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Overview of Contraception


Frances E. Casey

, MD, MPH, Virginia Commonwealth University Medical Center

Last full review/revision May 2020| Content last modified May 2020
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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.

  • Oral contraceptives (OCs): 19%

  • Female permanent contraception (sterilization): 29%

  • Male condoms: 13%

  • Male permanent contraception: 9%

  • Intrauterine devices (IUDs): 12%

  • Withdrawal (coitus interruptus): 6%

  • Progestin injections: 3%

  • Contraceptive rings or patches: 2%

  • Subdermal progestin implants: 4%

  • Fertility awareness methods (periodic abstinence): 2%

  • 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, permanent contraception)

  • About 6 to 9% with hormonal contraceptive methods unrelated to coitus and requiring user involvement (oral contraceptives, progestin injection, transdermal patch, vaginal ring)

  • > 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 diseases (STDs). Most importantly, they help protect against HIV. For most effective contraception, other birth control methods should be used with condoms.


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