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Topic of the Month: Unintended Pregnancy Prevention: Contraception

             - Reversible Methods of Birth Control

             - Permanent Methods of Birth Control

In the United States, almost half of all pregnancies are unintended.1 Several safe and highly effective methods of contraception (birth control) are available to prevent unintended pregnancy.  In the United States, most women of reproductive age use birth control. In 2002, 98% of women who had ever had sexual intercourse had used at least one method of birth control. However, 7.4% of women who were currently at risk of unintended pregnancy were not using a contraceptive method.2 The most popular method of birth control was the oral contraceptive pill, used by 11.6 million women in the United States, followed by female sterilization, condoms, male sterilization, and other methods of birth control.2 About 6% of women have ever used emergency contraception.2 Since 2000, several new methods of birth control have become available in the United States, including the levonorgestrel-releasing intrauterine system, the hormonal contraceptive patch, the hormonal contraceptive ring, the hormonal implant, a 91-day regimen of oral contraceptives, two new barrier methods, and a new form of female sterilization.

  1. Disparities in Rates of Unintended Pregnancy in the United States, 1994 and 2001* Finer LB, Henshaw SK, Perspectives on Sexual Reproductive Health, 2006:38:90–96. PDF icon PDF 507KB Health, 2006:38:90–96.
  2. Mosher WD, Martinez GM, Chandra A, Abma JC, Willson SJ. Use of contraception and use of family planning services in the United States, 1982–2002. Advance data from vital and health statistics; no 350. Hyattsville, Maryland: PDF icon PDF 1MB National Center for Health Statistics. 2004.

Types of Birth Control

Reversible Methods of Birth Control

  • Intrauterine Devices (IUDs)

Copper T IUD—An IUD is a small device that is shaped in the form of a “T.” Your doctor places it inside the uterus to prevent pregnancy. It can stay in your uterus for up to 10 years. This IUD is more than 99% effective at preventing pregnancy.

Mirena intrauterine system (IUS)—The IUS is a small T-shaped device like the IUD. It is placed inside the uterus by a doctor. It releases a small amount of progestin each day to keep you from getting pregnant. The IUS stays in your uterus for up to
5 years. The IUS is more than 99% effective at preventing pregnancy.

  • Hormonal methods

Oral contraceptives— Also called “the pill,” it contains the hormones estrogen and progestin. It is prescribed by a doctor. A pill is taken at the same time each day. If you are older than 35 years and smoke, have a history of blood clots or breast cancer, your doctor may advise you not to take the pill. The pill is 92–99% effective at preventing pregnancy.

Mini pill— Unlike the pill, the mini-pill only has one hormone, progestin, instead of both estrogen and progestin. It is prescribed by a doctor. It is taken at the same time each day. It is a good option for women who can’t take estrogen. They are 92–99% effective at preventing pregnancy.

Patch— This skin patch is worn on the lower abdomen, buttocks, or upper body (but not on the breasts). This method is prescribed by a doctor. It releases hormones progestin and estrogen into the bloodstream. You put on a new patch once a week for three weeks. During the fourth week, you do not wear a patch, so you can have a menstrual period. The patch is 92–99% effective at preventing pregnancy, but it appears to be less effective in women who weigh more than 198 pounds.

Hormonal vaginal contraceptive ring The NuvaRing releases the hormones progestin and estrogen. You place the ring inside your vagina. You wear the ring for three weeks, take it out for the week you have your period, and then put in a new ring. It is 92–99% effective at preventing pregnancy.

Injection or "shot" Women get shots of the hormone progestin in the buttocks or arm every three months from their doctor. It is 97–99% effective at preventing pregnancy.

Implant—The implant is a single, thin rod that is inserted under the skin of a women’s upper arm. The rod contains a progestin that is released into the body over 3 years. It is 99 percent effective at preventing pregnancy.

Emergency contraception—Emergency contraception is NOT a regular method of birth control. Emergency contraception can be used after no birth control was used during sex, or if the birth control method failed, such as if a condom broke.

One type of emergency contraception requires you to take two doses of hormonal pills 12 hours apart. You have to take the pills starting within three days (72 hours) after having unprotected sex. They are sometimes referred to as “morning after” pills, even though they can be used up to three days later. The pills are at least 75% effective at preventing pregnancy. Plan B is available over-the-counter for women aged 18 years and older. Plan B is available by prescription for women aged 17 years and younger. (Plan B is the brand name of one product approved by the Food and Drug Administration for use as emergency contraception.)

Another type of emergency contraception is having your doctor insert the Copper T IUD into your uterus within seven days of unprotected sex. This method is 99% effective at preventing pregnancy.

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  • Barrier Method's

Male condom— Worn by the man, a male condom keeps sperm from getting into a woman’s body. Latex condoms, the most common type, help prevent pregnancy and HIV and other STDs as do the newer synthetic condoms. “Natural” or “lambskin” condoms also help prevent pregnancy, but may not provide protection against STDs, including HIV. Male condoms are 85–98% effective at preventing pregnancy. Condoms can only be used once, and are most effective when used consistently and correctly.

You can buy condoms, KY jelly, or water-based lubricants at a drug store. Do not use oil-based lubricants such as massage oils, baby oil, lotions, or petroleum jelly with latex condoms. They will weaken the condom, causing it to tear or break.

Female condom— Worn by the woman, the female condom helps keeps sperm from getting into her body. It is packaged with a lubricant and is available at drug stores. It can be inserted up to eight hours before sexual intercourse. Female condoms are 79–95% effective at preventing pregnancy when used consistently and correctly, and may also help prevent STDs.

