Comparison of birth control methods: Difference between revisions

Revision as of 00:54, 4 September 2023

Revision as of 03:02, 4 September 2023

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There are many methods of [[birth control]] (or [[Birth control|contraception]]) that vary in requirements, [[Side effect|side effects]], and [[effectiveness]]. As the technology, education, and awareness about contraception has evolved, new contraception methods have been theorized and put in application. Although no method of birth control is ideal for every user, some methods remain more effective, affordable or intrusive than others. Outlined here are the different types of [[Safe sex|barrier methods]], [[Hormonal contraception|hormonal methods]], various methods including [[spermicide]]s, [[Emergency contraception|emergency contraceptives]], and surgical methods<ref name="cdc-2020">{{Cite web|date=2020-08-13|title=Contraception {{!}} Reproductive Health {{!}} CDC|url=https://www.cdc.gov/reproductivehealth/contraception/index.htm|access-date=2021-11-18|website=www.cdc.gov|language=en-us}}</ref> and a comparison between them.

While many methods may prevent conception, only [[Condom|male]] and [[Female condom|female condoms]] are effective in order to preventpreventing [[Sexually transmitted infection|sexually transmitted infections]].

==Methods==

===Hormonal methods===

The [[Intrauterine device|IUD (intrauterine device)]] is a T-shaped device that is inserted into the [[uterus]] by a trained medical professional. There are two different types of IUDs, a: copper or a [[Hormonal intrauterine device|hormonal]] IUD.<ref name="cdc-2020"/> The [[Copper IUDs|copper IUD]] (also known as a copper T intrauterine device) is a non-hormonal option of birth control. It is wrapped in copper which creates a toxic environment for [[sperm]] and eggs, thus preventing pregnancy.<ref>{{Cite web|title=Copper IUD (ParaGard) - Mayo Clinic|url=https://www.mayoclinic.org/tests-procedures/paragard/about/pac-20391270|access-date=2021-11-18|website=www.mayoclinic.org}}</ref> The failure rate of a copper IUD is approximately 0.8% and can prevent pregnancy for up to 10 years. The [[Hormonal IUDs|hormonal IUD]] (also known as levonorgestrel intrauterine system or LNg IUD) releases a small amount of the hormone called [[Progestogen (medication)|progestin]] that can prevent pregnancy for 3–63–8 years with a failure rate of 0.1-0.4%.<ref name="cdc-2020"/> IUDs can be removed by a trained medical professional at any time before the expiration date to allow for pregnancy.

[[Oral contraceptive pill|Oral contraceptives]] are another option, these are commonly known as '[[Combined oral contraceptive pill|the pill]]'. These are prescribed by a doctor and must be taken at the same time every day in order to be the most effective. There are two different options, there is a [[Combined oral contraceptive pill|combined pill]] option that contains both of the hormones [[estrogen]] and [[Progestogen (medication)|progestin]]., The other option isand a progestin-only pill. The failure rate of botheach of these oral contraceptives is 7%.<ref name="cdc-2020"/>

Some choose to get an [[Injection (medicine)|injection]] or a shot in order to prevent [[pregnancy]]. This is an option where a [[Health professional|medical professional]] will inject the hormone [[Progestogen (medication)|progestin]] into a woman's arm or [[buttocks]] every 3 months to prevent pregnancy. The [[failure rate]] is 4%.<ref name="cdc-2020"/>

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===Barrier methods ===

The [[Diaphragm (birth control)|diaphragm]] or [[cervical cap]] is a small shallow cup-like cap that is inserted into the vagina with spermicide to cover the cervix and block sperm from entering the uterus. It is inserted before sexual intercourse and comes in different sizes. It needs to be fitted by a medical professional. It has a failure rate of 17%.<ref name="cdc-2020"/>

A [[Contraceptivecontraceptive sponge|sponge]] canis also be used as aanother contraceptive method. Like the diaphragm, the contraceptive sponge contains [[spermicide]] and is inserted into the vagina and placed over the [[cervix]] to prevent [[sperm]] from entering the [[uterus]]. The sponge must be kept in place 6 hours after sexual intercourse before it can be removed and discarded. The failure rate for women who have had a baby before is 27%; Forfor those who have not had a baby, the failure rate is 14%.<ref name="cdc-2020"/>

The [[Condom|male condom]] is typically made of [[latex]] (but other materials are available, such as [[Lambskin condom|lambskin]], toif avoideither partner has a [[Latexlatex allergy|allergies]]). The male condom is placed over the male's penis and prevents the sperm from entering the partner's body. It can prevent pregnancy, and STDs such as, but not limited to, HIV if used appropriately. Male condoms can only be used once and are easily accessible at local stores in most countries. The failure rate is 13%.<ref name="cdc-2020"/>

The [[female condom]] is worn by the woman; it is inserted into the vagina and prevents the sperm from entering her body. It can help prevent [[Sexually transmitted infection|STDs]] and can be inserted up to 8 hours before intercourse. The failure rate is 21%.<ref name="cdc-2020"/>

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===Other methods===

[[Spermicide]]s come in various forms such as: gels, foams, creams, film, suppositories, or tablets. The spermicides create an environment in which sperm can no longer live;. they areThough typically used in addition to the male condom, diaphragm, or cervical cap., Theythey can also be used by themselves. byThey puttingare themput into the vagina no more than an hour before intercourse and kept inside the vagina for 6–8 hours after intercourse. The failure rate is 21%.<ref name="cdc-2020"/>

In the [[fertility awareness-based method]] a woman who has a predictable and consistent menstrual cycle tracks the days that she is fertile. The typical woman has approximately 9 [[Fertility|fertile]] days a month and either avoids intercourse on those days or uses an alternative birth control method for that period of time. The failure rate is between 2-23%.<ref name="cdc-2020" />

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[[Lactational amenorrhea]] (LAM) is an option for women who have had a baby within the past 6 months and are breastfeeding. This method is only successful if it has been less than 6 months since the birth of the baby, they must be fully breastfeeding their baby, and not having any periods.<ref name="cdc-2020" /> The method is almost as effective as an oral contraceptive if the 3 conditions are strictly followed.<ref>{{Cite web|title=Breastfeeding as Birth Control {{!}} Information About LAM|url=https://www.plannedparenthood.org/learn/birth-control/breastfeeding|access-date=2021-11-18|website=www.plannedparenthood.org|language=en}}</ref>

The '[[Coitus interruptus|pull out method]]' or [[coitus interruptus]] is a method where the male will remove his penis from the vagina before ejaculating; [[Fertilisation|this prevents [[Fertilisation|sperm from reaching the egg]] and can prevent pregnancy]]. This method has to be done correctly every time and is best if used in addition to other forms of birth control in order to prevent pregnancy. It has a failure rate of approximately 22%.<ref>{{Cite web|title=What is the Effectiveness of the Pull-Out Method?|url=https://www.plannedparenthood.org/learn/birth-control/withdrawal-pull-out-method/how-effective-is-withdrawal-method-pulling-out|access-date=2021-11-18|website=www.plannedparenthood.org|language=en}}</ref>

