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.
Last
Reviewed: 1/29/2002 by Catherine S. Bradley, M.D., Department of Obstetrics &
Gynecology, University of Pennsylvania Medical Center, Philadelphia, PA. Review
provided by VeriMed Healthcare Network.
