Are you looking to start taking birth control? Maybe you have tried a few options in the past and they aren’t working for you. Maybe you have even got pregnant while on a particular type birth control! Whatever your reason may be, the first logical question to ask when trying to determine your options is, “Which method of birth control is the MOST effective?” I mean, the whole point is that you don’t want to get pregnant, right?
There are a few things that we need to consider before we can answer that question.
Do you have any medical conditions? Are you taking any medication? Some medical conditions, such as HIV or Epilepsy, require medication which may interact with certain birth control methods, making them less effective and leading to more unintended pregnancies.
The next aspect to consider is whether the method suits your lifestyle.
Does your lifestyle allow for you to remember to take a pill at the same time every day? Do you have a regular routine? Are you so busy that you’re probably going to forget to take the pill at one point or another?
When talking about the efficacy of birth control, we HAVE to consider the very important problem of human error.
Birth control methods have different levels of efficacy depending on whether there is PERFECT use or TYPICAL use.
Perfect use is when the birth control method is used correctly ALL of the time. Typical use is what usually happens in real life. The two methods with the most risk of human error are the pill (because you need to remember to take it every day without fail) and condoms (many people actually do not know how to use a condom correctly!)
So when asking the question about which is the most effective at preventing pregnancy, we have to compare the efficacy of perfect use versus typical use.
The most effective method (with the lowest pregnancy rate) is the implant (eg. Nexplanon) which is 99.9% effective with both perfect and typical use.
The data for perfect use and typical use is exactly the same because after the implant is inserted, you only need to remember to have it removed and replaced after 3 years.
Other methods which are very effective include: vasectomy (99.85%), tubal ligation or sterilization (99.5%), the hormonal IUD (99.3%) and the copper IUD (99.2%).
These percentages are calculated by considering the number of unintended pregnancies that occur in a population of 100, over one year of using the method. This is referred to as the PEARL Index. For example, for the implant, as discussed above, the pregnancy rate is 0.1%.
What is very important to notice is that no method is 100% effective!
Unless, of course, you have had a hysterectomy or another surgery where the ovaries and Fallopian tubes were removed and you do not have the required anatomy in place for fertilisation. This type of surgery is not considered for birth control, due to the cost, side effects and complications that come with the surgery.
Choosing a birth control method is not as simple as choosing the most effective one.
There are so many things to consider! Each method comes with its own side effects which may or may not be acceptable or safe for certain people. This is why it is so important to have this conversation with your doctor. Talk about your concerns, your lifestyle, your current menstrual cycle and whether you could benefit from some of the non-contraceptive effects of some of the methods.
If you would like to learn more about birth control or have any questions, let me know in the comments and come join in the discussion on Instagram!
World Health Organization Department of Reproductive Health and Research (WHO/RHR) and Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP), Knowledge for Health Project. Family Planning: A Global Handbook for Providers (2018 update). Baltimore and Geneva: CCP and WHO, 2018.