© Thinkstock The idea of contraception has been around for thousands of years as a way to prevent pregnancy. While some of the first written descriptions of contraception appear as early as 1550 B.C., the safest and most effective methods of birth control were developed and refined in the 20th and 21st centuries.

To determine the most and least effective birth control methods, 24/7 Wall St. analyzed data from the Centers for Disease Control and Prevention for the most common forms of contraception. The most effective birth control methods led to 12 or fewer pregnancies in every 100 women, and the least effective methods led to 18 or more pregnancies per 100 women.

The effectiveness of a contraceptive method does not correlate with the rate of usage, as some of the least effective methods are the most common. The leading form of birth control in the United States is the oral contraceptive pill, used by 9.7 million women. With a 9% failure rate, the pill is less effective than five other major forms of birth control. The second most common form of birth control, female sterilization, is the fourth most effective contraceptive.

Load Error

While the most effective methods of birth control are a statistically surefire way to avoid unwanted pregnancy, they do not completely eliminate the risks associated with sexual intercourse. According to the CDC, some the most common sexually transmitted diseases in the United States are chlamydia, gonorrhea, and syphilis. The CDC estimates that nearly 20 million Americans contract an STD each year. The CDC recommends always using a condom to reduce the risk of contracting a STD.

Widespread access to methods of contraception is one of the hallmarks of a developed country and a major prerequisite of gender equality. The presence of family planning assistance in a country has been associated with a rise of female participation in the workforce. Approved by the Food and Drug Administration in 1960, the oral contraceptive pill was one of the first widely available birth control measures in the United States. The pill, as well as the introduction of new forms of intrauterine devices several years later, contributed to an increase in graduation and college attendance rates among women, as well as a rise in female workforce participation. Female workforce participation rose from 36.6% in March 1960 to 57.1% in March 2017.

In many developing countries, however, the widespread need for potentially life-saving birth control is not being met. The Guttmacher Institute estimates that roughly 222 million women worldwide have an unmet need for modern contraception, the majority of whom are in poor, developing countries. Given the poor medical infrastructure and high rates of infant and maternal mortality in many developing countries, providing birth control to all women in need of contraception could prevent 79,000 maternal deaths and 1.1 million infant deaths.

To determine the most and least effective birth control methods, 24/7 Wall St. analyzed data from the Centers for Disease Control and Prevention for the most common forms of contraception. The birth control methods with the highest failure rates were considered the least effective, and the lowest failure rates the most effective. Failure rates refer to the number out of every 100 women who experienced an unintended pregnancy within the first year of using the contraceptive method. Data on usage rates for the most and least effective methods of birth control among all female contraceptive users in the U.S. are for 2012 and came from the Guttmacher Institute.

These are the most and least effective forms of birth control.

© Thinkstock

15. Spermicide
> Failure rate: 28%
> Popularity:
> Method: Over-the-counter

One of the oldest birth control methods and first mentioned around 1850 B.C., spermicide has since been surpassed by many far more effective contraceptive methods. Spermicide is used to kill sperm and is available in forms such as cream, film, foam, or gel. The most common active ingredient is called nonoxynol-9, which prevents pregnancy by inhibiting sperm motility, causing the sperm to move slower towards the egg. By itself, spermicide prevents just 72% of pregnancies, the least effective of any major contraceptive measure. Because of its poor success rate, spermicide is often used in conjunction with other contraceptives such as patches and condoms.

© Thinkstock

14. Fertility-awareness based methods
> Failure rate: 24%
> Popularity: 1.4% of women who practice birth control
> Method: N/A

While each woman has a different menstrual cycle, the average woman is most fertile during ovulation, which is roughly two weeks after the first day of her period. Women are also often least fertile just before menstruation. Fertility-awareness methods are ways to track the menstrual cycle and ovulation times. Women can prevent pregnancy by abstaining from intercourse during the fertile days. However, the process is far less effective than other medical or surgical methods of birth control. Out of every 100 women using fertility-awareness based methods as their primary form of contraception, 24 experienced an unwanted pregnancy, nearly three times the rate of women using birth control pills, patches, or rings.

© Thinkstock

13. Sponge
> Failure rate: 12%-24%
> Popularity:
> Method: Over-the-counter

The sponge is a small, round piece of white plastic foam containing spermicide. It is about two inches across and has a small nylon strap to aid in removal. Like the diaphragm, the sponge is inserted into the vagina prior to sex. The sponge acts as a physical blockade between the cervix and sperm. It also releases spermicide that inhibits sperm motility and slows their movement. One benefit of sponges is that, unlike many other forms of birth control, they lack hormones, which can often have undesirable side effects. However, the sponge has been proven to be far less effective than hormonal methods, especially for women who have already had a child. Roughly 12% of women who regularly use the sponge as a contraceptive become pregnant within a year, and among women who have previously given birth in their lifetime and use the sponge, 24% become pregnant.

© Thinkstock

12. Withdrawal
> Failure rate: 22%
> Popularity: 4.8% of women who practice birth control
> Method: N/A

The withdrawal method, known as coitus interruptus, is a contraceptive method that involves the man withdrawing his penis from the woman’s vagina prior to ejactulation in order to prevent sperm from entering the uterus. The method requires a degree of self-control and can be ineffective even when done properly, as the penis often emits pre-ejaculation fluid containing sperm. While more than one in five women using the withdrawal method as a primary form of contraception have unwanted pregnancies, coitus interruptus remains a popular method of birth control. An estimated 5% of of couples in the United States who use some method of contraception use the withdrawal method, and 10% of couples use the method in conjunction with another form of birth control.

© Thinkstock

11. Female condom
> Failure rate: 21%
> Popularity:
> Method: Over-the-counter

Male and female condoms are the only contraceptive methods that also protect against STDs. The female condom is a pouch inserted into the vagina. Invented years after the male condom, the female condom was partially developed in response to the refusal among men to wear a male condom and to put women in control over the decision to use protection. The female condom is both less popular and slightly less effective than the male condom. While both are a physical barrier to block sperm from the uterus and should theoretically have a 100% success rate, the misuse of condoms has decreased the device’s effectiveness. More than one in five women who use female condoms as their primary source of birth control have unwanted pregnancies each year.

© Thinkstock

10. Male condom
> Failure rate: 18%
> Popularity: 15.3% of women who practice birth control
> Method: Over-the-counter

While male condoms are one of the most commonly used forms of birth controls, they are among the least effective. An estimated 93% of sexually active women have their partners use condoms. While advocacy group BirthControl.com estimates that condoms should be 98% effective by design, the misuse of condoms lowers the method’s effectiveness to just 82%. Users may put the condom on incorrectly, or it may break. Only 35% of public and private high schools in the U.S. teach their students how to properly use a condom as part of their sexual education curriculum. Condoms are also used as a primary means of STD prevention.

© Thinkstock

9. Diaphragm
> Failure rate: 12%
> Popularity:
> Method: Prescription

Over a one-year period, 12% of women using diaphragms as their regular method of birth control reported unexpected pregnancies. A diaphragm is a dome shaped cup made of silicone, just a few inches in diameter, which is inserted into the vagina prior to sex. The diaphragm covers the cervix and acts as a physical barrier to keep sperm from entering the uterus. For optimal protection, doctors recommend inserting the diaphragm into the vagina several hours before sex and to leave it in for six to eight hours after the man’s ejaculation. The effectiveness of the technique may also be improved by using it with spermicide.

© Thinkstock

8. Ring
> Failure rate: 9%
> Popularity: 2.0% of women who practice birth control
> Method: Prescription

Vaginal rings contain the hormones estrogen and progesterone — the same hormones used in birth control pills. Estrogen and progesterone prevent the egg from leaving the ovaries and thicken the mucus layer around the cervix, preventing sperm from fertilizing the egg. The vaginal ring is inserted into the vagina once a month and is removed after three weeks. The ring is 92% effective — only eight in 100 women using the ring report unintended pregnancies in a given year.

© Thinkstock

7. Patch
> Failure rate: 9%
> Popularity: 0.6% of women who practice birth control
> Method: Prescription

A contraceptive patch is a thin bandage-like piece of plastic less than two inches wide and two inches across that is applied to the user’s skin. Like vaginal rings, the contraceptive patch prevents pregnancies by secreting the hormones estrogen and progesterone into the body, which prevent the egg from leaving the ovaries and thickens mucus around the cervix, which prevents the sperm from reaching the egg. The patch is one of the most effective forms of birth control, preventing 91% of all unwanted pregnancies. It is also one of the easiest and less intrusive methods.

