All you need to know about Contraception (Birth Control) Options

Choosing the right birth control

Selecting the most suitable contraceptive method depends on several factors:

• Plans for starting a family in the future

• Frequency of sexual activity and number of partners.

• Effectiveness when used as directed.

• Age and general health.

• Protection against sexually transmitted infections (STIs).

• Potential side effects or risks.

• Additional benefits such as regulating or lightening menstrual cycles.

• Ease of use and personal comfort

• The need for discretion.

How does it prevent pregnancy?

Each method of contraception functions differently. Common processes include:

• Preventing sperm from reaching an egg.

• Altering the uterine lining to prevent implantation.

• Damaging sperm, hindering their ability to reach the egg.

• Suppressing ovulation (the release of an egg).

• Thickens the mucus of the cervix to block sperm movement.

What are the contraceptives with the most effectiveness?

The method that is more effective when it comes to avoiding pregnancy is abstinence, which involves refraining from sexual activity. However, this can be challenging for many couples. It is wise to have a secondary form of contraception in place.

Less effective options include withdrawal (“pulling out”) or fertility awareness techniques. Methods that require minimal effort or maintenance tend to be the most effective, such as IUDs, sterilisation, and contraceptive implants.

Combining methods, such as taking contraceptive pills alongside condom usage,  offers enhanced protection by reducing the risk of sexually transmitted infections and increasing reliability.

Forms of contraception

Before deciding on a contraceptive method, it’s important to discuss your options with a partner and medical professional. Proper and consistent use is the key to success. The various contraceptive methods are;

• Sterilisation: Surgical procedures that permanently prevent pregnancy in men or women.

• Barrier method: Physically block sperm from entering the uterus and must be used every time you have sex.

• Abstinence: Refraining from sexual activity entirely.

• Hormonal contraceptives: Regulate ovulation or alter the uterus and cervix using hormones. These can be short-acting (e.g., daily pills) or long-acting (e.g., implants or IUDs).

• Emergency contraceptive techniques: A last-resort option to prevent pregnancy after unprotected sex or contraceptive failure.

• Fertility awareness: Natural methods of identifying fertile periods to avoid pregnancy.

Barrier method

Use of spermicides

Description: This is a suppository, gel, or cream containing chemicals that immobilise sperm cells, preventing them from fertilising the egg. The vaginal gel given only by prescription also lowers vaginal pH to inhibit sperm movement.

Availability: Over-the-counter in most pharmacies. Vaginal gels require a prescription. 

How to use: Apply inside the vagina 15 to 30 minutes before having sex. Endeavour to apply again every time you have sexual intercourse, as the effectiveness lasts about an hour.

Effectiveness:

Spermicide alone: its effectiveness is only 70%.

Whencombined with another barrier method: Up to 94% effective.

Additional Information: Spermicides do not protect one against any sexually transmitted infections and may increase infection risks by irritating vaginal tissue.

Use of condoms

Description: This is a thin sheath made from materials such as lamb skin, latex, or plastic. It is worn over a penis that is erect; it prevents sperm from entering the vagina. A condom might rip during sexual intercourse, making it less reliable than some other contraceptive techniques.

Availability: Widely available for purchase at pharmacies and supermarkets.

How to use: Roll a new condom onto the penis before intercourse. Discard after a single use.

Effectiveness: Around 85% effective when used properly and without breakage.

Additional Information:

In case of condom failure, consider using other emergency contraception. Male condoms also serve as protection against sexually transmitted infections. Use water-based lubricants, as oil-based products can weaken the material and cause breakage.

Using female condoms

Description: A plastic pouch properly lubricated, with flexible rings at both ends, inserted into the vagina to block sperm.

Availability: Over-the-counter at pharmacies and shops.

How to use: Insert before intercourse, ensuring the open end slightly protrudes from the vagina and the closed end covers the cervix.

Effectiveness: Approximately 79% effective.

Additional Information: Offers some STI protection, though male condoms are more effective.

Vaginal diaphragm

Description: A reusable, flexible dome-shaped cup that fits over the cervix used with spermicide to block sperm.

Availability: Requires fitting by a medical practitioner unless using a one-size option.

How to use: Insert into the vagina, ensuring it covers the cervix. Apply spermicide around the rim. Leave in place for 6 to twenty-four hrs after sex.

Effectiveness: 87% to 94% effective with consistent use.

Additional Information: This does not prevent one from contracting sexually transmitted infections.

Sponge method

Description: A small, shaped like a doughnut, soaked in spermicide that acts as both a barrier and spermicide delivery method.

Availability: Sold over-the-counter in pharmacies.

How to use: Moisten with water before insertion to activate the spermicide. Leave in place for at least six hours after intercourse and remove within 30 hours.

Effectiveness: 76% to 91% effectiveness rate, with greater reliability for women who haven’t birthed a child before.

