Birth Control Options for Women - Introduction

Determining Effectiveness

Contraceptive effectiveness is characterized by "typical use" and "perfect use":

Typical use refers to use under real-life conditions, in which mistakes (such as forgetting to take a birth control pill at the right time) sometimes happen.
Perfect use refers to contraceptives that are used correctly each time intercourse occurs.

Research has shown that the four most effective standard female contraceptives are surgical sterilization, the IUD, Norplant implants, and Depo-Provera injections. They all have an estimated failure rate of less than 1% during the first year of normal (typical) use. Vasectomy (male surgical sterilization) is the only male contraceptive that is equally effective. By comparison, the estimated failure rate of the male latex condom used without spermicide is 14% with typical use and 3% with perfect use. To put these rates into perspective, it is worth noting that a sexually active woman of reproductive age who does not use contraception faces an 85% likelihood of becoming pregnant in the course of a year.

Access to Contraceptives

Birth control is a controversial subject. In recent years, there has been a growing movement in the United States to restrict a woman's access to contraceptives. In addition to the political battles over non-prescription access to emergency contraception (Plan B), a dozen states are considering legislation that would allow pharmacists to refuse to dispense medications due to moral or religious objections. There have been hundreds of reports of pharmacists refusing to fill birth control prescriptions. In response to this trend, several members of Congress introduced in April 2005 the Access to Legal Pharmaceuticals Act, which would override any state legislation. The bill would require that pharmacies fill birth control prescriptions and would protect women?s legal right to purchase such products.

Common Female Contraceptives
Contraceptive	First Year Failure Rate (Typical)	First Year Failure Rate (Perfect)	Protection Against Sexually Transmitted Diseases	Approximate Cost
Female Surgical Sterilization	One study reported a failure rate of 0.7 to 5.4% over 10 years.	Less than 1% per year.	None.	$1,000 to $2,500. May be covered by insurance.
Intrauterine Devices: IUD-Copper-Releasing or IUD-Progestin-Releasing, including LNG-IUS (Mirena)	IUD failure rates are second only to tubal ligation (permanent sterility). One study reported 5% failure rates over 10 years.	Less than 1% per year.	None.	$300 to $700 or more for insertion and tests. Lasts 10 years. Covered by Medicaid. Either IUD is less expensive overall than other contraceptives.
Oral Contraceptives-combined	5%.	Less than 1% per year.	None.	Cost varies depending on brand and insurance. Can run from $0 in insured patients to $50 a month. Less at family planning clinic.
Oral Contraceptives-progestin-only pill	5%.	Less than 1% per year.	None.
Levonorgestrel implants (Norplant)	Less than 1% per year.	Less than 1% per year.	None.	$500 to $600 for implant procedure and tests; $100 to $200 for removal. May be covered by some insurers. Medicaid covers insertion, but not removal.
Injected progestins (Depo-Provera, Noristerat)	Less than 1% per year.	Less than 1% per year.	None.	Costs vary. $120 for first injection and $60 for each following injection at some women's health centers and family planning clinics. May be partly covered by insurance or Medicaid. Among the least expensive contraceptives.
Injected combination of progestin and estrogen (Lunelle)	Less than 1% per year.	Less than 1% per year.	None.	Costs about $30 a month.
Diaphragm	20% (with spermicide).	6% (with spermicide).	Some protection against certain STDs (gonorrhea and Chlamydia); uncertain protection for HIV or HPV (cause of cervical cancer). May increase risk for urinary tract infections.	$13 to $25 for the diaphragm; $50 to $120 for fitting. Needs bi-annual replacement. $8 to $17 for spermicidal kit.
Cervical cap	20% (with spermicide; no previous births); 40% (with spermicide; previous births).	9% (with spermicide; no previous births); 26% (with spermicide; previous births).	Some protection.	Similar to costs for diaphragm.
Female Condom	12.4% to 22%.	5%.	Possibly protective against HIV and STDs. More research is needed.	Typically sold in packs of three or six. $2.00 t0 $3.00 per condom.
Natural Family Planning	Up to 25%.	6% to 15%. (Rates may be higher with newer approaches, such as the Creighton method.)	None.	Cost of any monitoring device, such as basal thermometer and possibly training (although often conducted free through a church).
Note on Male Condoms: If a women chooses a non-barrier method of contraception, a male or female condom should always be used during sex to help protect her against sexually transmitted diseases. The average rate of pregnancy for couples that rely only on male condoms for protection, however, is about 12%. Even for those who use a good-quality condom correctly, the annual risk for pregnancy is 3%.