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Why Do So Many Women End Up On The Pill When It Fails Them?

Many don't know that nearly one in ten women taking it will get pregnant within the year.

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Women overestimate the effectiveness of the Pill and condoms — the two most popular methods of birth control in this country — according to a new study in the American Journal of Obstetrics and Gynecology. After the study group of 4,100 women was counseled about other methods of birth control, such as IUDs, 71 percent chose to go on that or an implant. The findings suggest that many women choose the Pill because they don’t receive thorough counseling about their other birth control options or the true effectiveness of the Pill — which isn’t as great as pharmaceutical companies tell you it is.

This helps explain why the most popular methods of contraception in this country are the birth control Pill and condoms — if you don’t know all the information about all the methods of contraception available to you, why would you choose the one you know the least about? What many women don’t know about the Pill is that only if you take it exactly according to the manufacturer's instructions, including at the same time every day, that your chances of getting pregnant are 0.3 percent. But for whatever reason — business or forgetfulness — many women don't take the Pill exactly according to the instructions, bringing its real failure rate to a rather startling 9 percent, according to Dr. Nancy Stanwood, obstetrician/gynecologist and board member of Physicians for Reproductive Choice and Health. That means that nearly one out of 10 women will get pregnant while taking the Pill over the course of a year.

Given those statistics, it's probably not surprising that half of all pregnancies in the U.S. are unplanned. "It’s an embarrassingly high number for a developed nation," Dr. Stanwood says. "Amongst those [unplanned pregnancies], half were happening for women taking birth control. They’re trying to do the right thing. They’re using the method that is failing them."

That’s not the only reason the Pill is not the best form of birth control for many women. Many stop taking it due to side effects like depression, moodiness, and a decreased sex drive. And according to a November 2010 New York magazine piece, "infertility has become the Pill’s primary side effect" — a story that was sure to give some long-term Pill-takers pause about continued use.

So if it's so problematic, why is "going on the Pill" still perceived as something couples in committed monogamous relationships should work towards? Besides the perception of increased intimacy with condom-less sex, the Pill does have a better track record than condoms, which have an ideal failure rate of 2 percent and a real failure rate of 18 percent. And men often suggest their partners go on the Pill in the interest of avoiding desensitizing condoms.

Also, the other birth control options can seem unappealing — but that's probably more due to ignorance than anything else. The IUD — a matchstick-sized device that is inserted into the uterus that protects against pregnancy for five to 10 years — has a real failure rate of 0.10 percent. When I asked one straight guy if he would encourage a partner to get an IUD, he said probably not: "It's my understanding that IUDs aren't particularly common... It's also much easier to ask someone to take a Pill, than to stick something in their vagina." (Oh, is that so?)

But experts seem frustrated by this perception. "There’s a lot of assumption that everyone should just take the Pill, and that’s ridiculous. Hormones do a lot of different things to different people’s bodies," says Jaclyn Friedman, author of What You Really Really Want: The Smart Girl’s Shame-Free Guide to Sex & Safety, who tried the Pill herself but realized "it made me a little crazy." She now uses an IUD.

Two kinds of IUDs are approved for use in this country: one uses hormones and one does not. The hormones in the Pill work by going to the brain to make a woman’s body believe she is pregnant. The hormones in a hormonal IUD are localized to the uterus, so women who feel the Pill makes them moody or depressed are less likely to experience this with a hormonal IUD.

Amanda Ball, 26, says she’s happy with the IUD she got about a year ago, but notes that the procedure "brings you down for at least a day, and if you can’t deal with those side effects, that’s a lot to ask [of a partner]. I researched it and was willing to deal with it." (IUD insertion is not a painless process — many women experience quite a lot of cramping the day they get it put in, and the cramps can continue over the following weeks.)

But high cost of IUD insertion automatically eliminates it as an option for many women. If your healthcare plan covers it, you can pay a one-time copay for the insertion. But if it doesn't, the procedure can cost $400 to $500. "These methods have higher upfront costs, so many women are just priced out of them," Dr. Stanwood says. "So they use a method that isn’t as great as preventing pregnancy, that doesn’t fit their lives as well, and that isn’t fair. Women shouldn’t have to look in their pocket book to figure out what kind of contraception they should use."

Another option, of course, is to just go back to condoms — which shifts the birth control onus back to the man. Lachrista Greco, 26, says she liked how she felt once she went off the Pill after having taken it for seven years. "I just felt happier or something. I was never told that a side effect could be feeling depressed — that was never communicated to me. So once I got off it, it was amazing," says Greco, who now uses condoms as her primary method of birth control. "My emotions were more stable. I don’t have to be worrying about taking a Pill every day. I’m certainly glad to be off of it and I don’t intend to go back on it ever."

Friedman argues that women need to worry less about the convenience of their male partner. "We have to create space for women to think that sex can be for them and on their own terms," she says. "The idea that birth control should inconvenience men not at all is sort of inherent in how we as a culture do straight sex."

Greco, who is single, is glad that her partners now have to take responsibility for contraception. "I think society does not put responsibility on men in terms of sex and sexuality and it’s about time that they do," she says.

*The original version of this story incorrectly stated that the pill's ideal failure is 0.03 percent. The article has been updated to reflect the correct ideal failure rate of the pill, which is 0.3 percent.