Some birth control options are 100 times more reliable than others.
Unexpected pregnancy? Wrong time? Wrong partner? Wrong circumstances? Too bad. That’s the attitude of Christian Right fundamentalists, and conservative politicians who think that sucking up to fundamentalists will get them reelected.
Most people—including religious people—including Christians—don’t think this way. But fundamentalists and their lackeys are doing their damnedest to make pregnancy the price of sex by outlawing abortion while also driving down birth control knowledge and access. If they wanted to, they could make abortion almost obsolete by broadcasting information about the most reliable birth control methods and making them cheap and easy to get. They could also fund research on even better methods, including options for men. Instead, they spread misinformation about modern birth control options, shout about risks while being zipper-lips about bonus health benefits, and falsely claim that the most reliable methods work by turning your body into an abortion factory. What does that tell you?
One thing it tells me is that this isn’t just about abortion. ( See: Children as Chattel–The Common Root of Religious Child Abuse and the Pro-Life Movement) Another is this: Spreading accurate information about birth control options is an act of defiance.
So here goes the list. It’s organized from most trustworthy to least, because some methods are literally 100 times more reliable than others. But first, some quick comments:
- With regular unprotected sex, 85 out of 100 couples will get pregnant within a year. Unless you are trying to make a baby, unprotected sex is pregnancy roulette.
- Bedsider.org has the most accurate, up-to-date birth control chooser on the web.
- No one method fits (or works) for all of us, and none is perfect.
- How often contraception fails depends a lot on how much effort it takes, how often.
- Lastly, apologies in advance, guys: Your non-permanent options stink; you deserve better. In the meantime, if you have sex with females you should know what they are using and what options they have.
Implant (3-5 years) —The implant is a flexible rod the size of a matchstick that goes in the underside of a female arm. From there, it slow-releases hormones that prevent eggs from developing. It is the most reliable method currently available, with a 1 in 1000 annual failure rate. Another way to say this: If you used an implant for 1000 years, you could expect one pregnancy. That is because long-acting contraceptive devices like the implant or IUD flip the default setting on fertility to off making pregnancy “opt-in” instead of “opt-out.” Downsides: Costly up front if not covered by insurance. May cause irregular periods or hormonal side effects like headaches or sore breasts, especially at first. Upsides: Quick outpatient insertion. Get it and forget it for up to five years; quick return to normal fertility whenever removed. Safe for smokers, people with hypertension, and diabetics. Ok while breastfeeding. Bonus health benefits: May reduce PMS, depression, or endometriosis symptoms.
Hormonal IUD (3-8 years) —An IUD is a T-shaped bit of plastic that fits into the uterus; it is the birth control method most preferred by gynecologists for themselves and their partners. (Some people even turn samples into earrings.) This IUD releases a local micro-dose of progestin; and the female body responds by sealing off the cervix like it would during pregnancy, an internal barrier. Like the implant, it has a 1-in-1000 yearly failure rate. Downsides: Insertion, though brief, can be painful. May cause cramps at first. Some bodies spit that puppy right back out. Upsides: Get it and forget it. Lighter periods or none at all, so good for athletes or people who suffer from anemia or strong menstrual cramps and bleeding. Can reduce endometriosis. Quick return to normal fertility. Good while breastfeeding.
Vasectomy or Tubal Ligation (permanent) —A vasectomy is the only truly dependable method that lets a man control his own fertility. As in a tubal ligation for women, a tiny tube in the body is snipped so that gametes (sperm for males, eggs for females) can’t travel to the place they would meet. Both methods are almost as reliable as the implant or hormonal IUD. Downsides: Requires a medical procedure, and you can’t count on reversing it if you later change your mind. Upsides: One and done. No medications, no potential side effects, no repeat medical visits.
Copper IUD (10+ years) —Thin wires wrapped around the arms of this IUD release copper ions that make it so sperm can’t swim. The amount needed is so small that a copper IUD can work for a decade or more as an internal, hormone-free spermicide. (I had mine for 23 years.) Once settled into place, it has a 1-in-100 annual failure rate. Downsides: Insertion, though brief, can be painful. May cause cramps or backaches. Usually causes heavier periods during the first few months, so not good for women with anemia. Upsides: Get it and forget it till you want to get pregnant or menopause kicks in. Hormone-free for those who don’t do well on estrogen or progestin. Immediate return to normal fertility upon removal. Normal periods for those who want them. Good while breastfeeding.
The Shot (3 months) —The Depo-Provera shot suppresses ovulation–no eggs released to meet up with sperm. The annual pregnancy rate is 4 in 100—almost twice as good as the pill but a lot worse than IUDs and implants. Downsides: This is the only method with documented weight gain for some users. May cause irregular spotting. Can cause hormonal side effects like headaches or depression. Requires quarterly medical appointments. Upsides: Effort free for 3 months. Shorter, lighter periods. Works for people who don’t tolerate estrogen in birth control pills. (Note: Self-administered and six-month versions of the Depo shot are in the works.)