© Thinkstock

6. Pill
> Failure rate: 9%
> Popularity: 25.9% of women who practice birth control
> Method: Prescription

The Food and Drug Administration approved the active ingredient in today’s birth control pill in 1957. Oral contraceptives became popular by 1965, when one in four married women under age 45 were taking birth control pills. The oral contraceptive is the most commonly used method of birth control today, used by 9.7 million women. The oral contraceptive once required a monthly regimen by which a woman takes one pill daily for three weeks, followed by a seven day break period with no pills or placebo tablets as a method of maintaining habits. Women have more options today, with some extended-cycle pill regimens lasting from three months of taking active pills every day to one year. Today, 26% of all women using contraception use birth control pills as their preferred method.

© Thinkstock

5. Injectable
> Failure rate: 6%
> Popularity: 4.5% of women who practice birth control
> Method: By appointment

The first injectable contraceptives were developed in the 1950s. By combining progestogen — a hormone that controls ovulation — and alcohol, scientists discovered the possibility of a long-lasting contraceptive that would require far less frequent administration than the most popular birth control at the time, which had to be taken orally nearly every day. Today, birth control shots, also called Depo-Provera, are easily available by prescription and last three months. Shots are one of the most effective method of birth control, with a failure rate of only 6%. Like most methods on this list, birth control injections do not protect against STDs.

© Thinkstock

4. Female sterilization
> Failure rate: 0.5%
> Popularity: 25.1% of women who practice birth control
> Method: Surgery

While the earliest references to female sterilization can be traced as far back 1823, the safe and effective method used today was developed in the 1970s. Female sterilization involves the blocking of the fallopian tubes, thus preventing the egg from traveling from the ovaries to the uterus and preventing the sperm from reaching the egg. While the method was originally developed for eugenic reasons as a means of preventing the flow of hereditary disease, the growing popularity of birth control in the 1960s and the invention of the less invasive Essure procedure in 2002 has made the surgery one of the most popular contraceptive methods. Today 15.5% of U.S. women between the ages of 15 and 44 have undergone the procedure. The CDC estimates that just 0.5% of women with tubal sterilization become pregnant each year.

© Thinkstock

3. Intrauterine device (IUD)
> Failure rate: 0.2-0.8%
> Popularity: 10.3% of women who practice birth control
> Method: By appointment

Developed and refined in the 1960s, the intrauterine device is one of the most effective and popular forms of birth control. An IUD is a small, T-shaped device that is inserted into the uterus to prevent pregnancy, and it lasts from three to 10 years. There are multiple types of IUDs, such as copper and hormonal. Copper is toxic to sperm and makes the uterus and fallopian tubes secrete fluid that kills sperm. Just 0.8% of women using copper IUDs become pregnant. While copper IUDs are the most common form of intrauterine device, hormonal IUDs are the most effective. Hormonal IUDs release small amounts of progesterone into the uterus each day, the same hormone used in patches and vaginal rings. IUDs are one of the most effective form of birth control and women can return to fertility within several days of removing the device.

© Thinkstock

2. Male sterilization
> Failure rate: 0.15%
> Popularity: 8.2% of women who practice birth control
> Method: Surgery

Slightly more effective than female sterilization, only 0.15% of couples whose primary form of birth control is male vasectomy become pregnant each year. While technically reversible, vasectomies are a form of permanent contraception that requires only one surgery. The procedure involves the blocking of the vas deferens, the tubes that carry sperm. Once the tubes are cut, blocked, or tied, sperm is unable to leave the man’s penis and cannot cause pregnancy. Getting a vasectomy is a relatively quick process, often requiring just 30 minutes of surgery and one hour of short rest. While male sterilization is one of the most effective forms of contraception, the permanence of the procedure limits its popularity to mostly older men who have decided they do not want children in the future. The average age of a man who gets a vasectomy is 38.

© soc.ucsb.edu

1. Implant
> Failure rate: .05%
> Popularity: 1.3% of women who practice birth control
> Method: By appointment

An implant is a small, matchstick-sized rod inserted beneath the skin of a female’s upper arm. The implant releases progesterone, the same hormone used in patches and vaginal rings that prevent ovaries from releasing eggs and thickens the cervical mucus, blocking sperm from reaching a woman’s eggs. Once inserted, the implant lasts about four years. In addition to its convenience, the implant is the most effective contraceptive method available. Just 0.5% of women using implants as their primary form of birth control have unwanted pregnancies.

ALSO READ: 11 Medical Conditions Aspirin Can Treat

14. Fertility-awareness based methods
> Failure rate: 24%
> Popularity: 1.4% of women who practice birth control
> Method: N/A

While each woman has a different menstrual cycle, the average woman is most fertile during ovulation, which is roughly two weeks after the first day of her period. Women are also often least fertile just before menstruation. Fertility-awareness methods are ways to track the menstrual cycle and ovulation times. Women can prevent pregnancy by abstaining from intercourse during the fertile days. However, the process is far less effective than other medical or surgical methods of birth control. Out of every 100 women using fertility-awareness based methods as their primary form of contraception, 24 experienced an unwanted pregnancy, nearly three times the rate of women using birth control pills, patches, or rings.

13. Sponge
> Failure rate: 12%-24%
> Popularity: <0.1% of women who practice birth control
> Method: Over-the-counter

The sponge is a small, round piece of white plastic foam containing spermicide. It is about two inches across and has a small nylon strap to aid in removal. Like the diaphragm, the sponge is inserted into the vagina prior to sex. The sponge acts as a physical blockade between the cervix and sperm. It also releases spermicide that inhibits sperm motility and slows their movement. One benefit of sponges is that, unlike many other forms of birth control, they lack hormones, which can often have undesirable side effects. However, the sponge has been proven to be far less effective than hormonal methods, especially for women who have already had a child. Roughly 12% of women who regularly use the sponge as a contraceptive become pregnant within a year, and among women who have previously given birth in their lifetime and use the sponge, 24% become pregnant.

12. Withdrawal
> Failure rate: 22%
> Popularity: 4.8% of women who practice birth control
> Method: N/A

The withdrawal method, known as coitus interruptus, is a contraceptive method that involves the man withdrawing his penis from the woman’s vagina prior to ejactulation in order to prevent sperm from entering the uterus. The method requires a degree of self-control and can be ineffective even when done properly, as the penis often emits pre-ejaculation fluid containing sperm. While more than one in five women using the withdrawal method as a primary form of contraception have unwanted pregnancies, coitus interruptus remains a popular method of birth control. An estimated 5% of of couples in the United States who use some method of contraception use the withdrawal method, and 10% of couples use the method in conjunction with another form of birth control.

ALSO READ: The Best (and Worst) States for Business

11. Female condom
> Failure rate: 21%
> Popularity: <0.1% of women who practice birth control
> Method: Over-the-counter

Male and female condoms are the only contraceptive methods that also protect against STDs. The female condom is a pouch inserted into the vagina. Invented years after the male condom, the female condom was partially developed in response to the refusal among men to wear a male condom and to put women in control over the decision to use protection. The female condom is both less popular and slightly less effective than the male condom. While both are a physical barrier to block sperm from the uterus and should theoretically have a 100% success rate, the misuse of condoms has decreased the device’s effectiveness. More than one in five women who use female condoms as their primary source of birth control have unwanted pregnancies each year.

10. Male condom
> Failure rate: 18%
> Popularity: 15.3% of women who practice birth control
> Method: Over-the-counter

While male condoms are one of the most commonly used forms of birth controls, they are among the least effective. An estimated 93% of sexually active women have their partners use condoms. While advocacy group BirthControl.com estimates that condoms should be 98% effective by design, the misuse of condoms lowers the method’s effectiveness to just 82%. Users may put the condom on incorrectly, or it may break. Only 35% of public and private high schools in the U.S. teach their students how to properly use a condom as part of their sexual education curriculum. Condoms are also used as a primary means of STD prevention.

9. Diaphragm
> Failure rate: 12%
> Popularity: <0.1% of women who practice birth control
> Method: Prescription

Over a one-year period, 12% of women using diaphragms as their regular method of birth control reported unexpected pregnancies. A diaphragm is a dome shaped cup made of silicone, just a few inches in diameter, which is inserted into the vagina prior to sex. The diaphragm covers the cervix and acts as a physical barrier to keep sperm from entering the uterus. For optimal protection, doctors recommend inserting the diaphragm into the vagina several hours before sex and to leave it in for six to eight hours after the man’s ejaculation. The effectiveness of the technique may also be improved by using it with spermicide.

