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.
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 :)
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.
>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!)
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".
I believe the medical community refers to this as "patient non-compliance". It's an important factor for doctors to consider; it often makes sense to prescribe a "worse" medication if the "more effective" medicine has side effects which often cause patients to stop early or to skip or forget doses. New formulations of drugs are often advertised to doctors as being just as effective as previous versions but with "improved patient compliance" due to easier dosing schedules (e.g., daily instead of every 8 hours) or fewer side effects.
In response to the question of 'typical use', I think that it also depends on the context of birth control.
There are types of birth control which are somewhat passive; they are renewed at a pre-defined interval which is not related to intercourse.
Therefore, considering other types which are only necessary to be applied during the window of intercourse, 'normal use' might reasonably include times where that was the /plan/ but for which the users 'forgot'.
Example: I'd guess that when hormonal birth control fails despite being used perfectly, it could well be related to the person's particular biology. So if it failed for them one year, there'd be a high chance of it failing the next. And if it worked for the previous year, there's a lower chance of whatever goes wrong going wrong.
(I'd be curious to hear from someone who knows what they're talking about, though!)
i imagine the reason you're using a throwaway account (created 53 minutes ago, the same time as your comment as of my reading it) and guarding your words carefully is because you're tiptoeing around the fact that.... sometimes women lie about taking birth control in order to get pregnant 'accidentally on purpose'.
men and women both do terrible things; this is one of the things women do.
Contraceptives require a lot of discipline to be used correctly. Did you accidentally try putting a condom on the wrong way? Don't turn it around, throw it away. Did you have diarrhea after taking the pill? No sex this month.
The effectiveness of a contraceptive depends a lot on the discipline (and personality) of the people using them. Many people don't even read the instructions that come with the contraceptives. That's why they are ineffective, not because partners lie to another about using contraceptives.
> That's why they are ineffective, not because partners lie to another about using contraceptives.
sorry, i just don't agree. you seem to entirely discount deception and coercion, which are the female and male forms of the same kind of birth control 'failures' that people tend to lie about on surveys.
The good part is that the deception is already baked-in into the final statistics. Basically it tells you "if the woman you're sleeping with is on the pill, you have this much chance of having an unexpected child". So wear a condom and start getting paranoid when she asks that you have sex without one.
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.
>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."
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.
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.
Abstinence is basically off topic in this discussion. The goal is to "avoid pregnancy while having sex". Not having sex, is not a solution to this goal.
Telling someone not to drive if they don't want to die in a car crash, does not move car safety forward. Abstinence is often used as an extinguisher of information, not as a motivator.
Your information on IUDs is very out of date. Assuming you can pass an on-the-spot STI test and the time of insertion, IUDs are not considered to have any impact on fertility at this time.
Then our Doctors' information on IUDs was also very out of date. That was their recommendation. Despite the low risks, they were still risks we weren't willing to take.
Medicine is a vast, fast moving field. No shame in a doctor not knowing everything about everything. But if you want the best possible advice re: birth control I'd suggest finding a better doctor. :)
For your reference: The issue with IUDs and fertility is PID (Pelvic Inflamatory Disase). It was previously thought that having an IUD increased your risk of PID, but the latest research shows that the risk of PID is not associated with IUD use, but with IUD insertion. If you do not have an STI at the time of insertion, you're safe. Some research has even shown that the Mirena will lower the long term risk of PID, and a large study from China just came out showing that long-term use of IUD does not impact fertility.
You seem primarily concerned not with PID, but the risk of perforation during insertion in roughly 1 in every 2,000 women. Which, first off, is a pretty damn low rate, and compares favourably to the risks of other birth control options. And second, while a perforation can be serious, even if not caught it should just heal on its own. Worst case, it might require surgery, but it's not going to cause long term fertility issues.
Everyone has the right to choose which risks they're willing to take, to be sure. But I think you may be grossly misinformed if you think that the Mirena and similar IUDs convey significant risks of infertility. Don't get one inserted without an STI test, and get a followup check to make sure there's no perforation, and then there is no (repeat no) evidence of an increased rate of infertility.
Modern IUDs do not cause disease; may be protective against disease; and the original faulty models may have been wrongly blamed for disease which was prevalent in the population.