===Emergency contraceptives===

A [[Copper IUDs|copper IUD]] can be used as an [[Emergency contraception|emergency contraceptive]] as long as it is inserted within 5 days ofafter intercourse.<ref name="cdc-2020" />

There are two different types of [[Emergency contraception|emergency contraceptive pills]], one contains [[ulipristal acetatelevonorgestrel]] and can prevent pregnancy if taken within 53 days of intercourse. The other contains [[levonorgestrelulipristal acetate]] and can prevent pregnancy if taken within 35 days of intercourse. This option can be used if other birth control methods fail.<ref>{{Cite web|title=What Kind of Emergency Contraception Is Best For Me?|url=https://www.plannedparenthood.org/learn/morning-after-pill-emergency-contraception/which-kind-emergency-contraception-should-i-use|access-date=2021-11-18|website=www.plannedparenthood.org|language=en}}</ref>

Use of an emergency contraceptive should occur as soon as possible after unprotected sexual intercourse to reduce the chance of pregnancy.

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===Surgical methods===

[[Tubal ligation]] is also known as 'tying tubes'. This is the surgical process that awhere medical professional performs. This is done by closingcloses or tyingties the fallopian tubes in order to prevent sperm from reaching the eggs. This is often done as an [[outpatient surgical procedure]] and is effective immediately after it is performed. The failure rate is 0.5%.<ref name="cdc-2020" />

A [[vasectomy]] is a minor surgical procedure where a doctor will cut the [[vas deferens]] and seal the ends to prevent sperm from reaching the penis and ultimately the egg. The method is usually successful after 12 weeks post-procedure or untilwhen the sperm count is zero. The failure rate is 0.15%.<ref name="cdc-2020" />

==User dependence==

Different methods require different levels of diligence by users. Methods with little or nothing to do or remember, or that require a clinic visit less than once per year are said to be ''non-user dependent'', ''forgettable,'' or ''top-tier'' methods.<ref name="Hatcher20th">{{cite book |editor1-last=Hatcher |editor1-first=Robert A. |editor2-first=James |editor2-last=Trussell |editor3-first=Anita L. |editor3-last=Nelson | name-list-style = vanc |title=Contraceptive Technology |publisher=Ardent Media |___location=New York |year=2011 |edition=20th |isbn=978-1-59708-004-0}}{{page needed|date=June 2012}}</ref> Intrauterine methods, implants, and sterilization fall into this category.<ref name="Hatcher20th" /> For methods that are not user dependent, the actual and perfect-use failure rates are very similar.

Many hormonal methods of birth control, and LAM require a moderate level of thoughtfulness. For many hormonal methods, clinic visits must be made every three months to a year to renew the prescription. The pill must be taken every day, the patch must be reapplied weekly, or the ring must be replaced monthly. Injections are required every 12 weeks. The rules for LAM must be followed every day. Both LAM and hormonal methods provide a reduced level of protection against pregnancy if they are occasionally used incorrectly (rarely going longer than 4–6 hours between breastfeeds, a late pill or injection, or forgetting to replace a patch or ring on time). The actual failure rates for LAM and hormonal methods are somewhat higher than the perfect-use failure rates.{{citation needed|date=September 2023}}

Higher levels of user commitment are required for other methods.<ref name=WHOTable>{{cite report|title = Helping women understand contraceptive effectiveness | first1 = Kathleen Henry | last1 = Shears | first2 = Kerry Wright | last2 = Aradhya | name-list-style = vanc | url = http://www.fhi.org/NR/rdonlyres/eoabicg5w53xarcybsiefba5ruvr6r2dnkws7vj2hr3ndzv225gkvw2oxtkdlxzcl5yr3q3iok4kid/Mera08091.pdf | date = July 2008 | publisher = Family Health International}}</ref> Barrier methods, coitus interruptus, and spermicides must be used at every act of intercourse. Fertility awareness-based methods may require daily tracking of the menstrual cycle. The actual failure rates for these methods may be much higher than the perfect-use failure rates.<ref name="trussell2007body">{{cite book |last=Trussell |first=James |editor1-last=Hatcher |editor1-first=Robert A. |editor2-first=James |editor2-last=Trussell |editor3-first=Anita L. |editor3-last=Nelson |name-list-style=vanc |year=2007 |chapter=Contraceptive Efficacy |title=Contraceptive Technology |edition=19th |___location=New York |publisher=Ardent Media |isbn=978-0-9664902-0-6 |chapter-url=http://www.contraceptivetechnology.org/table.html |url-access=registration |url=https://archive.org/details/contraceptivetec00hatc }}{{page needed|date=June 2012}}</ref><!-- NOTE: This reference is to the same work as is referred to in the table, but the table has a separate reference list, so do not remove the body of this reference -->

==Side effects==

Different forms of birth control have different potential side effects. Not all, or even most, users will experience side effects from a method. The less effective the method, the greater the risk of pregnancy, and the side effects associated with pregnancy.

Minimal or no other side effects are possibleoccur with coitus interruptus, fertility awareness-based, and LAM. Some forms of periodic abstinence encourage examination of the cervix; insertion of the fingers into the vagina to perform this examination may cause changes in the vaginal environment. Following the rules for LAM may delay a woman's first post-partum menstruation beyond what would be expected from different breastfeeding practices.{{citation needed|date=April 2022}}

The less effective the method, the greater the risk of the side effects associated with pregnancy.

Barrier methods have a risk of allergic reactions. Users sensitive to latex may use barriers made of less allergenic materials - polyurethane condoms, or silicone diaphragms, for example. Barrier methods are also often combined with spermicides, which have possible side effects of genital irritation, vaginal infection, and urinary tract infection.{{citation needed|date=April 2022}}

Minimal or no other side effects are possible with coitus interruptus, fertility awareness-based, and LAM. Some forms of periodic abstinence encourage examination of the cervix; insertion of the fingers into the vagina to perform this examination may cause changes in the vaginal environment. Following the rules for LAM may delay a woman's first post-partum menstruation beyond what would be expected from different breastfeeding practices.{{citation needed|date=April 2022}}

-->Sterilization procedures are generally considered to have a low risk of side effects, though some persons and organizations disagree.<ref>{{cite web |last=Bloomquist |first=Michele | name-list-style = vanc | title = Getting Your Tubes Tied: Is this common procedure causing uncommon problems? | work = MedicineNet.com |publisher=WebMD |date=May 2000 |url=http://www.medicinenet.com/script/main/art.asp?articlekey=51216 |access-date=2006-09-25 }}</ref><ref>{{cite web |last=Hauber |first=Kevin C. | name-list-style = vanc |title=If It Works, Don't Fix It! |url=http://www.dontfixit.org/ |access-date=2006-09-25 }}{{MEDRS|date=September 2012}}</ref> Female sterilization is a more significant operation than vasectomy, and has greater risks; in industrialized nations, mortality is 4 per 100,000 tubal ligations, versus 0.1 per 100,000 vasectomies.<ref>{{cite journal | vauthors = Awsare NS, Krishnan J, Boustead GB, Hanbury DC, McNicholas TA | title = Complications of vasectomy | journal = Annals of the Royal College of Surgeons of England | volume = 87 | issue = 6 | pages = 406–10 | date = November 2005 | pmid = 16263006 | pmc = 1964127 | doi = 10.1308/003588405X71054 }}</ref>

Barrier methods have a risk of allergic reactions. Users sensitive to latex may use barriers made of less allergenic materials - polyurethane condoms, or silicone diaphragms, for example. Barrier methods are also often combined with spermicides, which have possible side effects of genital irritation, vaginal infection, and urinary tract infection.

