A 2008 report (PDF) from the Guttmacher Institute shows that almost half of women who are at risk of an unintended pregnancy--meaning they're having sex and don't want a baby--don't use birth control consistently and correctly. Some women have gaps in their use, some don't use their methods well, and others don't use birth control at all.
Why is staying on birth control so hard? Life changes make it really difficult to keep up with your pill. Who can remember--every month--to get a pill refill when you're moving/changing jobs/changing guys? Method problems are a huge factor--access, even for women with insurance, can be a problem. Some of the newer pills can have copays of $30, $40, even $50 a month...or aren't covered at all. Many plans have excluded IUDs for years, and now I'm even hearing about insurances that won't cover the NuvaRing. And hardest of all is ambivalence--not being sure that you don't want to be pregnant after all.
I often think that the most important feature of a contraceptive method is the timing of its use--more important than even side effects or effectiveness--since you have to use the method correctly for it to work at all. So if a patient is having trouble choosing birth control, I ask her:
- Can you really take a pill every day? Seriously, it's not human nature to do this--to take medication, every day, when you're feeling well. It's one thing if you have strep throat or a UTI (and you'll take anything to feel better)--it's another when you don't feel sick.
- Would you rather change your method every week or every month? On the surface, the patch and the ring are more convenient, since you avoid the "every day" problem of the pill. But trying to remember once a week or month may be even harder (unless you can count on your planner or Outlook to give you a reminder).
- How about coming into see me 4 times a year? Depo-Provera has the advantage of not having to remember anything at home, beyond scheduling your next appointment. But how many women really want to visit their gyno that much?
- So how about an IUD? I think that IUDs are ideal options for many women, because once they're placed, you can forget about it, until you're ready to have it removed. And birth control that's amazingly effective, that you don't have to pay attention to, may be the most effective method of all.
Photo credit: ton3vita