CONTRACEPTIVE EFFECTIVENESS

Trigger Question:   What’s the best advice that might be given to everyone about contraceptive effectiveness?

Q:        Is there some information about contraceptive effectiveness that might be given as a part of the answer to almost ALL questions about contraceptive effectiveness and might ALSO be included in the INSTRUCTIONS provided for women using every single approach to birth control?

A:        Contraceptive effectiveness questions are by far the most important questions on the minds of both users of contraceptives and providers of contraceptives.       

A person considering contraceptive use is often focused primarily on contraceptive effectiveness. This is usually why she is using pills, an IUD or an implant.  But the advice she or he receives from a variety of sources is so often conflicting.  We all know that this is true.  There is so much conflicting information “out there” on the internet, in family planning clinics and in private physicians’ offices.  Some of it is completely wrong.  Conflicting information makes many of the contraceptive decisions a couple must make tough at times.  Here are 4 possible global recommendations regarding contraceptive EFFECTIVENESS…..  

One response is “If in doubt the next time it looks as though sexual intimacy is about to lead to vaginal intercourse, definitely use a condom, outercourse or abstinence until you know where you stand.”

A Second response is: “When just starting to use a hormonal contraceptive, use it for 7 days before you count on the hormonal method as your sole contraceptive.”

And a Third Response is: “When contraceptive effectiveness is a high priority in a young woman wanting to preserve the capacity to have children in the future, use of one of the Long Acting Reversible Methods (LARC methods) may be far preferable to pills, patches, rings or injections.

And finally, a Fourth Response is: “For many, many women who are young and will have several to quite a number of different partners (6, 8,10 or more) before trying to become pregnant, dual protection using condoms makes so much sense.”  Most women who become infertile due to pelvic infections have never once been treated for PID (pelvic inflammatory disease).  Chlamydia is treacherous.  Dual protection is of course an STI message but it clearly relates to contraceptive effectiveness as well.

     Robert A. Hatcher MD, MPH