Sterilization procedures are generally considered to have a low risk of side effects, though some persons and organizations disagree.<!--

--><ref>{{cite web |last=Bloomquist |first=Michele | name-list-style = vanc | title = Getting Your Tubes Tied: Is this common procedure causing uncommon problems? | work = MedicineNet.com |publisher=WebMD |date=May 2000 |url=http://www.medicinenet.com/script/main/art.asp?articlekey=51216 |access-date=2006-09-25 }}</ref><ref>{{cite web |last=Hauber |first=Kevin C. | name-list-style = vanc |title=If It Works, Don't Fix It! |url=http://www.dontfixit.org/ |access-date=2006-09-25 }}{{MEDRS|date=September 2012}}</ref> Female sterilization is a more significant operation than vasectomy, and has greater risks; in industrialized nations, mortality is 4 per 100,000 tubal ligations, versus 0.1 per 100,000 vasectomies.<ref>{{cite journal | vauthors = Awsare NS, Krishnan J, Boustead GB, Hanbury DC, McNicholas TA | title = Complications of vasectomy | journal = Annals of the Royal College of Surgeons of England | volume = 87 | issue = 6 | pages = 406–10 | date = November 2005 | pmid = 16263006 | pmc = 1964127 | doi = 10.1308/003588405X71054 }}</ref>

After IUD insertion, users may experience irregular periods in the first 3–6 months with Mirena, and sometimes heavier periods and worse menstrual cramps with ParaGard. However, continuation rates are much higher with IUDs compared to non-long-acting methods.<ref>{{Cite journal|last=Committee on Practice Bulletins-Gynecology, Long-Acting Reversible Contraception Work Group|date=November 2017|title=Practice Bulletin No. 186: Long-Acting Reversible Contraception: Implants and Intrauterine Devices|url=https://www.ncbi.nlm.nih.gov/pubmed/29064972|journal=Obstetrics and Gynecology|volume=130|issue=5|pages=e251–e269|doi=10.1097/AOG.0000000000002400|issn=1873-233X|pmid=29064972|s2cid=35477591 }}</ref> A positive characteristic of IUDs is that fertility and the ability to become pregnant returns quickly once the IUD is removed.<ref name="plannedparenthood.org">{{cite web|url=http://www.plannedparenthood.org/health-topics/birth-control/iud-4245.htm|title=Planned Parenthood IUD Birth Control - Mirena IUD - ParaGard IUD|access-date=2012-02-26}}</ref>

Because of their systemic nature, hormonal methods have the largest number of possible side effects.<ref>{{cite web |last=Staff |first=Healthwise. |title=Advantages and Disadvantages of Hormonal Birth Control |url=http://healthlinksbc.org/kb/content/frame/tw9513.html |access-date=2010-07-06 }}</ref> Combined hormonal contraceptives contain estrogen and progestin hormones.<ref name="teal-2021">{{Cite journal |last1=Teal |first1=Stephanie |last2=Edelman |first2=Alison |date=2021-12-28 |title=Contraception Selection, Effectiveness, and Adverse Effects: A Review |url=https://jamanetwork.com/journals/jama/fullarticle/2787541 |journal=JAMA |language=en |volume=326 |issue=24 |pages=2507–2518 |doi=10.1001/jama.2021.21392|pmid=34962522 |s2cid=245557522 |issn=0098-7484|doi-access=free }}</ref> They can come in formulations such as pills, vaginal rings, and transdermal patches.<ref name="teal-2021" /> Most people who use combined hormonal contraception experience breakthrough bleeding within the first 3 months.<ref name="teal-2021" /> Other common side effects include headaches, breast tenderness, and changes in mood.<ref name="barr-2020">{{Cite journal |last=Barr |first=Nancy Grossman |date=December 15, 2020 |title=Managing Adverse Effects of Hormonal Contraceptives |url=https://www.aafp.org/afp/2010/1215/afp20101215p1499.pdf |journal=American Family Physician |volume=82 |issue=12 |pages=1499–1506 |pmid=21166370 |via=American Academy of Family Physicians}}</ref> Side effects from hormonal contraceptives typically disappear over time (3-5 months) with consistent use.<ref name="barr-2020" /> Less common effects of combined hormonal contraceptives include increasing the risk of deep vein thrombosis to 2 to -10 per 10 ,000 women per year and venous thrombotic events (see [[venous thrombosis]]) to 7 to -10 per 10,000 women per year.<ref name="teal-2021" />

Because of their systemic nature, hormonal methods have the largest number of possible side effects.<ref>{{cite web |last=Staff |first=Healthwise. |title=Advantages and Disadvantages of Hormonal Birth Control |url=http://healthlinksbc.org/kb/content/frame/tw9513.html |access-date=2010-07-06 }}</ref>

Combined hormonal contraceptives contain estrogen and progestin hormones.<ref name="teal-2021">{{Cite journal |last1=Teal |first1=Stephanie |last2=Edelman |first2=Alison |date=2021-12-28 |title=Contraception Selection, Effectiveness, and Adverse Effects: A Review |url=https://jamanetwork.com/journals/jama/fullarticle/2787541 |journal=JAMA |language=en |volume=326 |issue=24 |pages=2507–2518 |doi=10.1001/jama.2021.21392|pmid=34962522 |s2cid=245557522 |issn=0098-7484|doi-access=free }}</ref> They can come in formulations such as pills, vaginal rings, and transdermal patches.<ref name="teal-2021" /> Most people who use combined hormonal contraception experience breakthrough bleeding within the first 3 months.<ref name="teal-2021" /> Other common side effects include headaches, breast tenderness, and changes in mood.<ref name="barr-2020">{{Cite journal |last=Barr |first=Nancy Grossman |date=December 15, 2020 |title=Managing Adverse Effects of Hormonal Contraceptives |url=https://www.aafp.org/afp/2010/1215/afp20101215p1499.pdf |journal=American Family Physician |volume=82 |issue=12 |pages=1499–1506 |pmid=21166370 |via=American Academy of Family Physicians}}</ref> Side effects from hormonal contraceptives typically disappear over time (3-5 months) with consistent use.<ref name="barr-2020" /> Less common effects of combined hormonal contraceptives include increasing the risk of deep vein thrombosis to 2 to 10 per 10 000 women per year and venous thrombotic events (see [[venous thrombosis]]) to 7 to 10 per 10,000 women per year.<ref name="teal-2021" />

