
How Likely Is It That Birth Control Could Let You Down? - aaronbrethorst
http://www.nytimes.com/interactive/2014/09/14/sunday-review/unplanned-pregnancies.html
======
llamataboot
It amazes me that IUDs aren't more popular in the US, despite being widespread
in Europe. There is generally some pain during the the procedure, and some
heavier cramps during menstruation for a few months, but other than that it is
a method with virtually zero side effects, zero ability to screw it up, and as
good as it gets in terms of prevention. I know about 10 women in the US with
IUDs (including my wife) and all of them recommend them with an evangelical
fervor.

~~~
silencio
I think it's the upfront cost, which is still a problem.

The only reason I ever got my Mirena IUD was that it was the first month
Obamacare kicked in for mandatory birth control coverage and my insurance
covered it. Before then, I wasn't willing to entertain the idea of an $800+
option when I was doing okay with other things (mostly nuvaring). Mirena was
by far one of the best forms of birth control I had ever used though :)

There are definitely problems with the procedure and the IUDs themselves for
plenty of women, too, let's not ignore that. But it is hard to screw up and it
is a pretty easy method. I hope that better coverage leads to more IUDs and
less unwanted pregnancies :)

~~~
ChrisNorstrom
I thought there was a lawsuit on Mirena ? Due to side effects and
perforations.
[http://www.drugwatch.com/mirena/](http://www.drugwatch.com/mirena/)

~~~
silencio
Honestly, that looks like some ambulance chaser site.

All IUDs can perforate a uterus. Any form of birth control can cause side
effects. Any medication can cause problems in general. Hell, pregnancy has
side effects and can potentially cause death :P

You just learn to know what to look for and you get it looked at, that's all.
And your doctor can tell you if you're not a good candidate for a particular
medication (i.e. smokers shouldn't use hormonal contraceptives), like you
should be doing already.

------
adsjfk
>How the numbers were calculated: The probability that a woman doesn't get
pregnant at all over a given period of time is equal to the success rate of
her contraceptive method, raised to the power of the number of years she uses
that method.

This does assume that the chance of getting pregnant after a year is
independent of the person/people using it, though... presumably there are
reasons other than a random roll of the dice why various birth control methods
fail, which could well affect the distribution.

(It also seems absolutely crazy to give these statistics "per year" when I'd
feel pretty confident in saying that it depends on how often you have sex!)

~~~
eurleif
Well, there are separate numbers for "perfect use" versus "typical use".
Presumably, perfect use is independent of the person using it.

~~~
cperciva
Perfect use means "the user did not make any mistakes".

A woman who gets pregnant after forgetting to take the pill one day is a
"typical use" birth control failure; a woman who becomes pregnant because her
natural hormone levels are such that the birth control pill (consistently
taken at the same time every day) doesn't render her infertile is a "perfect
use" birth control failure.

Similarly, couples who intend to use condoms but occasionally forget (or get
carried away etc.) would be "typical use", but a man with a cat-like barbed
penis which makes holes in condoms could still qualify as "perfect use".

~~~
baddox
There's a comment worth reading all the way to the end.

~~~
cperciva
I like to think that all of my comments are worth reading to the end!

~~~
baddox
I'll skip right to the end from now on, to know what I'll be getting myself
into.

------
andrewstuart2
Unexpected pregnancy is only a fraction of the problems that birth control
brings. I've had way too many friends struggle for years to find the "right
birth control for them" at a high personal cost.

Unsurprisingly, trying to make your body think it's already pregnant via
external hormones can have some significant side effects. I mean, I suppose
decreased libido probably contributes to the effectiveness of a birth control
method, but why bother? Or how about some frustrating weight gain from your
body trying to nurture and protect a non-existent baby? Or maybe you prefer
that sex become uncomfortable or painful? Even IUDs are only recommended if
you're not thinking about ever having kids; the danger of infertility is still
too high.

"I don't want to wear condoms" is all-too-often the only reason that hormonal
birth control is ever considered. It's my personal opinion that men are the
ones that need to suck it up. Every time.

Chances sex is less pleasurable for men? Probably 100%. But the chances that
hormonal birth control will significantly diminish some woman's quality of
life are statistically significant. The only way to avoid it is to go with
condoms.

