When it comes to women and birth control, there truly is no “one size fits all” – and there are more options these days than ever.
According to the Centers for Disease Control and Prevention, some 19 percent of women of childbearing age prevent pregnancy via having themselves sterilized. Known as tubal ligation, the procedure involves a woman having her fallopian tubes tied (or closed) so that sperm and eggs cannot meet for fertilization.
The procedure can be done in a hospital or in an outpatient surgical center, though it is most commonly done immediately after childbirth. This method is highly effective, with a failure rate of just .5 percent.
CDC statistics indicate that 13 percent of women prevent pregnancy by using the pill, a prescription-only oral contraceptive that contains the hormones estrogen and progestin. The pill is more frequently the choice of younger women, because it is often inadvisable to women older than age 35, smokers, and those with a history of blood clots or breast cancer. The pill fails to prevent pregnancy about 7 percent of the time.
Similar to the pill and with the same failure rate are the transdermal patch, which releases estrogen and progestin into the bloodstream; and the vaginal contraceptive ring, which achieves the same effect but is manually inserted into the vagina.
After the pill, the most popular form of birth control appears to be long-acting, reversible methods. Some 10 percent of women of child-bearing age use this method, most commonly known as an intrauterine device. The IUD, installed in the uterus by a physician, can last from 3 to 10 years. It typically works by releasing a small amount of progestin daily. Its failure rate can be as high as .8 percent.
Other forms of long-acting, reversible contraception are the hormonal implant – a thin rod implanted into a woman’s upper arm every three years. The rod releases progestin, and the method has a failure rate of just .1 percent.
The other form is getting a progestin shot in the arm or buttocks every 90 days. This method’s failure rate is about 4 percent.
There also are the more traditional barrier methods, like the diaphragm, the contraceptive sponge, the female condom and spermicidal creams, gels, foam or tablets. While easier to use than other methods, barriers have a failure rate of 14 to 27 percent, according to the CDC.
Those methods are joined by ones in which a man takes the lead on pregnancy prevention. According to the CDC, 6 percent of women report that their primary method of birth control is having sex with a man who has had a vasectomy. Men also use barrier methods – most notably, condoms.
As always, birth-control safety is a concern for women, especially those trying a method for the first time.
But in a world of personal-injury lawsuits, many physicians are hesitant to speak publicly on safety. Even the American College of Obstetricians and Gynecologists would only say, through a spokesperson, “We don’t comment on [the safety of] individual products, but we do address what options are available for physicians to incorporate into clinical practice.
“We also support shared decision-making by patients and physicians based on each individual patients’ medical history, personal preferences, life situation, etc.,” the ACOG spokesperson continued. “So in other words, there is no universal safest, because different patients have different medical backgrounds — and because pregnancy itself carries more risk than any contraceptive presents, so preventing unintended pregnancy is the goal. In terms of efficacy, sterilization and long-acting reversible contraceptives (IUD and the implant) are the most effective, but they don’t suit every woman.”
Dr. David Evans, a recently retired gynecologist, says that in his 40-plus years of practice, he found that “there truly is no one method that’s best for everyone. Safety is always a concern, and there will always be a debate over which methods are safer than others. But the good news is that contraception is becoming both safer and more effective as medical science moves forward. Women – and everyone, really — should take comfort in that.”