Additional Information: This does not prevent one from contracting sexually transmitted infections. Instead, it may increase the rate of women having vaginal infections.

Cervical caps

Description: A small, thimble-shaped device made of silicone or rubber placed over the cervix.

How to use: Coat with spermicide before insertion. It can be placed up to six hours before intercourse and left for up to 48 hours.

Availability: Must be fitted by a healthcare provider.

Effectiveness: 78% to 85% effective.

Additional Information: Provides limited protection from sexually transmitted infections

Hormonal devices

Intrauterine Device (IUD)

Description: An intrauterine device (IUD) is a flexible,  small, T-shaped device placed in the uterus to prevent you from getting it. There are two types:

Copper IUDs (e.g., ParaGard T380A®) can last up to 10 years and create an environment that makes it difficult for sperm to reach an egg.

Hormonal IUDs (e.g., Mirena®, Kyleena®) release progestin, which thickens the cervix’s mucus and thins the lining of the uterus. These last between 3–7 years, depending on the brand.

Effectiveness: IUDs are nearly 100% effective at preventing pregnancy.

How to use: A healthcare provider performs a pelvic exam and inserts the IUD into your uterus during a simple office procedure.

Additional information:

Copper IUDs may cause heavier periods, while hormonal IUDs may cause irregular bleeding that improves over time. IUDs can be used for emergency contraception if inserted within five days of unprotected sex.

A healthcare provider must remove the IUD, and pregnancy with an IUD in place carries a higher risk of ectopic pregnancy.

Birth control implantation

Description: The birth control implant, such as Nexplanon®, is a tiny rod about the size of a matchstick that is placed under the upper arm’s skin. It releases the progestin hormone steadily and protects against pregnancy for up to 3 years.

Effectiveness: The birth control implant’s effectiveness is nearly 100%, making it one of the most reliable contraceptive techniques that can be easily reversed.

How to use: A medical professional numbs the area on your upper arm and uses a special applicator to place the implant under your skin. The procedure is quick and done in the office of the medical practitioner. The implant can only be removed by a medical professional.

Additional Information:

• It is low maintenance and does not interfere with sexual spontaneity.

• It requires a prescription and must be replaced every three years.

Side effects may include irregular bleeding, sore breasts, or headaches. Over time, bleeding may improve or stop entirely.

Progestin pills only

Description: also referred to as minipills, they contain only progestin and work by thinning the lining of the uterus, and also thickening the mucus of the cervix and thinning the uterine lining.

Effectiveness: With perfect use, its effectiveness can be 99%, but typical use reduces effectiveness to about 91%.

How to use: They must be taken at the same time daily to maintain effectiveness.

Additional Information:

Minipills are a good option for those who cannot use estrogen or are breastfeeding.

Irregular but light bleeding is the most common side effect.

Hormonal Contraceptives (Pill, Patch, Ring)

Description: These methods include vaginal rings (e.g., NuvaRing®), skin patches (e.g., Xulane®), and birth control pills. They contain oestrogen and progestin to prevent ovulation.

Effectiveness: Their effectiveness is up to 99% with perfect use, but real-life effectiveness is around 91% due to inconsistent use.

Availability: the contraceptive can only be obtained through a doctor’s prescription.

How to use

Ring: Inserted monthly and replaced every 4 weeks.

Patch: Worn weekly and replaced once per week 

Pill: Taken daily at the same time.

Additional Information:

Benefits include lighter periods, reduced cramps, and improved acne.

Side effects may include nausea, headaches, irregular bleeding, and breast pain or tenderness.

Oestrogen-containing methods may increase the risk of blood clots.

Birth control shot (Depo-Provera®)

Description: The shot contains the progestin hormone, which prevents ovulation and thickens cervical mucus.

Effectiveness: With timely injections, the effectiveness can be 99%. Nevertheless, effectiveness drops if shots are delayed.

Availability: based on prescription by a medical practitioner.

How to use: It is injected every 12 weeks by a medical practitioner or self-administered at home with a lower dose.

Additional Information:

Some users stop having periods after a year of use.

It may cause slight weight gain, and the patient might bleed irregularly. 

Fertility may take longer to return after stopping the shot compared to other methods.

Cervical mucus technique

Description: This technique involves monitoring your cervical mucus to determine when you’re most fertile. You abstain from intercourse during your fertile days.

Effectiveness: This technique is about 75% to 88% effective when used properly.

How to use: You can examine the mucus in your cervix using your finger or observe it in your underpants. Thick or pasty mucus indicates you’re not fertile, while fertile mucus is clear, resembles raw egg whites and is slippery. Learning these changes over your cycle helps you know when you’re ovulating.

Additional information

This technique requires dedication and includes abstaining from sex for up to 14 days. It may also be challenging to identify or know your safe days, especially if mucus patterns are unclear.