Hormonal contraceptives can come in multiple forms including injectables. Depot medroxyprogesterone acetate (DMPA), a progestin-only injectable, has been found to cause [[amenorrhea]] (cessation of menstruation); however, the irregular bleeding pattern returns to normal over time.<ref name="teal-2021" /><ref name="barr-2020" /> DMPA has also been associated with weight gain.<ref name="barr-2020" /> Other side effects more commonly associated with progestin-only products include [[acne]] and [[hirsutism]].<ref name="barr-2020" /> Compared to combined hormonal contraceptives, progestin-only contraceptives typically produce a more regular bleeding pattern.<ref name="teal-2021" />

===Sexually transmitted disease prevention===

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[[condom|Male]] and [[female condom]]s provide significant protection against [[sexually transmitted disease]]s (STDs) when used consistently and correctly. They also provide some protection against [[cervical cancer]].<ref>{{cite journal | vauthors = Winer RL, Hughes JP, Feng Q, O'Reilly S, Kiviat NB, Holmes KK, Koutsky LA | title = Condom use and the risk of genital human papillomavirus infection in young women | journal = The New England Journal of Medicine | volume = 354 | issue = 25 | pages = 2645–54 | date = June 2006 | pmid = 16790697 | doi = 10.1056/NEJMoa053284 | doi-access = free }}</ref><ref name="Hogewoning2003">{{cite journal | vauthors = Hogewoning CJ, Bleeker MC, van den Brule AJ, Voorhorst FJ, Snijders PJ, Berkhof J, Westenend PJ, Meijer CJ | title = Condom use promotes regression of cervical intraepithelial neoplasia and clearance of human papillomavirus: a randomized clinical trial | journal = International Journal of Cancer | volume = 107 | issue = 5 | pages = 811–6 | date = December 2003 | pmid = 14566832 | doi = 10.1002/ijc.11474 | doi-access = free }}</ref> Condoms are often recommended as an adjunct to more effective birth control methods (such as [[IUD]]) in situations where STD protection is also desired.<ref name=DualProtection>{{cite journal | vauthors = Cates W, Steiner MJ | title = Dual protection against unintended pregnancy and sexually transmitted infections: what is the best contraceptive approach? | journal = Sexually Transmitted Diseases | volume = 29 | issue = 3 | pages = 168–74 | date = March 2002 | pmid = 11875378 | doi = 10.1097/00007435-200203000-00007 | s2cid = 42792667 | doi-access = free }}</ref>

Other barrier methods, such as [[Diaphragm (contraceptive)|diaphragms]] may provide limited protection against infections in the upper genital tract. Other methods provide little or no protection against sexually transmitted diseases.{{Citation needed|date=September 2023}}

==Effectiveness==

===Cost and cost-effectiveness===

Family planning is among the most cost-effective of all health interventions.<ref name=Tsui>{{cite journal |author1-link=Amy Tsui| vauthors = Tsui AO, McDonald-Mosley R, Burke AE | title = Family planning and the burden of unintended pregnancies | journal = Epidemiologic Reviews | volume = 32 | issue = 1 | pages = 152–74 | year = 2010 | pmid = 20570955 | pmc = 3115338 | doi = 10.1093/epirev/mxq012 }}</ref> Costs of contraceptives include method costs (including supplies, office visits, training), cost of method failure ([[ectopic pregnancy]], [[Miscarriage|spontaneous abortion]], induced abortion, birth, child care expenses) and cost of side effects.<ref name=Trussell2009>{{cite journal | vauthors = Trussell J, Lalla AM, Doan QV, Reyes E, Pinto L, Gricar J | title = Cost effectiveness of contraceptives in the United States | journal = Contraception | volume = 79 | issue = 1 | pages = 5–14 | date = January 2009 | pmid = 19041435 | pmc = 3638200 | doi = 10.1016/j.contraception.2008.08.003 }}</ref> Contraception saves money by reducing [[unintended pregnancy|unintended pregnancies]] and reducing transmission of [[sexually transmitted infection]]s. By comparison, in the US, method related costs vary from nothing to about $1,000 for a year or more offor reversible contraception.

During the initial five years, vasectomy is comparable in cost to the IUD. Vasectomy is much less expensive and safer than tubal ligation. Since ecological breastfeeding and fertility awareness are behavioral they cost nothing or a small amount upfront for a thermometer or training. Fertility awareness based methods can be used throughout a woman's reproductive lifetime.{{Citation needed|date=September 2023}}

Not using contraceptives is the most expensive option. While in that case there are no method related costs, it has the highest failure rate, and thus the highest failure related costs. Even if one only considers medical costs relating to preconception care and birth, any method of contraception saves money compared to using no method.{{Citation needed|date=September 2023}}

Since ecological breastfeeding and fertility awareness are behavioral they cost nothing or a small amount upfront for a thermometer and / or training. Fertility awareness based methods can be used throughout a woman's reproductive lifetime.

The most effective and the most cost-effective methods are long-acting methods. Unfortunately these methods often have significant up-front costs, and requiring the user to pay a portion of these costs prevents some from using more effective methods.<ref name=Cleland>{{cite journal | vauthors = Cleland K, Peipert JF, Westhoff C, Spear S, Trussell J | title = Family planning as a cost-saving preventive health service | journal = The New England Journal of Medicine | volume = 364 | issue = 18 | pages = e37 | date = May 2011 | pmid = 21506736 | doi = 10.1056/NEJMp1104373 }}</ref> Contraception saves money for the public health system and insurers.<ref>{{Cite journal|last1=Jennifer J. Frost|last2=Lawrence B. Finer|last3=Athena Tapales|date=2008|title=The Impact of Publicly Funded Family Planning Clinic Services on Unintended Pregnancies and Government Cost Savings|url=http://muse.jhu.edu/content/crossref/journals/journal_of_health_care_for_the_poor_and_underserved/v019/19.3.frost.html|journal=Journal of Health Care for the Poor and Underserved|language=en|volume=19|issue=3|pages=778–796|doi=10.1353/hpu.0.0060|pmid=18677070|s2cid=14727184|issn=1548-6869}}</ref>{{Relevance inline|date=September 2023}}

Not using contraceptives is the most expensive option. While in that case there are no method related costs, it has the highest failure rate, and thus the highest failure related costs. Even if one only considers medical costs relating to preconception care and birth, any method of contraception saves money compared to using no method.

