If Birth Control Were Free, Which Type Would You Choose?

Originally published on May 24, 2012, on†bedsider.org.

In terms of effectiveness, not all birth control methods are created equal. And if there was any doubt as to which methods stand out in that arena, an article by the folks behind the Contraceptive CHOICE Project (just published in the New England Journal of Medicine) should put it to rest.

The Contraceptive CHOICE Project, a groundbreaking initiative by researchers at Washington University in St. Louis, offered women in the St. Louis region access to any kind of birth control they wanted for free (swoon, right?), then looked at what method(s) the participants chose and how well their choices worked for them. The researchers found that when cost and lack of information aren’t an issue, women are way more likely to choose a super-effective method of birth control like the IUD or the implantóin fact 75% of the project’s participants chose one of those methods. This is great news since the researchers also found that those methods are way less likely to fail than other methods. Intrigued yet? Let us tell you more:

  • Participants using the pill, the patch, or the ring were 20 times more likely to have an unintended pregnancy than participants using the IUD, the implant, or the shot. About one in 20 pill, patch, and ring users were pregnant at the end of a year; less than 1 in 300 IUD and implant users got pregnant during that time.
  • Younger women (those under 21) were much more likely to have trouble using the pill, the patch, or the ring effectively. They were almost twice as likely to have an unintended pregnancy while using those methods compared to their 21-and-over counterparts.
  • Study participants were a selected group (not a randomized trial). That said, they were a large group (to the tune of 7,486), and diverse.
  • The study results found the same level of effectiveness for the IUD and implant as we list on Bedsider, which come from the National Survey of Family Growth.
  • The shot was found to work just as well as the implant and the IUD, but the researchers only counted people who used it consistently, so their rates represent perfect use rather than typical.

The bottom line? Methods like the implant and the IUD are special because they’re so, so low-maintenance. Women who use them are much more likely to stick with them than with higher-maintenance methods like the pill, the patch, and the ring. They require a little more effort up frontóa visit to the health care provider and possibly a higher initial costóbut, for most women, the long-term benefit is well worth it.

We think senior study author Jeffrey Peipert, MD, said it best: “If there were a drug for cancer, heart disease or diabetes that was 20 times more effective, we would recommend it first.” Hopefully health care providers will take the cue, but in the meantime, you can take the initiative by learning more about the implant (there’s a new model coming to town) and the IUD and talking to your provider about your options.

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Veronica Danie
.2 years ago


Alexander Hay-Whitton

The pill has a 5% failure rate annually? Yeah, right.

Dennis H.
Dennis Hall2 years ago

Thanks for the article.

Paulinha Russell
Paulinha Russell3 years ago


Frank Figueredo
Frank Figueredo3 years ago

Everything has side effects. EVERYTHING. Don't we all see the commercials for class actions for what is now considered a "DANGEROUS or LIFE THREATENING" procedure or drug? These were all once "FDA APPROVED".

Ganaisha Calvin
Ganaisha Calvin4 years ago

i don't think i would ever do an iud

Victoria Gewe
Victoria M5 years ago

Here is just my 2 cents, but I've tried just about every form of birth control out there. The depo provera shot was really nice and convenient, but when I turned 31, I suddenly gained 50 pounds in 2 months as my metabolism changed!

I tried the Mirena for about a year when they got scared about potential bone loss from the depo, later shown to be blown out of proportion. I had it inserted while I was asleep in surgery to remove an ovarian cyst, so I can't comment on that process, but my body rejected it within a year. I have never had a baby, so that had an influence on that.

Next i tried the Implanon implant in my arm. That lasted 2 years before I got a 2-month-long period, which the gyn said is a normal side effect. The addition of estrogen didn't help, though the gyn thought it would.

So I'm back on the pill. Because of severe migraines, I actually take only the active pills and throw away the placebo pills in order to prevent menstruating and to keep my hormone levels constant, so at least I don't get a worse migraine a week out of every month.

I'm allergic to spermicide and super sensitive to condoms (my vagina is so sensitive that I'm even allergic to Monistat, which makes me develop sores that the doctors always swear is herpes until they do tests that come back negative to their surprise!) so I have to use hormonal birth control even if I weren't already using it to control my migraines.