Agreed, but IUDs by definition are implanted into the uterine wall, manually. Doctors can make mistakes or their hands can slip, causing a perforated uterus, which in turn can cause infertility.
But the doctor did not tell you how often that happens. So you have some unknown risk - how is anyone expected to make an informed choice?
Everything carries some risk. Female hormonal contraception carries some risk of death. (About 12 women per 10,000 taking the pill will experience a blood clot each year. This is potentially a life-changing or even life ending event.)
Even vasectomy is not perfect. There is risk involved with the procedure. You're likely going to get a lecture regardless of how many kids you've had, and if you've had zero be prepared for outright refusal by many doctors. There is also some stigma attached to it. Some women find a man who's had a vasectomy a turn off.
I did the chop, and had I wanted more, I would have frozen some sperm. The procedure itself is also reversible. Considering the cost/benefit ratio, and the risks of male vs. those of female sterilisation, I consider not doing it selfish and boorish.
Well I did experience pushback when I had my vasectomy at 22 with no kids. I've also read of men with multiple children getting lectured about the procedure.
It is potentially reversible, not 100% reversible. There is a huge chance you'll be sterile for life. Some men also report post-vasectomy pain syndrome.
The bigger problem with IUDs is that they can be exceptionally painful. Also, while people often seek out alternative birth control when they don't want to use condoms, the article clearly articulated a pretty high failure rate over ten years.
I don't know if I 100% agree with all of your points there, but I can see where you're coming from on them.
Regardless, I do really feel you're spot on about the attitudes that some gentlemen out there have towards condoms. Or, condoms are so inexpensive and practical, it makes a lot of sense to use them. Not to mention if they're properly sized they won't hurt or feel uncomfortable.
[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.
There are plants like that in the amazon - the indians give them to adolescents to make them infertile for about 5 years (might be a fungus because some other plants to start and end fertility looked the same to the author of the book I read, and the people she showed them).
There are a lot of amazing medical plants (one that you put on a rotting tooth - and it just falls out like that), and sadly we don't have access to most of them.. professionals I discussed this with put it on a high chance of, uh, interesting side effects (also psychological) and the high costs of testing. It's sad, still, especially since we are losing the knowledge.
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.
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?
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.
That's a potential problem with most hormonal contraceptives, not just the implant. That's also not something that all women experience. I've never had a problem beyond minimal weight gain with anything I've ever used (multiple forms of pills, nuvaring, depo, mirena IUD) and same for many of my female friends are in my situation, while I have some that only stick with very specific brands/types, and some that swore off birth control altogether.
I'm pretty happy that the implant is so effective for something so minimally invasive (in comparison to sterilization), personally, and I'll be considering it for my next form of birth control. I love what hormonal options do for me and I would never consider anything else.
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.
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.
better than sterilization.... I didn't expect that
This is probably because surgery is always a tradeoff: You want to get the job done, but you don't want to go crazy with the scalpel and cause unrelated injuries. In the case of vasectomies, men usually want the smallest possible cut to be made, to the point that it's not necessarily obvious whether the procedure was completed.
For a really scary example of how surgeries can fail: Surgical abortions have a 0.2% failure rate. You might think that an adult armed with a sharp knife should be able to kill a fetus rather more than 99.8% of the time -- but the added requirement of not killing the mother clearly makes things more difficult.
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.
> 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.
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.
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.
Might be a similar story to https://news.ycombinator.com/item?id=8927403, just for a different product. tldr; even if a drug's effect is questionable it can be put on the market or even recommended by official channels. As to the question why I can only guess, and my guess would be that money is the driving factor. Then again, I don't know anything at all about spermicides and whether they work (sometimes) or not so maybe someone with a better insight on the matter should comment on this.
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:
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.
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.
"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.
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.
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.
It's just another rhythm method, and this is covered by graph 2. The study you quote represents a "perfect use" because of the additional surveillance and support leading to better outcomes, associated with a study. BTW the study also compares with a low efficacy IUD; modern IUDs are much more effective.
The phrase "just another rhythm method" is potentially quite misleading or indicative of misunderstanding – I don't presume to know your motives for employing the phrase.
