Family Planning Birth Control

Birth control  couple
When it comes to birth control, there’s no one right contraceptive method. It helps to first understand your birth control options, and then choose the method that works best for your lifestyle. With about 50 percent of pregnancies in the United States unintended, and 1 in 5 unintended pregnancies among teens, it’s important to know your contraceptive options

A Brief History of Birth Control

Birth control methods and availability have changed over the years, ranging from fish bladder condoms in 3000 B.C. to the first rubber condom in 1838. One of the greatest public health achievements of the 20th century as reported by the Centers for Disease Control and Prevention is family planning, which has significantly improved the health of women, infants, and children.

Today, many different contraception options exist, but availability, religious and cultural barriers, as well as myths and fears associated with birth control may prevent people from using contraceptives.

Which Method is Right for You?

The following questions can help you choose a birth control method:

  • Effectiveness: How well does it prevent pregnancy? This is usually calculated as the percentage of women who become pregnant with the method each year. Different percentages can be understood by “typical” and “perfect” use, such as with birth control pills. Typical use accounts for forgetting to take a dose or possibly vomiting a dose. Perfect use means using exactly as directed and never missing a dose.
  • Safety: What side effects can be expected and how dangerous are they? Are there any other health benefits apart from preventing pregnancy?
  • Availability: How expensive is it? Where can I get it? Is it easy to access? How long does it last?
  • Compliance: Are you able to consistently follow the directions for use? For example, how good are you at taking a pill every day at the same time, using the patch weekly, or remembering to check your temperature? How good is your partner at withdrawal? How consistently do you and you partner use condoms?
  • Other factors: Age, lifestyle, number of children, reversibility of method, preference for non-hormonal methods, protection against sexually transmitted diseases, visibility.

Birth Control Options

These nine options range from an IUD to condoms and more. Here’s a closer look. 

1. Combined estrogen/progesterone oral contraception
This includes the oral contraceptive pill, patch, or ring. The birth control pill comes in different strengths and combinations with different types of progesterone. 

  • Effectiveness: The probability of pregnancy ranges between 1 and 9 percent, depending on perfect or typical use.
  • Side effects: Yes, with certain symptoms and conditions; risks of deep vein thrombosis; decreased milk supply.
  • Other benefits: Very regular periods, a reduction in pain and flow of periods, and a reduction in PMS symptoms, endometriosis symptoms, polycystic ovary syndrome, and acne. A reduction in ovarian and endometrial cancer with long-term use.
  • Availability: Cheap and easily obtainable at pharmacies.
  • Reversibility: Immediate return to fertility after discontinuation. 

2. Progesterone-only pill
This type of birth control pill must be taken at the same time each day and is often used during breast feeding with no effect on milk supply.

  • Effectiveness: The probability of pregnancy ranges between 1 and 13 percent.
  • Side effects: Irregular bleeding and spotting. Fewer side effects and contraindications than with estrogen/progesterone pill. 

3. Long-acting progesterone-only methods
Nexplanon is a small, single rod implanted underneath the skin of the arm 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 changes, and weight gain.
  • Reversibility: Immediate return to fertility after removal.

Depo-Provera is a birth control shot you get every three months.

  • Effectiveness: The probability of pregnancy ranges between 0.2 and 6 percent depending on perfect or typical use.
  • Side effects: Can lead to irregular spotting, mood changes, and weight gain. Bone demineralization occurs with long-term use, but rebounds with discontinuation.
  • Reversibility: Fertility can be delayed after discontinuation. If planning a pregnancy in the next 1-2 years, choose something else.

4. Intrauterine devices (IUD)
Copper IUD is a small, T-shaped copper implant that can last for 10 years. 

  • Effectiveness: The probability of pregnancy ranges between 0.5 and 0.8 percent.
  • Side effects: May increase menstrual flow and cramps.
  • Other benefits: Non-hormonal, highly cost effective. Can be used as emergency contraception within 5 days of unprotected intercourse.
  • Availability: The small implant must be inserted in a clinic.
  • Reversibility: Immediate return to fertility after discontinuation. 

Mirena/Kyleena/Skyla IUD (differ in size and hormone content) are all small, plastic T-shaped implants that can last for three to five years depending on which type. The device contains small amounts of progesterone that act locally on endometrium and mucous.

  • Effectiveness: The probability of pregnancy ranges between 0.1 and 0.2 percent.
  • Other benefits: Can reduce monthly blood flow and cramps; can result in no period.
  • Availability: The small implant must be inserted in a clinic.
  • Reversibility: Immediate return to fertility after discontinuation.

5. Male/Female Sterilization
Sterilization is a permanent method. These birth control methods should be seen as nonreversible.

Vasectomy is an office-based procedure where the vas deferens is interrupted, inhibiting sperm travel. Semen analysis is done 3 months after procedure to assure success. An alternate contraception method is needed during this time.

  • Effectiveness: The probability of pregnancy is less than 0.2 percent.
  • Risks: Risk of procedure and risk of regret.
  • Side effects: No long-term side effects

Laparoscopic tubal ligation (female sterilization) is performed in the operating room under general anesthesia as an outpatient procedure. It is immediate contraception. Several surgical techniques are commonly practiced to achieve tubal ligation.

  • Effectiveness: The probability of pregnancy is less than 1 percent.
  • Risks: Surgical risk, risk of anesthesia, risk of regret.
  • Side effects: No long-term side effects or hormonal effects.
  • Other benefits: Theoretical risk reduction for fallopian tube and ovarian cancer.

Essure (for women) is an office-based procedure that provokes scarring of tubes. Occlusion of tubes should be documented and needs time to heal (three to six months). Alternate contraception method is needed during this time.

  • Effectiveness: The probability of pregnancy 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.

6. Male/female condoms (Do not use together!)
Three different types of condoms are available: latex, natural membrane (has small pores, less effective for STD prevention), and polyurethane (female condom). Latex allergy condoms are generally more expensive.

  • Effectiveness: The probability of pregnancy ranges between 2 and 18 percent.
  • Other benefits: Protects against sexual transmitted disease.
  • Availability: Easy to access over-the-counter.

7. Vaginal Barriers with Spermicides
The types include a diaphragm, cervical cap, or contraceptive sponge.

  • Effectiveness: The probability of pregnancy varies widely between 5 percent and 30 percent.
  • Side effects: Spermicide can lead to vaginal irritation and therefore a higher chance of HIV infection and higher rates of urinary tract infections. 

8. Withdrawal method (coitus interruptus)

  • Effectiveness: The probability of pregnancy ranges between 5 and 22 percent. This range depends on experience of withdrawal and semen content of pre-ejaculate.
  • Other benefits: No cost, always available, no chemicals, fosters male responsibility and communication.
  • Side effects: May diminish pleasure for both partners.

9. Fertility awareness-based methods (rhythm method)

  • Effectiveness: The probability of pregnancy ranges between 0.5 and 24 percent depending on cycle regularity.
  • Other benefits: Increased awareness of cyclic function, increased communication between partners, no chemicals. 

The power to “choose a pregnancy” enables couples and families to better prepare for a pregnancy. For more information about different birth control methods, check out Planned Parenthood or the Centers for Disease Control and Prevention.