The decision to begin, prevent, or interrupt a pregnancy may be influenced by many factors, including personal, medical, family, and socioeconomic factors.
Contraception can be used by people to prevent pregnancy temporarily or to provide permanent contraception (sterilization). Abortion (interruption of pregnancy) may be considered when contraception has failed or has not been used, or when issues occur during the pregnancy.
Among contraceptive users in the United States, the most commonly used methods (1) are
Oral contraceptives (OCs): 21%
Female permanent contraception (sterilization): 28%
Male condoms: 13%
Male permanent contraception: 9%
Intrauterine devices (IUDs): 13%
Withdrawal (coitus interruptus): 6%
Progestin injections: 3%
Contraceptive rings or patches: 2%
Subdermal progestin implants: 3%
Fertility awareness methods (periodic abstinence): 3%
Female barrier methods: < 1%
(See table Comparison of Common Contraceptive Methods.)
Pregnancy rates tend to be higher during the first year of use of a contraceptive method and decrease in subsequent years as users become more familiar with the method. Also, as women age, fertility declines. By comparison, for fertile couples trying to conceive, the pregnancy rate is about 85% after 1 year if no contraceptive method is used.
In the first year of use, pregnancy rates with typical use are
< 1% for methods that do not require user involvement (IUDs, subdermal progestin implants, sterilization)
6 to 9% (approximately) for hormonal contraceptives that require user involvement but are not related to coitus (estrogen-progestin OCs, transdermal patches, or vaginal rings; progestin-only OCs; progestin injection)
> 10% for coitus-related methods (eg, condoms, diaphragms, fertility awareness methods, spermicides, withdrawal)
Despite the higher pregnancy rate associated with condom use, condoms (primarily latex and synthetic condoms) are highly protective against transmission of sexually transmitted infections (STIs), including HIV. As part of safer sex practices, condoms should be used even when a patient is using another birth control method.
If unprotected sex occurs, emergency contraception may help prevent an unintended pregnancy. Emergency contraception should not be used as a routine form of contraception.
Comparison of Common Contraceptive Methods
Type | Pregnancy Rate in First Year of Use With Perfect Use | Pregnancy Rate in First Year of Use With Typical Use | Percentage of Women Continuing Use at 1 Year | Requirements for Use | Selected Disadvantages |
|---|---|---|---|---|---|
Hormonal | |||||
Oral contraceptives (OCs) | 0.3% | 9% | 67% | Pill taken daily Progestin-only pills: Taken at the same time every day | Bloating, breast tenderness, nausea, headache Combined estrogen-progestin OCs: Increased risk of venous thromboembolism Progestin-only OCs: Irregular bleeding |
Transdermal patch (estrogen, progestin) | 0.3% | 9% | 67% | Weekly application and removal | Similar to OCs Local irritation |
Vaginal ring (estrogen, progestin) | 0.3% | 9% | 67% | Monthly application (inserted vaginally) and removal | Similar to OCs |
0.2% | 6% | 56% | Injection every 3 months | Amenorrhea, irregular bleeding, weight gain, headache, mood changes | |
0.05% | 0.05% | 84% | Implant every 3 years (some evidence supports ovulation suppression to 5 years) | Amenorrhea, irregular bleeding, headache, weight gain | |
intrauterine devices (IUDs) | 0.4% (3-year IUD: 13.5 mg), 0.2% (5-year IUD: 19.5 mg), or 0.2–0.6% (8-year IUD: 52 mg) | Same as perfect use | 78–80% | Insertion every 3, 5, or 8 years (depending on type) | Spontaneous expulsion, uterine perforation (rare) Irregular bleeding, amenorrhea |
Pericoital | |||||
Condom, external (male)* | 2% | 18% | 43% | Used with every episode of sexual intercourse | Allergic reaction |
Condom, internal (female)* | 5% | 21% | 41% | Used with every episode of sexual intercourse | Allergic reaction |
Diaphragm with spermicide | 6% | 12% | 57% | Used with every episode of sexual intercourse May be inserted up to 2 hours before intercourse Should be left in place ≥ 6 hours (and ≤ 24 hours) after intercourse | Occasionally vaginal irritation Increased incidence of urinary tract infections (UTIs) |
Cervical cap with spermicide | 10–13% | 18% (higher among parous women) | N/A | Used with every episode of sexual intercourse May be inserted 15 minutes to 40 hours before intercourse Should be left in the vagina for ≥ 6 hours (and ≤ 48 hours) after intercourse | Possibly vaginal irritation or ulceration if left in place for > 48 hours |
7% | 14% | — | Used within 1 hour before each episode of sexual intercourse | Vulvovaginal burning, itching, urinary tract and yeast infection | |
(containing sustained-release spermicide) | 9% for nulliparous women 20% for parous women | 12% for nulliparous women 24% for parous women | 36% | Used with every episode of sexual intercourse May be inserted ≤ 24 hours before intercourse Must remain in place for ≥ 6 hours after intercourse (should remain in a total of ≤ 30 hours after insertion) | Allergic reaction, vaginal dryness or irritation |
Spermicide alone | 18% | 28% | — | Must be placed in the vagina at least 10 to 30 minutes and no more than 1 hour before each episode of sexual intercourse Because efficacy is limited, often used with other barrier methods | Vaginal burning, irritation, rash, increase in urinary tract infections |
Other | |||||
IUD) | 0.6% | Same as perfect use | 78–80% | Insertion every 10 years | Spontaneous expulsion, uterine perforation (rare) Increased menstrual blood loss, pelvic pain |
Fertility awareness–based methods (periodic abstinence) | 4% or higher, depending on method | 24% | 47% | Training, effort, and multiple steps required for the more effective methods | No likely systemic or significant local adverse effects |
Withdrawal method | 4% | 22% | 46% | Used with each episode of sexual intercourse | Requires cooperative partner |
Permanent contraception (sterilization) | |||||
0.5% | Same as perfect use | 100% | Requires a procedure (typically done in an operating room) | Usually permanent | |
0.15% | Same as perfect use | 100% | Requires a procedure (done in an office) and a local anesthetic | Usually permanent | |
* Condoms, primarily latex and synthetic condoms, protect both partners against sexually transmitted infections. | |||||
N/A = not applicable. | |||||
Data based on Shoupe D: The Contraception Handbook: Evidence Based Practice Recommendations and Rationales, ed. 3. New York, Humana Press, 2020. doi:10.1007/978-3-030-46391-5 | |||||
General reference
1. Centers for Disease Control and Prevention (CDC): National Center for Health Statistics: Current Contraceptive Status Among Women Aged 15–49: United States, 2017–2019. NCHS Data Brief 388, October 2020. Accessed April 16, 2023.
