The present status of family planning.

It now is evident after over 25 years of experience with modern contraceptive techniques that the health benefits of using family planning in general and of oral contraceptives (OCs) in particular are substantial and outweigh any risks or complications. The task of medical practitioners is to make a realistic assessment of health perspectives for each individual as individualization and the careful selection of methods are essential in family planning. Equally important are careful follow-up and supervision including verbal and written instructions to ensure that users know what problems to expect when to report problems and what symptoms may be related to the method prescribed. In addition to preventing unwanted pregnancies OCs provide protection against a number of diseases: a significant reduction in the incidence of endometrial and ovarian cancer benign breast lesions ovarian cysts pelvic inflammatory disease ectopic pregnancy endometriosis and menstrual problems. The safety and health benefits of OCs have improved significantly with the practice of using low-dose pills for low low-risk women. The use of low-dose pills has reduced the effects of OCs on carbohydrate and lipid metabolism and coagulopathy. It also has reduced the incidence of side effects. Serious complications are now rare. Current research is focusing on reducing the metabolic and clinical risks of hormonal contraception even further. A promising new approach is the development of systems for the continuous delivery of low-dose progestogen in the form of the subcutaneous levonorgestrel implant system (Norplant) or the vaginal ring. There has been much opposition to injectable contraceptives particularly from the media and feminist groups in certain countries. The scientific bodies which have reviewed all the evidence continue to support their use. Progestogen-only or mini pills have been neglected and underused. The withdrawal of the IUD in the US is unfortunate as IUDs remain an exceptionally useful contraceptive method for a selected group of women. There are major problems with male contraception due to the difficulty in inhibiting spermatogenesis without interfering with testicular androgens and in achieving longterm azoospermia and thus far no satisfactory male contraceptive has been developed. As no 1 family planning method is ideally suitable for every couple doctors will have to continue to balance the benefits and risks and consider efficacy and acceptability advantages and disadvantages for individual couples.