The Guttmacher Institute is a research group dedicated solely to sexual and reproductive health. According to their most recent fact sheet, there are currently 62 million women between the ages of 15 and 44 living in the US. Guttmacher considers these women “in their childbearing years”; they can still get pregnant and safely carry a baby to term. At least 43 million of these women, 70%, are sexually active but don’t want to get pregnant. So by and large, they use contraceptives, birth control to prevent a pregnancy.
Birth Control: How It Works & How Effective It Is
The Guttmacher Institute estimates that 62% of all women who can get pregnant are “currently using a contraceptive method.” And while nearly everyone (99% of women) has used birth control at least once in their lifetime, the Institute’s numbers tell us that almost 24 million American women are not currently using contraception.
Only 30% of those 24 million are actively trying to get pregnant. 70%, 16.5 million, don’t want to get pregnant, but aren’t using birth control. Why not?
Our first thought was for religious reasons, but it’s probably not that. 99% of all self-identified Catholics and Protestants have used birth control at least once. Then we thought the answer would be economic. But the Centers for Disease Control found that income level didn’t change the likelihood of a woman using birth control, only the method that she would choose.
Age and adequate education on education seem to play a big part. 15 to 19 year olds are most likely not to use contraception during sex. When teenagers learn more about contraception and the various methods of birth control, they’re more likely to actually use it. Education might be the key.
What Types Of Birth Control Do American Women Use?
The Pill
- 17.1% of all women in their childbearing years take the pill.
Birth control pills, or “oral contraception,” are made of hormones, usually the primary female sex hormones: progestin and estrogen. Taken once daily, the pill prevents eggs from leaving the ovary (so they don’t meet sperm in the fallopian tube) and thickens cervical mucus, preventing sperm from reaching eggs.
Birth control pills are about 99% effective when taken every day. That means that 1 out of every 100 women using the pill daily will still get pregnant. Birth control sometimes fails because you’re taking another medication that diminishes its effect. Antibiotics, HIV medicines, and anti-seizure drugs can all lessen the pill’s impact. Hormone pills have also been shown to be less effective in women who are significantly overweight.
Birth control pills are now the most popular form of contraception in America. Around 10.5 million women in the US now use the pill.
Tubal Sterilization
- 16.5% of all women in their childbearing years have undergone a sterilization procedure.
Despite its permanency, female sterilization is surprisingly common. Around 10.2 million women have undergone a sterilization procedure, which generally involves blocking or closing a woman’s fallopian tubes. By blocking the tube, eggs can’t reach the uterus and meet sperm, making sterilization nearly 100% effective.
Although rare, a woman’s fallopian tubes can reconnect after a sterilization procedure. Women who experience pregnancy after being sterilized are very likely to experience complications; 1 out of 3 have ectopic pregnancies, when the fertilized egg develops inside a fallopian tube, rather than the uterus.
Male Condoms
- 10.2% of all women report using condoms as their contraceptive of choice.
Condoms used to be the most popular form of birth control, but the increased availability of hormone-based pills has decreased their use somewhat. Still, around 6.3 million women in the US use condoms during sex.
Some condoms are covered in spermicide, a chemical that kills sperm, which makes them good for vaginal sex, but unsafe for oral or anal sex. When used properly, condoms are about 98% effective.
The greatest benefit of condoms, unlike the other contraceptives we’ve discussed, is that they can protect you against some sexually-transmitted infections (STI), too. And condoms are available over-the-counter; they’re not prescriptions or surgical procedures.
Intrauterine Device (IUD)
- 3.5% of all women in their childbearing years use an IUD.
An IUD is a small device, shaped like a “T,” that is inserted into the uterus. There are two types: copper, like ParaGard, and hormonal, like Mirena and Skyla. Both types change the way sperm move, preventing them from joining with an egg. Hormonal IUDs release progestin, a hormone that can stop eggs from leaving the ovary altogether.
IUDs are extremely effective, more than 99%. They also last really long. Although they have to be implanted by a doctor, intrauterine devices can last as long as 12 years.
Vaginal Ring
- 1.3% of all women use a vaginal ring contraceptive.
NuvaRing, the only brand of vaginal ring, is a small circle that you can insert into your vagina on your own. It releases progestin and estrogin, hormones that stop eggs from leaving the ovary, and must be replaced once a month.
Vaginal rings are about as effective as birth control pills. If used all the time and correctly, they’re around 99% effective.
Which Type Of Birth Control Is Right For Me?
Different birth control methods can make some women feel sick or uncomfortable, while other women feel fine. Speak with your health care provider to learn which contraceptive method is best for you. Keep in mind the following concerns:
Effectiveness
Of the methods we discussed, here’s a list of their effectiveness from most effective to least:
- Sterilization
- IUD
- (TIE) NuvaRing and the Pill
- Male Condoms
Ease of use and access
- Condoms are cheap and available over-the-counter. Many cities run reproductive health programs that offer free condoms, too. Here’s a link to Philadelphia’s Take Control program, which lists 100 places across the city that provide condoms for free.
- Birth control pills require a prescription, so you’ll need a doctor. But after you pick them up, you’ll be set for a whole month.
- NuvaRing is a prescription, but you can put it in yourself.
- An IUD has to be inserted by a health care provider, but it can last for years.
- Vaginal sterilization is a surgical procedure, and recovery can take up to a week.
Price
- Over-the-counter, condoms cost about $1 each. If you had sex twice a week for a year, you’d spend about $104 on condoms.
- Birth control pills can cost up to $50 every month, less if you insurance that covers them. You would end up paying (at most) $600 annually.
- NuvaRing costs up to $80 every month, less if you have health insurance that covers it. Every year, you’d end up paying (at most) $960.
- IUDs cost up to $1,000, less if you have insurance, and you can think of that cost as being spread out over the years that it works.
- Vaginal sterilization can cost as much as $6,000 without an insurance plan that covers the procedure. But if you plan on never having children, it can last forever.
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