A couple’s decision to begin, prevent, or interrupt a pregnancy may be influenced by many factors including maternal medical disorders, risks involved in the pregnancy, and socioeconomic factors.
Contraception can be used by one or both members of a couple to prevent pregnancy temporarily. Some procedures are intended to provide permanent contraception Permanent Contraception In the US, one third of couples attempting to prevent pregnancy, particularly if the woman is > 30, choose permanent contraception with vasectomy or tubal ligation. Sterilization procedures... read more (sterilization). Abortion Induced Abortion In the US, about half of pregnancies are unintended. About 40% of unintended pregnancies end in induced abortion; 90% of procedures are done during the 1st trimester. In the US, abortion of... read more (interruption of pregnancy) may be considered when contraception has failed or not been used.
Among contraceptive users in the US, the most commonly used methods (1 General reference A couple’s decision to begin, prevent, or interrupt a pregnancy may be influenced by many factors including maternal medical disorders, risks involved in the pregnancy, and socioeconomic factors... read more ) 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%
In the first year of use, pregnancy rates with typical use are
< 1% with methods unrelated to coitus and not requiring user involvement (IUDs, subdermal progestin implants, sterilization)
About 6 to 9% with hormonal contraceptive methods unrelated to coitus and requiring user involvement (estrogen-progestin OCs, transdermal patches, or vaginal rings; progestin-only OCs; progestin injection)
> 10% with coitus-related methods requiring user involvement (eg, condoms, diaphragms, fertility awareness methods, spermicides, withdrawal)
Pregnancy rates tend to be higher during the first year of use and decrease in subsequent years as users become more familiar with the contraceptive method they have chosen. Also, as women age, fertility declines. For fertile couples trying to conceive, the pregnancy rate is about 85% after 1 year if no contraceptive method is used.
Despite the higher pregnancy rate associated with condom use, experts recommend that condoms always be worn during intercourse because condoms (primarily latex and synthetic condoms) protect against sexually transmitted infections (STIs). Most importantly, they help protect against HIV. For most effective contraception, other birth control methods should be used with condoms.
If contraception fails, emergency contraception Emergency Contraception Commonly used emergency contraception regimens include Insertion of a copper-bearing T380A IUD within 5 days of unprotected intercourse Insertion of a 52-mg levonorgestrel-releasing IUD, which... read more may help prevent an unintended pregnancy. Emergency contraception should not be used as a regular form of contraception.
General reference
1. 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 1/15/22.
2. 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
