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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.
So can you get pregnant on birth control?
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).
What are the different types of birth control?
There are four main categories of birth control (Bansode, 2020):
- 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).
Morning after pill: how does emergency contraception work?
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 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).
Non-hormonal birth control options
Talking with a healthcare provider about birth control options
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.
- Bansode, O. M., Sarao, M. S., & Cooper D. B. (2020) Contraception. [Updated 2020 Jul 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK536949/
- CooperSurgical. (2020). Paraguard prescribing information. Retrieved from https://14wub23xi2gmhufxjmvfmt1d-wpengine.netdna-ssl.com/wp-content/uploads/2018/10/PARAGARD-PI.pdf
- Daniels, K., & Abma, J.C. (2018). Current contraceptive status among women aged 15–49: United States, 2015–2017. National Center for Health Statistics Data Brief No. 327, December 2018. Retrieved on Apr 2, 2021 from https://www.cdc.gov/nchs/products/databriefs/db327.htm#:~:text=In%202015%E2%80%932017%2C%2064.9%25,and%20male%20condom%20(8.7%25)
- Guttmacher Institute. (2020, April). Contraceptive effectiveness in the United States. Fact sheet. Retrieved on Apr 2, 2021 from https://www.guttmacher.org/fact-sheet/contraceptive-effectiveness-united-states#
- Hatcher, R.A. (2018). Contraceptive Technology, 21st ed., New York: Managing Contraception. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Contraception: hormonal contraceptives. [Updated 2017 Jun 29]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK441576/
- Peragallo Urrutia, R., Polis, C. B., Jensen, E. T., Greene, M. E., Kennedy, E., & Stanford, J. B. (2018). Effectiveness of fertility awareness-based methods for pregnancy prevention: a systematic review. Obstetrics and Gynecology, 132(3), 591–604. doi: 10.1097/AOG.0000000000002784. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30095777/
- Sundaram, A., Vaughan, B., Kost, K., Bankole, A., Finer, L., Singh, S., & Trussell, J. (2017). Contraceptive Failure in the United States: Estimates from the 2006-2010 National Survey of Family Growth. Perspectives on Sexual and Reproductive Health, 49(1), 7–16. doi: 10.1363/psrh.12017. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28245088/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.