8. Ring
> Failure rate: 9%
> Popularity: 2.0% of women who practice birth control
> Method: Prescription

Vaginal rings contain the hormones estrogen and progesterone — the same hormones used in birth control pills. Estrogen and progesterone prevent the egg from leaving the ovaries and thicken the mucus layer around the cervix, preventing sperm from fertilizing the egg. The vaginal ring is inserted into the vagina once a month and is removed after three weeks. The ring is 92% effective — only eight in 100 women using the ring report unintended pregnancies in a given year.

ALSO READ: The Best Counties to Live In

7. Patch
> Failure rate: 9%
> Popularity: 0.6% of women who practice birth control
> Method: Prescription

A contraceptive patch is a thin bandage-like piece of plastic less than two inches wide and two inches across that is applied to the user’s skin. Like vaginal rings, the contraceptive patch prevents pregnancies by secreting the hormones estrogen and progesterone into the body, which prevent the egg from leaving the ovaries and thickens mucus around the cervix, which prevents the sperm from reaching the egg. The patch is one of the most effective forms of birth control, preventing 91% of all unwanted pregnancies. It is also one of the easiest and less intrusive methods.

6. Pill
> Failure rate: 9%
> Popularity: 25.9% of women who practice birth control
> Method: Prescription

The Food and Drug Administration approved the active ingredient in today’s birth control pill in 1957. Oral contraceptives became popular by 1965, when one in four married women under age 45 were taking birth control pills. The oral contraceptive is the most commonly used method of birth control today, used by 9.7 million women. The oral contraceptive once required a monthly regimen by which a woman takes one pill daily for three weeks, followed by a seven day break period with no pills or placebo tablets as a method of maintaining habits. Women have more options today, with some extended-cycle pill regimens lasting from three months of taking active pills every day to one year. Today, 26% of all women using contraception use birth control pills as their preferred method.

5. Injectable
> Failure rate: 6%
> Popularity: 4.5% of women who practice birth control
> Method: By appointment

The first injectable contraceptives were developed in the 1950s. By combining progestogen — a hormone that controls ovulation — and alcohol, scientists discovered the possibility of a long-lasting contraceptive that would require far less frequent administration than the most popular birth control at the time, which had to be taken orally nearly every day. Today, birth control shots, also called Depo-Provera, are easily available by prescription and last three months. Shots are one of the most effective method of birth control, with a failure rate of only 6%. Like most methods on this list, birth control injections do not protect against STDs.

4. Female sterilization
> Failure rate: 0.5%
> Popularity: 25.1% of women who practice birth control
> Method: Surgery

While the earliest references to female sterilization can be traced as far back 1823, the safe and effective method used today was developed in the 1970s. Female sterilization involves the blocking of the fallopian tubes, thus preventing the egg from traveling from the ovaries to the uterus and preventing the sperm from reaching the egg. While the method was originally developed for eugenic reasons as a means of preventing the flow of hereditary disease, the growing popularity of birth control in the 1960s and the invention of the less invasive Essure procedure in 2002 has made the surgery one of the most popular contraceptive methods. Today 15.5% of U.S. women between the ages of 15 and 44 have undergone the procedure. The CDC estimates that just 0.5% of women with tubal sterilization become pregnant each year.

ALSO READ: Huge Detroit Mansion Offered At $285,000

3. Intrauterine device (IUD)
> Failure rate: 0.2-0.8%
> Popularity: 10.3% of women who practice birth control
> Method: By appointment

Developed and refined in the 1960s, the intrauterine device is one of the most effective and popular forms of birth control. An IUD is a small, T-shaped device that is inserted into the uterus to prevent pregnancy, and it lasts from three to 10 years. There are multiple types of IUDs, such as copper and hormonal. Copper is toxic to sperm and makes the uterus and fallopian tubes secrete fluid that kills sperm. Just 0.8% of women using copper IUDs become pregnant. While copper IUDs are the most common form of intrauterine device, hormonal IUDs are the most effective. Hormonal IUDs release small amounts of progesterone into the uterus each day, the same hormone used in patches and vaginal rings. IUDs are one of the most effective form of birth control and women can return to fertility within several days of removing the device.

2. Male sterilization
> Failure rate: 0.15%
> Popularity: 8.2% of women who practice birth control
> Method: Surgery

Slightly more effective than female sterilization, only 0.15% of couples whose primary form of birth control is male vasectomy become pregnant each year. While technically reversible, vasectomies are a form of permanent contraception that requires only one surgery. The procedure involves the blocking of the vas deferens, the tubes that carry sperm. Once the tubes are cut, blocked, or tied, sperm is unable to leave the man’s penis and cannot cause pregnancy. Getting a vasectomy is a relatively quick process, often requiring just 30 minutes of surgery and one hour of short rest. While male sterilization is one of the most effective forms of contraception, the permanence of the procedure limits its popularity to mostly older men who have decided they do not want children in the future. The average age of a man who gets a vasectomy is 38.

1. Implant
> Failure rate: .05%
> Popularity: 1.3% of women who practice birth control
> Method: By appointment

An implant is a small, matchstick-sized rod inserted beneath the skin of a female’s upper arm. The implant releases progesterone, the same hormone used in patches and vaginal rings that prevent ovaries from releasing eggs and thickens the cervical mucus, blocking sperm from reaching a woman’s eggs. Once inserted, the implant lasts about four years. In addition to its convenience, the implant is the most effective contraceptive method available. Just 0.5% of women using implants as their primary form of birth control have unwanted pregnancies.

  • States With the Worst Roads
  • 25 Worst Tasting Beers in America
  • The 25 Healthiest Cities in America

Contents

Download Clue to send a daily reminder to take your pill.

Top things to know

  • Hormonal birth control (HBC) usually works when used correctly and consistently

  • Unintended pregnancies are declining because of increasing access to effective contraception

  • Human behavior can play a part in HBC being less effective. The effectiveness of any method depends on typical vs. perfect use.

  • Tracking your HBC in Clue can help you prevent failure

Most of the time, hormonal birth control doesn’t fail. When people use hormonal birth control consistently and correctly, pregnancy occurs in only 0.05 percent to 0.3 percent of people (depending on the method) over a year of use (1). (Compare that to the eighty-five percent of people who become pregnant within a year, when not using birth control.)

Almost half of pregnancies are unintended, but this number is declining, likely because of the increasing availability of highly effective methods of birth control (2).

If birth control is so effective, why do we hear so many stories about people becoming pregnant while using it? Generally, it’s because as humans, we are more flawed than the medical technology of birth control.

When we talk about birth control and why certain methods fail, it’s important to make a distinction between perfect use and typical use (1).

  • Typical use reflects how people actually use a type of birth control, even if they use it inconsistently or incorrectly.

  • Perfect use reflects how effective the form of birth control is if used exactly as prescribed (3).

While certain behaviors can put a person at risk for birth control failure, there are times when birth control fails without a real reason and without anyone to blame. Contraception is a modern technology, and no technology is perfect (1).

Why hormonal birth control fails

Hormonal birth control works to prevent pregnancy by stopping ovulation and/or, thickening cervical mucus (1, 4). Human behavior is commonly a factor in why these methods fail. Below, we address the different hormonal birth controls, and factors that may cause them to fail, in greater depth.

The pill

Failure rate: 9% typical use, 0.3% perfect use (1)

Human behavior is the most common reason that birth control pills fail (1). The majority of people using the pill forget to take one or more each month (5), while others have challenges filling the prescription monthly (6). Some people might stop taking it because they are concerned about side effects (1).

Taking medications like certain antibiotics, some anticonvulsants, and the herb St. John’s Wort can make the pill less effective (7, 8). Prolonged vomiting or diarrhea can prevent absorption of the pill and lead to pregnancy if a backup method isn’t used (9).

The patch

Failure rate: 9% typical use, 0.3% perfect use (1)

The patch contains hormones like the pill, but it sticks to the skin (1). The patch can fail if it detaches and isn’t replaced, or if the patch isn’t replaced weekly (1).

The ring

Failure rate: 9% typical use, 0.3% perfect use (1)

The ring is inserted into the vagina to deliver hormones (1). The ring can fail if it’s withdrawn accidentally during sex, when using a tampon, or having a bowel movement and not reinserted within three hours (1). It could also fail to prevent pregnancy if the same ring is used for more than four weeks (1).

The shot

Failure rate: 6% typical use, 0.2% perfect use (1)

The shot contains a progestin (a synthetic form of progesterone) that lasts three months (1). It can fail if a person doesn’t receive their next dose in time, or if it is given incorrectly (10).

