The key message from the evidence that although long acting and permanent methods of contraception incur higher initial costs than short acting methods, the long term protection that they provide and substantially greater effectiveness at preventing unintended pregnancies means that their overall cost-effectiveness is higher. Research included in this review describe this key message, including providing data identifying IUDs and sterilisation as having the lowest annual direct costs. The IUD is identified as being the most cost-effective method of contraception available. Average direct costs are found to be highest for implants, injectables and pills. There is evidence suggesting that if used for at least three years, the IUD, vasectomy and implant are the three most cost-effective methods of contraception when all direct medical costs including unintended pregnancies are taken into account. Long acting and permanent methods of contraception are reported to be between three and 60 times more effective than short acting methods, and that continuation rates for these methods are much higher.