If a woman is sexually active and she is fertile and physically able to become pregnant she needs to ask herself, “Do I want to become pregnant now?” If her answer is “No,” she must use some method of birth control (contraception).

If a woman does not want to get pregnant at this point in her life, when does she plan to become pregnant? Soon? Much later? Never? Her answers to these questions can determine the method of birth control that she and her male sexual partner use now and in the future.

It is estimated that there are 3.6 million unplanned pregnancies every year in the United States. Half of these unplanned pregnancies happen because a couple does not use any birth control at all, and the other half occur because the couple uses birth control, but not correctly.

In simple terms, all methods of birth control are based on either preventing a man’s sperm from reaching and entering a woman’s egg (fertilization) or preventing the fertilized egg from implanting in the woman’s uterus (her womb) and starting to grow.

Birth control methods can be reversible or permanent. Reversible birth control means that the method can be stopped at essentially any time without long-term effects on fertility (the ability to become pregnant). Permanent birth control usually means that the method cannot be undone or reversed, most likely because it involved surgery. Examples of permanent methods include vasectomy for the man or tubal ligation for the woman.

Birth control methods can also be classified according to whether they are a barrier method (for example, a condom) that blocks sperm, a mechanical method (for example, an intrauterine device), or a hormonal method (for example, the “pill”).

“Natural” methods do not rely on devices or hormones but on observing some aspect of a woman’s body physiology in order to prevent fertilization.

The direct responsibility for most of the methods of birth control that are currently available rests with the woman. The input of a health care provider may sometimes be essential in choosing appropriate birth control. New methods of birth control are being developed and tested all the time. And what is appropriate for a couple at one point may change with time and circumstances.

Unfortunately, no birth control method, except abstinence, is considered to be 100% effective and most of these choices offer little or no protection against sexually transmitted infections (sexually transmitted diseases, STDs), especially against HIV, the human immunodeficiency virus that causes AIDS.

For some individuals, economic considerations dictate their choice of contraceptive method. Abstinence is 100% effective and costs nothing, but may not always be a popular choice. “Natural” methods cost essentially nothing (if one does not use test kits or electronic monitors) but they require considerable discipline to be effective. Barrier methods, such as spermicides and condoms, are affordable to most people and can be effective if they are used consistently and correctly. The hormonal methods, such as “the pill,” are highly effective but their cost can add up if they must be purchased and regularly repeated.

The choice of a particular method of contraceptive also depends on a person’s age, health, and personal situation. For example, behavioral methods (fertility awareness or withdrawal), IUDs, and tubal ligation are not methods recommended for teenagers. A vasectomy or tubal ligation are not appropriate for a man or woman who wishes to have children in the future because surgical reversal is not guaranteed. Certain medical conditions can rule out a woman using a hormone-based method of birth control.

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