Contraceptive effectiveness questions are the most important questions on the minds of MANY, perhaps MOST users of contraceptives.  Is there some information about contraceptive effectiveness that might be provided as a part of the answer to many questions about contraceptive effectiveness and might ALSO be included in the ROUTINE INSTRUCTIONS provided for women using most approaches to birth control?

A:        Recently we received a request for such a summary on the website and in response to her request heard back:        

A woman considering contraceptive use is usually focused primarily on the contraceptive effectiveness of the method(s) she is interested in. Prevention of pregnancy is usually why she is using pills, an IUD or an implant. 

But, unfortunately, the advice she or, in some cases, he receives from a variety of sources is so often conflicting. Conflicting information from the internet, from family planning clinics and in private physicians’ offices significantly complicates the contraceptive decisions couples are trying to make.  Here are 4 possible recommendations regarding contraceptive effectiveness that might help shed light on many of the contraceptive effectiveness issues perplexing both users and providers of contraceptives:


1.         Abstinence, a condom, outercourse or withdrawal:  

If you are not using a contraceptive, the next time it looks as though sexual intimacy is about to lead to vaginal intercourse, definitely, WITHOUT EXCEPTION, use abstinence, a condom, outercourse or withdrawal until you know where you stand.

2.        Abstinence, a condom, outercourse or withdrawal: again!   When STARTING OR CONTINUING to use a hormonal contraceptive and there is any doubt as to when/whether it is effective, use it for 7 days before you count on the hormonal method as your sole contraceptive. Use abstinence, a condom, outercourse or withdrawal for those 7 days.

3.         Long Acting Reversible Methods (LARC methods): When contraceptive effectiveness is a very high priority for a woman who wants to preserve her capacity to have children in the future), use one of the Long Acting Reversible Methods (LARC methods). Pills, patches and rings are 20 times more likely to lead to an unintended pregnancy than use of an IUD or an implant.

4.        Dual protection: For many, many women who are young and will have several to quite a number of different partners (4, 6, 8, 10 or more) before trying to become pregnant, dual protection using condoms makes so much sense. Chlamydia, an important cause of future infertility is a treacherous infection that often operates under the radar screen. It does its damage without causing significant symptoms. In fact, most women who become infertile due to pelvic infections have never once been treated for PID (pelvic inflammatory disease). Dual protection using condoms consistently is an important sexually transmitted infection (STI) message but it also clearly increases contraceptive effectiveness.

Robert A. Hatcher MD, MPH

Professor of Gynecology and Obstetrics

Emory University School of Medicine

Atlanta, GA