Don't want kids? Don't want to take chances? Don't have sex. You think it's a
coincidence that one of the most pleasurable experiences possible also happens
to lead to the continuation of our species? Ha.

~~~
intopieces
>Don't want kids? Don't want to take chances? Don't have sex

This attitude has served our young people terribly [0]. Whether or not you
support abstinence-only education, your absolute refusal to acknowledge the
reality of human relationships and the sexual involvement that comes with it
makes your advice worthless, akin to saying "Don't want to die in a car-wreck?
Don't want to take chances? Don't leave your house."

[http://www.ncbi.nlm.nih.gov/pubmed/17885460](http://www.ncbi.nlm.nih.gov/pubmed/17885460)

~~~
andrewstuart2
Your linked article is not at all talking about what I'm saying.

All I'm saying by that is that there is one and only one guaranteed way to
avoid pregnancy. I'm all for proper education on the alternatives but
abstinence is the only contraceptive that's 100% effective at preventing
pregnancy.

That's why the "don't want to take chances" portion of my conclusion is so
critical. Education that contraceptives are imperfect is also critical IMO.

~~~
intopieces
Yes, you are correct that this is the only way guaranteed way to prevent
pregnancy. That information is not only obvious and well-known (I'm not sure
there is a group of people who thinks you can get pregnant without having
intercourse), but the attitude behind it perpetuates a culture of
misinformation, lack of information, and sex-negativity. You say you're pro-
education, but your attitude doesn't reflect that, as it matches precisely the
group of people that preach otherwise.

------
parennoob
The male birth-control pill is the need of the hour, yesterday. These stats
give me the chills.

~~~
parennoob
[can't edit original comment for some reason, so follow up:] ...A safe, low
side-effect, potentially reversible male birth-control pill would be a godsend
for men who want to control their reproductive potential.

I have heard that RISUG
)([http://en.wikipedia.org/wiki/Reversible_inhibition_of_sperm_...](http://en.wikipedia.org/wiki/Reversible_inhibition_of_sperm_under_guidance))
has shown promise, so may be something to watch out for.

------
cmdrfred
Really the ideal solution is to somehow make humans sterile by default with a
pill that allows you to become fertile on demand.

~~~
imjustsaying
We can even push stage 1 of the product out (100% sterilization of everyone,
everywhere) before we build stage 2 (the pill that reverses stage 1). At that
point, even non-profits will be throwing investment money into the business.

~~~
cmdrfred
You could open source and crowdfund stage one and your close relationship to
the project would give you the insight to develop stage two and patent it
first. Overpopulation in a future with limitless labor isn't a non-issue.
Charge maybe 20 grand a child?

[http://masseffect.wikia.com/wiki/Genophage](http://masseffect.wikia.com/wiki/Genophage)

------
daurnimator
I'm happy to read that a Hormonal implant is the most effective (even better
than sterilization.... I didn't expect that). [http://www.implanon-
usa.com/en/consumer/index.xhtml](http://www.implanon-
usa.com/en/consumer/index.xhtml)

~~~
sejje
Happy for what reason?

I've dated two women over a long period of time, part of the time with, and
part of the time without, a hormonal implant.

They both had drastic changes in mood, in my opinion for the worse, with the
implant in. Depressed, unambitious. For one of them that was nearly the
opposite of normal.

~~~
stinos
I'm not surprised. The pill tends to have such effects, though sometimes very
subtle, as well. For my wife it seriously reduced sex drive. Which we only
figured out after she stopped taking it. Which in turn and in the spirit of
the moment made us seriously question the whole anticonception-using-drugs
thing: what is this scam? How did society let this ever happen? Millions of
women paying huge amounts for something which basically makes them feel worse.
Erm, what? Of course we also realized it's not as black and white like that,
and it does prevent pregnancy. But still, something to think about.

~~~
kaybe
Depends, for women with strong problems during period the pill can improve
those a lot. Which might mean that instead of having to stay in bed with a hot
water bottle and terrible pain for a day+ each month one only feels slightly
uncomfortable.

------
misiti3780
Interesting "article", nice visualizations - where did that data come from
though ?

