Contraception/family planning

• Availability--Can the method be implemented without a prescription; provider visit; or, in the case of minors, parental consent?
• Cost--Is the method affordable for the individual or couple? It may prove helpful to weigh the cost issue with the question of whether the individual or couple could afford an undesired pregnancy.
• Effectiveness--It is important to look at the "user" effectiveness rate ("pearl index") rather than the theoretical effectiveness. This is expressed as number of pregnancies observed in 100 women using that method over a period of one year (pregnancies per 100 women per year of use).
• Health risk--The potential safety of particular methods of contraception should be evaluated for each user. Some methods of birth control may not be good options because of potential health risks (for example, oral contraceptives are usually not recommended for women over 40 years old who also smoke).
• Unplanned pregnancy--The significance of an unplanned pregnancy to the individual or couple should be considered when choosing a method of contraception. If the effect of an unplanned pregnancy is viewed as potentially devastating, a highly effective method should be chosen. In contrast, if a couple is simply trying to postpone pregnancy but feels that a pregnancy could be welcomed if it occurred earlier than planned, a less effective method may be an adequate choice.
• Partner involvement--The willingness of a partner to accept, cooperate in, and be supportive of, a given method of contraception may affect options for birth control. However, one may want to re-examine the choice to initiate or continue a sexual relationship with a partner unwilling to take an active and supportive role in contraception.

• Coitus interruptus--Withdrawal of the penis from the vagina prior to ejaculation. In theory, this method is probably as effective as some more conventional methods. However, in practice, some of the semen frequently escapes prior to full withdrawal. This may be sufficient to initiate a pregnancy. This is an unreliable method.
• Postcoital douche--Douching shortly after intercourse. Because sperm can make their way beyond the cervix within 90 seconds after ejaculation, this method is ineffective and unreliable.
• Breast feeding--It is a fallacy that women do not ovulate and therefore cannot become pregnant while breast feeding. In about 6% of women, ovulation returns with the first cycle after delivery. Women who are breast feeding infants and do not desire another pregnancy at that time need to use a reliable form of contraception. Combination oral contraceptives (estrogens and progestins oral contraceptives); cannot be taken while breast feeding. However the "mini pill" (progestin only) can be taken safely while breast feeding. In addition, Norplant (trademark name), Depo-Provera injections, and all barrier methods of contraception are safe to use while breast feeding.

• Condoms--Thin sheath (preferably latex to also protect from transmission of disease-causing organisms) placed on the penis or, in the case of the female condom, at the opening of the vagina prior to intercourse. Semen is collected inside the condom, which must be carefully maintained in place and then removed after intercourse. Condoms are readily available at low cost in most drug and grocery stores. Some family planning clinics may offer free condoms. About 12 pregnancies occur over 1 year out of 100 couples using this method. Effectiveness is increased when spermicide is also used.
• Vaginal spermicides--Sperm-killing chemical jellies, foams, creams, or suppositories, inserted into the vagina prior to intercourse. This method is readily available; all forms can be purchased in most drug and grocery stores. However, this method used by itself is not very effective. About 21 pregnancies occur over 1 year out of 100 women using this method.
• Diaphragm--Flexible rubber cup that is filled with spermicidal cream or jelly, and then placed into the vagina, over the cervix, prior to intercourse. It should be left in place for 6 to 8 hours after intercourse. Diaphragms must be prescribed by a woman's health care provider, who determines the appropriate type and size of diaphragm for the individual woman. About 18 pregnancies occur over one year in 100 women using this method.
• Vaginal contraceptive sponge--Soft synthetic sponge, saturated with a spermicide, which is moistened and inserted into the vagina, over the cervix, prior to intercourse. It is quite similar to the diaphragm as a barrier mechanism. After intercourse, the sponge should be left in place for 6 to 8 hours. This method is available without a prescription in most drug and grocery stores. About 18 to 28 pregnancies occur over one year out of 100 women using this method.
• Fertility awareness with abstinence ("natural family planning")--This method involves observing a variety of body changes in the woman (such as, cervical mucus changes, basal body temperature changes) and recording them on the calendar in an attempt to determine when ovulation occurs. The couple abstains from unprotected intercourse for several days before and after the assumed day ovulation occurs. This method requires special education and training in recognizing the body's changes as well as a great deal of continuous and committed effort. About 15 to 20 pregnancies occur over 1 year out of 100 women using this method (for women who are properly trained).

• Oral contraceptives (the "pill")--This method utilizes a combination of estrogen and progestin in dose regimens that prevent ovulation and regulate cycles. A health care provider must prescribe oral (by mouth) contraceptives. The method is highly effective if the woman remembers to take her pill consistently at the same time each day. Oral (by mouth) antibiotics may decrease the effectiveness of birth control pills. Therefore, a backup method of contraception should be used while taking antibiotics and until the next menstrual period after completion of the antibiotic. Because of the wide variety of oral contraceptives, women who experience unpleasant side effects on one type of pill are usually able to adjust adequately to a different oral contraceptive. It is important for women who are just starting on "the pill" to maintain adequate communication with their health care provider for optimal "matching" of the type of oral contraceptive to the individual patient. About 2 to 3 pregnancies occur over 1 year out of 100 women using this method.
• Progestin-only oral contraceptive ("The Mini-pill")--This type of birth control pill does not contain any estrogen component. It is therefore an alternative for those women who desire a highly effective method of contraception in a "pill" form but are sensitive to estrogen or cannot take a contraceptive containing estrogen for other reasons (such as breast feeding). The effectiveness of progestin-only oral contraceptives is slightly less than that of the combination type. About 3 to 7 pregnancies occur over a1 year period out of 100 women using this method.
• Progestin implants (such as Norplant, trade name)--Six small progestin-containing rods are implanted surgically beneath the skin, usually under the upper arm, by a woman's health care provider. The rods release a continuous dose of progestin that inhibits ovulation, changes the lining of the uterus, and thickens cervical mucus which may prevent sperm from entering the uterus. The implants provide contraceptive protection for a period of 5 years. Initial expense is several hundred dollars, but the cost may actually be less than buying a package of oral contraceptives every month over the same period of time. The method is highly effective. Less than 1 pregnancy occurs over 1 year out of 100 women using this type of contraception.
• Hormonal injections (such as Depo-Provera)--A progestin injection is ordered by a woman's health care provider and given into the muscular tissue of the upper arm or buttocks. This injection prevents ovulation. A single shot provides contraceptive protection for a period of 90 days. This method is highly effective and does not depend on patient compliance. Less than 1 pregnancy occurs over the course of a year in 100 women using this method.
• Intrauterine contraceptive device (IUD)--A small plastic and copper device, placed inside the woman's uterus by her health care provider, which changes the uterine environment to adequately prevent pregnancy. IUDs may be left in place for several years. The method should not be used by women who have a history of pelvic infection, ectopic pregnancy, or who have more than one sexual partner (and are therefore at higher risk for acquiring sexually transmitted diseases). About 2 to 3 pregnancies occur per year out of 100 women using this method.

• further information is desired regarding contraception (birth control).
• specific methods of contraception, requiring provider prescription or insertion, are desired.
• an episode of unprotected intercourse or method failure (for example, condom breakage) has occurred within the past 24 hours and a possible pregnancy is not desired.