Female Contraception
Choosing the appropriate contraceptive varies from individual to individual. Contraceptive options for American women include:
- Hormonal Contraceptives (oral contraceptives, implants, and injections).
- The Intrauterine Device (IUD).
- Barrier Devices with or without Spermicides (diaphragm, cervical cap, female condom).
- Natural Family Planning Methods.
- Female Sterilization (tubal ligation).
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| Artificial contraception methods work in different ways to decrease the likelihood that sexual intercourse will result in pregnancy. Barrier methods such as condoms (male or female), diaphragms (with or without spermicide) and sponges (with spermicide) have as their first line of defense the physical blocking of the sperm's entry into the uterus. If sperm cannot get into the uterus it cannot fertilize an egg, and pregnancy cannot occur. An IUD works in a different way, by making the uterus toxic to sperm and by disturbing the lining of the uterus so that it won't allow egg implantation. The hormones in oral contraceptives and hormone implants fool the ovaries into refraining from ovulation, and without a fertile egg, pregnancy will not occur. IUDs and oral contraceptives and hormones may be used as emergency contraception in the case of unprotected sex, but neither one will protect against sexually-transmitted disease. |
A 1995 survey of several thousand US women found that the most popular contraceptives (female or male) were female surgical sterilization (28% usage) and oral contraceptives (27%). None of the other female contraceptives had secured the allegiance of more than 3% of users. These included the long-acting and reversible IUDs, implants, or injectable contraceptives. Worldwide, however, the IUD is the most popular reversible contraceptive. None of the other female contraceptives had secured the allegiance of more than 3% of users. These included the long-acting and reversible IUDs, implants, or injectable contraceptives. Worldwide, however, the IUD is the most popular reversible contraceptive. When American women were asked why they did not use long-acting contraceptives, they responded with three main reasons:
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Click the icon to see an image of tubal ligation. |
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Click the icon to see an image of an IUD. |
- Lack of knowledge about them.
- Fear of side effects or health hazards.
- Satisfaction with current methods.
Experts believe that with proper education women would be more open to other contraceptive options. In fact, the new levonorgestrel intrauterine system (LNG-IUS) IUD has been described by one expert as a nearly ideal contraceptive.
[For more information see the Well-Connected Report #91, Female Contraception.]
Common Female Contraceptives
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Contraceptive
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First Year Failure Rate (With Typical Use)
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First Year Failure Rate (With Perfect Use)
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Protection Against Sexually Transmitted Diseases
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Approximate Cost
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Female Surgical Sterilization
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One study reported failure rate of 0.7 to 5.4% over 10 years.
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Failure less than 1%.
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None.
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$1,000 to $2,500. May be covered by insurance.
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Oral Contraceptives-combined
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5%.
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0.1%.
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None.
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$20 to $35 per month at pharmacy. Less at family planning clinic. May be covered by insurance.
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Oral Contraceptives-progestin-only pill
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5%.
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0.5%.
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None.
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IUD-Copper-Releasing
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One study reported 5% failure rates over 10 years with IUDs in general.
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Less than 1%.
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None.
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$300 to $700 or more for insertion and tests. Lasts 10 years. Covered by Medicaid. May be less at family planning clinics.
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IUD-Progestin-Releasing
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See above.
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Less than 1%.
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None.
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$300 to $700 or more for insertion and tests. Mirena IUD lasts five years. Covered by Medicaid. May be less at family planning clinics.
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Levonorgestrel implants (Norplant)
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Comparable to tubal ligation (see above).
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Failure less than 1%.
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None.
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$500 to $600 for implant procedure and tests; $100 to $200 for removal. May be covered by some insurers. Insertion, but not removal, is covered by Medicaid.
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Injected Progestins (Depo-Provera, Noristerat)
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0.3%.
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0.3%.
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None.
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Costs vary. $120 for first injection and $60 for each following injection at some women's health centers and family planning clinics. May be partly covered by insurance or Medicaid.
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Injected progestin and estrogen (Lunelle)
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Less than 1%.
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Less than 1%.
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None.
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Costs about $30 a month.
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Diaphragm
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20% (with spermicide).
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6% (with spermicide).
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Some protection for certain STDs (gonorrhea and Chlamydia); results uncertain for HIV or cervical cancer. May increase risk for urinary tract infections.
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$13 to $25 for the diaphragm; $50 to $120 for fitting. Needs biannual replacement. $8 to $17 for spermicidal kit.
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Cervical cap
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20% (with spermicide; no previous births); 40% (with spermicide; previous births).
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9% (with spermicide; no previous births); 26% (with spermicide; previous births).
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Some protection.
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Similar to costs for diaphragm.
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Female Condom
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12.4% to 22%.
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5%.
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Possibly protective against HIV and STDs. More research is needed.
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$2.50 per use.
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Natural Family Planning
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Up to 25%.
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6% to 15% (Rates are better with newer approaches, such as the Creighton method.)
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None.
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Virtually no cost, except for basal thermometer and possibly training (although usually conducted free through a church).
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Note: The average rate of pregnancy for couples that rely only on male condoms for protection is about 12%. Even for those who use a good-quality condom correctly, the annual risk for pregnancy is 3%.
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