Diaphragm or cervical cap— Each of these barrier methods are placed inside the vagina to cover the cervix to block sperm. The diaphragm is shaped like a shallow cup. The cervical cap is a thimble-shaped cup. Before sexual intercourse, you insert them with spermicide to block or kill sperm. The diaphragm is 84–94% effective at preventing pregnancy. Visit your doctor for a proper fitting because diaphragms and cervical caps come in different sizes.

Spermicides— These products work by killing sperm and come in several forms—foam, gel, cream, film, suppository, or tablet. They are placed in the vagina no more than one hour before intercourse. You leave them in place at least six to eight hours after intercourse. You can use a spermicide in addition to a male condom, diaphragm, or cervical cap. Spermicides alone are about 71–82% effective at preventing pregnancy. They can be purchased in drug stores.

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  • Fertility Awareness and Abstinence

Continuous abstinence— This method means not having vaginal intercourse at any time. It is the only 100% effective way to prevent pregnancy.

Natural family planning or fertility awareness— Understanding your monthly fertility pattern can help you plan to get pregnant or avoid getting pregnant. Your fertility pattern is the number of days in the month when you are fertile (able to get pregnant), days when you are infertile, and days when fertility is unlikely, but possible. If you have a regular menstrual cycle, you have about nine or more fertile days each month. If you do not want to get pregnant, you do not have sex on the days you are fertile, or you use a form of birth control on those days. These methods are 75–99% effective at preventing pregnancy.

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Permanent Methods of Birth Control

These methods are meant for people who want a permanent method of birth control. In other words, they never want to have a child, or they do not want more children. The methods listed here are more than 99% effective at preventing pregnancy.

  • Female SterilizationTubal ligation or “tying tubes.” A woman can have her fallopian tubes tied (or closed) so that sperm and eggs cannot meet for fertilization. The procedure can be done in a hospital or in an outpatient surgical center. You can go home the same day of the surgery and resume your normal activities within a few days. This method is effective immediately.
  • Transcervical Sterilization— A thin tube is used to thread a tiny device into each fallopian tube. It irritates the fallopian tubes and causes scar tissue to grow and permanently plug the tubes. It can take about three months for the scar tissue to grow, so use another form of birth control during this time. Return to your doctor for a test to see if scar tissue has fully blocked your fallopian tubes.
  • Male Sterilization–Vasectomy— This operation is done to keep a man’s sperm from going to his penis, so his ejaculate never has any sperm in it that can fertilize an egg. This operation is simpler than tying a woman’s tubes. The procedure is done at an outpatient surgical center. The man can go home the same day. Recovery time is less than one week. After the operation, a man visits his doctor for tests to count his sperm and to make sure the sperm count has dropped to zero; this takes about 12 weeks. Another form of birth control should be used until the man’s sperm count has dropped to zero. Learn more about vasectomy.

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Selected Resources

Protecting Against Unintended Pregnancy: A Guide to Contraceptive Choices (FDA)

Birth Control Methods (National Women’s Health Information Center)
Also available in Spanish

Emergency Contraception (National Women’s Health Information Center)
Also available in Spanish

Unintended Pregnancy Data and Statistics


Contraceptive Use Among Postpartum Women—12 States and New York City, 2004—2006
CDC researchers analyzed PRAMS data that included 43,887 postpartum women, and found that postpartum use of highly effective contraceptive methods can prevent unintended pregnancies and ensure adequate birth spacing. Unintended pregnancies and short interpregnancy intervals are associated with adverse maternal and infant outcomes. Source: MMWR 2009;58(30):821–826.

Fact sheet: Update on intrauterine devices (IUD) and pelvic infection
Women and their clinicians should be aware that today's IUDs are highly effective and safe for long-term contraceptive use for women at low risk for sexually transmitted diseases (STDs).  Source: MMWR 1997;46(41).

Nonoxynol-9 Spermicide Contraception Use—United States, 1999
An assessment of contraceptive use among women attending Title X family planning clinics in 1999 indicated that some women were using Nonoxynol-9 (N-9) spermicide. Data were collected from the national family planning program, which serves predominantly low-income women. Source: MMWR 2002:51(18):389–392.

Contraceptive Practices Before and After an Intervention Promoting Condom Use to Prevent HIV Infection and Other Sexually Transmitted Diseases Among Women—Selected U.S. Sites, 1993–1995
The findings in this report indicate that, among the reproductive-aged women who were encouraged to use condoms for HIV/STD prevention, consistent condom use for HIV/STD prevention increased among women using each contraceptive method studied. Source: MMWR 1997;47(17).

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Related Resources

Medical Eligibility Criteria for Contraceptive Use*
This document is one of WHO's two evidence-based guidelines for contraceptive use. It reviews the medical eligibility criteria for use of contraception, offering guidance about the safety of use of 19 different methods for women and men.

Selected Practice Recommendations for Contraceptive Use*
The document is one of WHO's two evidence-based guidelines on contraceptive use. It provides guidance about the safe and effective use of a wide range of contraceptive methods, and is the companion guideline to WHO's Medical Eligibility Criteria for Contraceptive Use.

American College of Obstetrics and Gynecology*

Family Planning (WHO)*

The Association of Reproductive Health Professionals*

Search PubMed for articles on Contraception Use
This search is being conducted on PubMed an NLM/NIH service.

Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion

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