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Unintended Pregnancy Prevention: Contraception

In the United States, almost half of all pregnancies are unintended.1 Several safe and highly effective methods of contraception (birth control) are available to prevent unintended pregnancy.  In the United States, most women of reproductive age use birth control. In 2002, 98% of women who had ever had sexual intercourse had used at least one method of birth control only 7.4 percent of women who were currently at risk of unintended pregnancy were not using a contraceptive method.2 The most popular method of birth control was the oral contraceptive pill, used by 11.6 million women in the United States, followed by female sterilization, condoms, male sterilization, and other methods of birth control.2 About 6% of women have ever used emergency contraception.2 Since 2000, several new methods of birth method have become available in the United States, including the levonorgestrel-releasing intrauterine system, the hormonal contraceptive patch, the hormonal contraceptive ring, a 91-day regimen of oral contraceptives, two new barrier methods, and a new form of female sterilization.

  1. Disparities in Rates of Unintended Pregnancy in the United States, 1994 and 2001*  Finer LB, Henshaw SK, Perspectives on Sexual Reproductive Health, 2006:38:90–96. PDF icon PDF 3.27MB Health, 2006:38:90–96.
  2. Mosher WD, Martinez GM, Chandra A, Abma JC, Willson SJ. Use of contraception and use of family planning services in the United States, 1982–2002. Advance data from vital and health statistics; no 350. Hyattsville, Maryland: PDF icon PDF 2.3MB National Center for Health Statistics. 2004.

Learn More About Birth Control

Only one method of birth control prevents pregnancy all the time. Abstinence. Abstinence means not having vaginal, anal, or oral sex at any time. NO other method of birth control prevents pregnancy all the time. But other methods are very effective at preventing pregnancy.

When choosing your birth control method, consider

  • your overall health
  • how often you have sex
  • the number of sexual partners you have
  • if you want to have children
  • how well it prevents pregnancy
  • potential side effects
  • your comfort level with using the method

Learning how to use some forms of birth control can take time and practice.

Know that many forms of birth control do NOT protect you from getting infected with HIV or other STDS, such as gonorrhea, the human papillomavirus (HPV) , herpes, and chlamydia. The best way to protect yourself is to be totally abstinent, 100 percent of the time. But using a latex male condom or a female condom correctly every time you have sex helps lower your chances of getting HIV or other STDs. They do not eliminate ALL risk, however.

Types of Birth Control

No single method of birth control is the “best” one. Each has its own advantages and disadvantages.

Barrier methods (act as a physical block between you and your sexual partner)

Male condom. Worn by the man, a male condom keeps sperm from getting into a woman’s body. Latex condoms help pre¬vent pregnancy and HIV and other STDs. “Natural” or “lambskin” condoms also help prevent pregnancy, but they do not protect against STDs, including HIV. Male condoms are 85 to 98 percent effective at preventing pregnancy. Condoms can only be used once. You can buy condoms, KY jelly, or water-based lubricants at a drug store. Do not use oil-based lubricants such as massage oils, baby oil, lotions, or petroleum jelly. They will weaken the condom, causing it to tear or break.

Female condom. Worn by the woman, this method keeps sperm from getting into her body. It is packaged with a lubricant and is available at drug stores. It helps reduce your chances of getting HIV and other STDs. It can be inserted up to eight hours before sexual intercourse. Female condoms are 70 to 95 percent effective at preventing pregnancy.

Diaphragm or cervical cap. Each of these barrier methods are placed inside the vagina to cover the cervix to block sperm. The diaphragm is shaped like a shallow cup. The cervical cap is a thimble-shaped cup. Before sexual intercourse, you insert them with spermicide to block or kill sperm. The diaphragm is 84 to 94 percent effective at preventing pregnancy. Visit your doctor for a proper fitting because diaphragms and cervical caps come in different sizes. Using diaphragm or cervical caps does not protect you against STDs.

Intrauterine devices (IUDs)

Copper T IUD. An IUD is a small device that is shaped in the form of a “T.” Your doctor places it inside the uterus to prevent pregnancy. It can stay in your uterus for up to 10 years. It does not protect you from HIV or other STDs. This IUD is 99 percent effective at preventing pregnancy.

Mirena intrauterine system (IUS). The IUS is a small T-shaped device like the IUD. It is placed inside the uterus by a doctor. It releases a small amount of hormone each day to keep you from getting pregnant. The IUS stays in your uterus for up to 5 years. It does not protect you from HIV or other STDs. The IUS is 99 percent effective at preventing pregnancy.

