What's the most effective birth control method?

A practical guide to how well different contraceptive choices work

Why would I want birth control?

When young women start becoming sexually active they may not want to have children right away. There are many reasons why a woman may wish to postpone motherhood until a later stage of her life. That’s always an individual choice. Of course, pregnancies are best avoided with sexual abstinence, but if you aren’t ready to live without sex, you’ll need to use some form of birth control. Otherwise, you’ll always be at risk of accidentally getting pregnant.

Some people think they can time the cycle right (fertility awareness) — for example by having sex right at the end or shortly after the period is over—or that the partner ejaculates outside the vagina (withdrawal). While these methods technically qualify as behavioral birth control, they aren’t very reliable. They may work well a few times but if they don’t you’ll end up pregnant, and just one failure is enough. For example, studies estimate that practicing withdrawal still makes it ~20% likely that you’ll get pregnant within a year. For fertility awareness, the chances of accidental pregnancy are 24%. 

Therefore, to be on the safe side, some 60% of females of reproductive age in the U.S. regularly use some form of birth control devices and medications, ranging from condoms to the pill. 

What’s the most effective contraceptive option?

There’s no one universally accepted “best” birth control choice. Different women will make different choices, influenced by a lot of factors, including availability, costs, comfort, effects on period or hormonal balance, and other health side effects. Some women also want to combine birth control with protection against sexually transmitted infections (STIs). For STI prevention male condoms offer by far the best protection short off abstinence.

The question that concerns us here and that arguably also is the most important question for most women is how effective each birth control option is for preventing an unwanted pregnancy. By the time a new contraceptive device or medication is entering the market, it already has passed various safety and effectiveness related trials and tests by the manufacturer and regulators such as the U.S. FDA. When we speak about how effective a certain contraceptive method is, there are two types of effectiveness:  the effectiveness observed in those tests under ideal conditions, and the typical effectiveness seen in everyday use by normal people. The premise here is that the average person won’t always use birth control as correctly or consistently as it was the case in ideal test settings.

So, below we’ll tell you both the ideal and typical effectiveness rates for each birth control method when practiced for one year with normal sexual activity. These rates compare against the fact that without proper birth control 85% of reproductive-aged women will get pregnant within a year. 

We’ll start our review with the most common birth control methods:

Male Condoms

  • Pregnancy risk with ideal use = 2%
  • Pregnancy risk with typical use = 18%

Female Condoms

  • Pregnancy risk with ideal use = 5%
  • Pregnancy risk with typical use = 21%

Combined Pill (continuous use)

  • Pregnancy risk with ideal use = <1%
  • Pregnancy risk with typical use = 9%

Birth Control Mini-Pill (continuous use)

  • Pregnancy risk with ideal use = <1%
  • Pregnancy risk with typical use = 9%

Vaginal Ring (NuvaRing)

  • Pregnancy risk with ideal use = <1%
  • Pregnancy risk with typical use = 9%

Birth Control Patch

  • Pregnancy risk with ideal use = <1%
  • Pregnancy risk with typical use = 9%

Morning-After Pill

  • Pregnancy risk with ideal use =  <5%
  • Pregnancy risk with typical use = 13%

Hormonal Birth Control Shot

  • Pregnancy risk with ideal use = <1%
  • Pregnancy risk with typical use = 6%

Implantable Rod

  • Pregnancy risk with ideal use = <1%
  • Pregnancy risk with typical use = <1%

Progestin IUD

  • Pregnancy risk with ideal use = <1%
  • Pregnancy risk with typical use = <1%

Copper IUD

  • Pregnancy risk with ideal use = <1%
  • Pregnancy risk with typical use = <1%

Diaphragm (with Spermicide)

  • Pregnancy risk with ideal use = 6%
  • Pregnancy risk with typical use = 12%

Sponge with Spermicide

  • Pregnancy risk with ideal use =  11%
  • Pregnancy risk with typical use = 22%

Tubal Ligation (nonreversible female sterilization)

  • Pregnancy risk with ideal use = <1%
  • Pregnancy risk with typical use = <1%

Vasectomy (nonreversible male sterilization)

  • Pregnancy risk with ideal use = <1%
  • Pregnancy risk with typical use = <1%

As you’ve probably already realized by now, the most effective birth control method, short of abstinence and sterilization, is hormonal birth control, regardless of whether you use it as oral pills, skin patches, vaginal rings, or IDUs. If you pay careful attention to the instructions from your doctor and the manufacturer and use the birth control as prescribed, you can move closer to the ideal effectiveness rate, which is <1% with most hormonal birth control options.

For more information on each above-discussed contraceptive choice, talk you your regular doctor or gynecologist. She’ll help you find a suitable method and issue a prescription if needed.   

References:

Trussell, James. “Contraceptive Failure in the United States.” Contraception, vol. 83, no. 5, May 2011, pp. 397–404, 10.1016/j.contraception.2011.01.021. Accessed 16 Apr. 2020.

Kakaiya, Roshni, et al. “Women’s Perceptions of Contraceptive Efficacy and Safety.” Contraception and Reproductive Medicine, vol. 2, no. 1, 20 June 2017, contraceptionmedicine.biomedcentral.com/articles/10.1186/s40834-017-0046-5, 10.1186/s40834-017-0046-5. Accessed 16 Apr. 2020.

Zieman, Miriam, et al. “Contraceptive Efficacy and Cycle Control with the Ortho EvraTM/EvraTM Transdermal System: The Analysis of Pooled Data.” Fertility and Sterility, vol. 77, 1 Feb. 2002, pp. 13–18, www.fertstert.org/article/S0015-0282(01)03275-7/fulltext, 10.1016/S0015-0282(01)03275-7. Accessed 16 Apr. 2020.

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