Contraceptive Confusion
There's a slew of new birth control methods to choose from. The best for you? It's the one you'll use correctly
It's been nearly half a century since the birth control pill changed the way Americans manage their sex lives. But despite the availability of myriad methods of contraception today, a staggering 50 percent of pregnancies in the United States every year are unintentional--and 60 percent of those 3 million annual accidents occur when the woman is using birth control.
Clearly, something's not working. "It's a consumer failure," says David Archer, professor of obstetrics and gynecology at Eastern Virginia Medical School in Norfolk, Va., and director of the school's center for research on birth control. It's not enough to go on the pill, Archer says: Women need to take it every day without fail--which proved impossible for nearly 30 percent of patients in one well-regarded study from the Centers for Disease Control and Prevention. Miss often enough, he says, and "sooner or later, you're going to get burned."
To the rescue comes a proliferation of new choices, intended to be more convenient and fail-safe. Can't remember to take a pill every day? Try a monthly vaginal ring or an every-three-month shot. Do side effects from the pill undermine your effort to be responsible? New formulations may be easier on your body (and, as a bonus, they'll do away with your menstrual periods). Would you rather not think about birth control at all? Consider a new implant approved by the Food and Drug Administration in July that promises protection for up to three years.
You've undoubtedly heard some fanfare about all the new birth control methods. Consumer advertising by pharmaceutical companies for prescription options increased from a mere $459,000 in 2001 to $31.2 million four years later, according to TNS Media Intelligence in New York. But doctors, too, want you to get this message: More choice leads to more effective contraception. If you're happy with your method, there's no need to ponder a switch. If you're not, or if your record on compliance isn't good, here's a quick guide to the whole range of choices. Sometimes insurance plans cover them; sometimes they don't.
The pill. It's by far the most popular method of birth control--and can be 99.7 percent effective for women who take it faithfully, without a slip. The pill is cheap, too ($15 to $35 a month) and usually is covered by insurance.
Women already have more than two dozen versions of the pill to choose from, and new combinations seem to arrive every day. Drug companies keep working to lower the dose of estrogen, which is associated with blood clots, heart attack, stroke, and high blood pressure in some women, and are now racing to introduce pills that limit or put an end to periods. Most pills contain both estrogen and progestin, which work together to inhibit ovulation. Progestin also thins the uterine lining and thickens cervical mucus, making it difficult for the sperm to reach the egg. A few progestin-only "minipills" do away with estrogen--but need to be taken at the exact same time each day, which many women find an unmeetable challenge.
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