Post-‘Roe,’ Contraceptive Failures Carry Bigger Stakes

With most abortions outlawed in at least 13 states and legal battles underway in others, contraceptive failures now carry bigger stakes for tens of millions of Americans. Those stakes are the new backdrop for couples making decisions about which form of contraception to choose or calculating the chances of pregnancy.

Understanding Perfect vs. Typical Use

Researchers distinguish between the perfect use of birth control, when a method is used consistently and correctly every time, and typical use, when a method is used in real-life circumstances. “No one walks into my office and says, ‘I plan on missing a pill,’” said obstetrician-gynecologist Dr. Mitchell Creinin. “There is no such thing as perfect use, we are all real-life users,” said Creinin, a professor at the University of California-Davis who wrote a widely used textbook that details contraceptive failure rates. But no prescription drug or medical device works flawlessly, and people’s use of contraception is inexact.

Contraceptive Failure Statistics

Even when the odds of contraception failure are small, the number of incidents can add up quickly. More than 47 million women of reproductive age in the United States use contraception and, depending on the birth control method, hundreds of thousands of unplanned pregnancies can occur each year. No birth control, short of a complete female sterilization, has a 0.00% failure rate.

Based on the provided data, the effectiveness and impact of different methods are summarized as follows:

• Oral Contraceptives: The failure rate for typical use is 7%. For every million women taking pills, 70,000 unplanned pregnancies could occur in a year.
• IUDs and Implants: These methods fail to prevent pregnancy 0.1% to 0.4% of the time. Some 4.8 million women use IUDs or implants in the U.S., leading to as many as 5,000 to 20,000 unplanned pregnancies a year.
• Intrauterine Device Success: Intrauterine devices can prevent pregnancy 99.6% of the time.

The Real-Life Impact of Birth Control Methods

Birth control options have improved over the decades. Oral contraceptives are now safer, with fewer side effects. According to the most recent data available, more than 6.5 million women ages 15 to 49 use oral contraceptives, leading to about 460,000 unplanned pregnancies.

Even seemingly minuscule failure rates of IUDs and birth control implants can lead to surprises. An intrauterine device releases a hormone that thickens the mucus on the cervix. Sperm hit the brick wall of mucus and are unable to pass through the barrier. Implants are matchstick-sized plastic rods placed under the skin, which send a steady, low dose of hormone into the body that also thickens the cervical mucus and prevents the ovaries from releasing an egg. But not always. The hormonal IUD and implants fail to prevent pregnancy 0.1% to 0.4% of the time.

Legal Landscape and Clinical Reality

Abortion has been outlawed in Arkansas since the Supreme Court’s ruling on Dobbs v. Jackson Women’s Health Organization in late June. The only exception is when a patient’s death is considered imminent. “We’ve had women come through here for abortions who had an IUD, and they were the one in a thousand,” said Gordon Low, a nurse practitioner. Another complication is the belief among many that contraceptives should work all the time, every time. “In medicine, there is never anything that is 100%,” said Dr. Régine Sitruk-Ware, a reproductive endocrinologist at the Population Council, a nonprofit research organization.