Half of all pregnancies each year in the United States are unintended (Finer, 2011). These may follow contraceptive method failure or stem from lack of contraceptive use. Specifically, 10 percent of sexually active American women not pursuing pregnancy did not use any birth control method (Jones, 2012). And, for sexually active fertile women not using contraception, pregnancy rates approach 90 percent at 1 year.
For those seeking contraception, various effective contraceptive methods are available. Preferences of United States women are shown in Table 38-1. With these methods, wide variations are seen between estimated failure rates of perfect and typical use during the first year. Similarly, the World Health Organization (WHO) has grouped methods according to effectiveness tiers that reflect these failure rates (Table 38-2). Implants and intrauterine devices are found in the top tier. They are effective in lowering unintended pregnancy rates and are considered long-acting reversible contraception (LARC) (Winner, 2012). The American College of Obstetricians and Gynecologists (2013c) recognizes these efficacy tiers and the high unintended pregnancy rate. Thus, the College recommends that clinicians provide counseling on all options and encourages highly effective LARC for all appropriate candidates.
TABLE 38-1Method Use among Women in the United States |Favorite Table|Download (.pdf) TABLE 38-1 Method Use among Women in the United States
|Method ||Percentage |
|Female sterilization ||16.5 |
|Male sterilization ||6.2 |
|Combination pill ||17.1 |
|Progestin-only pill ||0.4 |
|Implants or patch ||0.9 |
|DMPA ||2.3 |
|Vaginal ring ||1.3 |
|Intrauterine devices ||3.5 |
|Male condom ||10.2 |
|Periodic abstinence || |
| Calendar method ||0.6 |
| Natural family planninga ||0.1 |
|Withdrawal ||3.2 |
|Other methodsb ||0.3 |
|Not using contraceptionc ||37.8 |
TABLE 38-2Contraceptive Failure Rates During the First Year of Method Use in Women in the United States |Favorite Table|Download (.pdf) TABLE 38-2 Contraceptive Failure Rates During the First Year of Method Use in Women in the United States
|Methoda ||Perfect Use ||Typical Use |
|Top Tier: Most Effective || || |
|Intrauterine devices || || |
| Levonorgestrel system ||0.2 ||0.2 |
| T 380A copper ||0.6 ||0.8 |
|Levonorgestrel implants ||0.05 ||0.05 |
|Female sterilization ||0.5 ||0.5 |
|Male sterilization ||0.1 ||0.15 |
|Second Tier: Very Effective || || |
|Combination pill ||0.3 ||9 |
|Vaginal ring ||0.3 ||9 |
|Patch ||0.3 ||9 |
|DMPA ||0.2 ||6 |
|Progestin-only pill ||0.3 ||9 |
|Third Tier: Effective || || |
|Condom || || |
| Male ||2 ||18 |
| Female ||5 ||21 |
|Diaphragm with spermicides ||6 ||12 |
|Fertility-awareness || ||24 |
| Standard days ||5 || |
| Two day ||4 || |
| Ovulation ||3 || |
| Symptothermal ||0.4 || |
|Fourth Tier: Least Effective || || |
|Spermicides ||18 ||28 |
|Sponge || || |
| Parous women ||20 ||24 |
| Nulliparous women ||9 ||12 |
|No WHO Category...|
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