The implant

Failure rate 0.05% typical use, 0.05% perfect use (1, 11)

Hormonal implants are thin rods that are inserted under the skin in the upper arm (1). Although the implant is one of the most effective forms of birth control (1), it can fail if it’s not correctly inserted or if a person is taking antiepileptic drugs (12).

Why IUDs fail

Hormonal IUD

Failure rate: 0.2% typical use, 0.2% perfect use (1)

Intrauterine devices, or IUDs, are small implants placed inside the uterus. While the hormonal IUD thickens cervical mucus and sometimes prevents ovulation like other hormonal birth control methods, the presence of the IUD inside the uterus also causes inflammation that is toxic to both sperm and eggs (1).

An IUD can fail if it is not placed correctly by the healthcare provider, or if it’s expelled from the uterus (1). All human anatomy varies slightly from person to person, and uteruses come in a variety of shapes, sizes, and positions. Someone with a uterus that is smaller than average, shaped or positioned atypically may be more at risk for IUD failure because if the device is not in the appropriate position, it may be less effective or be more likely to be expelled (13).

While the copper IUD does not contain hormones, we’ve included its failure rates here for comparison and clarity.

Copper IUD

Failure rate: 0.8% typical use, 0.6% perfect use (1, 11)

How to prevent your birth control from failing

1. Use two birth control methods simultaneously (1).

No, this doesn’t mean using two condoms at once. It means pairing a hormonal method with another method that doesn’t involve hormones but is still effective at preventing pregnancy. Some good options are condoms, spermicides, or withdrawal.

2. If you’re on the pill and need a reminder to take it, Clue can send you a birth control pill reminder notification. You can also track when you take your pills.

If you miss a pill and don’t know what to do, Clue can walk you through the difference between a taken, late and missed pill and let you know what your next step should be.

Choosing a birth control method is an important decision, but just because one method is the most effective doesn’t mean it’s the most effective for you.

While pills have prevented millions of pregnancies, they won’t work if you know you’re not good at remembering to take them every day.

over 115k ratings

over 115k ratings

3. Explore options that don’t require daily effort.

The patch is a good option for many people because you only need to remember to change it once a week. Applying it is usually pretty easy, but if you use a lot of creams, lotions, or sunscreens, it might not adhere well. You’ll need to make sure your skin is clean and dry before attaching the patch and pressing it for ten seconds. Then, make sure all of the edges are stuck to the skin—peeling edges can cause the patch to be pulled off (1).

The ring also needs to be changed infrequently. If you don’t have trouble remembering to change it each month, you just need to remember to check that it’s still inserted after sex, tampon use and bowel movements.

IUDs and the implant have the lowest risk for human error, since you don’t have to worry about taking them or changing them frequently, but they can be inserted incorrectly by the healthcare provider, or expelled after the fact. After your IUD or implant is inserted, you can ask your healthcare provider to show you how to feel for it to know it’s there—then make sure you check it regularly.

If you’re having trouble using your birth control correctly and consistently, talk to your healthcare provider about trying a new option.

Photo; Courtesy

Studies show that 53 per cent of unplanned pregnancies occur in women who are using contraceptives.

ALSO READ: Health: Alarm as girls exposed to illegal birth control shots

Of these unplanned pregnancies caused by contraceptive failures, more than 75 per cent occur in women who are 20 years or older – not in teenagers.

While it is astonishing and worrying that contraceptives could fail among so many women, research has shown that some of the pregnancies occur as a result of negligence on the part of the women. But what could these women have done that produced these results?

Using contraceptives inconsistently or incorrectly

It is probably the most obvious reason. If you forget to use a condom or diaphragm or any other barrier method during sex, your chances of getting pregnant are high. But while forgetting is the crime of some victims of unplanned pregnancies, ignorance can be another cause. Barrier methods must be used every time a couple has sex. Yes, every time.

If you forget to take the pill, you are likely to get pregnant. If this happens to you, the only way to raise your chances of to prevent pregnancy in that cycle is to double up with another contraceptive method such as a condom.

Still, condoms burst due to incorrect use. This includes using a condom with a water-based lubricant, using an expired condom and storing it or handling a condom incorrectly. Condoms are delicate and they can be torn by fingernails, keys, jewellery or teeth. Your best bet while using a condom is to combine its use with a vaginal spermicide just in case it tears.

Taking certain drugs or herbal remedies

If you’re on a hormonal birth control method, especially the oral pill, always tell your doctor about it when he or she is prescribing medicine. Just to be sure, mention this to your pharmacist and read the leaflet that comes with your medicine to see if there is some information about drug interactions.

The contraceptive does not suit you

In a 2003 study done in France, two-thirds of women who had unplanned pregnancies reported using contraceptives, with one in five users taking the pill and one in 10 using intrauterine devices (IUDs).

Lead investigator Nathalie Bajos, PhD, concluded that the research showed most clearly that there is often a mismatch between a woman’s contraceptive needs and the methods they use.

“It is absolutely essential to differentiate between what are the theoretically most effective methods of contraception and what is the most practical method for a particular woman at a particular time in a particular relationship,” she said.

When the findings of this study were published by WebMD, UK reproductive health advocate Melissa Dear recommended that healthcare professionals needed to be better trained to give women information about all of their choices and help them identify which ones will work best for them.

The contraceptive fails

Few studies can claim to prove the failure of the oral or injectable contraceptive because of the high chances of human error. However, with the methods that are more trackable such as IUDs, touted as the most effective reversible methods, failures are easier to track.

If the IUD drops into the cervix, for example or it is expelled from the uterus altogether, pregnancy is likely to occur. It is the reason manufacturers recommend that you check once a month that the IUD string is hanging from the cervix into the vaginal opening.

For More of This Stories Subscribe to the Standard Epaper to get a copy of Eve Woman in the Standard

Do not miss out on the latest news. Join the Eve Digital Telegram channel HERE.

The Pill is the most commonly used form of birth control in the U.S. When taken exactly as directed, it’s 99.7 percent effective, making it a smart choice for many women.

But the Pill is not magic, so if it’s not taken as directed, it’s not going to do its job as well.

Some myths floating around out there about what might cause your birth control to fail are just that: myths. But there are a handful of things that could truly interfere with the Pill’s level of effectiveness—and could lead to an unplanned pregnancy.

1. Missing a pill or starting a pack late.

“The number one reason birth control pills fail is because women are not taking them daily,” Fahimeh Sasan, D.O., assistant professor of obstetrics, gynecology and reproductive science at the Icahn School of Medicine at Mount Sinai, tells SELF. Specifically, missing a pill is the biggest mistake you can make.

Does missing one pill mean you’re definitely going to get pregnant? No. But it does mean that you could get pregnant—especially if it’s the first active pill in the pack. “For most pills if you are in the middle or toward the end of your pack you should be fine, but if it is the first day of active pills and you forget to restart, this might be a problem,” says Nikki B. Zite, M.D., program director and professor of obstetrics and gynecology surgery at The University of Tennessee Graduate School of Medicine. “The first week of pills after the placebos are the most important to stop the egg from developing,” Zite says, so leaving a gap between the end of one pack and the start of the next one will put you at a higher risk of pregnancy than if you were to miss a pill mid-cycle.

If you miss a single pill other than the first one, take it as soon as you remember, and you should be fine. If you miss more than two pills, “it is likely best to consider yourself not protected.” You should not have unprotected sex until you are through that pack, including the placebos.

To help yourself remember, set a daily alarm, or try an app that reminds you. If you still tend to forget, ask your gynecologist about switching to a “set it and forget it” method, like an IUD, Zite suggests.

via whatshouldwecallbiddies2. If you have inflammatory bowel disease or other digestive disorders.

Bowel conditions like Crohn’s disease and IBD may prevent the body from absorbing any oral medication correctly, including the Pill. “Anything that interferes with the body’s ability to absorb the hormones or increases the rate at which they are metabolized (broken down) can decrease the effectiveness of birth control pills,” Zite says. Chronic diarrhea can also impede absorption. In fact, the Mayo Clinic says that if you’ve had serious diarrhea or vomiting for two or more days, you should act as though you’ve missed a pill. Zite recommends women with chronic bowel issues choose a non-oral method of contraception.

3. Taking certain seizure or migraine medications.

A certain category of epilepsy medications taken to prevent seizures are “liver enzyme-inducing,” meaning that they boost the rate at which the liver breaks down hormones. This means any hormonal birth control can be affected, including methods like the patch. Zite warns that some seizure medications—such as Topamax—can also be used for migraines, “so women should make sure that all their providers are aware of their birth control before starting any new medications.”

