| Subject | Contents |
| Definition | |
| Alternative Names | Birth control; Family planning and contraception |
| Information | Contraception and family planning are methods used by sexually active individuals and couples to prevent pregnancy . Reasons for using contraception or birth control include personal desires (to never have children, postpone having children, or stop having children); medical conditions that could threaten maternal, fetal, or infant health (such as diabetes , hypertension , heart disease , HIV infection ); and social concerns regarding the effects of an increasing population on the environment. FACTORS TO CONSIDER WHEN DECIDING ON A FORM OF CONTRACEPTION Availability -- Can the method be used without a prescription, provider visit, or, in the case of minors, parental consent? Cost -- Is the method affordable for the individual or couple? It may prove helpful to weigh the cost issue with the question of whether the individual or couple could afford an undesired pregnancy. Effectiveness -- How well does the method prevent pregnancy? It is important to look at the "user" effectiveness rate (pearl index), rather than the theoretical effectiveness. This is reported as the number of pregnancies observed in 100 women using that method over a period of one year. Health risk -- The safety of particular methods of contraception should be considered for each user. Some methods of birth control may not be good options because of potential health risks (for example, oral contraceptives are usually not recommended for women over age 35 who also smoke). Unplanned pregnancy -- The significance of an unplanned pregnancy to the individual or couple should be considered when choosing a method of contraception. If the effect of an unplanned pregnancy is viewed as potentially devastating, 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. Partner involvement -- The willingness of a partner to accept, cooperate in, and be supportive of, a given method of contraception may affect options for birth control. However, one may want to reexamine the choice to start or continue a sexual relationship with a partner unwilling to take an active and supportive role in contraception. METHODS OF CONTRACEPTION AND RELATED EFFECTIVENESS RATES "Folk" methods: Coitus interruptus -- Withdrawal of the penis from the vagina prior to ejaculation. In theory, this method is probably as effective as some more conventional methods. However, in practice, some of the semen frequently escapes prior to full withdrawal. This may be sufficient to initiate a pregnancy. This is an unreliable method. Postcoital douche -- Douching shortly after intercourse. Because sperm can make their way beyond the cervix within 90 seconds after ejaculation, this method is ineffective and unreliable. Breastfeeding -- It is not true that women cannot become pregnant while breastfeeding. In about 6% of women, ovulation returns with the first cycle after delivery. Women who are breastfeeding infants and do not desire another pregnancy at that time need to use a reliable form of contraception. The "mini pill" (progestin only) can be taken safely while breastfeeding. Low-dose combination oral contraceptives (estrogens and progestins oral contraceptives) can also be taken while breastfeeding, although the estrogen in these pills may decrease breastmilk in some women. In addition, Norplant (trademark name), Depo-Provera injections, and all barrier methods of contraception are safe to use while breastfeeding. "Traditional" methods: Condoms -- Thin sheath (preferably latex to also protect from transmission of disease-causing organisms) 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 maintained in place and then removed after intercourse. Condoms are readily available at low cost in most drug and grocery stores. Some family planning clinics may offer free condoms. 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. Effectiveness is increased when spermicide is also used. Vaginal spermicides -- Sperm-killing chemical jellies, foams, creams, or suppositories, inserted into the vagina prior to intercourse. This method is readily available; all forms can be purchased in most drug and grocery stores. However, this method used by itself is not very effective. About 26 pregnancies occur over 1 year out of 100 women using this method alone, so spermicides are often combined with other methods (such as condoms). Diaphragm -- 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 each woman. About 20 pregnancies occur over 1 year in 100 women using this method. Vaginal contraceptive sponge -- Soft synthetic sponge, saturated with a spermicide, which is moistened and inserted into the vagina, over the cervix, before intercourse. It is quite similar to the diaphragm as a barrier mechanism. After intercourse, the sponge should be left in place for 6 to 8 hours. This method is available without a prescription in most drug and grocery stores. About 18 to 28 pregnancies occur over 1 year out of 100 women using this method. This method was removed from the market a few years ago, but plans are underway to re-introduce it in the near future. Fertility awareness