The most effective and the most cost-effective methods are long-acting methods. Unfortunately these methods often have significant up-front costs, requiring the user to pay a portion of these costs prevents some from using more effective methods.<ref name=Cleland>{{cite journal | vauthors = Cleland K, Peipert JF, Westhoff C, Spear S, Trussell J | title = Family planning as a cost-saving preventive health service | journal = The New England Journal of Medicine | volume = 364 | issue = 18 | pages = e37 | date = May 2011 | pmid = 21506736 | doi = 10.1056/NEJMp1104373 }}</ref> Contraception saves money for the public health system and insurers.<ref>{{Cite journal|last1=Jennifer J. Frost|last2=Lawrence B. Finer|last3=Athena Tapales|date=2008|title=The Impact of Publicly Funded Family Planning Clinic Services on Unintended Pregnancies and Government Cost Savings|url=http://muse.jhu.edu/content/crossref/journals/journal_of_health_care_for_the_poor_and_underserved/v019/19.3.frost.html|journal=Journal of Health Care for the Poor and Underserved|language=en|volume=19|issue=3|pages=778–796|doi=10.1353/hpu.0.0060|pmid=18677070|s2cid=14727184|issn=1548-6869}}</ref>

===Effectiveness calculation===

Failure rates may be calculated by either the [[Pearl Index]] or a [[decrement table|life table method]]. A "perfect-use" rate is where anyall rules of the method are rigorously followed, and (if applicable) the method is used atfor every act of intercourse.

Actual failure rates are higher than perfect-use rates for a variety of reasons:

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In the '''user action required''' column, items that are ''non-user dependent'' (require action once per year or less) also have a blue background.

Some methods may be used simultaneously for higher effectiveness rates. For example, using condoms with spermicides the estimated perfect use failure rate would be comparable to the perfect use failure rate of the implant.<ref name="Hatcher20th" /> However, mathematically combining the rates to estimate the effectiveness of combined methods can be inaccurate, as the effectiveness of each method is not necessarily independent, except in the perfect case.<ref>{{cite journal | vauthors = Kestelman P, Trussell J | title = Efficacy of the simultaneous use of condoms and spermicides | journal = Family Planning Perspectives | volume = 23 | issue = 5 | pages = 226–7, 232 | year = 1991 | pmid = 1743276 | doi = 10.2307/2135759 | jstor = 2135759 }}</ref>

If a method is known or suspected to have been ineffective, such as a condom breaking, or a method could not be used, as is the case for [[rape]] when user action is required for every act of intercourse, [[emergency contraception]] (ECP) may be taken up to 72 to 120 hours after [[sexual intercourse]]. Emergency contraception should be taken shortly before or as soon after intercourse as possible, as its efficacy decreases with increasing delay. Although ECP is considered an emergency measure, levonorgestrel ECP taken shortly before sexual intercourse may be used as a primary method for women who have sexual intercourse only a few times a year and want a hormonal method, but don’tdon't want to take hormones all the time.<ref name=shelton>{{cite journal | vauthors = Shelton JD | title = Repeat emergency contraception: facing our fears | journal = Contraception | volume = 66 | issue = 1 | pages = 15–7 | date = July 2002 | pmid = 12169375 | doi = 10.1016/S0010-7824(02)00313-X | url = https://zenodo.org/record/1259569 }}</ref> The failure rate of repeated or regular use of LNG ECP is similar to the rate for those using a barrier method.<ref name="WHO ECP Effectiveness">{{cite journal | title = Efficacy and side effects of immediate postcoital levonorgestrel used repeatedly for contraception. United Nations Development Programme/ United Nations Population Fund/World Health Organization/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction, Task Force on Post-Ovulatory Methods of Fertility Regulation. [e-mail] | journal = Contraception | volume = 61 | issue = 5 | pages = 303–8 | date = May 2000 | pmid = 10906500 | doi = 10.1016/S0010-7824(00)00116-5 }}</ref><!-- Please make a proposal and discussion on the talk page

before making major changes to the table (e.g. adding or removing methods). -->

<!--

This table lists the [[force of mortality|rate of pregnancy]] during the first year of use.<!--

User action required - frequency action is required to employ the method.

Sorting - larger is less frequent.

Line 149 ⟶ 140:

{| class="wikitable sortable"

This table lists the|+ [[force of mortality|rateRate of pregnancy]] during the first year of use.<!--

|-

! Birth control method !! class=unsortable|Brand/common name !! Typical-use failure rate (%) !! Perfect-use failure rate (%) !! Type !! Implementation !! User action required

|-

| [[Contraceptive implant]]

| [[Implanon]]/Nexplanon,<ref name="trussell2011" /> [[Jadelle]],<ref>{{cite journal | vauthors = Sivin I, Campodonico I, Kiriwat O, Holma P, Diaz S, Wan L, Biswas A, Viegas O, el din Abdalla K, Anant MP, Pavez M, Stern J | title = The performance of levonorgestrel rod and Norplant contraceptive implants: a 5 year randomized study | journal = Human Reproduction | volume = 13 | issue = 12 | pages = 3371–8 | date = December 1998 | pmid = 9886517 | doi = 10.1093/humrep/13.12.3371 | display-authors = 8 | doi-access = free }}</ref> the implant || style="background:#e0ffff" |{{sort|000.05|0.05}} <br />(1 ofin 2000) || style=background:#e0ffff | {{sort|000.05|0.05}} <br />(1 in 2000) || Progestogen || Subdermal implant || style=background:#e0ffff| {{sort | 03.000 | 3-5 years}}

|-

| [[Vasectomy]]<ref name=trussell2011/>

| Male sterilization || style="background:#e0ffff" | {{sort|000.15|0.15}} <br />(1 ofin 666) || style=background:#e0ffff | {{sort|000.10|0.1}} <br />(1 in 1000) || Sterilization || Surgical procedure ||style=background:#e0ffff| {{sort | 98.000 | Once}}

|-

| [[Combined injectable contraceptive|Combined injectable]]<ref>{{cite web |title=FDA Approves Combined Monthly Injectable Contraceptive |work=The Contraception Report |publisher=Contraception Online |date=June 2001 |url=http://www.contraceptiononline.org/contrareport/article01.cfm?art=176 |access-date=2008-04-13 |archive-url = https://web.archive.org/web/20071018054424/http://contraceptiononline.org/contrareport/article01.cfm?art=176 |archive-date = October 18, 2007}}</ref>

| Lunelle, Cyclofem || style=background:#e0ffff | {{sort|000.20|0.2}} <br />(1 ofin 500) || style=background:#e0ffff | {{sort|000.20|0.2}} <br />(1 in 500) || Estrogen +& progestogen || Injection || {{sort | 00.100 | Monthly}}

