Can you get pregnant on birth control?

No method of birth control is 100% effective—after all, nearly half of pregnancies in the U.S. each year are accidental. However, some types of birth control are more effective than others.

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Your chances of getting pregnant while on birth control also have a lot to do with whether you use contraceptive methods correctly, all the time—“perfect use”—versus the mistakes that happen in real life—“typical use.” For instance, with perfect use, your chances of getting pregnant using the family awareness (rhythm) method are only about 1–5%. But in real life—typical use—you have up to a 34% chance of getting pregnant, about one in three (Guttmacher, 2020). 

There are four main categories of birth control (Bansode, 2020):

• Hormonal

• Non hormonal intrauterine device (IUD)

• Barrier methods

• Fertility awareness methods (FAMs)

Hormonal birth control

Hormonal birth control methods include birth control pills, implants, hormonal IUDs, patches, vaginal rings, and injections. This type of contraception works by preventing ovulation, meaning that there is no egg for sperm to fertilize. Hormonal implants and IUDs have the lowest failure rates of any type of birth control (Sundaram, 2017).

• Pills—Birth control pills (oral contraceptives) are used more than any other type of contraception, apart from female sterilization (Daniels, 2018). There are two types of birth control pills: combination pills, or combined estrogen-progestin oral contraceptives (COCs), and mini-pills. COCs contain both progestin, a synthetic form of progesterone (a hormone naturally found in your body), and estrogen. Mini-pills contain only progestin. Birth control pills are taken once a day. They have a typical-use failure rate of 7% and a perfect-use failure rate of less than 1% (Hatcher, 2018; Guttmacher, 2020).

• Implants—Contraceptive implants are flexible plastic rods about the size of a matchstick. They’re inserted under the skin of your upper arm, where they continuously release progestin into your body for up to three years. Their effectiveness is greater than 99%, meaning fewer than one woman in 100 will get pregnant while using them (Hatcher, 2018; Guttmacher, 2020).

• Intrauterine devices (IUDs)—Hormonal IUDs are T-shaped plastic devices with strings attached for removal. They’re inserted into your uterus, where they release progestin, and can remain there for three to five years. Like implants, their effectiveness is greater than 99% (Hatcher, 2018; Guttmacher, 2020).

• Patches—Birth control patches are placed on your skin once a week for three weeks, then taken off for the fourth week to mimic your menstrual cycle. Patches release estrogen and progestin into your bloodstream. They have a typical-use failure rate of 7% and a perfect-use failure rate of less than 1% (Hatcher, 2018; Guttmacher, 2020).

• Vaginal rings—Birth control vaginal rings are small, flexible rings that release progestin and estrogen into your system. They’re inserted into your vagina and remain there for about a month, when they need to be replaced. They have a typical-use failure rate of 7% and a perfect-use failure rate of less than 1% (Hatcher, 2018; Guttmacher, 2020).

• Injections (birth control shots)—With contraceptive shots, progestin is injected into the muscles of your shoulder or buttocks, or under the skin of your abdomen or thigh, every 12 weeks. Contraceptive shots suppress ovulation (production of eggs). Injections have a typical-use failure rate of 4% and a perfect-use failure rate of less than 1% (Hatcher, 2018; Guttmacher, 2020).

Non hormonal IUDs

Non hormonal IUDs don’t release hormones. Instead, they’re wrapped with copper wire. The way copper IUDs work isn’t well understood, but it’s believed that their presence in the uterus interferes with sperm, eggs, or possibly the embryo before it implants. 

• Copper IUDs—Copper IUDs can be left in place in your uterus for up to 10 years. Like hormonal IUDs, their effectiveness is greater than 99% (CooperSurgical, 2020).

Barrier methods

Barrier methods include contraceptive sponges, spermicides, diaphragms, and male and female condoms. Sponges and diaphragms are used with spermicides that kill sperm before it can enter your uterus. Condoms hold the sperm so it can’t enter your uterus.

• Sponges, spermicides, and diaphragms—Contraceptive sponges and spermicides contain sperm-killing chemicals. Diaphragms are used with spermicidal gels. These barrier methods have a typical-use failure rate of 14–27% and a perfect-use failure rate of 4–20% (Hatcher, 2018; Guttmacher, 2020).

• Male and female condoms—Condoms block sperm from entering the uterus. Male condoms have a typical-use failure rate of 13% and a perfect-use failure rate of 2% (Hatcher, 2018; Guttmacher, 2020). Female condoms have a typical-use failure rate of 21% and a perfect-use failure rate of 5% (Hatcher, 2018).

Fertility awareness methods (FAMs)

• FAMs (rhythm method)—There are many different variations on this method, but they’re all based on letting you know when you’re fertile so you can avoid having sex during that time. FAMs have a typical-use failure rate of 2–34% and a perfect-use failure rate of less than 1% to 5% (Guttmacher, 2020; Peragallo, 2018).

Talk to your healthcare provider about your best choices for contraception. Your provider will have insights into what will work best for you, taking into consideration your health, lifestyle, age, and preferences.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

April 14, 2021

Written by

Alison Dalton

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.