Birth Control: Where to Begin

Let’s start off with some numbers. About two thirds of college students are sexually active. When you think about the number of women that is, all over the country, it really adds up. Although college is certainly the time to explore and gain a better understanding of oneself, exploration of sexual interests does come with certain considerations. Among the concerns faced by sexually active adults is that of finding and using effective contraception.

Sex education in the United States has been in need of remodeling for a long time. Eighteen states teach that sexual activity is meant only for after marriage. Although this decision may have been made with the best intentions, the states utilizing the abstinence-only sex education have often ended up with the highest rates of teenage pregnancy compared to states with more comprehensive education. The discrepancy is likely due to the fact that students who are only taught about abstinence have little to no awareness of the contraceptives that are available to them often at little to no cost. In fact, in the US, information about contraception is only required to be taught in 17 states and the District of Columbia. That leaves 33 states where students are graduating from high school with no structured education about their options for birth control.

Contraceptives have a long history full of twists and turns. Ancient methods ranged anywhere from relatively harmless crocodile dung pessaries or lambskin condoms all the way to dangerous practices such as drinking liquid mercury. Luckily for us modern day girls, we have a broad range of options and none of them involve crocodiles! There are options such as the implant, IUDs (intrauterine devices), the shot, the vaginal ring,the patch, the pill, condoms (male and female), diaphragms, sponges, cervical caps, and spermicide. There are also solutions such as tubal ligation, but they're usually not considered by younger people due to their permanent nature. Lifestyle changes such as the pull-out method and fertility awareness are also options, but they are far more difficult to utilize effectively.

I realize that feels like a lot of options, which can be overwhelming, but the easiest way to go about making decisions is to create a list of characteristics you’d like for your birth control and organize it by priority. For example, some women would be fine with a method that requires use every day while others would prefer something low-maintenance.

Another important component is the unfortunate matter of discomfort. Some women experience little to no discomfort with their contraceptives, while others spend months acclimating or switching methods before finding a comfortable one. Thus, it is important to keep likelihood of comfort in mind. Someone who particularly hates shots would likely be uncomfortable getting one every three months, while someone with a low pain tolerance could have a difficult time having an IUD inserted.

Lastly, short-term and long-term costs must be considered. Some methods have a considerable up-front cost but are long-lasting, while other methods are less expensive but must be replaced more frequently. Thus, every method has its benefits and disadvantages, and every woman should analyze each one to decide which one has the qualities she’s looking for.

Now, let’s get into the specifics of the birth control methods most likely to be used by college students. Hopefully, after browsing through this list and a few additional resources, you’ll be able to find your contraception soulmate!  

  1. The Implant:

It is a tiny rod the size of a matchstick is put in the skin of the upper arm, where it releases a hormone that prevents pregnancy, with 99% effectiveness.

Pros: It lasts a long time (up to 5 years), and is one of the most effective options.

Cons: It has to be put in by a doctor or nurse and can be expensive (up to $1300, which is $9-$36 per month).

  1. The IUD:

This one is my personal favorite and is a t-shaped device that either uses hormones or copper to prevent pregnancy, with 99% effectiveness. 

Pros: It lasts a long time (3-12 years), and is one of the most effective options. 

Cons: It has to be put in by a doctor or nurse and can be expensive (up to $1300, which is $9-$36 per month). 

  1. The Shot:

It is an injection that uses a hormone to prevent pregnancy with 94% effectiveness.

Pros: It lasts for three months and does not have to be used every time you have sex. 

Cons: It has to be administered by a doctor or nurse and can cost up to $100 per injection ($33 per month, approximately). 

  1. The Vaginal Ring:

It is a flexible ring that releases hormones to prevent pregnancy with 91% effectiveness.

Pros: A doctor or nurse does not have to insert it and it can be stored for up to 4 months (or more if refrigerated and unused). 

Cons: The ring has to be changed on time every month and has to be stored in specific conditions. It can cost up to $200 per ring ($50 per month, approximately).

  1. The Patch:

It is a patch placed on the belly, arm, butt, or back that releases hormones to prevent pregnancy with 91% effectiveness.