|-

| [[IUD with progestogen]]<ref name=trussell2011/>

| Mirena, Skyla, Liletta || style=background:#e0ffff | {{sort|000.20|0.2}} <br />(1 ofin 500)|| style=background:#e0ffff | {{sort|000.20|0.2}}<br />(1 in 500) || Intrauterine & progestogen || Intrauterine ||style=background:#e0ffff| {{sort | 05.000 | 3-7 years}}

|-

| {{color|gray|[[Essure]] (removed from markets)}}<ref>{{cite web|url=https://www.fda.gov/cdrh/pdf2/p020014.html |title=Essure System - P020014 |publisher=[[United States Food and Drug Administration]] Center for Devices and Radiological Health |url-status=dead |archive-url=https://web.archive.org/web/20081204184301/https://www.fda.gov/cdrh/pdf2/p020014.html |archive-date=2008-12-04 }}</ref>

| femaleFemale sterilization || style=background:#e0ffff | {{sort|000.26|0.26}} <br />(1 ofin 384) || style=background:#e0ffff | {{sort|000.26|0.26}} <br />(1 in 384) || Sterilization || Surgical procedure || style=background:#e0ffff| {{sort | 98.000 | Once}}

|-

| [[Tubal ligation]]<ref name=trussell2011/>

| Tube tying, female sterilization || style=background:#e0ffff | {{sort|000.50|0.5}} <br />(1 ofin 200) || style=background:#e0ffff | {{sort|000.50|0.5}} <br />(1 in 200) || Sterilization || Surgical procedure ||style=background:#e0ffff| {{sort | 98.000 | Once}}

|-

| Bilateral [[salpingectomy]]<ref>{{cite journal |last1=Castellano |first1=Tara |last2=Zerden |first2=Matthew |last3=Marsh |first3=Laura |last4=Boggess |first4=Kim |title=Risks and Benefits of Salpingectomy at the Time of Sterilization |journal=Obstetrical & Gynecological Survey |date=November 2017 |volume=72 |issue=11 |pages=663–668 |doi=10.1097/OGX.0000000000000503|pmid=29164264 }}</ref>

| Tube removal, "bisalp" || style=background:#e0ffff | {{sort|000.75|0.75}} (1 ofin 133) after 10 years<ref group="note">No data for 1 year failure rates</ref> || style=background:#e0ffff | {{sort|000.75|0.75}} after 10 years || Sterilization || Surgical procedure || style=background:#e0ffff | {{sort| 98.000 | Once}}

|-

| [[IUD with copper]]<ref name=trussell2011/>

| [[Paragard]], Copper T, the coil || style=background:#e0ffff | {{sort|000.80|0.8}} <br />(1 ofin 125) || style=background:#e0ffff | {{sort|000.60|0.6}}<br />(1 in 167) || Intrauterine & copper || Intrauterine ||style=background:#e0ffff| {{sort | 05.100 | 3 to 12+ years}} <!-- sort longer than 5 years -->

|-

| Forschungsgruppe NFP symptothermal method, teaching sessions + application<ref name=trussell2011/><ref name=pmid17314078>{{cite journal | vauthors = Frank-Herrmann P, Heil J, Gnoth C, Toledo E, Baur S, Pyper C, Jenetzky E, Strowitzki T, Freundl G | title = The effectiveness of a fertility awareness based method to avoid pregnancy in relation to a couple's sexual behaviour during the fertile time: a prospective longitudinal study | journal = Human Reproduction | volume = 22 | issue = 5 | pages = 1310–9 | date = May 2007 | pmid = 17314078 | doi = 10.1093/humrep/dem003 | display-authors = 8 | doi-access = free }}</ref>

| Sensiplan by Arbeitsgruppe NFP ([[Malteser International|Malteser Germany]] gGmbh) || style=background:#e0ffe0 | {{sort|001.68|1.68}} <br />(1 of 60) || style=background:#e0ffff | {{sort|000.43|0.43}}<br /> (1 ofin 233)}} || Behavioral || Teaching sessions, observation, charting and evaluating a combination of fertility symptoms|| {{sort | 00.006 | Three teaching sessions + daily application}}

|-

| [[Lactational amenorrhea method|LAM]] for 6 months only; not applicable if menstruation resumes<ref name=trussell2007/><ref group=note>The pregnancy rate applies until the user reaches six months postpartum, or until menstruation resumes, whichever comes first. If menstruation occurs earlier than six months postpartum, the method is no longer effective. For users for whom menstruation does not occur within the six months: after six months postpartum, the method becomes less effective.</ref>

| Ecological breastfeeding || style="background:#e0ffe0" | {{sort|002.00|2}} <br />(1 ofin 50) || style=background:#e0ffff | {{sort|000.50|0.5}} <br />(1 in 200) || Behavioral || Breastfeeding || {{sort | 00.004 | Every few hours}}

|-

| {{color|gray|2002<ref name=leaapproval>{{cite journal|url=https://www.popline.org/node/266385|title=FDA approves Leas Shield.|date=1 June 2002|journal=Contraception Report|volume=13|issue=2|access-date=10 December 2017|archive-url=https://web.archive.org/web/20171211053439/https://www.popline.org/node/266385|archive-date=11 December 2017|url-status=dead}}</ref> cervical cap and [[spermicide]] used by nulliparous (discontinued in 2008) used by nulliparous}}<ref name=lea/><ref name=lea group=note/><ref name=nulliparous group=note/>

| [[Lea's Shield]] || style=background:#e0ffe0 | {{sort|005.00|5}} <br />(1 ofin 20) || style=background:#dcdcdc | {{sort|100.00|no data}} || Barrier +& spermicide || Vaginal insertion || {{sort | 00.030 | Every act of intercourse}}

|-

| [[Medroxyprogesterone acetate|MPA]] shot<ref name="ReferenceA">http://www.contraceptivetechnology.org/wp-content/uploads/2013/09/Contraceptive-Failure-Rates.pdf {{Bare URL PDF|date=March 2022}}</ref>

| [[Depo Provera]], the shot || style="background:#ffffc0" | {{sort|004.00|4}} <br />(1 ofin 25) || style=background:#e0ffff | {{sort|000.20|0.2}}<br />(1 in 500) || Progestogen || Injection || {{sort | 00.300 | 12 weeks}}

|-

| {{color|gray|[[Testosterone (medication)|Testosterone]] injection for male ([[Off-label use|unapproved]], experimental method)}}<ref>{{cite journal | vauthors = Gu Y, Liang X, Wu W, Liu M, Song S, Cheng L, Bo L, Xiong C, Wang X, Liu X, Peng L, Yao K | title = Multicenter contraceptive efficacy trial of injectable testosterone undecanoate in Chinese men | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 94 | issue = 6 | pages = 1910–5 | date = June 2009 | pmid = 19293262 | doi = 10.1210/jc.2008-1846 | doi-access = free }}</ref>

