

‎Several hormonal and non-hormonal approaches are already being researched, with some candidates in advanced clinical trials.

‎The move reflects a broader effort to expand contraceptive choices beyond methods currently available to women.

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‎What the new guidance means

‎WHO’s latest recommendations place greater emphasis on choice, access and flexibility in contraception.

‎The agency says people should have access to a range of safe and effective options and be able to choose a method that suits their circumstances, change it when their needs change, or stop using it when they choose.

‎But expanding the menu of contraceptive options is only one part of addressing the global gap.

‎For the 164 million women identified by WHO as having an unmet need for contraception, access to reliable information, affordable services and quality healthcare remains central to enabling informed reproductive decisions.

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‎Read the WHO’s Guidelines on Expanding Contraceptive Options for the full recommendations.

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