4. Not taking your progestin-only pill at the same time every day.

If you’re taking a combination pill (it’s the most standard, and includes a mix of estrogen and progestin), laboring over exact timing isn’t necessary. But progestin-only pills (aka mini-pills) are much more time-sensitive. These are commonly used while breastfeeding or when a woman cannot take estrogen for any other reason. “They work mostly by making cervical mucous unfavorable for sperm. Within three hours the mucous is able to be penetrated…so not much wiggle room there.” Planned Parenthood says to use backup for 48 hours after a late or missed mini-pill.

5. Taking certain antibiotics.

Most standard antibiotics, like the ones your doc prescribes for an upper respiratory infection, UTI, or post-wisdom teeth removal, are not going to affect your birth control, Sasan says. But a few less common types of antibiotics might interact poorly. “For example, rifampicin and rifabutin which can be used to treat or prevent diseases including tuberculosis and meningitis,” Sasan says. To be completely sure, you should always check with your doctor when adding a new prescription medication.

6. Or antiretroviral medications.

If you’re taking medication for HIV, the effectiveness of hormonal birth control pills may be compromised. Drugs known to interact are several protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), according to the National Institutes of Health. These drug interactions can impact the amount of hormones in the blood, potentially rendering the Pill less effective. They can also increase the risk of other, more dangerous hormone-related effects, like thromboembolism, a sometimes-fatal condition that happens when a blood clot breaks away and clogs a blood vessel elsewhere in the body.

7. Treating mood disorders with St. John’s wort.

The herb is most commonly taken for depression and related conditions like anxiety. But it might increase the breakdown of estrogen, according to the National Institutes of Health, making oral contraception less effective. “It’s best to avoid St. John’s wort and to discuss other herbal supplements with the prescriber or pharmacists,” Zite recommends.

7 facts anyone taking birth control should know

1) Birth control pills prevent pregnancy through two different mechanisms

All birth control pills use hormones to prevent pregnancy. Some contain a hormone called progestin. Others contain two hormones, progestin and estrogen. All of them work by doing two things: They prevent women from ovulating, and they cause the cervical mucus to thicken, which makes it more difficult for a sperm to penetrate and make contact with an egg if the woman is ovulating.

In a way, birth control mimics the body’s response to pregnancy. “There is some truth to the idea that birth control pills trick your body into thinking you’re pregnant,” said Dr. Vanessa Cullins, Planned Parenthood’s vice president of external medical affairs. “When you’re pregnant, you don’t ovulate, and the cervical mucus is thickening to prevent anything from easily getting into your uterus.”

2) Lots of women take birth control incorrectly

If women follow the exact instructions for taking birth control pills — every day, at the same time — they prevent pregnancy in 99 percent of all cases. But lots of people don’t do that. In real life, birth control pills have a 9 percent failure rate. That means nine of every 100 women using birth control pills as their only means of contraception become pregnant in any given year.

“It’s hard to actually when you’re living a busy life,” Cullins says. “If you take these pills every single day, the chances of getting pregnant is 1 percent. But typically the chance is much higher than that, because people miss pills. This isn’t just true with birth control pills. It’s true with any prescription medication.”

Birth control pills have a higher failure rate than other contraceptives, like intra-uterine devices (IUDs) or birth control rings.

The main difference: Pills have to be taken every day, which leaves more room for human error.

3) There’s a three-hour window for taking your birth control pill “on time”

I asked Cullins whether there is wiggle room in terms of when birth control is effective. For instance, if a birth control user typically takes a pill at 9 am but one morning waits until 11 am, is she at greater risk for pregnancy?

The answer is no. Cullins said that for those taking progestin-only pills, “on time” means taking the pill within the same three-hour window daily. A three-hour difference is not enough to lower the pill’s efficacy. “That’s acceptable,” she said.

For combination progestin-estrogen pills, the space is even wider. Women who miss one day of their pill can take two pills the next day without reducing their birth control’s effectiveness. This chart with data from Planned Parenthood shows the organization’s recommendations for how to handle a missed combination pill.

“Two or three missed pills is when you need to begin to get concerned, and once you get to three missed pills, you need to consider emergency contraception and using backup birth control until she has finished the first week of the pills of the new package that is begun after her bleed from emergency contraception,” Cullins said.

4) Missing a period on the pill doesn’t mean something’s wrong

Missing a period while on the pill doesn’t indicate anything abnormal, Cullins said, as long as you have been taking the pill consistently and correctly each day.

“It’s not dangerous not to have your period while on the pill,” she says. “What happens is, over time, the uterine lining can become very thin if you take the pill regularly. All that means is if you stop bleeding on the pill, the lining has become so thin that you don’t have anything to bleed from.”

This is not permanent: When a woman stops taking birth control pills, the ovaries start making more estrogen, the uterine lining gets thicker, and women start to bleed again.

Missed periods after taking your pills incorrectly, however, could indicate a pregnancy. In that situation, it’s worth taking a pregnancy test.

5) We don’t know whether most antibiotics make birth control less effective

There are two antibiotics that researchers have found make birth control pills less effective: griseofulvin, an antifungal used to treat athlete’s foot and ringworm, and rifampicin, which is typically used to treat tuberculosis.

The reason that happens is that these drugs speed up the liver’s metabolism, which makes the liver metabolize the hormones in the birth control faster. As a result, hormones leave the blood stream faster and are unable to adequately affect the ovaries to prevent ovulation or the cervix to prevent thickening of the cervical mucus.

Lots of antibiotics, not just the two listed above, come with warnings that they’ll make birth control ineffective and suggest using a backup method of contraception. While a backup method is never a bad idea, there’s actually sparse evidence that these other drugs make birth control less effective. “Uncertainty persists with respect to the other broad-spectrum antibiotics,” researchers in the journal Contraception wrote in a review article about interactions between birth control and antibiotics. They argue that in light of that uncertainty, it is completely appropriate for women to use a backup method — but not to ditch their antibiotics out of concern over interactions.

6) Those “sugar pills” at the end of a birth control pack? They have active ingredients.

Lots of birth control packs have four weeks of pills: three weeks of pills that prevent pregnancy and one week of pills that are inactive.

Women can safely skip that last week of pills and still prevent pregnancy, Cullins said. But that doesn’t mean the last week’s pills are just sugar pills. As it turns out, some of them actually have active ingredients to make the pills work better or aid in women’s health.

“Some of the pills might have low-dose estrogen for three to four days, to help prevent breakthrough bleeding ,” she said. “Others sometimes contain iron or folic acid or other vitamins. And the hard part about skipping the pills is that you have to remember exactly when to start back up.”

7) Even under Obamacare, not everyone with insurance gets free birth control

The number of women getting free birth control pills has quadrupled under Obamacare, recent research shows. Two-thirds of women in a recent Guttmacher Institute survey reported paying zero dollars for their contraceptive.

But that still leaves one-third of women paying something for birth control, even after Obamacare has mandated it be free.

The one-third of women still paying for their birth control are most likely in grandfathered health insurance plans. These are the plans that existed before Obamacare that do not have to comply with the contraceptives mandate (or most other Obamacare requirements, for that matter).

Grandfathered plans are, however, disappearing. When a company significantly changes its insurance (drops a benefit, for example, or changes what enrollees have to pay), then it loses its grandfathered status. Just over a quarter of health insurance plans are currently grandfathered, a number that has steadily dropped since Obamacare passed.

As that figure declines, the number of women accessing no-cost contraceptives will likely continue growing.

“To me it’s reprehensible that, once again, women’s health will be an afterthought, even as other fields go rip-roaring ahead of us with precision medicine,” says Christofield. “This is the one category of drugs used by hundreds of millions of people, and I just can’t stomach the idea that we’re continuing to place it on a back burner, saying we’ll come back to it once we’ve figured it out in these other spaces.”

Lazorwitz is one of the few people trying to change that. He’s spent most of his career studying how contraceptives interact with other drugs, but a few years ago he started noticing the rise of pharmacogenomics research in cancer and heart drugs. He looked around and couldn’t find anything like that on birth control, despite the fact that nearly half of all US women of reproductive age use it. “We give the same hormones to every woman, but do they work the same in every woman?” he asked himself. No one had ever bothered to find out.

So he and a few colleagues assembled a small study of 350 women who all took the most reliable form of hormonal birth control—an implant under the skin—and tested them for 120 genetic variations they suspected could play a role in hormone metabolism. They also measured the concentration of hormones in their blood. That’s how they found a gene called CYP3A7*1C, which is usually active in fetuses and then switches off sometime before birth. But women with this mutation continue to produce the CYP3A7 enzyme into adulthood, supercharging their body’s ability to break down the active ingredient in hormonal birth control.

