Some birth control methods, such as the pill, intrauterine devices (IUDs), and patches, are highly effective with correct and consistent use. Other methods, such as “pulling out,” fertility awareness, and spermicide alone, are less effective, even with perfect use.
A wide range of contraception options is available, and people can choose the option that best suits them and their lifestyle. One important aspect to consider is efficacy, as some methods are better at preventing pregnancy than others.
It is important to note that barrier methods, including internal and external condoms, are the only form of contraception that can stop the spread of sexually transmitted infections.
This article discusses the different types of birth control, how effective they are with perfect and typical use, and some options a person has if birth control fails.
A range of birth control options is available, and their
|Method||Efficacy (perfect use)||Efficacy (typical use)|
|lactational amenorrhea method||>99% (in 6 months)||98% (in 6 months)|
|fertility awareness-based methods||95–99% (depending on the method)||76–88% (depending on the method)|
|withdrawal, or “pull-out,” method||96%||80%|
Under the Affordable Care Act, many health insurance plans cover prescription birth control methods approved by the Food and Drug Administration (FDA). People who have health insurance can ask their coverage provider about the birth control options and services available through their policy.
Those who have Medicaid have covered birth control options, but they should contact their state’s Medicaid office for details because benefits can vary by location.
Anyone who does not have insurance may be able to access free or low cost birth control options at a family planning clinic.
Below is an outline of the several types of birth control available and their efficacy.
Long-acting reversible contraception (LARC)
LARC methods are prescription-only birth control options that:
- last 3–10 years, depending on the method
- require insertion and removal by a healthcare professional
- provide long-term, high efficacy pregnancy prevention
IUDs are one type of LARC. These small, T-shaped devices use either copper (e.g., ParaGard) or the synthetic hormone progestin (e.g., Mirena, Kyleena, Liletta, Skyla) to prevent pregnancy. IUDs are more than 99% effective, and a healthcare professional will replace them every 3–10 years, depending on the type.
Another type of LARC is the birth control implant, Nexplanon. Like hormonal IUDs, the implant uses progestin to prevent pregnancy — however, a healthcare professional places the implant in a person’s arm rather than in their cervix. Nexplanon is more than 99% effective and lasts up to 3 years.
Short-acting hormonal contraceptives
These prescription-only hormonal birth control methods require the person to use them daily or monthly:
- Oral contraceptives: These are also called the pill or the minipill. A person must take a pill at the same time every day. Perfect use is 99% effective, and typical use is 91% effective.
- Shot: This is an injection (Depo-Provera) that a healthcare professional gives to a person once every 3 months. Perfect use is 99% effective, and typical use is 94% effective.
- Patch: The patch (Xulane, Twirla) is a new adhesive patch that a person can place on their arm, belly, back, or buttocks every week. Perfect use is 99% effective, and typical use is 91% effective.
- Ring: A person will insert this hormone-filled flexible plastic ring into their vagina for 3 weeks, remove it for 7 days to allow a period, and then insert a new ring. With the NuvaRing, perfect use is 99% effective and typical use is 91% effective. The newer Annovera ring is 97.3% effective.
Barrier methods of birth control prevent sperm from entering the uterus and fertilizing an egg. Because they are nonhormonal, barrier methods can be good choices for people who are sensitive to hormones.
- Condoms: External condoms fit around the penis, and internal condoms fit inside the vagina. External condoms are around 98% effective with perfect use and 82% effective with typical use, while internal condoms are around 95% effective with perfect use and 79% effective with typical use.
- Sponges: The sponge (Today Sponge) forms a barrier around the uterine opening to prevent sperm from entering the uterus. It is typically available OTC. Perfect use is around 91% effective, and typical use is around 80% effective.
- Diaphragms: These block the uterine opening to prevent sperm from entering the uterus. Perfect use is around 94% effective, and typical use is around 88% effective.
