Recommendations for Contraceptive Use
RH TOC		Dual Method Use

Q.1. When should users be advised to use dual methods for increased contraceptive efficacy of their contraceptive method?

For some contraceptives, users are typically advised to use dual methods:

• Diaphragm: Current instructions recommend the use of the diaphragm with spermicide. Research indicates the spermicide improves the contraceptive effectiveness.
• Vasectomy: Men are advised to use condoms, or have their partners use a contraceptive method, for approximately three months (or 20 ejaculations) after the vasectomy to make sure no sperm are in the ejaculate. Where possible, men should have a semen analysis before having intercourse without a back-up method.
• Condoms: In some programs condom users are also advised to use a spermicide to increase effectiveness. Where possible, this idea has been incorporated into spermicidally lubricated condoms.

Some providers urge pill users to have supplies of condoms as a back-up in the case of missed pills or when the pill user has run out of pills. This is a reasonable approach and provides a good opportunity for counseling on correct pill use.

Lactational amenorrhea method (LAM) users and breastfeeding women should be provided with barrier methods or progestin-only pills (POPs) to start when they want or need to. Preferably POPs should not be used prior to six weeks postpartum by breastfeeding women. Among LAM users, POPs may be used while she is still relying on LAM as dual protection or when the LAM criteria no longer apply.

Another approach to using dual methods is to provide emergency contraceptive pills (ECPs) to users of barrier methods (condom, diaphragm, sponge, spermicide), oral contraceptive (OC) pills, or natural family planning (NFP). Providing ECPs means giving the correct number of pills for emergency contraception (EC), along with instructions for their use. Having EC readily available is likely to decrease the risk of unintended pregnancy in cases of slippage/breakage/non-use of barriers, multiple missed OC pills, failure to abstain when necessary when using NFP, or other causes of unprotected intercourse.

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Any part of Recommendations for Updating Selected Practices in Contraceptive Use may be reproduced or adapted to meet local needs without prior permission from the TG/CWG Secretariat, provided the TG/CWG is acknowledged and the material is made available free of charge or at cost.