Comparison of birth control methods
There are many different methods of birth control, which vary in what is required of the user, side effects, and effectiveness. It is also important to note that not each type of birth control is ideal for each user. Outlined here are the different types of barrier methods, spermicides, or coitus interruptus that must be used at or before every act of intercourse. Immediate contraception, like physical barriers, include diaphragms, caps, the contraceptive sponge, and female condoms may be placed several hours before intercourse begins. The female condom should be removed immediately after intercourse, and before arising.Comparison of birth control methods#cite note-CT19thEdCh19-1| Some other female barrier methods must be left in place for several hours after sex. Depending on the form of spermicide used, they may be applied several minutes to an hour before intercourse begins. Additionally, the male condom should be applied when the penis is erect so that it is properly applied prior to intercourse.
With an insertion of an IUD, female or male sterilization, or hormone implant, there is very little required of the user post initial procedure; there is nothing to put in place before intercourse to prevent pregnancy.Comparison of birth control methods#cite note-plannedparenthood.org-2| Intrauterine methods require clinic visits for installation and removal or replacement only once every several years, depending on the device. This allows the user to be able to try and become pregnant if they so desire, upon removal of the IUD. Conversely, sterilization is a one-time, permanent procedure. After the success of surgery is verified, no subsequent action is usually required of users.
Implants provide effective birth control for three years without any user action between insertion and removal of the implant. Insertion and removal of the Implant involves a minor surgical procedure. Oral contraceptives require some action every day. Other hormonal methods require less frequent action - weekly for the patch, twice a month for vaginal ring, monthly for combined injectable contraceptive, and every twelve weeks for MPA shots. Fertility awareness-based methods require some action every day to monitor and record fertility signs. The lactational amenorrhea method requires breast feeding at least every four to six hours.
User dependence
Different methods require different levels of diligence by users. Methods with little or nothing to do or remember, or that require a clinic visit less than once per year are said to be non-user dependent, forgettable or top-tier methods. Intrauterine methods, implants and sterilization fall into this category. For methods that are not user dependent, the actual and perfect-use failure rates are very similar.Many hormonal methods of birth control, and LAM require a moderate level of thoughtfulness. For many hormonal methods, clinic visits must be made every three months to a year to renew the prescription. The pill must be taken every day, the patch must be reapplied weekly, or the ring must be replaced monthly. Injections are required every 12 weeks. The rules for LAM must be followed every day. Both LAM and hormonal methods provide a reduced level of protection against pregnancy if they are occasionally used incorrectly. The actual failure rates for LAM and hormonal methods are somewhat higher than the perfect-use failure rates.
Higher levels of user commitment are required for other methods. Barrier methods, coitus interruptus, and spermicides must be used at every act of intercourse. Fertility awareness-based methods may require daily tracking of the menstrual cycle. The actual failure rates for these methods may be much higher than the perfect-use failure rates.
Side effects
Different forms of birth control have different potential side effects. Not all, or even most, users will experience side effects from a method.The less effective the method, the greater the risk of the side-effects associated with pregnancy.
Minimal or no other side effects are possible with coitus interruptus, fertility awareness-based, and LAM. Some forms of periodic abstinence encourage examination of the cervix; insertion of the fingers into the vagina to perform this examination may cause changes in the vaginal environment. Following the rules for LAM may delay a woman's first post-partum menstruation beyond what would be expected from different breastfeeding practices.
Barrier methods have a risk of allergic reaction. Users sensitive to latex may use barriers made of less allergenic materials - polyurethane condoms, or silicone diaphragms, for example. Barrier methods are also often combined with spermicides, which have possible side effects of genital irritation, vaginal infection, and urinary tract infection.
Sterilization procedures are generally considered to have low risk of side effects, though some persons and organizations disagree. Female sterilization is a more significant operation than vasectomy, and has greater risks; in industrialized nations, mortality is 4 per 100,000 tubal ligations, versus 0.1 per 100,000 vasectomies.
After IUD insertion, users may experience irregular periods in the first 3–6 months with Mirena, and sometimes heavier periods and worse menstrual cramps with ParaGard. However, "ninety-nine percent of IUD users are pleased with them". A positive characteristic of IUDs is that fertility and the ability to become pregnant returns quickly once the IUD is removed.
Because of their systemic nature, hormonal methods have the largest number of possible side effects.
Sexually transmitted disease prevention
and female condoms provide significant protection against sexually transmitted diseases when used consistently and correctly. They also provide some protection against cervical cancer. Condoms are often recommended as an adjunct to more effective birth control methods in situations where STD protection is also desired.Other barrier methods, such as diaphragm may provide limited protection against infections in the upper genital tract. Other methods provide little or no protection against sexually transmitted diseases.
Effectiveness calculation
Failure rates may be calculated by either the Pearl Index or a life table method. A "perfect-use" rate is where any rules of the method are rigorously followed, and the method is used at every act of intercourse.Actual failure rates are higher than perfect-use rates for a variety of reasons:
- mistakes on the part of those providing instructions on how to use the method
- mistakes on the part of the method's users
- conscious user non-compliance with method.
- insurance providers sometimes impede access to medications
Effectiveness
The table below color codes the typical-use and perfect-use failure rates, where the failure rate is measured as the expected number of pregnancies per year per woman using the method:For example, a failure rate of 20% means that 20 of 100 women become pregnant during the first year of use. Note that the rate may go above 100% if all women, on average, become pregnant within less than a year. In the degenerated case of all women becoming pregnant instantly, the rate would be infinite.
In the user action required column, items that are non-user dependent also have a blue background.
