Dr. Mitchell Creinin, an obstetrician-gynecologist, said: "No one goes into my office and says, 'I plan on missing a pill.'"
The variety of birth control methods has increased throughout time. Nowadays, oral contraceptives are safer and have fewer negative effects. In 99.6% of cases, intrauterine devices can avoid pregnancy. However, no over-the-counter medication or medical device is error-free, and people rarely utilize contraception precisely.
Dr. Mitchell Creinin, an obstetrician-gynecologist, said: "No one goes into my office and says, 'I plan on missing a pill.'"
We are all real-life users, according to Creinin, a professor at the University of California-Davis and author of a widely used textbook on contraceptive failure rates.
Contraception failure can still occur even in cases when the likelihood is low because it happens frequently enough. In the United States, more than 47 million women of reproductive age take some form of birth control, although depending on the method, hundreds of thousands of unforeseen pregnancies may still happen annually. For tens of millions of Americans, contraceptive failures now involve greater risks because the majority of abortions are illegal in at least 13 states and legal disputes are ongoing in others.
Researchers make a distinction between perfect birth control use, which is when a method is applied consistently and correctly each time, and usual use, which is when a method is applied in practical situations. The failure rate of all birth control methods is zero percent, barring complete female sterilization.
The failure rate of birth control pills when used as prescribed is 7%. 70,000 unintended pregnancies could happen annually for every million women taking tablets. More than 6.5 million women between the ages of 15 and 49 use oral contraceptives, which results in around 460,000 unintended pregnancies, according to the most current data available.
IUD and birth control implant failure rates, even when they appear to be tiny, might cause surprises.
The hormone that thickens the mucus on the cervix is released via an intrauterine device. Sperm are blocked from passing past the barrier by the mucus like a brick wall. A consistent, low dose of a hormone that thickens cervical mucus and stops ovaries from releasing an egg is delivered into the body by implants, which are matchstick-sized plastic rods inserted beneath the skin. Yet not always. In 0.1% to 0.4% of cases, hormonal IUDs and implants are unable to prevent conception.
In the US, 4.8 million women utilize IUDs or implants, resulting in 5,000 to 20,000 unforeseen pregnancies annually.
Planned Parenthood nurse practitioner Gordon Low stated, "We've had ladies come through here for abortions who had an IUD, and they were the one in a thousand."
Since the Supreme Court's decision in late June's case of Dobbs v. Jackson Women's Health Organization, abortion has been illegal in Arkansas. The only exception is when it's thought that a patient will pass away soon.
Couples' decisions on the best method of contraception to use or estimating their odds of becoming pregnant now take place against this new background of stakes.
Many people's conviction that contraceptives should always be effective presents another challenge.
Reproductive endocrinologist Dr. Régine Sitruk-Ware of the Population Council, a non-profit research group, stated that "in medicine, there is never anything that is 100%."
Sitruk-Ware noted that numerous variables undermine the effectiveness of contraceptives. The liver's ability to digest birth control pills can be interfered with by several HIV and tuberculosis drugs, as well as the herbal supplement St. John's wort. A medical professional might improperly place an IUD in the uterus. Due to the weight-dependent hormone in the pill, emergency contraception, including Plan B, is less effective in women who weigh more than 165 pounds.
And things are busy.
You might be delayed in taking your next medication, getting to the doctor to get "your next vaginal ring inserted," said Sitruk-Ware.
The likelihood of a failure is reduced by using contraception consistently and appropriately, but Alina Salganicoff, KFF's director of women's health policy, noted that for many people, access to birth control is anything from dependable. Year after year, birth control pills are required, but "the vast majority of women can only receive a one- to two-month supply," the expert claimed.
Even vasectomies may fail.
The tube that delivers sperm to the semen is severed during a vasectomy.
With a failure rate of 0.15 percent, the treatment is one of the most reliable birth control options and does not have the negative consequences of hormonal birth control. However, cells in the body can still recover on their own, including after a vasectomy, even after the vas deferens has been severed.
According to Creinin, if you cut your finger, the skin will grow back over the wound. That tube may grow back together, and that's one of the ways it fails, depending on how big the gap is and how the treatment is carried out.
Men's reversible birth control options, such as a sperm-suppressing gel applied to the shoulders, are being studied by researchers. Zero pregnancies have taken place among the 350 trial participants and their partners thus far. The new techniques won't be offered to customers for several years, according to expectations. For males, who are fertile for a large portion of their life, vasectomies and condoms continue to be the only methods of contraception.
Condoms have one of the highest typical-use failure rates of all pregnancy control devices at 13%. Although they are frequently misused or torn, condoms are an essential tool in the fight against HIV and other sexually transmitted illnesses. The typical-use failure rate indicates that for every million couples who use condoms, 130,000 unforeseen pregnancies could happen each year.
One component of preventing pregnancy is navigating the failure rates of birth control medications and medical equipment. According to Jennifer Evans, an assistant teaching professor and health education expert at Northeastern University, convincing a male sexual partner to use a condom may take bargaining or persuasion skills that are challenging to maneuver.
Sexual negotiation skills are more difficult to master today since historically, women have had little to no control over their bodies and little to no say in sexual activity, according to Evans.
Men who force women into having sex without using a condom are the subject of some of Evans' study. One "stealthing" technique involves a man putting on a condom but then taking it off before or during sexual contact without the other person's knowledge or agreement.
According to Evans, "in a lot of these stealth situations, women may not even be aware that the condom has been misused." "It implies they can't engage in any kind of prophylactic actions, like having a Plan B or even promptly getting an abortion," said the expert.
According to Evans, stealthing is frequently done by heterosexual men who are antagonistic to women. They claim that having sex without using a condom is more pleasurable or claim that they do it "for the rush of indulging in a conduct they know is not OK," she said. Evans advises women to avoid having sex with someone they believe won't use a condom properly.
Since Roe v. Wade has been overruled, the effects are considerably worse than they were before, according to Evans.
KHN and Science Friday worked together to produce this article. Sarah Varney, a senior correspondent for KHN, and Shoshannah Buxbaum, a producer for Science Friday, talk in this interview.
A national newsroom called KHN (Kaiser Health News) delivers in-depth reporting on health-related topics. KHN is one of the three main operational projects at KFF, together with Polling and Policy Analysis (Kaiser Family Foundation). KFF is a charitable organization that educates the public about health issues.
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