The Ring (1 month) —A soft, flexible ring around the cervix delivers the same estrogen-progestin combination as some birth control pills. Out of 100 users, 7 will get pregnant in any given year. Downsides: Must be changed out every 3 or 4 weeks. Same side effects as similar pills. User needs to be comfortable inserting and removing the ring with their fingers. Upsides: Benefits of pills without having to remember every day. Lighter, less crampy periods, less acne. Monthly periods can be skipped if desired. Some protection against bone thinning, ovarian and endometrial cancers, anemia, and some infections.
The Patch (1 week) —Similar in look to a nicotine patch, an estrogen-progestin patch works pretty much like birth control pills except you only have to remember once a week rather than every day. Like the shot, ring and pill, it keeps eggs from being released. Out of 100 users, 7 will get pregnant in a year. Downsides: Need to swap out weekly. Potential hormonal side effects. Upsides: Lighter, less crampy periods, less acne. Monthly periods optional. Some protection against bone thinning, ovarian and endometrial cancers, anemia, and some infections.
The Pill (every day) —A variety of birth control pills offer different combinations of estrogen and progestin, or just progestin (called the mini-pill), which let people try out which formulas work best for them. Out of 100 users, 7 will get pregnant in a year. Downsides: Hard to remember—85 percent of women miss three or more doses each month. Potential hormonal side effects. Upsides: Lighter, less crampy periods. Monthly periods can be skipped if desired. Estrogen-containing pills reduce acne and protect slightly against bone thinning, ovarian or endometrial cancers, anemia, and some infections.
Condoms (every time) —The condom is the only nonpermanent option for men who want to manage their own fertility, and it is the only method that protects against sexually transmitted infections. But as birth control goes, condoms aren’t very reliable: Thirteen out of 100 couples relying on condoms will face a pregnancy within a year. Downsides: Can reduce sexual pleasure, high effort, easy to get it wrong. Upsides: inexpensive, no prescription required, no side effects, protection against STIs.
Periodic abstinence (one week every month) — Some couples, for religious or other reasons, prefer simply to avoid sex during the female partner’s fertile days. Periodic abstinence has been used to avoid pregnancy for generations; now a variety of tools can help to track monthly cycles or even detect signs of ovulation. On average, these methods result in pregnancy each year for about 15 in 100 couples, but tracking tools are getting better. Downsides: Requires careful monitoring, effort, discipline, and a certain kind of couple. Substantial pregnancy risk. Upsides: Inexpensive, no prescription or side effects.
Diaphragm, female condom (every time) — Diaphragms and female condoms are barriers made from silicone or rubber. Inserted before intercourse, they block sperm from reaching the uterus. Around 1 in 5 couples relying on these methods will get pregnant each year, half again as many as those using male condoms. (My mom had five diaphragm babies.) That said, the female condom is the one female-controlled method that protects against STIs. Downsides: Substantial risk of pregnancy. Takes practice to insert consistently and correctly. Can irritate the vagina. Upsides: No side effects, condom offers STI protection, diaphragm reduces pelvic infections.
No one method works for all people. Some, like me, have medical conditions that mean they shouldn’t take hormones (in my case migraines). Some have personal or ancestral trauma and don’t feel ready to have a healthcare provider put something inside them. Some trust shots; others hate them. Some can remember to take a pill at the same time every day for years on end, while most of us can’t. Some want lighter, less-frequent periods while others like their monthly cycle. For any given person, one or more of these considerations may be worth a higher degree of pregnancy risk. We all make trade-offs.
But to do so, we need to know what we are and aren’t trading off. Everyone who doesn’t want to be pregnant right now deserves to know their options. How well does each birth control option stack the odds in favor of—birth control? The differences, as I’ve already said, can be huge: A couple relying on condoms is 100 times more likely to face an unsought pregnancy and a potential abortion quest than a couple relying on an implant or hormonal IUD.
Abortion rights and sex ed and contraceptive access for young people are under siege in much of the United States. Some Christians and politicians think the price of sex should be pregnancy roulette and then parenthood, however unwanted or mistimed. Women are being treated like moral degenerates or criminals because they chose not to incubate an unsought or unhealthy pregnancy. In other words, the stakes are high, and spreading accurate information is an act of defiance.
So do it.
Valerie Tarico is a psychologist and writer in Seattle, Washington. She is the author of Trusting Doubt: A Former Evangelical Looks at Old Beliefs in a New Light and Deas and Other Imaginings. Her articles about religion, reproductive health, and the role of women in society have been featured at sites including The Huffington Post, Salon, The Independent, Quillette, Free Inquiry, The Humanist, AlterNet, Raw Story, Grist, Jezebel, and the Institute for Ethics and Emerging Technologies. Subscribe at ValerieTarico.com.
Good synopsis! Should be taught in schools. What is especially important is the failure rates. People should know there are “surprises.” Though not always foolproof, something is always better than nothing. Chosen pregnancies have a better chance of becoming cherished children. I’m sure there are some children who wish they had not been born.
Thanks for this article. I hope men, too, will become more educated about birth control. Sometimes, better use of the brain is indicated.
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brilliant graphic & great info here – tx for publicizing
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