In a post-Roe world, contraception failure is riskier than ever
This article was originally featured on KHN.
“No one walks into my office and says, ‘I plan on missing a pill,'” said obstetrician-gynecologist Dr. Mitchell Creinin.
“There’s no perfect use, all of us are real-life users,” Creinin, a professor from the University of California-Davis, said. Creinin wrote a widely cited textbook which details contraceptive failures.
Even though contraception failure is rare, it can quickly add up. More than 47 million women of reproductive age in the United States use contraception and, depending on the birth control method, hundreds of thousands of unplanned pregnancies can occur each year. With most abortions outlawed in at least 13 states and legal battles underway in others, contraceptive failures now carry bigger stakes for tens of millions of Americans.
Researchers distinguish between perfect use, which is when a method of birth control is used consistently and correctly every single time, and common use, which is when it is used in real-life situations. There is no birth control that has a lower than a complete female sterilization. 00% failure rate.
The failure rate for most birth control pills is 7%. For every million women taking pills, 70,000 unplanned pregnancies could occur in a year. According to the most recent data available, more than 6.5 million women ages 15 to 49 use oral contraceptives, leading to about 460,000 unplanned pregnancies.
Even seemingly small failure rates of IUDs or birth control implants can cause surprises.
An intrauterine device releases hormones that thicken the mucus in the cervix. Sperm are unable to cross the barrier because they have hit the brick wall of mucus. Implants are small, matchstick-sized plastic rods that are placed under the skin. They send a steady, low amount of hormone into the body. This thickens cervical mucus and stops the ovaries releasing eggs. However, not all cases are successful. Implants and hormonal IUDs fail to prevent pregnancy in 0.1% to 0.4% of cases.
Some 4.8 million women use IUDs or implants in the U.S., leading to as many as 5,000 to 20,000 unplanned pregnancies a year.
“We have had women come through here to have abortions who had an intrauterine device, and they were one in a million,” Gordon Low, a nurse practitioner at Planned Parenthood Little Rock, said.
Since the Supreme Court’s decision in Dobbs and Jackson Women’s Health Organization late June, Arkansas has outlawed
Abortion. Only exceptions are made when the patient’s death can be considered imminent.
These stakes are the new backdrop to couples making decisions about contraception or calculating their chances of getting pregnant.
Another problem is the belief that contraceptives should always work.
“In medicine, there is never anything that is 100%,” said Dr. Regine Sitruk-Ware, a reproductive endocrinologist at the Population Council, a nonprofit research organization.
All sorts of factors can interfere with contraceptive effectiveness, said Sitruk Ware. Certain drugs for HIV and tuberculosis, as well as the herbal supplement St. John’s Wort, can cause liver problems when processing birth control pills. An IUD might be inserted incorrectly by a medical provider into the uterus. Emergency contraception, including Plan B, is less effective in women weighing more than 165 pounds because the hormone in the medication is weight-dependent.
Life is hectic.
” You may have to wait to take your next pill,” Sitruk-Ware said. Or, go to the doctor to get “your next vaginal rings .”
Using contraception consistently, correctly and consistently reduces the chance of a failure. However, Alina Salganicoff KFF director of women’s policy , stated that access to birth control is not always reliable for many people. Although birth control pills are needed year after year, the vast majority of women cannot get a supply of birth control pills for more than one to two months.
Even vasectomies can fail.
During a vasectomy the surgeon will cut the tube that carries the sperm to the sperm.
This method is one of the most efficient methods of birth control. The failure rate is 0. 15% — and avoids the side effects of hormonal birth control. Even after the vasectomy, cells can still heal themselves.
” If you cut your finger, the skin will cover it up.” Creinin said. “Depending on the size of the cut and the way it was done, the tube might grow back together and that’s one reason it fails .”
Researchers are looking for reversible birth control methods that men can use, such as a hormonal Gel placed on the shoulders to suppress sperm production. Among the 350 participants in the trial and their partners, so far zero pregnancies have occurred. It will likely take several years for the new methods on the market to become available to consumers. Condoms and vasectomies are still the only contraceptive options for men who are fertile for most of their lives.
At 13%, the typical-use failure rate of condoms is among the highest of birth control methods. Condoms are essential in stopping the spread HIV and other sexually transmitted diseases. However, condoms are often mishandled or tampered with. The typical-use failure rate means that for 1 million couples using condoms, 130,000 unplanned pregnancies could occur in one year.
Preventing pregnancy is not just about reducing the failure rate of birth control medications and medical devices. It can be difficult to convince a male partner to use a condom. Jennifer Evans, a Northeastern University assistant professor and health education specialist, says that this can require negotiation or persuasion skills.
Historically, women had little to no control over sexual intercourse. This has made it difficult for them to negotiate their sexual-negotiation skills, according to Evans.
A part of Evans’ research is on men who coerce women to have sex without condoms. Stealthing is a tactic that involves a man putting on a condom and then removing it before or during sex without the consent of the other person.
” In a lot these theft cases women don’t necessarily know that the condom was used improperly,” stated Evans. It means that they are unable to engage in preventative behaviors such as taking a Plan B, or even going to an abortion in a timely fashion .
Evans found that heterosexual men who steal from women often have hostile attitudes to them. They claim that having sex without a condom is easier or that they do it for the “thrill of engaging in a behavior that they know is wrong,” she said. Evans warns women who suspect that a sexual partner won’t use a condom correctly not to have sex.
” The consequences were already severe previously,” stated Evans. “But now that Roe is overturned, they are even more right now .”
This story is a collaboration between Science Friday and KHN. Listen to the conversation that Sarah Varney, senior correspondent at KHN, and Shoshannah Buxbaum, Science Friday producer, are having.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization that provides information to the nation on health issues.