The XX Factor

Good News: Birth Control Has Become More Effective in Recent Years

A health worker teaches women how to properly use a intra uterine device (IUD) during the World Population Day in Manila July 11, 2008.

Jay Directo/AFP/Getty Images

For all the bad news surrounding the politics of reproductive health care these days, there’s been an awful lot of apolitical good news in the meantime. The abortion rate recently declined to its lowest level since Roe v. Wade. Unplanned pregnancies, though still making up almost half of all pregnancies in the United States, have plummeted. Teen births and pregnancies have fallen dramatically in recent years, too.

In a totally unrelated development, it turns out birth control is working quite well these days as well. A report released this week finds that contraception has become significantly more effective since the 1990s. According to the Guttmacher Institute, the failure rate for the five most common types of contraceptives fell from about 15 percent in 1995 to just over 10 percent in 2006-2010. It’s working!

The study, which use data from the Center for Disease Control and Prevention’s National Survey of Family Growth, looks at how successful various methods of birth control are in actual practice. In 2002, the last time data were collected, the failure rate was about 12 percent overall. “Failure rate” refers to the percentage of women using the method who become pregnant over the course of one year. It is not a measure of whether the method works in ideal conditions, but how well it works in real life: A condom may be perfectly engineered, but if it is only put on halfway through sex—or left off altogether once in a while—its likelihood of preventing pregnancy drops.

In an interview with NPR, one of the report’s co-authors said there were several possible explanations for the improvement. It may be that public health campaigns are working, for example, or that people are using birth control more consistently and correctly than they used to. But one factor that seems likely to have played a role is the rising popularity of long-active reversible contraceptives, or LARCs. LARCs, which include IUDs and implants, had the lowest failure rate in the study, just 1 percent. (Condoms had among the highest failure rates, at 13 percent, but that number has improved by five percentage points since 1995.) LARCs are successful in large part because they require so little from women: Users don’t have to remember to take a pill every day at the same time, or to convince their partners to put on a condom. They simply have to visit their doctor once.

The FDA first approved IUDs in the 1960s, and models including the Tatum-T, the Saf-T-Coil, and Gynekoil took off quickly. By 1970, 3 million American women had inserted one. The method seemed on track to become a popular alternative to the pill. But that trajectory changed in the mid-1970s, when a particular model called the Dalkon Shield was found to have serious design flaws that led to thousands of serious infections and several deaths. By 1986, only one IUD remained on the market.

The method has been slowly making a comeback since the late 1980s, and the use of LARCs has skyrocketed in recent years. In 2002, just 2.4 percent of women on birth control were using long-acting methods; by 2013, according to the National Center for Health Statistics, that share had risen to 11.6 percent. There’s some evidence that Trump’s election—and the potential loss of the ACA’s IUD coverage—gave the method another little boost: One medical billing company reported that the number of IUD-related doctor visits spiked between October and December last year.