Lazorwitz recognizes that their study was limited by only looking for gene-drug interactions that other people had looked for before. He says their next step is to repeat the experiment with a much larger cohort and with whole genome sequencing, so they can surface new genetic variants that could affect birth control efficacy. He also wants to investigate the links between DNA and side effects. But such studies are expensive and time-consuming. They aren’t a priority for federal biomedical funding institutions, and pharmaceutical companies have no financial incentives to invest in them. Hormonal contraceptives might be a blunt instrument, but they work—and they mint the companies that make them billions of dollars annually.

“Am I grateful for the pill?” asks Piraye Beim, CEO of Celmatix, a company focused on reproductive health. “Yes. Absolutely. Do I deserve something better? Yes.” Celmatix is perhaps the only company in the world building a massive data engine explicitly to power precision reproductive medicine.

Modeled on the National Institutes of Health’s cancer genome atlas, Beim’s company has spent 10 years building a private version for women’s health. With 850 terabytes of data—a mix of proprietary genetics studies of 7,000 women, fertility treatment outcomes for 500,000 patients, and data from public studies, including ones like Lazorwitz’s—Beim hopes to eliminate the guesswork. “We’ve got the playbook from oncology; we know how to decode these different genetic responses and then build DNA tests to help people make informed decisions,” says Beim. “But it’s still really, really early days.”

The company is mining its database to investigate a range of women’s health questions. Last August, Celmatix teamed up with Ferring Pharmaceuticals, a Swiss maker of fertility drugs used during in vitro fertilization, to investigate how a woman’s DNA dictates how her body responds to such treatment. The hope is to identify genetic risks for some adverse IVF outcomes, such as ovarian hyperstimulation syndrome, which, though rare, can be fatal. Celmatix also hopes to discover new drug targets for diseases like endometriosis and polycystic ovarian syndrome and, potentially, to identify next-generation contraceptives. That last project is just getting underway, with funding from the Bill & Melinda Gates Foundation; the long-term goal is to create completely new kinds of birth control that aren’t just reformulations of the same old hormones.

“Hormones are a very powerful tool, but they’re the biggest hammer you could possibly use,” says Beim. New molecules might only target ovary cells, for example, instead of every cell in a woman’s body. And one day, that could mean women will have real choices when it comes to birth control, not just the illusion of choice. Let’s just hope it doesn’t take another 60 years to get there.

More Great WIRED Stories

  • Turn on auto-updates everywhere you can
  • Even if you forgot about Foursquare, it didn’t forget you
  • My Jibo is dying and it’s breaking my heart
  • Meet this super-smart film critic—and YouTube star
  • Save the lemurs! Eat the crickets!
  • 👀 Looking for the latest gadgets? Check out our latest buying guides and best deals all year round
  • 📩 Get even more of our inside scoops with our weekly Backchannel newsletter

Can a person get pregnant while taking the pill?

Although the birth control pill is generally very effective, some situations can reduce its effectiveness and may sometimes result in unintended pregnancies. These include:

Missing a day

Manufacturers intend for people to take the pill daily for it to be most effective. If a person misses a day, their hormone levels may not remain at consistent enough levels to prevent pregnancy.

If a person finds it difficult to take the pill on a daily basis, other birth control methods may better suit their needs. A doctor or gynecologist can advise on the range of alternative contraceptives.

Vomiting

Sometimes a person may be ill when they take the pill. When a person vomits, the pill can come back up, or they may not fully absorb it into their body.

Anyone who experiences vomiting shortly after taking the pill should take another pill as soon as possible and then take their next pill as usual.

Not taking the pills at the same time each day.

In addition to taking birth control pills daily, a person should also take the pills at around the same time each day. This can maintain their hormone levels more consistently.

A person should always take the minipill within the same 3-hour time window every day. Someone who misses their window should use a backup birth control method for the next 2 days or avoid having sex.

Many people set a daily alarm reminding them to take their pill at the correct time each day.

Not starting a new pack right away

Share on PinterestSome medications and supplements can interact with the pill and decrease its effectiveness.

It is essential to start a new pack of pills the day after finishing the previous one. However, sometimes a person may not have their new package yet. Missing a few days between packs can make the pill less effective at preventing pregnancy.

According to the CDC, anyone who misses two or more pills in a row should use a backup contraceptive method or avoid sexual intercourse until they have taken the birth control pill for 7 consecutive days.

Medications that interfere with the pill

Some medications can make the pill less effective. Medications include certain antibiotics, such as rifampicin, and anti-fungal drugs, such as griseofulvin.

A person should use backup contraception while taking these medications and for 48 hours after finishing the course.

Other more long-term medications and supplements may also affect how well birth control pills work. These can include:

  • epilepsy drugs, such as phenobarbital, phenytoin, and carbamazepine
  • anti-viral medications used to treat HIV
  • St. John’s Wort, which is a herbal remedy

Contraception

Reversible Methods of Birth Control

Intrauterine Contraception

  • Copper T intrauterine device (IUD) —This IUD is a small device that is shaped in the form of a “T.” Your doctor places it inside the uterus to prevent pregnancy. It can stay in your uterus for up to 10 years. Typical use failure rate: 0.8%.1
  • Levonorgestrel intrauterine system (LNG IUD)—The LNG IUD is a small T-shaped device like the Copper T IUD. It is placed inside the uterus by a doctor. It releases a small amount of progestin each day to keep you from getting pregnant. The LNG IUD stays in your uterus for up to 3 to 6 years, depending on the device. Typical use failure rate: 0.1-0.4%.1

Hormonal Methods

  • Implant—The implant is a single, thin rod that is inserted under the skin of a women’s upper arm. The rod contains a progestin that is released into the body over 3 years. Typical use failure rate: 0.01%.1
  • Injection or “shot”—Women get shots of the hormone progestin in the buttocks or arm every three months from their doctor. Typical use failure rate: 4%.1
  • Combined oral contraceptives—Also called “the pill,” combined oral contraceptives contain the hormones estrogen and progestin. It is prescribed by a doctor. A pill is taken at the same time each day. If you are older than 35 years and smoke, have a history of blood clots or breast cancer, your doctor may advise you not to take the pill. Typical use failure rate: 7%.1

  • Progestin only pill—Unlike the combined pill, the progestin-only pill (sometimes called the mini-pill) only has one hormone, progestin, instead of both estrogen and progestin. It is prescribed by a doctor. It is taken at the same time each day. It may be a good option for women who can’t take estrogen. Typical use failure rate: 7%.1
  • Patch—This skin patch is worn on the lower abdomen, buttocks, or upper body (but not on the breasts). This method is prescribed by a doctor. It releases hormones progestin and estrogen into the bloodstream. You put on a new patch once a week for three weeks. During the fourth week, you do not wear a patch, so you can have a menstrual period. Typical use failure rate: 7%.1

  • Hormonal vaginal contraceptive ring—The ring releases the hormones progestin and estrogen. You place the ring inside your vagina. You wear the ring for three weeks, take it out for the week you have your period, and then put in a new ring. Typical use failure rate: 7%.1

Barrier Methods

  • Diaphragm or cervical cap—Each of these barrier methods are placed inside the vagina to cover the cervix to block sperm. The diaphragm is shaped like a shallow cup. The cervical cap is a thimble-shaped cup. Before sexual intercourse, you insert them with spermicide to block or kill sperm. Visit your doctor for a proper fitting because diaphragms and cervical caps come in different sizes. Typical use failure rate for the diaphragm: 17%.1
  • Sponge—The contraceptive sponge contains spermicide and is placed in the vagina where it fits over the cervix. The sponge works for up to 24 hours, and must be left in the vagina for at least 6 hours after the last act of intercourse, at which time it is removed and discarded. Typical use failure rate: 14% for women who have never had a baby and 27% for women who have had a baby.1
  • Male condom—Worn by the man, a male condom keeps sperm from getting into a woman’s body. Latex condoms, the most common type, help prevent pregnancy, and HIV and other STDs, as do the newer synthetic condoms. “Natural” or “lambskin” condoms also help prevent pregnancy, but may not provide protection against STDs, including HIV. Typical use failure rate: 13%.1 Condoms can only be used once. You can buy condoms, KY jelly, or water-based lubricants at a drug store. Do not use oil-based lubricants such as massage oils, baby oil, lotions, or petroleum jelly with latex condoms. They will weaken the condom, causing it to tear or break.

