How effective is birth control? Pill, condoms, IUD, implant, shot

Some birth control methods, such as the pill, intrauterine devices (IUDs), and patches, are highly effective with correct and consistent use. Other methods, such as “pulling out”, fertility awareness and spermicide alone, are less effective, even with perfect use.

A wide range of contraceptive options are available, and people can choose the option that best suits them and their lifestyle. One important aspect to consider is effectiveness, as some methods are better at preventing pregnancy than others.

It is important to note that barrier methods, including internal and external condoms, are the only form of contraception that can stop the spread of sexually transmitted infections.

This article discusses the different types of birth control, how effective they are with perfect and typical use, and some options a person has if birth control fails.

A range of birth control options are available, and their efficiency varies depending on usage.

Under the Affordable Care Act, many health insurance plans cover prescription birth control methods approved by the Food and Drug Administration (FDA). People who have health insurance can ask their coverage provider about the birth control options and services available through their policy.

Those on Medicaid have covered birth control options, but they should contact their state’s Medicaid office for details because benefits may vary by location.

Anyone without insurance may be able to access free or low-cost birth control options at a family planning clinic.

Below is an outline of the different types of birth control available and their effectiveness.

Long-acting reversible contraception (LARC)

LARC methods are prescription-only birth control options that:

  • lasts 3–10 years, depending on the method
  • requires insertion and removal by a healthcare professional
  • provides long-term, high-efficiency pregnancy prevention

IUDs are one type of LARC. These small, T-shaped devices use either copper (eg ParaGard) or the synthetic hormone progestin (eg Mirena, Kyleena, Liletta, Skyla) to prevent pregnancy. IUDs are more than 99% effective, and a healthcare professional will replace them every 3-10 years, depending on the type.

Another type of LARC is the birth control implant, Nexplanon. Like hormonal IUDs, the implant uses progestin to prevent pregnancy—however, a healthcare professional places the implant in a person’s arm rather than in their cervix. Nexplanon is over 99% effective and lasts up to 3 years.

Short-acting hormonal contraceptives

These prescription-only hormonal birth control methods require the person to use them daily or monthly:

  • Oral contraceptives: It is also called the pill or the minipill. A person should take a pill at the same time every day. Perfect use is 99% effective, and typical use is 91% effective.
  • Shot: It is an injection (Depo-Provera) that a healthcare professional gives to a person once every 3 months. Perfect use is 99% effective, and typical use is 94% effective.
  • Plaster: The patch (Xulane, Twirla) is a new adhesive patch that a person can place on their arm, stomach, back or buttocks every week. Perfect use is 99% effective, and typical use is 91% effective.
  • Ring: A person will place this hormone-filled flexible plastic ring in their vagina for 3 weeks, remove it for 7 days to allow for a period, and then insert a new ring. With the NuvaRing, perfect use is 99% effective and typical use is 91% effective. The newer Annovera ring is 97.3% effective.

Barrier methods

Barrier methods of birth control prevent sperm from entering the uterus and fertilizing an egg. Because they are non-hormonal, barrier methods can be good choices for people who are sensitive to hormones.

  • Condoms: External condoms fit around the penis, and internal condoms fit inside the vagina. External condoms are approximately 98% effective with perfect use and 82% effective with typical use, while internal condoms are approximately 95% effective with perfect use and 79% effective with typical use.
  • Sponges: The sponge (Today Sponge) forms a barrier around the uterine opening to prevent sperm from entering the uterus. It is typically available OTC. Perfect use is about 91% efficient, and typical use is about 80% efficient.
  • Diaphragms: It blocks the uterine opening to prevent sperm from entering the uterus. Perfect use is about 94% efficient, and typical use is about 88% efficient.
  • Cervical caps: A cap (FemCap) covers the cervix. It is similar to a diaphragm, but smaller. Perfect use is about 86% efficient, and typical use is about 71% efficient.
  • Spermicides: These are creams, gels and films that contain chemicals that kill sperm. They are available OTC or by prescription. Perfect use is about 82% efficient, and typical use is about 72% efficient. Phexxi, an FDA-approved vaginal gel, works similarly to spermicide by creating an inhospitable environment for sperm.

