What Kind of Birth Control is Best?

The birth control pill became available in the early 1960's and since that time "the pill" has had a profound impact on our culture. Today, many sexually active people question whether the pill is the best method of contraception. Differences between the success and failure of birth control methods typically depend on the amount of usage error. Therefore, when choosing a birth control method, young men and women must weigh the risks of user error with their individual lifestyles. Failure is minimized with surgical procedures such as a vasectomy (less than 0.2% failure rate!), however, because the procedure may be reversible, many younger people do not elect to use this type of birth control.

After vasectomy, hormonal treatments, such as the pill, the ring, the patch, and intrauterine devices (IUDs) are the most effective techniques not requiring surgery. The pill (3% failure rate), typically consisting of the two female hormones, progesterone and estrogen, "tricks" the woman's brain into believing it is already pregnant. To keep circulating levels of estrogen and progesterone continually high enough to inhibit ovulation, the woman must remember to faithfully take a birth control pill every day at the same time of day. The vaginal ring (1% failure rate) is a doughnut-shaped device that is placed in the vagina where it slowly releases progestin, estrogen, or both, functioning much like the pill; it is kept in place for three weeks and then removed on the forth to permit menstruation. The contraceptive patch (1% failure rate) is a thin strip of plastic material that sticks to the skin, releasing hormones like the pill and the ring; it is replaced weekly. The IUD (6% failure rate) is also highly effective, can produce unwanted side effects like irregular bleeding and pelvic pain.

A variety of barrier techniques are used by women, including the diaphragm and the contraceptive sponge. These devices block the cervical opening, and when used with a spermicide, produce acceptable failure rates (16%). The main disadvantage of these methods is the repeated insertion and removal of the devices, which some women find problematic (must be inserted immediately before sex; removal sometimes messy).

Can the condom be considered "tried and true"? Although it has gained considerable favor due to its ability to protect the user from sexually transmitted diseases, its failure rate is similar to that of the diaphragm & sponge (15%).

Behavioral techniques such as "withdrawal" and "the rhythm method" are still used due to that good old-fashioned natural feeling, but have the highest failure rates (25%) next to chance alone (90%). Withdrawal leaves much room for error due to timing the withdrawal of the penis from the vagina before ejaculation, and neglect of the fact that men usually have pre-ejaculate. While using the rhythm method, women determine the days when they are ovulating based on rises in body temperature and viscosity of the vaginal mucous. Unfortunately for this type of birth control, as nature usually dictates, women often find that their libido increases around ovulation.

Failure rates will decrease dramatically when multiple methods are used simultaneously: condoms with spermicide, condoms and birth control pills. One would guess that abstinence is the BEST method to prevent pregnancy and sexually transmitted diseases, but how do we calculate the "failure rates" on people who claim to be abstinent?

Learn more about this author, Daisy Dupree.
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