Rhythmic  technique

Description: The calendar technique (rhythm method) involves tracking your menstrual cycle to predict ovulation. By identifying your fertile days—when pregnancy is most likely—you can avoid sexual intercourse during this period.

Effectiveness: This method is among the least reliable forms of birth control, with effectiveness ranging from 75% to 88%, even when used correctly.

How to use: You record your menstrual cycles on a calendar for several months for ovulation prediction.

Additional information

This technique is unsuitable for individuals with an irregular cycle. However, it is not expensive and has no side effects. 

BBT (Basal Body Temperature)

Description: This technique involves measuring your basal body temperature (BBT) for ovulation identification. You’ll need a thermometer that will measure one-tenth of a degree.

Effectiveness: On its own, BBT is unreliable because it only confirms ovulation has occurred, not when it is imminent. Since pregnancy can happen up to five days before ovulation, this method is not highly effective.

How to use: You take your temperature early in the morning before getting up or standing up. A rise of less than half a degree indicates ovulation has occurred. After this temperature increase, unprotected sex is safe for up to 72 hours.

Additional information

This technique requires consistency and dedication to daily temperature tracking. Although it is not expensive, it is less reliable than other methods, such as hormonal contraception or barrier techniques.

Emergency contraceptive techniques

Description: Emergency contraceptive techniques are a short-term method to prevent pregnancy after unprotected intercourse. Its effectiveness is high when taken within three days but can work up to five days after.

The pill with the highest effectiveness contains ulipristal (brand name: ella®), which is only available via prescription. Over-the-counter options include levonorgestrel-based pills (Plan B One-Step®, Take Action®, etc.).

Availability: Ulipristal (ella®) requires a prescription from a medical professional. Levonorgestrel pills are available over the counter at most pharmacies.

How do they work: the pills delay ovulation to prevent pregnancy.

Effectiveness: The morning-after pill’s effectiveness can reach as high as 90% when taken within 3 days. However, they are ineffective if ovulation has already occurred.

Can IUDs be used as an emergency contraceptive technique?

Certainly, both progestin IUDs (e.g., Mirena®, Liletta®) and copper (e.g., Paragard®) are highly effective when inserted within five days of sex without protection. Copper intrauterine devices prevent sperm from fertilising the egg, while progestin intrauterine devices thicken the cervical mucus to block sperm.

Additional information

The intrauterine devices are prescribed and inserted by a medical practitioner. This technique can cause menstrual irregularity. Use condoms or abstain from intercourse for at least five days after taking the pill to prevent pregnancy. If your period is delayed, take a pregnancy test. Frequent uses of emergency pills are not advisable—talk to your healthcare provider about long-term contraception options.

Abstinence

Description: This is the only technique that has 100% effectiveness. It means completely refraining from any sexual activity. It also provides full protection against sexually transmitted infections (STIs).

Additional information

Abstinence is a personal decision, and no one should pressure you to have sexual intercourse if you are not prepared for it. Consider how it will affect you physically and emotionally before you make your decision. 

Sterilisation

Tubal Ligation

Description: This is a minor surgical procedure that blocks the fallopian tubes by sealing, clamping, or tying them. Here, the tubes are not removed.

Effectiveness: This procedure’s effectiveness is almost at 100%, but in rare cases, it may result in an ectopic pregnancy if pregnancy occurs.

• Vasectomy

Description: This is a minor surgical procedure to block the vas deferens, the tubes responsible for carrying the sperm.

Effectiveness: This procedure’s effectiveness is nearly 100%, but it requires additional contraception for several months until tests confirm no sperm in semen.

How to use: Under local anaesthesia, a little incision is made in the scrotum to access and cut or tie the vas deferens.

Additional information

While a vasectomy can be reversed in some cases, it should be considered permanent. This procedure does not protect the patient against  STIs.

Salpingectomy

Description:  It is permanent. This involves preventing eggs from reaching the uterus by removing the fallopian tubes. This also blocks sperm from meeting the egg.

Effectiveness: This method’s effectiveness is nearly 100%.

How to use: A healthcare provider removes the fallopian tubes using a laparoscope through small incisions while you’re under general anaesthesia.

Additional information

Salpingectomy is a permanent surgical procedure. Reversing the procedure is difficult and expensive, with risks involved. It provides zero protection against STIs.

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FAQs

What is the best technique for preventing  STIs?

The use of condoms is the most effective method for preventing sexually transmitted infections. On the other hand, they are less effective at preventing one from getting pregnant compared to other techniques. Combining condoms with another form of contraception provides better protection.

How effective is the withdrawal method (pulling out)?

The withdrawal method, where the penis is removed from the vagina before orgasm (ejaculation), is highly unreliable. Pre-ejaculate can still contain sperm. Around 20% of people relying solely on this method will become pregnant within a year.