Hormonal methods

Oral contraceptives. Also called “the pill,” it contains the hormones estrogen and progestin. It is prescribed by a doctor. A pill is taken at the same time each day. It does not protect against HIV or other STDs. If you are older than 35 and smoke, or have a history of blood clots, breast cancer, or endometrial cancer, your doctor may advise you not to take the pill. The pill is 92 to 99 percent effective at preventing pregnancy.

Mini pill. Unlike the pill, the mini-pill only has one hormone, progestin, instead of both estrogen and progestin. It is prescribed by a doctor. It is taken at the same time each day. Mothers who breastfeed ca use the mini-pill because it will not affect their milk supply. It is a good option for women who can’t take estrogen or for women who have a risk of blood clots. The mini-pill does not protect against HIV or other STDs. They are 92 to 99.9 percent effective at preventing pregnancy.

Patch (Ortho Evra). This skin patch is worn on the lower abdomen, buttocks, or upper body. This method is prescribed by a doctor. It releases hormones progestin and estrogen into the bloodstream. You put on a new patch once a week for three weeks. During the fourth week, you do not wear a patch, so you can have a menstrual period. The patch is 92 to 99 percent effective at preventing pregnancy. But it appears to be less effective in women who weigh more than 198 pounds. It does not protect against HIV or other STDs.

Hormonal vaginal contraceptive ring (NuvaRing). The NuvaRing releases the hormones progestin and estrogen. Your doctor places the ring inside your vagina to go around your cervix (the opening to your womb). You wear the ring for three weeks, take it out for the week you have your period, and then put in a new ring. It is 92 to 99 percent effective at preventing pregnancy. This method does not protect you from HIV or other STDs.

Depo-Provera. Women get shots of the hormone progestin in the buttocks or arm every three months from their doctor. It does not protect you from HIV or other STDs. It is 97 to 99 percent effective at preventing pregnancy.

Emergency contraception. Emergency contraception is NOT a regular method of birth control. It should never be used as one. Emergency contraception should only be used after no birth control was used during sex, or if the birth control method failed, such as if a condom broke. Neither of the two methods described here protects you from HIV or other STDs.

One type of emergency contraception requires you to take two doses of hormonal pills 12 hours apart. You have to take the pills starting within three days (72 hours) after having unprotected sex. They are sometimes referred to as “morning after” pills, even though they can be used up to three days later. The pills are 75 to 89 percent effective at inhibiting ovulation, fertilization, or implantation of a fertilized egg in the uterine wall, or all three. Plan B is available over the counter for women age 18 and older. Plan B is available by prescription for women age 17 and under. (Plan B is the brand name of one product approved by the Food and Drug Administration for use as emergency contraception.)

Another type of emergency contraception is having your doctor insert the Copper T IUD into your uterus within seven days of unprotected sex. This method is 99.9 percent effective at inhibiting ovulation, fertilization, or implantation of a fertilized egg in the uterine wall, or all three.

Surgical options

Surgical sterilization. These surgical methods are meant for people who want a permanent method of birth control. In other words, they never want to have a child, or they do not want more children. Both methods listed here are 99 to 99.5 percent effective at preventing pregnancy. These surgical options do not protect you from HIV or other STDs.

Tubal ligation or “tying tubes.” A woman can have her fallopian tubes tied (or closed) to stop eggs from going down to her uterus where they can be fertilized. The procedure can be done in a hospital or in an outpatient surgical center. You can go home the same day of the surgery and resume your normal activities within a few days. This method is effective immediately. In the first year after the surgery, your chance of getting pregnant is less than 1 percent. Over time, the ends of your fallopian tubes could fuse back together, and it may be possible to get pregnant. Failure rates have been reported in women who had their tubes tied earlier in their lives. But these failure rates are lower in women who are older when they have tubal ligation.

Vasectomy [va-sec-toe-me]. This operation is done to keep a man’s sperm from going to his penis, so his ejaculate never has any sperm in it that can fertilize an egg. This operation is simpler than tying a woman’s tubes. The procedure is done at an outpatient surgical center. The man can go home the same day. Recovery time is less than one week. After the operation, a man visits his doctor for tests to count his sperm and to make sure the sperm count has dropped to zero. It may take a few weeks for that to happen. Another form of birth control should be used until the man’s sperm count has dropped to zero. Learn more about vasectomy.

Other methods

Continuous abstinence. This method means not having vaginal, anal, or oral sex at any time. It is the only 100-percent effective way to prevent pregnancy, HIV, and other STDs.

