Making decisions about birth control

There are several decisions a woman needs to make when choosing a method of birth control, and her choices will change with her needs and her life situation.

Fortunately there are many birth control options. Some of the decisions a woman can make about birth control include:

Reversible or permanent?

Most birth control options are reversible, allowing a woman to choose to have children later in life. There are also surgical procedures that are not reversible and provide permanent birth control. These are most often used by couples in stable partnerships who have completed their families or are sure they will not want children in the future.

There are three possible procedures:

• vasectomy, which makes a man infertile
• tubal ligation, which makes a woman infertile
• Essure hysteroscopic tubal occlusion procedure

None of these procedures protects against sexually transmitted infections.

Hormonal or non-hormonal?

Reversible birth control methods fall into four main categories:

• hormonal contraceptives that control a woman’s hormone levels to prevent pregnancy
• barrier methods that provide a physical or chemical barrier to prevent an egg from coming in contact with sperm
• fertility awareness methods
• LARCs – long-acting reversible contraception

Hormonal methods include the birth control pill, patch, ring  and Depo Provera injections.

Fertility awareness methods rely on tracking your body’s fertile times and avoiding sexual intercourse or using a barrier method at these times.

LARCs include long-acting methods such as an IUD or an IUS (intra-uterine system), which can remain in place for a long time, but are reversible.

Long-acting or short-acting?

Some methods of birth control provide protection for a short time, while others can prevent pregnancy for years.

A condom, for example, prevents pregnancy for a single act of intercourse. At the other end of the spectrum, an IUD can prevent pregnancy for several years.

How effective is it?

Some birth control methods are better at preventing pregnancy than others. Methods that eliminate the possibility for human error – such as IUDs – are among the most effective. Hormonal birth control – such as the pill, patch or ring – is very effective when used as directed.

Some birth control options are more effective when used in combination with another method. For example, spermicides are not very effective when used alone, but using them in combination with condoms can provide effective protection.

The effectiveness of fertility awareness methods depends greatly on the woman’s commitment to tracking her fertile times, and her and her partner’s willingness to either avoid intercourse or use another method of birth control during those times.

When choosing a birth control method, a woman may want to think about how important effectiveness is to her and her partner, and weigh that against other factors such as availability, cost and ease of use.

Is it immediately available, or does it require a doctor visit or prescription?

Hormonal birth control requires a prescription from a doctor. A woman also needs to see a doctor to have an IUD inserted, or be fitted for a diaphragm.

Birth control options that do not require a doctor’s visit or a prescription include condoms, sponges, spermicides and withdrawal.

Fertility awareness does not require a prescription, but it does require time and attention to learn the method.

Does it offer protection against sexually transmitted infections?

Most methods of birth control do not protect against sexually transmitted infections (STIs). The most effective protection against STIs is to use condoms.

Condoms provide effective protection from many STIs, including HIV, Chlamydia and gonorrhea. They also provide some protection against herpes and human papillomavirus (HPV). Because herpes and HPV are spread by skin-to-skin contact, condoms may not provide full protection because they may not cover all affected skin.

Emergency contraception

If a couple forgets to use their birth control method, or their method fails, emergency contraception  can be used. There are two options for emergency contraception:

• Emergency contraceptive pills (e.g. Plan B) can be used up to 72-120 hours after unprotected sex.
• A post-coital IUD can be used up to seven days after unprotected sex. This is the most effective method of emergency contraception: close to 99 per cent effective.

Emergency contraception should not be used as an ongoing birth control strategy.