  • Female condom—Worn by the woman, the female condom helps keeps sperm from getting into her body. It is packaged with a lubricant and is available at drug stores. It can be inserted up to eight hours before sexual intercourse. Typical use failure rate: 21%,1 and also may help prevent STDs.
  • Spermicides—These products work by killing sperm and come in several forms—foam, gel, cream, film, suppository, or tablet. They are placed in the vagina no more than one hour before intercourse. You leave them in place at least six to eight hours after intercourse. You can use a spermicide in addition to a male condom, diaphragm, or cervical cap. They can be purchased at drug stores. Typical use failure rate: 21%.1

Fertility Awareness-Based Methods

  • Fertility awareness-based methods—Understanding your monthly fertility patternexternal icon can help you plan to get pregnant or avoid getting pregnant. Your fertility pattern is the number of days in the month when you are fertile (able to get pregnant), days when you are infertile, and days when fertility is unlikely, but possible. If you have a regular menstrual cycle, you have about nine or more fertile days each month. If you do not want to get pregnant, you do not have sex on the days you are fertile, or you use a barrier method of birth control on those days. Failure rates vary across these methods.1-2 Range of typical use failure rates: 2-23%.1

Lactational Amenorrhea Method

For women who have recently had a baby and are breastfeeding, the Lactational Amenorrhea Method (LAM) can be used as birth control when three conditions are met: 1) amenorrhea (not having any menstrual periods after delivering a baby), 2) fully or nearly fully breastfeeding, and 3) less than 6 months after delivering a baby. LAM is a temporary method of birth control, and another birth control method must be used when any of the three conditions are not met.

Emergency Contraception

Emergency contraception is NOT a regular method of birth control. Emergency contraception can be used after no birth control was used during sex, or if the birth control method failed, such as if a condom broke.

  • Copper IUD—Women can have the copper T IUD inserted within five days of unprotected sex.
  • Emergency contraceptive pills—Women can take emergency contraceptive pills up to 5 days after unprotected sex, but the sooner the pills are taken, the better they will work. There are three different types of emergency contraceptive pills available in the United States. Some emergency contraceptive pills are available over the counter.

Permanent Methods of Birth Control

  • Female Sterilization—Tubal ligation or “tying tubes”— A woman can have 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. You can go home the same day of the surgery and resume your normal activities within a few days. This method is effective immediately. Typical use failure rate: 0.5%.1
  • Male Sterilization–Vasectomy—This operation is done to keep a man’s sperm from going to his penis, so his ejaculate never has any sperm in it that can fertilize an egg. The procedure is typically done at an outpatient surgical center. The man can go home the same day. Recovery time is less than one week. After the operation, a man visits his doctor for tests to count his sperm and to make sure the sperm count has dropped to zero; this takes about 12 weeks. Another form of birth control should be used until the man’s sperm count has dropped to zero. Typical use failure rate: 0.15%.1
  1. Trussell J, Aiken ARA, Micks E, Guthrie KA. Efficacy, safety, and personal considerations. In: Hatcher RA, Nelson AL, Trussell J, Cwiak C, Cason P, Policar MS, Edelman A, Aiken ARA, Marrazzo J, Kowal D, eds. Contraceptive technology. 21st ed. New York, NY: Ayer Company Publishers, Inc., 2018.
  2. Peragallo Urrutia R, Polis CB, Jensen ET, Greene ME, Kennedy E, Stanford JB. Effectiveness of fertility awareness-based methods for pregnancy prevention: A systematic reviewexternal icon. Obstet Gynecol 2018;132:591-604.

5 Ways Birth Control Can Fail

Maybe you’ve been on the Pill since you were 16. Or perhaps you’re someone who always keeps a condom in your purse-just in case. Whatever your contraceptive of choice, you’re confident that using it means you won’t be sporting a baby bump in the near future. And, to a certain extent, you should be able to breathe easy: Modern birth control is extremely effective. But nothing works 100 percent of the time, and slipups occur more often than you might think. According to the Guttmacher Institute, a whopping 49 percent of all pregnancies in the United States are unintentional-and not everyone who finds herself unexpectedly knocked up was snoozing through sex-ed class. In fact, half of all women who accidentally get pregnant were using some type of birth control.

So what’s going wrong? A lot of it comes down to user error, such as neglecting to take an oral contraceptive every day. “Life is busy and complicated for most people, and sometimes having to think about one more thing is too much,” says Katharine O’Connell White, M.D., division chief of general obstetrics and gynecology at Baystate Medical Center in Springfield, MA.

Of course, taking care of an un-anticipated addition to your family is no easy feat either. Here’s what went wrong for five readers, plus strategies for getting it right.

Pill Problems

Image zoom Sarah Kehoe

Sarah Kehoe

Jennifer Mathewson was a police officer in the Air Force when she developed a urinary tract infection. Her doctor put her on an antibiotic but never mentioned it could interfere with the oral contraceptive she was taking. One day, as she was standing at attention and listening to the sergeant give the day’s orders, she fainted. Although light-headedness is a common pregnancy symptom, she had no idea she was expecting until she got to the hospital and underwent blood tests. “I was single and only 19, so I was pretty scared,” says Mathewson, who is now 32 and works as a journalist in Idaho. “But I wanted to have the baby, and I’m grateful I did.”

What Are the Odds?

When used perfectly, the combined pill (which has estrogen and progesterone) and the progestin-only minipill are 99.7 percent effective. But that number drops to 91 percent with so-called “typical use”-meaning the way that most women take them. “In some cases, the failure rate can be as high as 20 percent because they forget to take it regularly or they run out of pills and don’t get a refill right away,” notes Andrew M. Kaunitz, M.D., associate chairman of obstetrics and gynecology at the University of Florida College of Medicine-Jacksonville.

Protect Yourself

1. Time it right. Popping the Pill at the same time every day is smart, and it’s critical if you’re taking the progestin-only mini version (the hormones in it are only active for 24 hours). If you’re prone to forgetfulness, program your phone to beep you, try an app like the Drugs.com Pill Reminder ($1; itunes.com), or get in the habit of taking it with breakfast. Still struggling to stay on schedule? Consider switching to an equally effective patch or ring, which you only have to replace weekly or monthly.

2. Mind your meds. Whenever you fill a prescription for a new drug, read the insert or ask your doc or pharmacist if it could compromise the Pill’s effectiveness. Because oral contraceptives are metabolized through the liver, other medications that are processed this same way-including some antibiotics, anti-fungals, and anti-seizure drugs-may interfere with them, explains Sarah Prager, M.D., an associate professor of obstetrics and gynecology at the University of Washington School of Medicine. When in doubt, use condoms. Extra protection is also in order if you have a stomach bug and vomit within two or three hours of taking your pill (believe it or not, that’s considered a missed dose).

Condom Complications

Image zoom

Sarah Kehoe

Last summer, Lia Lam was having sex with a new boyfriend when she had a feeling the condom they were using had broken. “But I thought I was just being paranoid and didn’t say anything,” says Lam, 31, an actress in Vancouver, Canada. After they finished, he pulled out and her hunch was confirmed: The bottom half of the condom was still inside her. In hindsight, Lam thinks the incident occurred because she was a little too dry during the act. “We didn’t panic, but we had only been dating a month and a half and were hardly ready to be parents,” she says. So they headed to the drugstore to buy emergency contraception (the “morning-after” pill), which prevents pregnancy by postponing ovulation or stopping a fertilized egg from implanting in the uterus.

What Are the Odds?

When used exactly as intended, male latex condoms (the most common kind) are 98 percent effective; with typical use, that number drops to 82 percent. (Other types, such as those made from lambskin and polyurethane, may be somewhat less effective, but they’re good options if you or your guy is allergic to latex.) The biggest reasons condoms fail: People use them inconsistently or put them on too late, or they break during sex.

Protect Yourself

1. Watch his technique. Your guy should put on a condom before his genitals get anywhere near your vaginal region. He should pinch the condom, roll it down slowly so all the air is out and there’s space to collect semen, and remove it right after ejaculation (while he’s still hard). Holding it at the base of the penis as it’s withdrawn will help prevent spillage.

2. Lube up. As Lam learned, excess friction can cause a condom to tear. Opt for a water- or silicone-based lubricant. A definite no-no: using oil- or petroleum- based products, which can compromise the integrity of latex.

3. Check expiration dates. Condoms do have a shelf life, which shouldn’t be ignored. And if a rubber seems dry or stiff when it’s taken out of the package, toss it.

4. Have a backup plan. If a condom fails, follow Lam’s lead and purchase emergency contraception. There are three brands: ella, Next Choice One Dose, and Plan B. Anyone 15 or older can buy these without a prescription, though you’ll have to ask the pharmacist because they’re kept behind the counter. You have up to five days to take ella; the others must be used within 72 hours.

