It is estimated that 49 percent of the 6.7 million pregnancies in the United States in 2006 were unintended. In that year, 5 percent of women of reproductive age had 3.2 million pregnancies that were unplanned. This high rate of unintended pregnancies occurred in spite of most women reporting the use of some form of contraception. So what are the facts?
Effectiveness of different methods can be broken down to 3 tiers:
- Most effective: Intrauterine contraception (IUD), contraceptive implants, and sterilization are associated with a low pregnancy rate in all users
- Effective: Injectable contraceptives are the most effective in this tier of choices. The birth control pill, the transdermal contraceptive system (patch), and the vaginal ring are also associated with a very low pregnancy rate if they are taken consistently and correctly, but actual pregnancy rates are substantially higher because of inconsistent/incorrect use.
- Least effective: Other methods of contraception, including diaphragm/cervical caps, condoms, spermicides, withdrawal, and periodic abstinence are associated with actual pregnancy rates that are much higher than perfect use rates. The overall pregnancy rates associated with these methods have varied considerably among studies.
Intrauterine devices (IUDs) and implants, are long acting, highly effective methods which are underutilized in the U.S. and they are the best way to address the problem of high failure rates related to “typical” rather than “perfect” use. In other words, once they are placed, they work without anybody having to remember to do anything.
In the United States in 2002 the most frequently used methods of birth control were:
- oral contraceptive pill (11.7 million women)
- female sterilization (10.3 million women)
- male condom (6.9 million women)
- male sterilization (3.5 million women)
- long acting hormonal injections (2 million women)
Given that the oral contraceptive pill and female sterilization are the most popular methods of contraception, here is “state of the art” information for each method:
The new low low dose pill is a birth control pill with only 10 micrograms of estrogen. The original birth control pill developed in the 1960s had 50 micrograms of estrogen and is no longer used. Standard low dose pills today have between 20 and 35 micrograms in various combinations with a progesterone. This new pill provides the same effectiveness with a significantly lower dose of estrogen. It is ideal for women who experience estrogen related side effects on the standard low dose pills, for postpartum breastfeeding women, and for women transitioning to menopause.
Permanent birth control or female sterilization in the past required an incision and a general or regional anesthetic. Available since 2002, the newest method for occluding the fallopian tubes requires neither. This procedure can be performed in the office with a local anesthetic, is well tolerated and highly effective.
We believe that having an understanding of the available contraceptive methods allows women to make choices of methods that are most consistent with their lifestyle and beliefs, and therefore most likely to be successful for them. It is important to consider all of the following factors in making a decision:
- Efficacy
- Convenience
- Duration of action
- Reversibility and time to return of fertility
- Effect on uterine bleeding
- Frequency of side effects and adverse events
- Affordability
- Protection against sexually transmitted diseases
- Medical contraindications