Pros: There are three patches in each month’s supply, and it does not have to be applied by a doctor or nurse.

Cons: The patch has to be switched out every week on the same day and costs up to $150 per month.

  1. The Pill:

It is a pill containing hormones that prevents pregnancy, with 91% effectiveness

Pros: It is known to potentially make periods easier to predict and tolerate, as well as reduce or prevent acne. It is extremely convenient and does not have to be utilized during sex.

Cons: The pill has to be taken every day and some women have a hard time remembering to do so.

  1. The (Male) Condom:

It is a thin sheath worn on the penis during sex to prevent pregnancy, with 85% effectiveness.

Pros: It provides protection against STDs as well, and are easy to acquire (especially since they don’t require a prescription). They cost about $2 per condom, but most university health centers actually give them away for free!

Cons: It has to be utilized every time there is any genital contact

  1. The (Female) Condom:

It is a thin sheath that goes in the vagina to prevent pregnancy, with 79% effectiveness.

Pros: It provides protection against STDs as well, and are relatively easy to acquire (especially since they don’t require a prescription). They cost the same as male condoms, around $2, and can be found at health centers as well.

  1. The Diaphragm:

It is a small cup-like device inserted in the vagina to cover the cervix and prevent pregnancy, with 88% effectiveness.

Pros: It does not have to be inserted by a doctor or nurse, and can be inserted up to 2 hours before sex. They also don’t use hormones and can last up to 2 years and costs up to $75 ($3 per month, approximately).

Cons: It does require a prescription, and it has to be used during sex, every time. It can also be difficult to insert correctly and comfortably. It also has to be left in for 6 hours after sex.

  1. The Sponge:

It is a small plastic sponge that contains spermicide and covers the cervix to prevent pregnancy, with 76-88% effectiveness.

Pros: It costs up to $15 for 3 and doesn't require a prescription. 

Cons: It has to be put in before every time you have sex.

  1. The Cervical Cap

It is a small silicone cup covering the cervix to prevent pregnancy with 71-86% effectiveness.

Pros: It is convenient and can be put in place hours before sex. They don’t have hormones and are reusable for up to a year. It costs up to $90 per cap ($8 per month, approximately).

Cons: It requires a prescription and has to be put in every time you have sex, which can be inconvenient. It can also be hard to use properly.

  1. Spermicide

It is a chemical put into the vagina before sex to help prevent pregnancy, with 71% effectiveness.

Pros: It doesn’t require a prescription and costs as little as 60 cents per use, according to Planned Parenthood. It can be inserted before sex and has no hormones.

Cons: It has to be put in before each time you have sex and can come with messiness and side effects for some women.

 

As you can see, all the methods listed have vastly different characteristics, costs, and levels of effectiveness. Although I can’t tell you exactly which one will work best for you, I would suggest that you keep in mind that high effectiveness is a top priority, and work around that as much as possible. However, any method is better than nothing, and utilizing multiple methods at a time can often be even better than relying on only one. For example, many women use an IUD or the pill in addition to condoms, which not only reduces chances of pregnancy, but also chances of STD transmission.

Take your time to do plenty of research and have your list of priorities before consulting a gynecologist or nurse for further information. They will then be able to clarify any areas of confusion and set you up with an appointment if needed. For those of you overwhelmed by the options, the Planned Parenthood website (https://www.plannedparenthood.org/learn/birth-control) actually has a quiz to help narrow down the options, which can be immensely helpful. Planned Parenthood can also give you more information about co-pays for implants, IUDs, shots, etc. if you call or visit your local clinic and give them your information. Some clinics have extremely low cost options that may not be shown on the website, so it's worth taking some time to explore in person or over the phone, especially if you can't cover it with your insurance. 

Lastly, don’t give up if your birth control method feels uncomfortable or inconvenient at first. Try to give yourself time to acclimate, but if it isn’t working, try another one! I promise you that the peace of mind of always having a plan in place makes time investment worthwhile. If you’re having a hard time finding where to start, just take a moment to relax and remember that there’s no need to be intimidated or overwhelmed. These resources are here to help women just like you and me, so we should utilize them. Just take things step by step, ask plenty of questions, and find the method that works for you!