Looking back at the greatest public health achievements of the 20th century, the Centers for Disease Control and Prevention (CDC) put family planning in the top ten for significantly improving the health of women, infants, and children. Even though much progress has been made, still about 50 percent of pregnancies in the United States are unintended, and one in five unintended pregnancies are among teens.
Methods and availability of birth control have changed over the years, ranging from fish bladder condoms in 3000 B.C. to the first rubber condom in 1838. Nowadays there are many different contraception options, but availability, religious and cultural barriers, as well as myths and fears associated with birth control may prevent people from using it. The following introduction to birth control can help put some minds at ease.
There is no one right contraceptive method. Individuals need to first understand their options, and then choose a birth control method that will work best for them. The following criteria should be taken into consideration when choosing a birth control method:
- Effectiveness: How well can the method prevent a pregnancy? This is usually calculated as the percentage of women becoming pregnant with this method in a year. Different quotes are often explained by “typical” and “perfect” use.
- Safety: What side effects can be expected and how dangerous are they? Are there any other benefits of the method apart from preventing pregnancy? The World Health Organization developed medical eligibility criteria for each birth control method including fertility awareness methods in order to grade the safety of a method in certain conditions.
- Availability: How expensive is the method? Where can I get it? Is it easy to access? How long does it last?
- Compliance: Is the individual able to consistently follow a birth control method’s directions for use. For example, how good is she at taking a pill every day at the same time, using the patch weekly, or remembering to check her temperature? How good is her partner at withdrawal? How consistently do she and her partner use condoms?
- Other factors to consider: Age, life style, number of children, reversibility of method, preference for nonhormonal methods, protection against sexually transmitted diseases, visibility.
Overview of Birth Control Options:
Combined Estrogen/Progesterone Methods (COC)
- Forms: Oral contraceptive pill, patch, or ring. The pill can come in different strengths and combinations with different progesterones.
- Effectiveness: The probability of pregnancy using this method ranges between 1 and 9 percent. Differences are due to perfect or typical use.
- Side Effects: Certain contraindications, risks of deep vein thrombosis
- Other Benefits: Very regular periods; reduction in pain and flow of periods; reduction in premenstrual syndrome symptoms, endometriosis symptoms, polycystic ovary syndrome, and acne. Long-term usage reduction in ovarian and endometrial cancer.
- Availabilty: Pill is the cheapest of the three forms
- Reversibility: Return to fertility immediately after stopping
Progesterone Only Pill (POP)
- Use: This pill must be taken at the same time each day and is often used during lactation with no effect on milk supply
- Effectiveness: The probability of pregnancy using this method ranges between 1 and 13 percent (no significant differences in view of used progesterone)
- Side Effects: Less side effects than with COC and less contraindications; Irregular bleeding and spotting
Long-Acting Progesterone Only Methods
- Form: Small, single rod underneath the skin that can stay for three years. The small rod must be inserted and removed in a clinic.
- Effectiveness: Less than 1 percent probability of pregnancy
- Side Effects: Can lead to irregular spotting, mood effects, and weight gain
- Reversibility: Immediate return to fertility after removal
- Depo Provera
- Form: shot every three months
- Effectiveness: The probability of pregnancy using this method ranges between 0.2 and 6 percent. Differences are due to perfect or typical use.
- Side Effects: Can lead to irregular spotting, mood effects, and weight gain; Bone demineralization effect after five year of use
- Reversibility: Fertility can be delayed after discontinuation
Intrauterine Devices (IUD):
- Copper IUD
- Form: Small, T-shaped copper implant that can last for 10 years. The small implant must be inserted in a clinic.
- Effectiveness: The probability of pregnancy using this method ranges between 0.5 and 0.8 percent.
- Side Effects: May increase menstrual flow and cramps
- Other Benefits: Nonhormonal, highly cost effective, can be used as emergency contraception
- Reversibility: Immediate return to fertility after discontinuation
- Mirena/Skyla IUD (differ in size and hormone content)
- Form: Small, T-shaped implant that can last for three to five years. The implant contains small amounts of progesterone that act locally on endometrium and mucous. The small implant must be inserted in a clinic.
- Effectiveness: The probability of pregnancy using this method ranges between 0.1 and 0.2 percent.
- Other Benefits: Can reduce monthly blood flow and cramps
- Reversibility: Immediate return to fertility after discontinuation
- Form: This is an office-based procedure that provokes scaring of tubes. Occlusion of tubes should be documented and needs time to heal (three to six months).
- Effectiveness: The probability of pregnancy using this method ranges between 1.8 and 3.5 percent.
- Risks: Risk of procedure and risk of regret
- Side Effects: No long-term side effects or hormonal effects
- Reversibility: Sterilization is a permanent method and should be seen as nonreversible.
Male/Female Condoms (Do not use together!)
- Forms: Three different materials: latex, natural membrane (has small pores, less effective for STD prevention), or polyurethane (female). Latex allergy condoms are generally more expensive.
- Effectiveness: The probability of pregnancy using this method ranges between 2 and 18 percent.
- Other Benefits: Protects against sexual transmitted disease
- Availability: Easy to access over the counter
Vaginal Barriers with Spermicides
- Diaphragm, Cervical Cap, Contraceptive Sponge
- Effectiveness: The probability of pregnancy using this method varies widely between 5 and 30 percent.
- Side Effects: Spermicide use can lead to vaginal irritation and therefore higher chance of HIV infection, higher rates of urinary tract infections
Withdrawal (Coitus Interruptus)
- Effectiveness: The probability of pregnancy using this method ranges between 5 and 22 percent. This range depends on experience of withdrawal and semen content of preejaculate.
- Other Benefits: No cost, always available, no chemicals, fosters male responsibility and communication
- Side Effects: may diminish pleasure for both
Fertility Awareness-Based Methods (FAB)
- Effectiveness: The probability of pregnancy using this method ranges between 0.5 and 24 percent. Depends on regularity of cycle.
- Other Benefits: Increased awareness of cyclic function, increased communication between partners, no chemicals
The power to “choose a pregnancy” enables women and their families to better prepare for a pregnancy. For more information about different birth control methods, check out the online resources below.