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Appendix D: Contraceptive Effectiveness

Providers should counsel clients about the effectiveness of different contraceptive methods. Method effectiveness is measured as the percentage of women experiencing an unintended pregnancy during the first year of use, and is estimated for both typical and perfect use (Table).


TABLE. Percentage of women experiencing an unintended pregnancy during the first year of typical use* and the first year of perfect use of contraception and the percentage continuing use at the end of the first year — United States

Method

% of women experiencing an unintended pregnancy within the first year of use

% of women continuing use at 1 year§

Typical use

Perfect use

No method

85.0

85.0

Spermicides**

28.0

18.0

42.0

Fertility awareness-based methods

24.0

47.0

Standard days method††

5.0

2-day method††

4.0

Ovulation method††

3.0

Symptothermal method

0.4

Withdrawal

22.0

4.0

46.0

Sponge

36.0

Parous women

24.0

20.0

Nulliparous women

12.0

9.0

Condom§§

Female

21.0

5.0

41.0

Male

18.0

2.0

43.0

Diaphragm¶¶

12.0

6.0

57.0

Combined pill and progestin-only pill

9.0

0.3

67.0

Evra patch

9.0

0.3

67.0

NuvaRing

9.0

0.3

67.0

Depo-Provera

6.0

0.2

56.0

Intrauterine contraceptives

ParaGard (copper T)

0.8

0.6

78.0

Mirena (LNG)

0.2

0.2

80.0

Implanon

0.05

0.05

84.0

Female sterilization

0.5

0.5

100.0

Male sterilization

0.15

0.1

100.0

Emergency Contraceptives: Emergency contraceptive pills or insertion of a copper intrauterine contraceptive after unprotected intercourse substantially reduces the risk of pregnancy.***

Lactational Amenorrhea Method: LAM is a highly effective, temporary method of contraception.†††

Source: Adapted from Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussell J, Nelson AL, Cates W, Kowal D, Policar M, eds. Contraceptive technology: 20th revised ed. New York, NY: Ardent Media; 2011.

* Among typical couples who initiate use of a method (not necessarily for the first time), the percentage of couples who experience an accidental pregnancy during the first year if they do not stop use for any other reason. Estimates of the probability of pregnancy during the first year of typical use for spermicides and the diaphragm are taken from the 1995 National Survey of Family Growth corrected for underreporting of abortion; estimates for fertility awareness-based methods, withdrawal, the male condom, the pill, and Depo-Provera are taken from the 1995 and 2002 National Survey of Family Growth corrected for underreporting of abortion. See the text for the derivation of estimates for the other methods.

Among couples who initiate use of a method (not necessarily for the first time) and who use it perfectly (both consistently and correctly), the percentage of couples who experience an accidental pregnancy during the first year if they do not stop use for any other reason. See the text for the derivation of the estimate for each method.

§ Among couples attempting to avoid pregnancy, the percentage of couples who continue to use a method for 1 year.

The percentages becoming pregnant in columns labeled "typical use" and "perfect use" are based on data from populations in which contraception is not used and from women who cease using contraception to become pregnant. Among such populations, approximately 89% become pregnant within 1 year. This estimate was lowered slightly (to 85%) to represent the percentage of women who would become pregnant within 1 year among women now relying on reversible methods of contraception if they abandoned contraception altogether.

** Foams, creams, gels, vaginal suppositories, and vaginal film.

†† The Ovulation and 2-day methods are based on evaluation of cervical mucus. The Standard Days method avoids intercourse on cycle days 8 through 19. The Symptothermal method is a double-check method based on evaluation of cervical mucus to determine the first fertile day and evaluation of cervical mucus and temperature to determine the last fertile day.

§§ Without spermicides.

¶¶ With spermicidal cream or jelly.

*** Ella, Plan B One-Step, and Next Choice are the only dedicated products specifically marketed for emergency contraception. The label for Plan B One-Step (1 dose is 1 white pill) says to take the pill within 72 hours after unprotected intercourse. Research has indicated that all of the brands listed here are effective when used within 120 hours after unprotected intercourse. The label for Next Choice (1 dose is 1 peach pill) says to take one pill within 72 hours after unprotected intercourse and another pill 12 hours later. Research has indicated that that both pills can be taken at the same time with no decrease in efficacy or increase in side effects and that they are effective when used within 120 hours after unprotected intercourse. The Food and Drug Administration has in addition declared the following 19 brands of oral contraceptives to be safe and effective for emergency contraception: Ogestrel (1 dose is 2 white pills), Nordette (1 dose is 4 light-orange pills), Cryselle, Levora, Low-Ogestrel, Lo/Ovral, or Quasence (1 dose is 4 white pills), Jolessa, Portia, Seasonale or Trivora (1 dose is 4 pink pills), Seasonique (1 dose is 4 light-blue-green pills), Enpresse (1 dose is 4 orange pills), Lessina (1 dose is 5 pink pills), Aviane or LoSeasonique (one dose is 5 orange pills), Lutera or Sronyx (1 dose is 5 white pills), and Lybrel (1 dose is 6 yellow pills).

††† However, for effective protection against pregnancy to be maintained, another method of contraception must be used as soon as menstruation resumes, the frequency or duration of breastfeeds is reduced, bottle feeds are introduced, or the baby reaches age 6 months.



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