For maximum effectiveness, people using barrier methods should use them correctly and every time they have sex. Using a barrier method with spermicide is more effective than using a barrier method or spermicide alone.

Fertility Awareness Methods

When a person uses a fertility awareness method as birth control, it means that they avoid sexual intercourse during their fertile days. People are most fertile around the time of ovulation.

There are several types of fertility awareness-based methods, also called natural birth control, including but not limited to:

  • checking basal body temperature
  • checking of cervical mucus
  • ovulation tracking
  • tracking of menstrual cycles

With perfect use, fertility awareness methods are about 95% effective. With typical use, they are about 76% efficient.

Lactational amenorrhea method (LAM)

LAM is a temporary method of birth control that someone who has recently had a baby might consider. LAM works on the basis that exclusive breastfeeding suppresses fertility.

It can be an effective birth control method if:

  • the person’s period has been absent (amenorrhea) since they gave birth
  • the baby breastfeeds exclusively on demand
  • the baby is less than 6 months old

With perfect use, less than one person will get pregnant in 6 months. With typical use, less than two people will become pregnant. Someone using LAM as birth control should consider adding another method of contraception if any of the above conditions change.

Withdrawal method

Withdrawal, or the “pull out” method, involves removing the penis from the vagina before ejaculation so that sperm do not enter the vagina and reach an egg.

With perfect execution, extraction is approximately 96% effective. However, this method is rarely perfect and the typical success rate is closer to 78%.

Currently, emergency contraception (EC) options include IUDs and emergency contraceptive pills (ECPs), commonly called “morning after” pills.

According to the American College of Obstetricians and Gynecologists, the copper IUD (ParaGard) is the most effective form of EC. However, a 2021 study found that hormonal IUDs, such as Mirena, are not inferior to ParaGard as EC options.

A medical professional must insert the IUD within 5 days, or 120 hours, of sexual intercourse without a barrier method. Once inside, the IUD lowers the chance of getting pregnant by more than 99.9%.

If a person wants a short-term solution, they can take an ECP.

Pills containing ulipristal (eg ella) are prescription-only ECPs that a person takes within 5 days of sexual intercourse without a barrier method. Over 6 or 7 out of every 10 people who would have become pregnant will not become pregnant after taking ulipristal.

The FDA states that morning-after pills containing levonorgestrel (eg, Plan B and other progestin-only pills) prevent pregnancy in seven out of eight people who would have gotten pregnant. These pills are most effective when a person takes them within 3 days of sex without a barrier method. They are available OTC.

It is important to note that ECPs are not abortion pills. ECPs work to prevent pregnancy from occurring, while abortion pills terminate an existing pregnancy.

Body weight and morning-after pills

There is a gray area about how a person’s body weight affects the effectiveness of emergency contraceptive pills.

According to the Centers for Disease Control and Prevention (CDC), ECPs may be less effective for people with a body mass index of 30 or more. However, the FDA states that available data are inconclusive and warrants more research.

If a person has concerns about the effectiveness of ECPs and their weight, they should contact a doctor to discuss the best option for them.

It is important to contact a doctor and set up a birth control plan before having sex.

When choosing a form of contraception, a person can talk to a doctor about:

  • when or if they want to get pregnant
  • the efficiency figure
  • potential side effects
  • how often they have sex
  • how many sex partners they have
  • their age and general health
  • their confidence level with the method (eg remember to take a pill every day, make sure their partner wears a condom)

There are many OTC and prescription-only birth control options available.

Some methods, including implants and IUDs, are highly effective and last for years. Other options, such as the withdrawal method and fertility awareness methods, are less effective and leave more room for error.

While there is no overall “best” birth control option, a person can talk to a doctor about the option that is likely to work best for them. They can also discuss the options they have if birth control fails.

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