Contraception Alternatives

As many women of child bearing age know choosing a birth control method can be a difficult decision.  There are a variety of options to select from and it is often difficult to know what is best for you.  The decision is often made more difficult when you and your partner have decided that your family is complete of that you children.

According to the CDC, “among reversible methods of birth control, intrauterine contraception and the contraceptive implant remain highly effective for years once correctly in place. The effectiveness of the contraceptive shot, pills, patch and ring, and barrier and fertility awareness-based methods, depends on correct and consistent use—so these methods have lower effectiveness with typical use.” (www.CDC.gov)

Below is a chart that offers comparison of various birth control options.  While most of the contraceptive methods are not “permanent” it is helpful to review the advantages and disadvantages of contraceptive methods.

Procedure/Method Theoretical* Failure Rate
Actual**
Failure Rate
Advantages Disadvantages
Vasectomy .02-0.1% .02-0.2% Effective male procedure; in-office minimal to no pain, minimal downtime, successful, permanent method of contraception. Should be considered permanent; very small risk of infection and complications.
Tubal Ligation & Essure procedure  0.2% 0.2-0.4% Effective female procedure; outpatient surgical facility, downtime, infection, risk permanent method of birth control. More expensive and complicated than vasectomy with higher surgical risk, infection rate and complications.
Birth Control Pill (combination) 0.1% .16-3% High success rate in compliant patient; effective method of reversible contraception. Side effects can be significant based on women’s health history and age.
Condom 1-3% 1-33% No side effects; adds protection from sexually transmitted diseases. Reduced sensation; risk of pregnancy if not used correctly; application cumbersome, high failure rate as compared to other methods.
Diaphragm 1-6% 1-21% No loss of sensation; no medication required, effective method of reversible contraception. Prescription required; application cumbersome, high failure rate as compared to other methods.
Spermicidal jelly, foam, cream or suppositories 3% 13-28% No serious side effects or loss of sensation; prescription not required, effective method of reversible contraception. Cumbersome; lower effectiveness, high failure rate when used alone (not in combination of condom).
Hormonal Implants .2% .2% High effectiveness; one implant lasts up to 5 years. Requires surgical insertion and removal; irregular vaginal bleeding.
Intrauterine device (IUD) 0.6-1.5% 0.5-3% One-time application; high success rate; no loss of sensation. Prescription required; some side effects.
Natural family planning (“rhythm method”) 1-3% 14-47% Nothing to buy or apply. Requires abstention for 5-15 days per month; very high risk of pregnancy.
Withdrawal 4% 19% Nothing to buy or apply. Reduced satisfaction; very high risk of pregnancy.
No Method 85% 85% Nothing to buy or apply. Play now, pay later.



*Theoretical Rate signifies rate when method is used correctly over a one year period.

**Actual Rate signifies rate when method is used routinely over a one year period.

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Adapted from:
1. Trussell J, Hatcher RA, Cates W, Stewart FH, Kost K. A Guide to Interpreting Contraceptive Efficacy Studies. Obstetrics and Gynecology 1990; 76:558-67.

2. Mishell DR, Jr. Contraception. New England Journal of Medicine 1989; 320: 777-787.

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