Non-surgical sterilization (Essure Permanent Birth Control System). It is the first non-surgical method of sterilizing women. A thin tube is used to thread a tiny device into each fallopian tube. It irritates the fallopian tubes and causes scar tissue to grow and permanently plug the tubes. It can take about three months for the scar tissue to grow, so use another form of birth control during this time. Return to your doctor for a test to see if scar tissue has fully blocked your fallopian tubes. With blocked tubes, you can’t get pregnant. Research studies followed more than 600 women for one year. None had any pregnancies when the devices were implanted correctly. It does not protect you from HIV or other STDs.

Natural family planning or fertility awareness. Understanding your monthly fertility pattern can help you plan to get pregnant or to avoid getting pregnant. Your fertility pattern is the number of days in the month when you are fertile (able to get pregnant), days when you are infertile, and days when fertility is unlikely, but possible. If you have a regular menstrual cycle, you have about nine or more fertile days each month. If you do not want to get pregnant, you do not have sex on the days you are fertile, or you use a form of birth control on those days. These methods are 75 to 99 percent effective at prevention pregnancy. They do not protect you from HIV or other STDs.

Spermicides. These products work by killing sperm and come in several forms—foam, gel, cream, film, suppository, or tablet. They are placed in the vagina no more than one hour before intercourse. You leave them in place at least six to eight hours after intercourse. You can use a spermicide in addition to a male condom, diaphragm, or cervical cap. Spermicides alone are about 71 to 82 percent effective at preventing pregnancy. They can be purchased in drug stores. Vaginal spermicide with Nonoxynol-9 will not protect you from HIV or other STDs, such as gonorrhea or chlamydia.

Sexually Transmitted Diseases (STDs)

STDs can be a real threat to your health especially if they are not treated. STDs can result in life-long problems, including blindness, bone deformities, mental retardation, and death for infants infected by their mothers during pregnancy or birth. In women, STDs can lead to pelvic inflammatory disease (PID), infertility, ectopic pregnancies (pregnancies that occur in the fallopian tubes instead of the uterus), and cancer of the reproductive system. Learn more about STDs.

Courtesy of the National Women’s Health Information Center

Selected Resources

Fact sheet: Update on intrauterine devices (IUD) and pelvic infection
Women and their clinicians should be aware that today's IUDs are highly effective and safe for long-term contraceptive use for women at low risk for sexually transmitted diseases (STDs).  Source: MMWR 1997;46(41).

Protecting Against Unintended Pregnancy: A Guide to Contraceptive Choices (FDA)

Birth Control Methods (National Women’s Health Information Center)
Also available in Spanish

Emergency Contraception (National Women’s Health Information Center)
Also available in Spanish

International Surveys
Reproductive health surveys collect data on contraceptive use in developing countries ..more

Related Resources

Medical Eligibility Criteria for Contraceptive Use*
This document is one of WHO's two evidence-based guidelines on contraceptive use. It reviews the medical eligibility criteria for use of contraception, offering guidance on the safety of use of 19 different methods for women and men.

Selected Practice Recommendations for Contraceptive Use*
The document is one of WHO's two evidence-based guidelines on contraceptive use. It provides guidance on the safe and effective use of a wide range of contraceptive methods, and is the companion guideline to WHO's Medical Eligibility Criteria for Contraceptive Use.

Fertility, Family Planning, and Reproductive Health of U.S. Women: Data From the 2002 National Survey of Family Growth National Vital Statistics System PDF iconPDF 4.8MB 

Use of Contraception and Use of Family Planning Services in the United States: 1982–2002. Advance Data No. 350. PDF iconPDF 1.5 MB 

Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2002. Series No. 23, Volume 24. PDF iconPDF 710 KB

Nonoxynol-9 Spermicide Contraception Use - United States, 1999
An assessment of contraceptive use among women attending Title X family planning clinics in 1999 indicated that some women were using Nonoxynol-9 (N-9) spermicide. Data were collected from the national family planning program, which serves predominantly low-income women. Source: MMWR 2002:51(18):389–392.

Contraceptive Practices Before and After an Intervention Promoting Condom Use to Prevent HIV Infection and Other Sexually Transmitted Diseases Among Women—Selected U.S. Sites, 1993–1995
The findings in this report indicate that, among the reproductive-aged women who were encouraged to use condoms for HIV/STD prevention, consistent condom use for HIV/STD prevention increased among women using each contraceptive method studied. Source: MMWR 1997;47(17).

American College of Obstetrics and Gynecology*

Family Planning (WHO)*

The Association of Reproductive Health Professionals*

Search PubMed for articles on Contraception Use
This search is being conducted on PubMed an NLM/NIH service.


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Page last reviewed: 3/26/08
Page last modified: 9/14/07
Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion

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