Family planning: choosing when to have children

Modern contraception is safe, free at government health centres, and available without your partner’s or family’s permission. It lets you decide when to have children and how many — a decision that shapes your health, your family’s finances, and your children’s chances.

Spacing pregnancies at least 2 years apart is one of the biggest things you can do for maternal and child health.

On this page

• Methods available in Ethiopia
• How to choose
• What each method feels like
• After birth
• When something goes wrong
• Emergency contraception
• Where to get help

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Methods available in Ethiopia

All of these are free at government health centres. Confidential — no partner permission needed. You can stop and start at any time (except sterilisation).

Method	How it works	How often	Effectiveness (typical use)
Combined pill	Hormones, once a day	Daily	91%
Progestin-only pill (“mini-pill”)	Hormone, once a day at exact same time	Daily	91%
Injection (Depo-Provera)	Hormone injection	Every 3 months	94%
Implant (Implanon, Jadelle)	Small rod under arm skin	3-5 years	99.9%
IUD (copper T)	Small copper device in womb	Up to 12 years	99.4%
IUS (hormonal)	Small hormonal device in womb	5-8 years	99.9%
Male condom	Latex barrier	Every act	87%
Female condom	Latex or nitrile barrier	Every act	79%
Female sterilisation	Blocking or removing fallopian tubes	Permanent	99.5%
Male sterilisation (vasectomy)	Cutting sperm ducts	Permanent	99.85%
Lactational Amenorrhea Method (LAM)	Exclusive breastfeeding	First 6 months only	98% (all 3 conditions met)

Only male and female condoms also protect against HIV and STIs. If you use another method, still use condoms if HIV/STI risk is present.

How to choose

There is no single “best” method — the best is the one you will actually use consistently. Consider:

• Do you want more children later? If yes → reversible method (pill, injection, implant, IUD). If no → permanent (sterilisation) is an option.
• How well can you remember daily? If not well → injection, implant, or IUD (nothing to remember daily).
• Are you breastfeeding? Combined pill NO (dries up milk). Progestin-only pill YES. Injection YES. Implant YES. IUD YES.
• Do you have irregular periods? Injection or hormonal IUS often stops periods entirely (safe). Combined pill regulates them.
• Blood pressure high, migraine with aura, or smoker over 35? Avoid combined pill; injection/implant/IUD are safer.
• HIV positive? All methods safe. Condoms in addition, to prevent transmission.
• How much can you travel to the health centre? Every 3 months for injection is doable. Once every 3-5 years for implant is easier.
• Partner support? Not required for any method — but if he objects, hidden methods (injection, implant, IUD) are options.

Ask the health worker to walk you through the ones that fit your situation. There’s no wrong answer, and you can switch any time.

What each method feels like

Pills — start a new pack every month. Common early side effects: light spotting, nausea, breast tenderness — usually fade in 2-3 months.

Injection (Depo) — a nurse injects it in your arm or buttock. Takes 5 minutes. Some women stop having periods entirely on Depo (safe). Fertility can take 6-18 months to return after the last shot — plan ahead if you want to conceive soon.

Implant — a small numbing injection, then a health worker slides a matchstick-sized rod under the skin of your upper arm. Takes 10 minutes. Some spotting for the first 3-6 months. Removal is quick when you’re ready.

IUD — placed inside the womb during a pelvic exam. Cramping for a day or two after. First few periods may be heavier (copper) or lighter (hormonal). You can check the strings monthly to be sure it’s in place.

Condoms — use every time. Correct use: check expiry date, open carefully, put on before any contact, leave space at the tip, don’t reuse.

After birth

• Exclusive breastfeeding + no periods yet + baby under 6 months = LAM (Lactational Amenorrhea Method) is 98% effective
• Otherwise you can get pregnant as early as 4 weeks after birth, even before your period returns
• Insert IUD within 48 hours of delivery or after 6 weeks
• Get implant from 6 weeks
• Start progestin-only pills at 6 weeks
• Injection from 6 weeks
• Combined pill: wait until 6 months (dries up milk earlier than that)

See postpartum care for the full timeline.

When something goes wrong

::: urgentAdvice severity=“urgent”

Urgent — go to a health facility today if you have:

• Missed 2 or more pills and had sex — think about emergency contraception (see below)
• Severe abdominal pain with an IUD in place
• Heavy bleeding that is very different from your normal periods
• Signs of pregnancy (missed period, morning sickness) while using contraception
• Yellow skin or eyes, severe leg pain, severe chest pain, sudden vision changes while on combined pills (rare but serious)
• The strings of your IUD feel much longer or shorter than before, or you cannot feel them :::

::: doList

Do

• Take pills at the same time every day (progestin-only pill is time-sensitive to within 3 hours)
• Get your Depo injection on time — schedule the next appointment before you leave
• Feel for your IUD strings once a month
• Use condoms in addition if HIV/STI risk is present
• Come back if side effects bother you — there are options :::

::: dontList

Don’t

• Do not skip pills to “give your body a rest” — not needed and reduces effectiveness
• Do not remove an implant yourself
• Do not reuse condoms
• Do not use two condoms together — friction breaks both
• Do not use expired condoms :::

Emergency contraception

If a condom broke, you missed pills, or you had unprotected sex — emergency contraception (EC) can reduce pregnancy risk by 85-95% if taken within 72 hours (best within 24).

Two options in Ethiopia:

• Levonorgestrel pill (Postpill, Plan B) — one tablet, over the counter at most pharmacies
• Copper IUD — inserted within 5 days, also becomes your ongoing contraception

EC is not the same as an abortion pill — it prevents pregnancy from starting. If you’re already pregnant, EC doesn’t do anything.

See our emergency contraception article for more detail.

Where to get help

• Any government health centre — free, confidential, all methods available
• Marie Stopes Ethiopia clinics — sliding-scale fees, all methods, extensive coverage
• Family Guidance Association of Ethiopia (FGAE) clinics — youth-friendly services
• Pharmacies — pills, condoms, and emergency contraception over the counter

Under 18? Every government health centre must serve you without a parent or partner present. That is the law under the Ethiopian Reproductive Health guidelines.

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Reviewed by Dr. Hanna Alemayehu, MD, MPH — Family medicine, Addis Ababa

Sources: WHO Family Planning fact sheet 2023; Ethiopian MoH National Reproductive Health Strategy 2021; WHO Medical Eligibility Criteria 5th ed.

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Draft notes: ~1200 words · grade 7 · Ethiopian context: Marie Stopes, FGAE, real-world effectiveness numbers, LAM criteria, Depo return-to-fertility timeline, health-centre confidentiality law · No cost — everything free at government facilities · Cross-references postpartum-care and emergency-contraception articles.