Contraception; Family planning and contraception
There are many different birth control and family planning methods to help sexually active individuals and couples prevent pregnancy. The information below summarizes many of the pros and cons of each method.
Here are some factors to consider when selecting a birth control method:
- Effectiveness - how well does the method prevent pregnancy? Look at the the number of pregnancies in 100 women using that method over a period of one year. If an unplanned pregnancy would be viewed as potentially devastating to the individual or couple, a highly effective method should be chosen. In contrast, if a couple is simply trying to postpone pregnancy, but feels that a pregnancy could be welcomed if it occurred earlier than planned, a less effective method may be a reasonable choice.
- Cost - is the method affordable?
- Health risk - learn any potential health risks. For example, birth control pills are usually not recommended for women over age 35 who also smoke.
- Partner involvement - The willingness of a partner to accept and support a given method may affect your choice of birth control. However, you also may want to re-consider a sexual relationship with a partner unwilling to take an active and supportive role.
- Permanence - do you want a temporary (and generally less effective) method, or a long-term or even permanent (and more effective) method?
- Preventing HIV and other STDs - many methods offer no protection against STDs. In general, condoms are the best choice for preventing STDs, especially combined with spermicides.
- Availability - Can the method be used without a prescription, provider visit, or, in the case of minors, parental consent?
- A condom is a thin sheath placed on the penis or, in the case of the female condom, within the vagina prior to intercourse. Semen is collected inside the condom, which must be carefully kept in place and then removed after intercourse.
- Condoms are readily available in most drug and grocery stores. Some family planning clinics offer free condoms.
- Latex condoms help prevent HIV and other STDs.
- About 14 pregnancies occur over 1 year out of 100 couples using male condoms, and about 21 pregnancies occur over 1 year out of 100 couples using female condoms. They are more effective when spermicide is also used.
- Spermicides are chemical jellies, foams, creams, or suppositories that kill sperm.
- They can be purchased in most drug and grocery stores.
- This method used by itself is not very effective. About 26 pregnancies occur over 1 year out of 100 women using this method alone. Spermicides are generally combined with other methods (such as condoms or diaphragm) as extra protection.
- Warning - the spermicide nonoxynol-9 can help prevent pregnancy, but also may increase the risk of HIV transmission.
- A diaphragm is a flexible rubber cup that is filled with spermicidal cream or jelly, and then placed into the vagina, over the cervix, before intercourse. It should be left in place for 6 to 8 hours after intercourse.
- Diaphragms must be prescribed by a woman’s health care provider, who determines the correct type and size of diaphragm for the woman.
- About 5-20 pregnancies occur over 1 year in 100 women using this method, depending on proper use.
- A similar, smaller device is called a cervical cap.
- Vaginal contraceptive sponges are soft synthetic sponges saturated with a spermicide. Prior to intercourse, the sponge is moistened, inserted into the vagina, and placed over the cervix. After intercourse, the sponge is left in place for 6 to 8 hours.
- It is quite similar to the diaphragm (which must be obtained from a doctor) as a barrier mechanism.
- About 18 to 28 pregnancies occur over one year for every 100 women using this method. The sponge may be more effective in women who have not previously delivered a baby.
- This method was removed from the U.S. market, but plans are underway to re-introduce it in the near future.
BIRTH CONTROL PILLS
- Also called oral contraceptives or just the “pill”, this method uses the hormones estrogen and progestin to prevent ovulation.
- A health care provider must prescribe birth control pills.
- The method is highly effective if the woman remembers to take her pill consistently each day.
- Women who experience unpleasant side effects on one type of pill are usually able to adjust to a different type.
- About 2 to 3 pregnancies occur over 1 year out of 100 women who never miss a pill.
- The “mini-pill” is a type of birth control pill that contains only progestin, no estrogen.
- It is an alternative for women who are sensitive to estrogen or cannot take estrogen for other reasons.
- The effectiveness of progestin-only oral contraceptives is slightly less than that of the combination type. About 3 pregnancies occur over a 1 year period in 100 women using this method.
