Backup methods

* Backup methods include abstinence, male and female condoms, spermicides, and withdrawal.

Tell her that spermicides and withdrawal are the least effective contraceptive methods.

If possible, give her condoms.

Providing the Intrauterine Device (IUD)

When to start

Important: in many cases a woman can start the IUD any time it is reasonably certain she is not pregnant. To be reasonably certain she is not pregnant, use the Pregnancy Checklist).

Woman’s situation	When to start
Having menstrual cycles	Any time of the month If she is starting within 12 days after the start of her monthly bleeding, no need for a backup method. If it is more than 12 days after the start of her monthly bleeding, she can have the IUD inserted any time it is reasonably certain she is not pregnant. No need for a backup method.
Switching from another method	Immediately, if she has been using the method consistently and correctly or if it is otherwise reasonably certain she is not pregnant. No need to wait for her next monthly bleeding. No need for a backup method. If she is switching from injectables, she can have the IUD inserted when the next injection would have been given. No need for a backup method.
Soon after childbirth	Any time within 48 hours after giving birth (requires a provider with specific training in postpartum insertion). If it is more than 48 hours after giving birth, delay IUD insertion until 4 weeks or more after giving birth.
Fully or nearly fully breastfeeding Less than 6 months after giving birth	If her monthly bleeding has not returned, she can have the IUD inserted any time between 4 weeks and 6 months after giving birth. No need for a backup method. If her monthly bleeding has returned, she can have the IUD inserted as advised for women having menstrual cycles (see above).
Woman’s situation	When to start
Fully or nearly fully breastfeeding (continued) More than 6 months after giving birth	If her monthly bleeding has not returned, she can have the IUD inserted any time it is reasonably certain she is not pregnant. No need for a backup method. If her monthly bleeding has returned, she can have the IUD inserted as advised for women having menstrual cycles (see above)
Partially breastfeeding or not breastfeeding More than 4 weeks after giving birth	If her monthly bleeding has not returned, she can have the IUD inserted if it can be determined that she is not pregnant. No need for a backup method. If her monthly bleeding has returned, she can have the IUD inserted as advised for women having menstrual cycles (see above).
No monthly bleeding (not related to childbirth or breastfeeding)	Any time if it can be determined that she is not pregnant. No need for a backup method.
After miscarriage or abortion	Immediately, if the IUD is inserted within 12 days after first- or second-trimester abortion or miscarriage and if no infection is present. No need for a backup method. If it is more than 12 days after first- or secondtrimester miscarriage or abortion and no infection is present, she can have the IUD inserted any time it is reasonably certain she is not pregnant. No need for a backup method. If infection is present, treat or refer and help the client choose another method. If she still wants the IUD, it can be inserted after the infection has completely cleared. IUD insertion after second-trimester abortion or miscarriage requires specific training. If not specifically trained, delay insertion until at least 4 weeks after miscarriage or abortion.
Woman’s situation	When to start
For emergency contraception	Within 5 days after unprotected sex. When the time of ovulation can be estimated, she can have an IUD inserted up to 5 days after ovulation. Sometimes this may be more than 5 days after unprotected sex.
After taking emergency contraceptive pills (ECPs)	The IUD can be inserted on the same day that she takes the ECPs. No need for a backup method.

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