Some methods may be used simultaneously for higher effectiveness rates. For example, using condoms with spermicides the estimated perfect use failure rate would be comparable to the perfect use failure rate of the implant. However, mathematically combining the rates to estimate the effectiveness of combined methods can be inaccurate, as the effectiveness of each method is not necessarily independent, except in the perfect case.
If a method is known or suspected to have been ineffective, such as a condom breaking, emergency contraception may be taken up to 72 to 120 hours after sexual intercourse. Emergency contraception should be taken shortly before or as soon after intercourse as possible, as its efficacy decreases with increasing delay. Although ECP is considered an emergency measure, levonorgestrel ECP taken shortly before sex may be used as a primary method for woman who have sex only a few times a year and want a hormonal method, but don’t want to take hormones all the time. Failure rate of repeated or regular use of LNG ECP is similar to rate for those using a barrier method.
This table lists the rate of pregnancy during the first year of use.
| Birth control method | Brand/common name | Typical-use failure rate | Perfect-use failure rate | Type | Implementation | User action required |
| Contraceptive implant | Implanon, Jadelle, the implant | | Progestogen | Subdermal implant | ||
| Vasectomy | male sterilization | | Sterilization | Surgical procedure | ||
| Combined injectable | Lunelle, Cyclofem | | Estrogen + progestogen | Injection | ||
| IUD with progestogen | Mirena, Skyla, Liletta | | Intrauterine & progestogen | Intrauterine | ||
| Essure | female sterilization | | Sterilization | Surgical procedure | ||
| Tubal ligation | female sterilization | | Sterilization | Surgical procedure | ||
| IUD with copper | Paragard, Copper T, the coil | | Intrauterine & copper | Intrauterine | ||
| Forschungsgruppe NFP symptothermal method, teaching sessions + application | Sensiplan by Arbeitsgruppe NFP | | Behavioral | Teaching sessions, observation, charting and evaluating a combination of fertility symptoms | ||
| LAM for 6 months only; not applicable if menstruation resumes | ecological breastfeeding | | Behavioral | Breastfeeding | ||
| Lea's Shield | | Barrier + spermicide | Vaginal insertion | |||
| MPA shot | Depo Provera, the shot | | Progestogen | Injection | ||
| Testosterone Undecanoate | | Testosterone | Intramuscular Injection | |||
| 1999 cervical cap and spermicide | FemCap | | no data | Barrier & spermicide | Vaginal insertion | |
| Contraceptive patch | Ortho Evra, the patch | | Estrogen & progestogen | Transdermal patch | ||
| Combined oral contraceptive pill | the Pill | | Estrogen & progestogen + Placebo | Oral medication | ||
| Ethinylestradiol/etonogestrel vaginal ring | NuvaRing, the ring | | Estrogen & progestogen | Vaginal insertion | ||
| Progestogen only pill | POP, minipill | Progestogen | Oral medication | |||
| Ormeloxifene | Saheli, Centron | SERM | Oral medication | |||
| Emergency contraception pill | Plan B One-Step® | Levonorgestrel | Oral medication | |||
| Standard Days Method | CycleBeads, iCycleBeads | | Behavioral | Counting days since menstruation | ||
| Diaphragm and spermicide | | Barrier & spermicide | Vaginal insertion | |||
| Plastic contraceptive sponge with spermicide used by nulliparous | Today sponge, the sponge | Barrier & spermicide | Vaginal insertion | |||
| Lea's Shield | | Barrier + spermicide | Vaginal insertion | |||
| Prentif | Barrier + spermicide | Vaginal insertion | ||||
| Male latex condom | Condom | | Barrier | Placed on erect penis | ||
| Female condom | | Barrier | Vaginal insertion | |||
| Coitus interruptus | withdrawal method, pulling out | | Behavioral | Withdrawal | ||
| Symptoms-based fertility awareness ex. symptothermal and calendar-based methods | TwoDay method, Billings ovulation method, Creighton Model | | Behavioral | Observation and charting of basal body temperature, cervical mucus or cervical position | ||
| Calendar-based methods | the rhythm method, Knaus-Ogino method, Standard Days method | Behavioral | Calendar-based | |||
| Plastic contraceptive sponge with spermicide used by parous | Today sponge, the sponge | | Barrier & spermicide | Vaginal insertion | ||
| Spermicidal gel, foam, suppository, or film | | Spermicide | Vaginal insertion | |||
| Prentif | Barrier + spermicide | Vaginal insertion | ||||
| Abstinence pledge | | Behavioral | Commitment | |||
| None | | Behavioral | Discontinuing birth control | |||
| Placebo | | Placebo | Oral medication | |||
| Birth control method | Brand/common name | Typical-use failure rate | Perfect-use failure rate | Type | Implementation | User action required |
Table notes
Table references
Cost and cost-effectiveness
Family planning is among the most cost-effective of all health interventions. Costs of contraceptives include method costs, cost of method failure and cost of side effects. Contraception saves money by reducing unintended pregnancies and reducing transmission of sexually transmitted infections. By comparison, in the US, method related costs vary from nothing to about $1,000 for a year or more of reversible contraception.During the initial five years, vasectomy is comparable in cost to the IUD. Vasectomy is much less expensive and safer than tubal ligation.
Since ecological breastfeeding and fertility awareness are behavioral they cost nothing or a small amount upfront for a thermometer and / or training. Fertility awareness based methods can be used throughout a woman's reproductive lifetime.
Not using contraceptives is the most expensive option. While in that case there are no method related costs, it has the highest failure rate, and thus the highest failure related costs. Even if one only considers medical costs relating to preconception care and birth, any method of contraception saves money compared to using no method.
The most effective and the most cost-effective methods are long-acting methods. Unfortunately these methods often have significant up-front costs, requiring the user to pay a portion of these costs prevents some from using more effective methods. Contraception saves money for the public health system and insurers.