~~~
reubenmorais
Sources are listed after the article:

> Sources: James Trussell, Office of Population Research, Princeton
> University; Brookings Institution

~~~
raquo
That's not saying much. The guy wrote hundreds of articles on this topic since
1972:
[http://www.princeton.edu/~trussell/publications.htm](http://www.princeton.edu/~trussell/publications.htm)

The charts also ignore the fact that risk is more correlated with number of
usages rather than number of years of usage, so the numbers themselves are
quite useless.

Overall, I am disappointed by this... um... style of journalism.

~~~
reubenmorais
> The charts also ignore the fact that risk is more correlated with number of
> usages rather than number of years of usage, so the numbers themselves are
> quite useless.

I don't know how you're expecting that to be measured/reported. They're just
building on top of how effectiveness of contraceptive methods is already
reported, which comes from polling actual people and extrapolating from that,
not some theoretical calculation of the chance of failure per individual
sexual relation.

~~~
raquo
I'd say it's not unreasonable to expect a question of "how many times did you
use said contraception last year" in the poll/questionnaire. If the "perfect"
scenario can be self-reported, this is fair game as well I think.

------
xpda
5% of female sterilizations fail? That certainly doesn't sound right.

~~~
silencio
The 'tied tubes' type can fail because the tubes can grow back together. The
implant type (causes scar tissue to form and block the tubes) can fail if the
tubes are not fully blocked or something else happens to them.

------
thrownaway2424
If spermicides are useless why are they allowed to market them?

~~~
gleenn
They aren't useless, for instance you can use them in addition to condoms to
increase the effectiveness.

------
michaelsbradley
For couples looking for a non-surgical, non-pharmaceutical approach to family
planning, the _Billings_ and _Sympto-Thermal_ methods of NFP are are good
options:

[http://www.thebillingsovulationmethod.org/](http://www.thebillingsovulationmethod.org/)

[http://ccli.org/nfp/stm-method/ccl-stm-method.php](http://ccli.org/nfp/stm-
method/ccl-stm-method.php)

Both are well-researched (backed by solid science), easy to learn and use, and
have effectiveness rates as good or better than many methods of artificial
contraception. Also, they naturally help the couples become increasingly aware
of their fertility, and can aid them in achieving pregnancy if/when that is
desirable.

~~~
thrownaway2424
The charts in this article disagree with your "easy to learn" statement about
fertility awareness methods. It is one of the least effective in typical use
although theoretically it's not bad. As you say these methods are more useful
for getting pregnant than for not.

~~~
michaelsbradley
Here is the paper presented by Prof. S. Z. Qian in September 2000 regarding a
large trial of the Billings Method conducted in China:

[http://www.lifeissues.net/writers/qia/qia_01nfpchina.html](http://www.lifeissues.net/writers/qia/qia_01nfpchina.html)

"Due to its high efficacy, low expenditure and extreme safety incomparable by
any other contraceptive methods, the BOM is well accepted by the Chinese
couple of different cultural and economical backgrounds."

So, while I do not have enough background information on the chart provided by
NYT, it doesn't seem to square with other known data.

~~~
silencio
I don't think it necessarily contradicts the NYT chart. Fertility awareness
~can~ be fairly effective.

I think the problem is that the linked paper only studied women for 12 months
(try doing NFP for 10 years and saying it's effective) and they cherrypicked
them too... normal cycles (!), partnered, specific age range, para 1 (!!!).
That is definitely not going to match up with what NYT used and I wouldn't be
surprised if any one of those points ends up making a difference.

I'm trying to get pregnant for the first time right now with still irregular
cycles, and NFP for the purpose of pregnancy (educated, and I spend a LOT of
time on a lot of communities about this) is a huge headache. There's no way
I'd try this as birth control.

~~~
michaelsbradley
I'm in my late 30s and have met and know couples who use/d NFP for a decade+.
No one I've spoken with has said it's a huge headache, though some have
candidly admitted that the self-control factor is sometimes challenging (that
aspect is going to vary by couple, of course).

I can't speak to your experience, and as you say you have irregular cycles.
BOM can actually be quite simple for many couples, STM a little less so since
it tracks more fertility signs.

Here's a more recent report on a German study:

[http://humrep.oxfordjournals.org/content/22/5/1310.short](http://humrep.oxfordjournals.org/content/22/5/1310.short)

"The STM is a highly effective family planning method, provided the
appropriate guidelines are consistently adhered to."