Now, there is a true sense in which all NFP methods can be described as "rhythm" methods, i.e. human female fertility displays cyclic characteristics (generally speaking) between puberty and menopause, so methods which employ observation of a woman's fertility signs are tuning into the "rhythm" of her cycle.
But, "rhythm method" has become synonymous with Calendar Rhythm Method, the early-modern forms of which date back to the 1920s. The failure rate for typical use of historical rhythm method is higher than, say, the pill or condoms, and since the middle of the last century it has been dismissed as an effective form of birth control.
Several NFP methods developed since that time (mid 20th Century) involve more than marking days on a calendar. The woman, or the couple together, track one or more well-researched signs of fertility: basal body temperature, cervical mucus, changes in the cervix. Current and past observations are correlated according to straightforward rules to determine the start and end of a fertile period (i.e. "abstinence days" from vaginal intercourse, for those hoping to avoid pregnancy). So while days do get marked on a calendar, these methods are different enough in practice, and with respect to their effectiveness, that it's incorrect to lump them together with the older rhythm method. To avoid misperception, researchers themselves refer to these methods as FA, FAB, or FAM – "fertility awareness [based] [method/s]" – and not as "rhythm methods".
There is a true successor to the old calendar rhythm method. It was developed in the late 1990s and is called the Standard Days Method. See:
As to the NYT's chart: as I said previously, I am a little dubious that it accurately reflects the worldwide data collected for the effectiveness of modern NFP. Which is not to say that I think the chart's creator is intentionally trying to mislead the Times' readership.
I have no comment on the effectiveness of modern IUDs, though I refer you to the German study I linked in a later comment above for additional info on NFP's effectiveness.
The larger point, sometimes missed by people who have a knee-jerk reaction to mention of NFP, is that its modern methods offer viable, drug-free, surgery-free, inexpensive approaches to birth control, which can be used effectively by rich and poor alike.
You seem very interested in this topic and I applaud your enthusiasm but I still think you are overselling the ease of this method. Basal temperature is tricky to measure and if you have any responsibilities of any kind in the morning you are likely to get the timing wrong or just skip it some days. Certainly those with a child or children already will find even sparing 90 seconds first thing after waking to be difficult. Children are selfish little assholes and aren't interested in your 90 seconds to yourself.
Cervical mucus that you gloss over involves sticking two digits way up your vagina every day and then evaluating the outcome. There's nothing wrong or gross about that but lots of people are unable to treat their own body with the required detachment.
The focus of my comments has not been on the methods' ease of use. I did write "easy to learn", and I think the research backs up that claim.
I am aware of what is involved in tracking the various signs. Like most any voluntary human routine – exercise, special diet, regular study, etc. – the hardest part is in the beginning, i.e. making the commitment, getting in the habit, sticking to it. How difficult or easy it is to adopt an NFP tracking-routine is going to vary by the woman/couple. If for some women basal temperature and cervical mucus are perceived or prove to be difficult signs to track, for whatever reason, they could look into the Standard Days Method (linked above). Some may prefer that method in the first place.
It occurs to me that you can divide birth control methods into those that require self-discipline, e.g. rhythm and barrier methods and the pill, vs. ones that don't like IUDs, Norplant and of course surgery. And that there's a population for whom none of the self-discipline methods are going to work in the long term (I've been around women who had an amazing difficultly in taking the pill every day...).
Then there's the confounding factor of the backstops, the "morning after" medicines and abortion, with the further confounding factor of cultural acceptance of them. I've read that there's almost no stigma associated with abortion in Japan, which I connect with another thing I've read, that a baby isn't considered to be ... real?, really counted as alive in some sense, until it survives for 3 days. Which helps deal with the high natural mortality rate right after birth.
Which needs to be remembered when you e.g. try to compare life expectancy rates between countries, since infant mortality is such a major factor in that, and countries vary wildly in how they score it. E.g. the US tries very hard, much harder than most counties, to save preemies and those with birth defects, whereas the latter are unlikely to ever exit the neonatal unit alive in the PRC (something that came up in discussion of the couple in Armenia where it's claimed the mother gave the father of their newborn son with Downs Syndrome the ultimatum of divorce if he wanted to keep the child, one pretty clear implication being he would be killed if not).