with abstinence (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 the calendar in an attempt to determine when ovulation occurs. The couple abstains from unprotected intercourse 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 women who are properly trained). "Modern" methods: Oral contraceptives (the "pill") -- This method utilizes a combination of estrogen and progestin medications in doses that prevent ovulation and regulate cycles. A health care provider must prescribe oral (by mouth) contraceptives. The method is highly effective if the woman remembers to take her pill consistently at the same time each day. Oral antibiotics may decrease the effectiveness of birth control pills. Therefore, a backup method of contraception should be used while taking antibiotics and until the next menstrual period after completion of the antibiotic. Because of the wide variety of oral contraceptives, women who experience unpleasant side effects on one type of pill are usually able to adjust to a different oral contraceptive. It is important for women who are just starting on "the pill" to communicate with their health care provider for optimal "matching" of the type of oral contraceptive to each patient. About 2 to 3 pregnancies occur over 1 year out of 100 women using this method. Progestin-only oral contraceptive (the "mini-pill") -- This type of birth control pill does not contain any estrogen component. It is therefore an alternative for those women who desire a highly effective method of contraception in a "pill" form, but are sensitive to estrogen or cannot take a contraceptive containing 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. Progestin implants (such as Norplant) -- Six small progestin-containing rods are implanted surgically beneath the skin, usually under the upper arm, by a woman's health care provider. The rods release a continuous dose of progestin that inhibits ovulation, changes the lining of the uterus, and thickens cervical mucus, which may prevent sperm from entering the uterus. The implants provide contraceptive protection for a period of 5 years. Initial expense is several hundred dollars, but the cost may actually be less than buying a package of oral contraceptives every month over the same period of time. The method is highly effective. Less than 1 pregnancy occurs over 1 year out of 100 women using this type of contraception. Hormonal injections (such as Depo-Provera) -- A progestin injection is ordered by a woman's health care provider and given into the muscular tissue of the upper arm or buttocks. This injection prevents ovulation. A single shot provides contraceptive protection for up to 90 days. This method is highly effective and does not depend on patient compliance. Less than 1 pregnancy occurs over 1 year in 100 women using this method. Intrauterine contraceptive device (IUD) -- A small plastic or copper device, placed inside the woman's uterus by her health care provider, which changes the uterine environment to prevent pregnancy. 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, ectopic pregnancy , or who have more than one sexual partner (and are therefore at higher risk for acquiring sexually transmitted diseases). Depending on the IUD used, 1 to 3 pregnancies occur per year out of 100 women using this type of contraception. Permanent or irreversible methods: Tubal ligation -- This procedure is the most commonly used method of female sterilization. Tubal ligations are usually done in an outpatient surgical center. During tubal ligation, a woman's fallopian tubes are cut, sealed, or obstructed by a special clip, preventing eggs and sperm from entering the tubes, thus preventing conception. The operation can sometimes be reversed if a woman later chooses to become pregnant. Following tubal ligation reversal, about 60% to 80% of women eventually become pregnant. However, it is best to consider tubal ligation a permanent form of contraception. Vasectomy -- A vasectomy is a simple, permanent sterilization procedure for men. The operation, usually done in a physician's office, requires cutting and sealing the vas deferens (tubes in the male reproductive system that carry sperm.) Like tubal ligations, vasectomies can sometimes be reversed through a vasovasectomy, an operation to reattach and open the vas deferens. Men who undergo vasovasectomies have a 30% to 40% chance of fathering children. However, it is best to consider vasectomy a permanent form of contraception. Emergency or "morning-after" contraception -- 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 is reserved for emergency situations and not as a regular method of birth control. Emergencies include being raped; 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 HEALTH CARE PROVIDER IF You would like to have further information regarding contraception (birth control). You want to start using a specific method of contraception that requires provider prescription or insertion. You have had unprotected intercourse or method failure (for example, condom breakage) within the past 72 hours, and you do not want to become pregnant. |
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