- Cervical caps: A cap (FemCap) covers the cervix. It is similar to a diaphragm but smaller. Perfect use is around 86% effective, and typical use is around 71% effective.
- Spermicides: These are creams, gels, and films containing chemicals that kill sperm. They are available OTC or by prescription. Perfect use is around 82% effective, and typical use is around 72% effective. Phexxi, an FDA-approved vaginal gel, acts similarly to spermicide by creating an inhospitable environment for sperm.
For maximum efficacy, people using barrier methods must use them correctly and every time they have sex. Using a barrier method along with spermicide is more effective than using a barrier method or spermicide alone.
Fertility awareness methods
When a person uses a fertility awareness method as birth control, it means they avoid sexual intercourse during their fertile days. People are most fertile around the time of ovulation.
There are multiple types of fertility awareness-based methods, also called natural birth control, including but not limited to:
- checking basal body temperature
- checking cervical mucus
- tracking ovulation
- tracking menstrual cycles
With perfect use, fertility awareness methods are around 95% effective. With typical use, they are around 76% effective.
Lactational amenorrhea method (LAM)
LAM is a temporary method of birth control that someone who has recently had a baby might consider. LAM works on the basis that exclusively breastfeeding suppresses fertility.
It may be an effective birth control method if:
- the person’s period has been absent (amenorrhea) since they gave birth
- the infant is exclusively breastfeeding on demand
- the infant is younger than 6 months old
With perfect use, fewer than one person will become pregnant in 6 months. With typical use, fewer than two people will become pregnant. Someone using LAM as birth control should consider adding another method of contraception if any of the above conditions change.
Withdrawal, or the “pull-out” method, involves removing the penis from the vagina before ejaculation so sperm does not enter the vagina and reach an egg.
With perfect execution, pulling out is roughly 96% effective. However, this method is rarely perfect and the typical success rate is closer to 78%.
Currently, emergency contraception (EC) options include IUDs and emergency contraception pills (ECPs), which are commonly called “morning-after” pills.
According to the American College of Obstetricians and Gynecologists, the copper IUD (ParaGard) is the most effective form of EC. However, a 2021 study found that hormonal IUDs, such as Mirena, are not inferior to ParaGard as EC options.
A medical professional must insert the IUD within 5 days, or 120 hours, of sexual intercourse without a barrier method. Once in, the IUD lowers the chance of getting pregnant by more than 99.9%.
If a person wants a short-term solution, they can take an ECP.
Pills containing ulipristal (e.g., ella) are prescription-only ECPs a person takes within 5 days of sexual intercourse without a barrier method. About
The FDA states that morning-after pills containing levonorgestrel (e.g., Plan B and other progestin-only pills) prevent pregnancies in seven out of every eight people who would have become pregnant. These pills are most effective when a person takes them within 3 days of sex without a barrier method. They are available OTC.
It is important to note that ECPs are not abortion pills. ECPs work to prevent pregnancy from happening, while abortion pills end an existing pregnancy.
Body weight and morning-after pills
There is a gray area regarding how a person’s body weight affects the efficacy of emergency contraception pills.
According to the
If a person has concerns about the efficacy of ECPs and their weight, they should contact a doctor to discuss the best option for them.
It is important to contact a doctor and establish a birth control plan before having sex.
When choosing a form of contraception, a person can talk with a doctor about:
- when or if they want to get pregnant
- the efficacy rate
- potential side effects
- how frequently they have sex
- how many sexual partners they have
- their age and overall health
- their confidence level with the method (e.g., remembering to take a pill every day, making sure their partner wears a condom)
There are many OTC and prescription-only birth control options available.
Some methods, including implants and IUDs, are highly effective and last years. Other options, such as the withdrawal method and fertility awareness methods, are less effective and leave more room for error.
While there is no overall “best” birth control option, a person can talk with a doctor about the option that is likely to work best for them. They can also discuss the options they have if birth control fails.