Tubal Ligation Trouble

Image zoom

Sarah Kehoe

After Crystal Consylman gave birth to her third child at age 21, she decided to have a tubal ligation (aka getting her tubes tied), a surgical procedure in which the fallopian tubes are cut or blocked to permanently prevent pregnancy. Seven years later, in 2006, she was shocked to learn she was pregnant. It was an ectopic pregnancy, meaning the embryo had implanted outside the uterus and was not viable. “I had massive internal bleeding and almost died,” recalls Consylman, now 35, who works at a law firm in Lancaster, PA. When she was rushed in for emergency surgery, she assumed the surgeon fixed the botched tubal ligation-but that wasn’t so. After having a second ectopic pregnancy 18 months later, her fallopian tubes were removed entirely.

What Are the Odds?

Female sterilization is 99.5 percent effective, but the ends of the tubes do occasionally find their way back together. In the rare instance you get pregnant afterward, there’s a 33 percent chance of it being ectopic because a fertilized egg can become caught in the damaged area.

Protect Yourself

1. Choose your surgeon carefully. Look for a board-certified gynecologist who’s performed the procedure at least several dozen times.

2. Follow post-op procedures. Having your tubes tied should render you instantly sterile, but your physician may want you to come in for a follow-up a few weeks later to see if you’re healing properly. And if you choose a tubal ligation alternative-such as Essure, a newer option in which tiny coils are placed in the fallopian tubes to block them-you’ll need a special X-ray three months later to confirm the tubes are fully closed. Meanwhile, you’ll want to use backup contraception.

Sterilization Snafus

Image zoom

Sarah Kehoe

After having two children, Lisa Cooper and her husband decided their family was complete, so he had a vasectomy. But five years later, the Shreveport, LA–based businesswoman began gaining weight for no apparent reason and spotting without a full-blown period. Because she was 37, she chalked it up to perimenopause. “By the time I took a pregnancy test and went to the doctor, I was 19 weeks along,” says Cooper, now 44. It turns out her husband had skipped the follow-up testing, which is the only way to confirm that the surgery was successful. After welcoming their third and fourth children, Cooper’s husband went for a second vasectomy-and this time he saw his doctor afterward as recommended.

What Are The Odds?

A vasectomy is 99.9 percent effective, making it the most reliable birth control method available. But even here, human error can occur. During the procedure, the vas deferens, the tube that carries sperm to the ejaculatory duct, is clipped or banded, explains Philip Darney, M.D., a professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco. But if the snip is made in the wrong place, it won’t work. Another potential glitch: “The severed ends can grow back together if they aren’t spread far enough apart.”

Protect Yourself

1. Select a solid surgeon. As with a tubal ligation, pick a provider who is board-certified and has plenty of these procedures under her belt. Your primary care physician can probably offer up several recommendations. And it’s always prudent to check up on the doctor’s rep; your state’s licensing board can provide info about any malpractice suits.

2. Wait for the all-clear sign. Cooper’s story illustrates the importance of your partner getting a semen analysis about three months after the procedure; it’s essential to ensure he’s sterile. Until then, use another contraceptive method.

IUD Issues

Image zoom

Getty Images

In 2005, Kristen Brown decided to get an IUD (intrauterine device) because she’d heard it was virtually foolproof. She and her husband already had three kids and weren’t ready for more. Two years later, Brown began experiencing severe pelvic pain and heavy bleeding. Concerned she might have fibroids or endometriosis, she went to see her ob-gyn, who informed her that she was pregnant. Because of the bleeding, she was put on bed rest, but a month later she miscarried. “The experience was very emotionally and physically painful, and I lost a lot more blood-so much that I almost needed a transfusion,” recalls Brown, now 42 and a writer in Jacksonville, FL. The doctors never figured out exactly what went wrong with the IUD, but it probably moved from its original position. Says Brown, “The ordeal shattered my illusion of the safety and effectiveness of birth control.”

What Are The Odds?

The IUD, a tiny “T”-shaped device inserted into the uterus to prevent sperm from fertilizing an egg, is more than 99 percent effective with both perfect and typical use. Though extremely rare, the most common reason IUDs fail is because they shift into the cervix. An IUD can also be expelled from the uterus, perhaps without you realizing it. (For example, you could flush it down the toilet.) Having polyps, fibroids, or strong uterine contractions (which cause bad menstrual cramps) can increase the risk of it slipping out.

Protect Yourself

1. Do a status check. Manufacturers suggest that once a month you make sure the 1- to 2-inch plastic string attached to the device is hanging down through the cervix into the vagina as it should be. If it’s missing or it seems longer than usual, see your doctor (and use backup birth control in the meantime). But never pull on the thread. “Women have accidentally removed their IUDs this way,” warns Prager.

2. Start strong. If you opt for the ParaGard (copper IUD), it should work as soon as you get it. Skyla and Mirena, which contain a small amount of progestin, are also instantly effective if they’re inserted within seven days after the start of your period; otherwise, use a backup method for one week. Skyla is good for up to three years, Mirena lasts up to five, and ParaGard can stay in for up to 10. “We call IUDs forgettable contraception,” says Kaunitz, “because you don’t need to remember anything to stay protected.”

  • By Stacey Colino

Answers to Frequently Asked Questions About…

When can I take a pregnancy test and be sure that it is accurate?

If it has been at least 10 days since you had unprotected sex and you have not gotten your period when you think you should have, you can take a home pregnancy test to find out if you are pregnant. Before that, a negative test result won’t be accurate, and you definitely can’t tell if you’re going to get pregnant in the first few days after sex – the time when you would be taking emergency contraceptive pills (sometimes called “morning after pills” or “day after pills”). If the test is negative but you are still worried, you can take a second home pregnancy test in another week. If the result is positive, you should contact your health care provider to discuss your options, including prenatal care or abortion.

If you think you might already be pregnant because your period is late, you can take a home pregnancy test before using emergency contraception – although it’s not necessary from a medical standpoint. Emergency contraceptive pills won’t work if you are already pregnant, and they will not harm you or your fetus (although evidence for ella is still limited).

Remember, emergency contraception significantly reduces the chances that you will become pregnant if you had sex and your birth control failed, you didn’t use contraception, or you were forced to have sex. If you have had sex and think that you might be at risk of pregnancy, take action right away to find out what your options are for emergency contraception. Clinical studies show that ella is effective for 5 days after unprotected sex, and that progestin-only pills (like Plan B One-Step or Next Choice One Dose) work up to 4 days after. However, what’s important for each individual woman is where is you are in your menstrual cycle (how close you are to ovulation). If you are close to ovulation, EC may not be able to prevent pregnancy if you wait 5 days. Therefore, the best thing to do is take EC as soon as you can get it. A thorough and up-to-date academic review of the medical and social science literature on emergency contraception is available here .

———-

If your birth control fails, blame your genes

“My aunt Sue fell pregnant with all three of her babies while on the pill.”

Everyone’s heard one of those stories. And while you may assume that perhaps the now-mum-of-three is somehow at fault, or perhaps something else hindered the absorption of hormones, there may be a scientific explanation for it (which is outside her realms of control).

Have you fallen pregnant while on contraception? Image: iStock.

“Genes attacking hormones”

Research has revealed that some women carry a gene variant that breaks down hormones used in contraception.

The study, which was published in the journal Obstetrics & Gynecology looked at 350 healthy women who had etonogestrel (rod) implants for 12–36 months.

The women underwent DNA testing to identify gene variants relating to those which affect hormonal contraception.

Some examples of hormonal contraceptives are: the contraceptive pill, implant, ring, an intra-uterine system (IUS) and hormone injections.

The results showed that one in 20 women carry the specific gene which essentially attacks the hormone before the boy is able to absorb it.

One in 20 women carry this gene variant. Image: iStock.

“We should listen to our patients”

The study’s lead author, Dr Lazorwitz, pointed out how there has been an assumption in the past that if a woman fell pregnant while on birth control, it must have somehow been her fault.

“When a woman says she got pregnant while on birth control, the assumption was always that it was somehow her fault,” the study’s lead author, Dr Lazorwitz told The Independent.

“These findings show that we should listen to our patients and consider if there is something in their genes that caused this.”

This research shows that not only is it not always a woman’s fault when she falls pregnant while on hormonal contraception, but some women simply cannot rely on it as a form of contraception.

Dr Lazorwitz said there is still more research needed on the topic, but for now, let’s hope it takes some of the unnecessary blame away from women already in a tricky enough situation.

When birth control fails

Leave a Reply

Your email address will not be published. Required fields are marked *