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Contraception article:

Contraception article:

Despite major advances in contraception that occurred during the 20th century, about 49% of pregnancies in the United States are unintended. More than half of these pregnancies end in abortion.1

In 2000, 54% of women who obtained abortions had used a contraceptive method during the month they became pregnant; the most common methods were male condoms (28%) and oral contraceptives (OCs) (14%). Most of the unintended pregnancies resulted from incorrect or inconsistent use of contraceptives.2Among the remaining 46% of women who had an abortion in 2000, the reasons they gave for not using birth control included concerns about contraceptive methods (32%) and unexpected intercourse (27%).2

Advances in contraceptive technology have resulted in improved compliance and fewer side effects. Here we describe recent developments in hormonal and nonhormonal methods. The Table provides a comparative summary of existing methods.

   
    Table — A comparative summary of available contraceptive methods

      % of women who had an unintended pregnancy within the first year          
     
         
  Method   Typical
use
  Perfect use   % of
women who continued use at 1 y
  Risks and side effects  
 
 
  No method   85   85      
 
 
  Spermicides   29   15   42   Allergy to spermicide  
 
 
  Withdrawal   27   4   43   None known

 

 
 
 
  Periodic
abstinence
  Unknown   1 - 9     None known  
 
 
  Cervical cap with
spermicide: parous/
nulliparous
  32/16   26/9   46/57   Vaginal and bladder infections, allergy to spermicide  
 
 
  Diaphragm with spermicide   16   6   57   Vaginal and bladder infections, allergy to spermicide  
 
 
  Female condom   21   5   49   Difficult to use, vaginal and bladder infections  
 
 
  Male condom   15   2   53   Decrease in spontaneity, allergic reactions  
 
 
  Combined OC   8   0.3   68   Nausea, vomiting, headaches, dizziness, mood changes, breast tenderness, spotting, breakthrough bleeding  
 
 
  Patch (Ortho Evra)   0.8   0.6   68   Same as OC, application site reactions  
 
 
  Vaginal contraceptive ring (NuvaRing)   0.65   0.3   68   Vaginitis, breast tenderness, spotting, bleeding  
 
 
  Depo-Provera injection   3   0.3   56   Menstrual changes, weight gain, headaches, mood changes  
 
 
  Monthly injection (Lunelle)   Unknown   0.05   56   Same as OC, weight gain, bleeding irregularity  
 
 
  Copper IUD (Paragard)   0.8   0.6   78   Increase in menstrual flow and cramping, risk of perforation and PID after insertion  
 
 
  Levonorgestrel-releasing IUD (Mirena)   0.1   0.1   81   Irregular bleeding, amenorrhea, risk of perforation and PID after insertion  
 
 
  Female sterilization   0.5   0.5   100    
 
 
  Male sterilization   0.15   0.1   100    
 
 
  OC, oral contraceptive; IUD, intrauterine device; PID, pelvic inflammatory disease.
Adapted from Hatcher RA et al, eds. A Pocket Guide to Managing Contraception 2004-2005. 2004.10
 
 

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