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). If unprotected sex occurs, emergency contraception may help prevent an unintended pregnancy. Emergency contraception should not be used as a routine form of contraception.Abortion (medical or procedural) may be considered when contraception has failed or has not been used, or when issues occur during the pregnancy.
In a United States survey from 2015-2017 of women ages 15 to 49, 21% were not using any contraceptive method (among non-users, many were seeking pregnancy, pregnant, postpartum, or not sexually active) (1).
Among contraceptive users in the United States, the most commonly used methods (2) are:
Female permanent contraception (sterilization): 18%
Oral contraceptives (OCs): 14%
Long-acting reversible contraception (intrauterine devices, subdermal progestin implants): 10%
Male condoms: 8%
(See table Comparison of Common Contraceptive Methods.)
Various factors influence the efficacy of a contraceptive method to prevent pregnancy, including whether an individual uses the method exactly as intended (ideal use) versus use that varies from instructions (typical use), eg, missing a pill or changing a patch a few days late. 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.
Contraceptive methods vary by how much effort and compliance are required by the individual using the method:
No additional involvement after start of method (except for removal after several years for certain methods): intrauterine devices (IUDs), subdermal progestin implants, sterilization
Need to take doses consistently on a daily, weekly, or every-several-weeks schedule at home or at a health care clinic: estrogen-progestin OCs, transdermal patches, or vaginal rings; progestin-only OCs; progestin injection
Need to use the method around the time of coitus: condoms, diaphragms, fertility awareness methods, spermicides, pH regulator gel
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.
Age and fertility status are also factors. For fertile couples trying to conceive, the pregnancy rate is about 85% after 1 year if no contraceptive method is used. As women age, fertility declines.
Drug interactions with hormonal contraceptives can decrease contraceptive efficacy or alter the therapeutic efficacy of concurrent medications.
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), including estrogen-progestin and progestin alone | 0.3% | 9% | 67% | Pill taken daily Progestin-only pills: Taken at the same time every day | Bloating, breast tenderness, nausea, headache 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 |
Progestin injection (depot medroxyprogesterone acetate)(depot medroxyprogesterone acetate) | 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 | |
Levonorgestrel-releasing Levonorgestrel-releasingintrauterine 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 | |
Contraceptive sponge (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 | |||||
Copper IUD (intrauterine copper contraceptive, see Copper IUD (intrauterine copper contraceptive, seeIUD) | 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 performed in an operating room) | Usually permanent | |
0.15% | Same as perfect use | 100% | Requires a procedure (performed in an office) with a local anesthetic and confirmatory testing 3 months after the procedure | 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 | |||||
References
1. Daniels K, Abma JC. Current Contraceptive Status Among Women Aged 15-49: United States, 2017-2019. NCHS Data Brief. 2020;(388):1-8.
2. 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 July 14, 2025.