- Implants, such as Norplant, are small rods implanted surgically beneath the skin, usually on the upper arm. The rods release a continuous dose of progestin to prevent ovulation.
- Implants work for 5 years. The initial cost is generally higher than some other methods, but the overall cost may be less over the 5-year period.
- Less than 1 pregnancy occurs over 1 year out of 100 women using this type of contraception.
- Progestin injections, such as Depo-Provera, are given into the muscles of the upper arm or buttocks. This injection prevents ovulation.
- A single shot works for up to 90 days.
- Less than 1 pregnancy occurs over 1 year in 100 women using this method.
- The skin patch (Ortho Evra) is placed on your shoulder, buttocks, or other convenient location. It continually releases progestin and estrogen. Like other hormone methods, a prescription is required.
- The patch provides weekly protection. A new patch is applied each week for three weeks, followed by one week without a patch.
- About 1 pregnancy occurs over 1 year out of 100 women using this method.
- The vaginal ring (NuvaRing) is a flexible ring about 2 inches in diameter that is inserted into the vagina. It releases progestin and estrogen. Like other hormone methods, a prescription is required.
- The woman inserts it herself and it stays in the vagina for 3 weeks. Then, she takes it out for one week.
- About 1 pregnancy occurs over 1 year out of 100 women using this method.
- The IUD is a small plastic or copper device placed inside the woman’s uterus by her health care provider. IUDs may be left in place for up to ten years in some patients.
- The method should not be used by women who have a history of pelvic infection or ectopic pregnancy.
- 1 to 3 pregnancies occur per year out of 100 women using this method.
NATURAL FAMILY PLANNING
- This method involves observing a variety of body changes in the woman (such as cervical mucus changes, basal body temperature changes) and recording them on a calendar to determine when ovulation occurs. The couple abstains from unprotected sex for several days before and after the assumed day ovulation occurs.
- This method requires special education and training in recognizing the body’s changes as well as a great deal of continuous and committed effort.
- About 15 to 20 pregnancies occur over 1 year out of 100 women using this method (for those who are properly trained).
- During tubal ligation, a woman’s fallopian tubes are cut, sealed, or blocked by a special clip, preventing eggs and sperm from entering the tubes.
- The operation can sometimes be reversed if a woman later chooses to become pregnant. However, tubal ligations are best for women and couples who believe they never wish to have children in the future. Tubal ligations are best viewed as a permanent method.
- A vasectomy is a simple, permanent procedure for men. The vas deferens (the tubes that carry sperm) are cut and sealed.
- Vasectomies can sometimes be reversed. However, vasectomies are best for men and couples who believe they never wish to have children in the future. Vasectomies are best viewed as a permanent method.
EMERGENCY (“MORNING AFTER”) BIRTH CONTROL
- The “morning after” pill consists of two doses of hormone pills taken as soon as possible within 72 hours after unprotected intercourse.
- The pill may prevent pregnancy by temporarily blocking eggs from being produced, by stopping fertilization, or keeping a fertilized egg from becoming implanted in the uterus.
- The morning after pill may be appropriate in cases of rape; having a condom break or slip off during sex; missing two or more birth control pills during a monthly cycle; and having unplanned sex.
- Call your provider for more information about the morning after pill.
- Coitus interruptus - withdrawal of the penis from the vagina prior to ejaculation. Some semen frequently escapes prior to full withdrawal, enough to cause a pregnancy.
- Douching shortly after sex - sperm can make their way beyond the cervix within 90 seconds after ejaculation, so this method is ineffective and unreliable.
- Breastfeeding - women who are breastfeeding CAN become pregnant.
CALL YOUR HEALTH CARE PROVIDER IF
- You would like to further information about birth control options.
- You want to start using a specific method of birth control that requires your provider’s prescription or insertion.
- You have had unprotected intercourse or method failure (for example, a broken condom) within the past 72 hours, and you do not want to become pregnant.
by David A. Scott, M.D.
All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.