There’s no question that contraceptives have been fundamental in the modern fight for gender equality. Since women and birthing people gained the ability to choose if and when they wanted children, they have attained greater education, economic power and freedom from health risks associated with pregnancy.
Today, people can choose from a seemingly endless array of contraceptive options, each differing in efficacy and usage method. However, this abundance of options can sometimes lead to confusion about the risks and benefits of each method, especially when social and cultural stigma further mystifies the importance of contraceptives. So, how do contraceptives work, anyway?
The biology behind birth control differs for each method, but non-permanent contraception generally falls into four different categories: barrier methods, short-acting hormonal methods, long-acting reversible contraceptives (LARCs) and emergency contraceptives. While most people are familiar with barrier methods — condoms, diaphragms, sponges and other physical means of blocking sperm from entering the uterus — these devices have relatively high rates of failure, with 12 to 24% of people experiencing unintended pregnancies during their first year of use.
Conversely, the most effective non-permanent contraceptives are LARCs. These methods include hormonal intrauterine devices (IUDs), tiny T-shaped devices that release pregnancy-preventing chemicals into the uterus, and subdermal implants, hormone-secreting rods inserted into a person’s arm. IUDs and implants, which can remain in the body for years, both rely on a hormone called progestin. When slowly released, this chemical messenger suppresses the release of eggs from the ovaries, thickens cervical mucus to trap wayward sperm and thins out the uterus’s lining (the endometrium) to prevent fertilized eggs from implanting. Notably, the only LARC that does not use hormones is the copper IUD, which relies instead on the spermicidal properties of charged copper ions. While each of these LARCs boasts an impressive 0.05 to 0.08% failure rate, some female users report adverse symptoms like irregular bleeding or cramping, making it important to monitor the body’s reaction to these devices.
When you initially read the term “birth control,” your mind probably jumped to “the pill,” a colloquial term for oral contraceptives. However, birth control pills are not the only short-term hormonal contraceptives on the market — skin patches, tri-monthly injections and vaginal rings are also available. Similar to LARCs, they use progestin — often in combination with another hormone, estrogen — to stop ovulation and fertilization. Though these short-term hormonal contraceptives have slightly higher failure rates than LARCs, ranging from 6 to 9%, they are easier to discontinue without seeing a doctor. They have also recently grown more accessible, with the first over-the-counter birth control pill, Opill, becoming available online and in pharmacies March 2024.
If you need to prevent pregnancy shortly after unprotected intercourse, emergency contraceptive pills (or “morning-after” pills) are another progestin-based method that can lower the risk of pregnancy to 0.1% if taken within five days of intercourse. These emergency contraceptives do not require a prescription, but they may be less cost-effective than other methods — one common brand, Plan B One-Step, retails for around $40 to $50 per tablet (though generic brands are often cheaper).
If you’re someone with a uterus, you might be wondering, “Hey! Why is it always my job to prevent pregnancy?” Currently, that would be true, but the past few decades have seen renewed resources and attention devoted to developing birth control for individuals assigned male at birth. The Food and Drug Administration (FDA) has yet to approve any of these birth control products, but excitingly, recent clinical trials have shown that a new hormonal gel, which users would spread on their shoulders daily, is safe and effective. We might have to wait a few more years for this sperm-suppressing gel to hit the market, but it may eventually encourage individuals with male and female reproductive organs to share the responsibility of pregnancy prevention more equally.
Since every form of contraception carries different benefits and risks, you should choose birth control based on information from a trustworthy medical source, such as a family physician or gynecologist. The internet is rife with misinformation about contraception, including a new rash of social media influencers spreading negative falsehoods about birth control pills and touting less effective contraceptive methods like menstrual cycle tracking. The good news is that scientists and physicians are working every day to develop new contraceptives and alleviate the adverse effects of existing options. Hopefully, their research will ensure that we’ll one day live in a world where, regardless of one’s physiology or lifestyle, there’s an ideal birth control option available for everyone.
