(Published September 2009)

Using This Guide

Contraceptives with high efficacy rates have been available for several decades. Still, nearly half of all pregnancies in the United States are unintended.¹  Use of less effective methods, coupled with inconsistent, incorrect, and discontinued use of contraception, contribute to this public health problem. Experts estimate that at current rates, at least half of all women in the United States will experience an unintended pregnancy, and one in three will have had an abortion by age 45.² The risk of unintended pregnancy is often further complicated by gaps in contraceptive use. Gaps may be caused by difficulty in using or accessing methods, infrequent sexual activity, or misperceptions of risk of pregnancy.³

Patients need counseling about and access to the broadest number of contraceptive options so that they can select the one(s) best suited for their lifestyles and reproductive plans. Because patient-provider discussions about contraceptive options are the strongest indicator of selection, adherence, and satisfaction with a method, it is imperative that providers understand and are able to present patients with all available options.⁴

This Quick Reference Guide for Clinicians provides brief information about all contraceptive methods currently available in the United States. It is designed to help health care providers quickly counsel women about choosing the most appropriate and effective contraception for them.

In this guide, effectiveness for each contraceptive method is actually expressed as a failure rate, or the percentage of women who can be expected to become pregnant within the first year they use that method. Effectiveness rates are given with both perfect use (correct and consistent use of the method with every act of intercourse) and typical use (actual use, including occasional, inconsistent, or incorrect use). Except where otherwise noted, these rates are based on those reported in the 19 th edition of Contraceptive Technology.⁵

Separate sections in this guide are devoted to each of the following methods:

• Male sterilization (vasectomy)
• Female sterilization (surgical and nonsurgical tubal occlusion)
• Implant
• Intrauterine contraception (IUC)
• Injectable
• Oral contraceptives (progestin-only, combined, extended, continuous)
• Transdermal patch
• Vaginal ring
• Male condom
• Withdrawal
• Female condom
• Emergency contraception
• Diaphragm
• Sponge
• Fertility awareness
• Cervical cap
• Spermicides

Each section describes the method; presents information on its use, effectiveness, risks, and side effects; and concludes with a list of principal advantages and disadvantages of that method and counseling messages. Contraindications are only included for medical devices and medications. The last section of this Quick Reference Guide for Clinicians includes a comparison chart of the methods described in this guide, to help make counseling more efficient.

For a list of useful clinical resources on contraception, see ARHP’s Reproductive Health Topic Area on Contraception, located at www.arhp.org/topics/contraception.

The following abbreviations are used throughout this document:

• BMD – bone mineral density
• COCs – combined oral contraceptives
• EC – emergency contraception
• FC - female condom
• FDA – Food and Drug Administration
• HIV – human immunodeficiency virus
• IUC – intrauterine contraception
• IUD – intrauterine device
• LNG IUS – levonorgestrel intrauterine system
• OCs – oral contraceptives
• PID – pelvic inflammatory disease
• STI – sexually transmitted infection (assumed to include HIV)
• TSS – toxic shock syndrome
• UTI – urinary tract infection
• VTE – venous thromboembolism

Although time during office visits is limited, health care providers have a clear responsibility to counsel their patients on contraceptive options, focusing on the most effective methods, including long-acting reversible contraception. It is important for health care providers to factor each patient’s personal and sexual situation into the effectiveness equation. Costs of methods are variable and may influence choice for some women. The most effective methods do not protect against STIs; they may also be the hardest to access. A discussion about having a backup method for situations such as missed pills or delayed access may help a patient avoid an unplanned pregnancy.⁶ The Association of Reproductive Health Professionals has created this Quick Reference Guide to facilitate an effective, comprehensive discussion with patients and foster individualization of contraceptive choice.