| Testosterone Undecanoate || style="background:#ffffc0" | {{sort|006.10|6.1}} <br />(1 ofin 16) || style="background:#e0ffe0" | {{sort|001.10|1.1}}<br />(1 in 91) || Testosterone || Intramuscular Injection || {{sort | 00.030 | Every 4 weeks}}

|-

| 1999 [[cervical cap]] and spermicide (replaced by second generation in 2003)<ref>{{cite web|url=http://www.femcap.com/clinician-protocol.php|title=Clinician Protocol|publisher=FemCap manufacturer|url-status=dead|archive-url=https://web.archive.org/web/20090122203056/http://www.femcap.com/clinician-protocol.php|archive-date=2009-01-22}}</ref>

| [[FemCap]] || style=background:#ffffc0 | {{sort|007.60|7.6}}{{Failed verification|date=December 2017}} (estimated) <br />(1 ofin 13) || style=background:#dcdcdc | no data || Barrier & spermicide || Vaginal insertion || {{sort | 00.030 | Every act of intercourse}}

|-

| [[Contraceptive patch]]<ref name="ReferenceA"/>

| Ortho Evra, the patch || style="background:#ffffc0" | {{sort|007.00|7}} <br />(1 ofin 14) || style="background:#e0ffff" | {{sort|000.30|0.3}}<br />(1 in 333) || Estrogen & progestogen || Transdermal patch || {{sort | 00.070 | Weekly}}

|-

| [[Combined oral contraceptive pill]]<ref>{{Cite web |url=http://www.contraceptivetechnology.org/wp-content/uploads/2013/09/Contraceptive-Failure-Rates.pdf/ |title=ArchivedContraceptive copyFailure Rates |access-date=2021-03-25 |archive-date=2021-05-09 |archive-url=https://web.archive.org/web/20210509081525/https://www.contraceptivetechnology.org/wp-content/uploads/2013/09/Contraceptive-Failure-Rates.pdf |url-status=dead }}</ref>

| theThe Pillpill || style=background:#ffffc0 | {{sort|007.00|7}} <br />(1 ofin 14)<ref name="contraceptivetechnology.org">{{cite book | vauthors = Trussell J | chapter = Contraceptive Efficacy. | veditors = Hatcher RA, Trussell J, Nelson AL, Cates W, Kowal D, Policar M | title = Contraceptive Technology | edition = Twentieth Revised | ___location = New York NY | publisher = Ardent Media | year = 2011 | chapter-url = http://www.contraceptivetechnology.org/wp-content/uploads/2013/09/CTFailureTable.pdf | access-date = 2014-03-30 | archive-date = 2017-02-15 | archive-url = https://web.archive.org/web/20170215224018/http://www.contraceptivetechnology.org/wp-content/uploads/2013/09/CTFailureTable.pdf | url-status = dead }}</ref> || style=background:#e0ffff | {{sort|000.30|0.3}}<br />(1 in 333) || Estrogen & progestogen + Placeboplacebo<ref name=placebo>see [[Combined oral contraceptive pill#Role of placebo pills|Combined oral contraceptive pill § Role of Placebo Pills]]</ref> || Oral medication || {{sort | 00.010 | Daily}}

|-

| [[Ethinylestradiol/etonogestrel]] vaginal ring<ref name="ReferenceA"/>

| [[NuvaRing]], the ring || style=background:#ffffc0 | {{sort|007.00|7}} <br />(1 ofin 14) || style=background:#e0ffff | {{sort|000.30|0.3}} <br />(1 in 333) || Estrogen & progestogen || Vaginal insertion || {{sort | 00.099 | In place 3 weeks / 1 week break}} <!-- every 3 weeks then 1 week, so sorting to just under monthly -->

|-

| [[Progestogen only pill]]<ref name=trussell2011/>

| POP, minipill || style=background:#ffffc0 | {{sort|009.00|9}}<ref name="contraceptivetechnology.org"/><br />(1 in 11) || style=background:#e0ffff | {{sort|000.30|0.3}}<br />(1 in 333) || Progestogen + placebo<ref name=placebo/> || Oral medication || {{sort | 00.010 | Daily}}

|-

| [[Ormeloxifene]]<ref>{{cite book | vauthors = Puri V |year=1988 |chapter=Results of multicentric trial of Centchroman |editor1=Dhwan B. N. |display-editors=etal |title=Pharmacology for Health in Asia : Proceedings of Asian Congress of Pharmacology, 15–19 January 1985, New Delhi, India |___location=Ahmedabad |publisher=Allied Publishers }}<br />

{{cite book | vauthors = Nityanand S |year=1990 |chapter=Clinical evaluation of Centchroman: a new oral contraceptive | veditors = Puri CP, Van Look PF |title=Hormone Antagonists for Fertility Regulation |___location=Bombay |publisher=Indian Society for the Study of Reproduction and Fertility }}</ref>

| Saheli, Centron || style=background:#ffffc0 | {{sort|009.00|9}} <br /> (1 in 11)|| style=background:#e0ffe0 | {{sort|002.00|2}}<br />(1 in 50) || [[Selective estrogen receptor modulator|SERM]] || Oral medication || {{sort | 00.070 | Weekly}}

|-

| Emergency contraception pill || Plan B One-Step® || style=background:#dcdcdc | {{sort|100.00|no data}} || style=background:#dcdcdc | {{sort|100.00|no data}} || Levonorgestrel || Oral medication || {{sort | 00.030 | Every act of intercourse}}

|-

|[[Calendar-based contraceptive methods#Standard Days Method|Standard Days Method]]<ref name=trussell2011/>

| CycleBeads, iCycleBeads || style="background:#fda;"| {{sort|012.00|12}} <br />(1 ofin 8.3) || style=background:#e0ffe0 | {{sort|005.00|5}}<br />(1 in 20) || Behavioral || Counting days since menstruation || {{sort | 00.010 | Daily}}

|-

| [[Diaphragm (contraceptive)|Diaphragm]] and [[spermicide]]<ref name=trussell2011/>

| || style="background:#fda;"| {{sort|012.00|12}} <br />(1 ofin 6) || style=background:#ffffc0 | {{sort|006.00|6}} <br />(1 in 12) || Barrier &+ spermicide || Vaginal insertion || {{sort | 00.030 | Every act of intercourse}}

|-

| Plastic [[contraceptive sponge]] with spermicide used by nulliparous<ref name="ReferenceA"/><ref name=nulliparous group=note/>

| [[Today sponge]], the sponge || style="background:#fda;"| {{sort|014.00|14}} <br />(1 in 7) || style=background:#ffffc0 | {{sort|009.00|9}} <br />(1 in 11) || Barrier &+ spermicide || Vaginal insertion || {{sort | 00.030 | Every act of intercourse}}

