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 gotten pregnant while on a particular type of birth control! Whatever your reason may be, the first logical question to ask when trying to determine your options is, “Which birth control method 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?
Or are you taking any medication? Some medical conditions, such as HIV or Epilepsy, require medication which may interact with certain birth control methods. This may make them less effective and can lead to unintended pregnancies.
Make sure that you tell your doctor about any medications you may be taking, including anything you buy over-the-counter.
Does the method suit your lifestyle?
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? Are you an organised person with a regular routine? Or are you so busy that you’re probably going to forget to take the pill at one point or another? This is so important! You want a method that doesn’t feel like work, but actually works for you.
When talking about the efficacy of birth control, we HAVE to consider the very important problem of human error. The birth control method can only work as well as the person remembering to take it properly.
Birth control methods have different levels of efficacy depending on whether there is PERFECT use or TYPICAL use.
When you read an information brochure about different methods of birth control, you need to know whether the stats they are giving you are a result of perfect use or typical use. Perfect use is when the birth control method is used correctly ALL of the time. This tends to only happens during clinical trials. Typical use is what usually happens in real life with real humans.
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!)
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 for this method. This is 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: a 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%.
No method is 100% effective!
Unless, of course, you have had a hysterectomy or another surgery where the ovaries and fallopian tubes were removed. Pregnancy cannot happen if 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.
Now that we know which are the most effective birth control methods, you need to find one that works for you. 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.
At the end of the day, you need a method that works for you. You do not have to stick to one method if you’re not happy with it!
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Disclaimer: This blog contains my opinions and doesn’t reflect the opinions of the Department of Health of South Africa or The Southern African Sexual Health Association. All information is accurate and true to the best of my knowledge, but it’s possible that there may be omissions, errors or mistakes. While I am a qualified medical doctor, I am not your doctor. The information presented on this blog is for entertainment and/or informational purposes only and shouldn’t be seen as professional medical advice. If you rely on any information presented, it’s at your own risk. Please consult a professional before taking any sort of action. I reserve the right to manage this blog as I see fit, including the right to remove harmful or unhelpful comments.
- 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.