More effective birth control harder to get

I read the FDA’s guide to birth control for women where various methods of birth control are compared by effectiveness, availability, and use.

The FDA's stunning guide to birth control for women

They grouped birth control methods into categories:

  • Barrier methods (condoms, spermicides),
  • hormonal methods (pills, rings, patches),
  • emergency contraception (the morning after pill),
  • implanted devices (IUD, implanon) and
  • permanent methods (tubile ligation, vasectomy).

What is interesting is that only the some of the barrier methods are available over the counter, with the exception of the morning after pill. All the rest must be administered by a healthcare professional. So, the majority of methods are out of the reach of regular people unless they have access to health care.

Another interesting point was that the change of getting pregnant was much higher with the barrier methods than with the other methods. So prescription-only methods are more effective, and harder to get.

The FDA has a nice little chart comparing effectiveness of methods. They are missing a column, though. Accessibility is missing from the diagram. You can practically draw a line between over the counter and prescription methods and see the jump in effectiveness. Is it ethical that these methods are harder to obtain?

Compare effectiveness, but not accessibility

A quick breakdown of availability and efficiency:

Barrier methods

Male condom, over the counter, 11-16% chance of pregnancy
Female condom, over the counter, 20% chance of pregnancy
Diaphragm with spermicide, prescription, 15% chance of pregnancy
Sponge with spermicide, over the counter, 16-32% chance of pregnancy
Cervical cap with spermicide, prescription, 17-23% chance of pregnancy
Spermicide alone, over the counter, 30% chance of pregnancy

Hormonal methods

Oral contraceptive, prescription, 5% chance of pregnancy
Patch, prescription, 5% chance of pregnancy
Vaginal contraceptive ring, prescription, 5% chance of pregnancy
Shot/injection, prescription, <1% chance of pregnancy
Emergency contraception, over the counter if over 18, 15% chance of pregnancy

Implanted devices

Copper IUD, inserted by doctor, <1% chance of pregnancy
IUD with Progestin, inserted by doctor, <1% chance of pregnancy
Implantable rod, inserted by doctor, <1% chance of pregnancy

So the more available, over the counter methods are much less effective than prescription only methods. Now, for things that need to be injected or implanted, I can see why a trip to the doctor’s office is needed. But for patches, pills and rings, these are dispensed by prescription but actually administered by the patient herself. So the service the doctor is supposedly doing for the patient is screening them for risks and controlling the supply.

Could a women self-screen for risks? The questionnaire for birth control seems pretty straightforward…do you smoke, do you have a history of stroke or blood clots? High blood pressure an uncommon risk, heart disease and stroke are rare.

What isn’t clear is if the women who smoke or have a history of heart disease should avoid the pill completely or if they can still use it but need to keep an eye out for certain symptoms. It seems this information could be made available to patients through a brochure, or a website, like everything else.


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