|-

| {{color|gray|2002<ref name=leaapproval/> cervical cap and [[spermicide]] used by parous (discontinued in 2008) used by parous}}<ref name=lea>{{cite journal | vauthors = Mauck C, Glover LH, Miller E, Allen S, Archer DF, Blumenthal P, Rosenzweig A, Dominik R, Sturgen K, Cooper J, Fingerhut F, Peacock L, Gabelnick HL | title = Lea's Shield: a study of the safety and efficacy of a new vaginal barrier contraceptive used with and without spermicide | journal = Contraception | volume = 53 | issue = 6 | pages = 329–35 | date = June 1996 | pmid = 8773419 | doi = 10.1016/0010-7824(96)00081-9 | display-authors = 8 | doi-access = free }}</ref><ref name=lea group=note>In the effectiveness study of Lea's Shield, 84% of participants were parous. The unadjusted pregnancy rate in the six-month study was 8.7% among spermicide users and 12.9% among non-spermicide users. No pregnancies occurred among nulliparous users of the Lea's Shield. Assuming the effectiveness ratio of nulliparous to parous users is the same for the Lea's Shield as for the Prentif cervical cap and the Today contraceptive sponge, the unadjusted six-month pregnancy rate would be 2.2% for spermicide users and 2.9% for those who used the device without spermicide.{{Synthesis inline|date=September 2023}}</ref><ref name=parous group=note/>

| [[Lea's Shield]] || style="background:#fda;"| {{sort|015.00|15}} <br />(1 ofin 6) || style=background:#dcdcdc | {{sort|100.00|no data}} || Barrier +& spermicide || Vaginal insertion || {{sort | 00.030 | Every act of intercourse}}

|-

| {{color|gray|1988 [[cervical cap]] and [[spermicide]] (discontinued in 2005) used by nulliparous}}<ref name=nulliparous group=note/>

| [[Prentif]] || style="background:#fda;"| {{sort|016.00|16}} <br />(1 in 6.25) || style=background:#ffffc0 | {{sort|009.00|9}}<br />(1 in 11) || Barrier +& spermicide || Vaginal insertion || {{sort | 00.030 | Every act of intercourse}}

|-

| Male [[latex]] [[condom]]<ref name="ReferenceA"/>

| Condom || style="background:#fda;"| {{sort|013.00|13}} <br />(1 ofin 7) || style=background:#e0ffe0 | {{sort|002.00|2}} <br />(1 in 50) || Barrier || Placed on erect penis || {{sort | 00.030 | Every act of intercourse}}

|-

| [[Female condom]]<ref name=trussell2011/>

| || style="background:#fcc;"| {{sort|021.00|21}} <br />(1 ofin 4.7) || style=background:#e0ffe0 | {{sort|005.00|5}} <br />(1 in 20) || Barrier || Vaginal insertion|| {{sort | 00.030 | Every act of intercourse}}

|-

| [[Coitus interruptus]]<ref name="ReferenceA"/>

| withdrawalWithdrawal method, pulling out || style="background:#fcc;"| {{sort|020.00|20}} <br />(1 ofin 5)<ref name="Jones_2009">{{cite journal | vauthors = Jones RK, Fennell J, Higgins JA, Blanchard K | title = Better than nothing or savvy risk-reduction practice? The importance of withdrawal | journal = Contraception | volume = 79 | issue = 6 | pages = 407–10 | year = 2009 | pmid = 19442773 | doi = 10.1016/j.contraception.2008.12.008 | url = http://www.guttmacher.org/pubs/journals/reprints/Contraception79-407-410.pdf }}</ref> || style=background:#e0ffe0 | {{sort|004.00|4}} <br />(1 in 25) || Behavioral || Withdrawal || {{sort | 00.030 | Every act of intercourse}}

|- <!-- Please see discussion under Sorting order and 4 May revert before editing the symptoms-based fertility awareness entry. -->

| Symptoms-based [[fertility awareness]] ex. symptothermal and calendar-based methods<ref name="ReferenceA"/><ref group="note">No formal studies meet the standards of ''Contraceptive Technology'' for determining typical effectiveness. The typical effectiveness listed here is from the [[Centers for Disease Control and Prevention|CDC]]'s National Survey of Family Growth, which grouped symptoms-based methods together with calendar-based methods. See [[Fertility awareness#Effectiveness]].</ref><ref group=note>The term [[fertility awareness]] is sometimes used interchangeably with the term [[natural family planning]] (NFP), though NFP usually refers to use of periodic abstinence in accordance with [[Catholic]] beliefs.</ref>

| TwoDay method, [[Billings ovulation method]], [[Creighton Model]] || style="background:#fcc;"| {{sort|024.00|24 }} <br />(1 ofin 4) || style=background:#e0ffe0 | {{sort|0.40|0.40&ndash;4}} <br />(1 in 25&ndash;250) || Behavioral || Observation and charting of [[basal body temperature]], [[cervical mucus]] or cervical position || Daily

|-

| [[Calendar-based methods]]<ref name=trussell2011/>

| The rhythm method, Knaus-Ogino method, Standard Days method || style="background:#dcdcdc" | {{sort|100.00|no data}} || style=background:#e0ffe0 | {{sort|005.00|5}}<br />(1 in 20) || Behavioral || Calendar-based || {{sort | 00.010 | Daily}}

|-

| Plastic [[contraceptive sponge]] with spermicide used by parous<ref name="ReferenceA"/><ref name=parous group=note/>

| Today sponge, the sponge || style="background:#fcc;"| {{sort|027.00|27}} <br />(1 ofin 3.7) || style="background:#fda;"| {{sort|020.00|20}}<br />(1 in 4) || Barrier & spermicide || Vaginal insertion || {{sort | 00.030 | Every act of intercourse}}

|-

| [[Spermicide|Spermicidal]] gel, suppository, or film<ref name="ReferenceA"/>

| || style="background:#fcc;"| {{sort|028.00|21}} <br />(1 ofin 5) || style="background:#fda;"| {{sort|018.00|16}}<br />(1 in 6.25) || Spermicide || Vaginal insertion || {{sort | 00.030 | Every act of intercourse}}

|-

| {{color|gray|1988 [[cervical cap]] and [[spermicide]] used by parous (discontinued in 2005) used by parous}}<ref name=parous group=note/>

| [[Prentif]] || style="background:#fcc;"| {{sort|032.00|32}}<br />(1 in 3) || style="background:#fcc;"| {{sort|026.00|26}} <br />(1 in 4)|| Barrier +& spermicide || Vaginal insertion || {{sort | 00.030 | Every act of intercourse}}

|-

| None (unprotected intercourse)<ref name=trussell2011/>

| || style="background:#fcc;"| {{sort|085.00|85}} <br />(6 ofin 7) || style="background:#fcc;"| {{sort|085.00|85}} <br />(6 in 7)|| Behavioral || Discontinuing birth control || style=background:#e0ffff| {{sort | 98.000 | N/A}}

|- class=sortbottom

! Birth control method !! class=unsortable|Brand/common name !! Typical-use failure rate (%) !! Perfect-use failure rate (%) !! Type !! Implementation !! User action required