The most popular kind of birth control on campus is condoms, with 61 percent of women reporting that they used that method the last time they had sex. The pill came in a close second, with 58 percent, followed by withdrawal at 33 percent, according to a 2016 report by the American College Health Association from a survey of 80,129 undergraduate students. (Survey respondents often reported more than one method used.)
And yet, these commonly used contraceptive methods have failure rates that may give one pause. For 100 women over the course of a year, there would be nine pregnancies with the pill, 18 with condom use and 22 with the withdrawal method.
The top two birth control options in terms of effectiveness are intrauterine devices (IUDs) and progestin implants. With these methods, the failure rate is less than one pregnancy per 100 women in a year.
These two methods have another advantage for users, which earns them the moniker long-acting reversible contraceptives, or LARCs. After a one-time procedure, women are protected from getting pregnant for at least three years or up to 10 years, depending on the product.
There are fewer or milder side effects with these long-acting methods, compared with birth control pills. Copper IUDs such as Paragard can increase menstrual pain and flow, especially in the first year of use. Hormone-releasing IUDs, such as Mirena and Skyla, can cause spotting or irregular bleeding, especially in the first six months of use.
The hormones released by IUDs stay locally in the uterus, says Kristyn Brandi, an OB/GYN at Boston University. “So you don’t get the same side effects as taking the pill, such as changes in mood and breast tenderness,” she says.
A birth control implant can cause spotting throughout the monthly cycle. And its slowly released hormone distributes through the whole body, so hormonal side effects can occur, but “less so than the pill,” Brandi says.
With implants and hormonal IUDs, often menstrual periods become much lighter and in some women disappear altogether — a side effect that many view as a benefit.
Why don’t more young women use these long-acting, super-effective methods? In that survey of college students, IUDs were reported to be used by 9 percent of females and implants by 6 percent.
One reason is lingering myths about their safety in young women. “It’s a myth that you can’t have an IUD if you haven’t had a child,” says Krishna Upadhya, a Johns Hopkins pediatrician who specializes in adolescent health.
Older versions of IUDs were thought to be too large for some young women, but that’s no longer a concern, says Joanne Brown, a nurse practitioner at the University of Kentucky’s health service. “The newer IUDs are very small.”
Another reason more young women don’t use IUDs or implants is access, particularly on campus. Whereas 98 percent of campus health services provide birth control pills, only 40 percent provide the implant or IUDs. “It can depend on the size of a college, how many providers or what level of services they have,” says Brown, who works with the American College Health Association on sexual health issues.
Implants and IUDs require a procedure, not just a consultation and a prescription.
Cost can be a barrier, as well. The Affordable Care Act required health insurers to cover birth control, but that doesn’t mean that every plan covers every birth control method. Getting an IUD can cost several hundred dollars and as high as $1,000, including a medical exam and insertion.
Even if you’re paying some of the cost, IUDs are the most cost-effective birth control method, Brandi says. The non-hormonal IUD Paragard is good for 10 years and cost-wise beats paying $20 per month for birth control pills.
A relatively new IUD called Liletta is made by a nonprofit company with the aim of making them cost-friendly. “It costs $50 for a clinic to use,” Brandi says.
Birth control implants, which last three years, are generally cheaper than IUDs, at a couple of hundred dollars, but can run as high as $800, including insertion.
Upadhya, who sees patients up to age 25, says she helps them explore all the options -- not just effectiveness and side effects, but how a particular option fits in with their lives. Comfort level can play a role, she says. “The pill is the thing that everyone has heard of. People are very comfortable with the idea of it.”
As Brandi puts it: “The most effective form of birth control is the one people practice. Some people are good pill takers.”
The bottom line is there are a lot of options: the LARCs, the pill, the patch, the ring and the shot. “Even if you’ve had a problem with other kinds of birth control, Brandi advises, “talk to you doctor; she’ll help you figure out how to find something that will work.”