When it comes to birth control, we have a lot of choices—which is great when it comes to preventing unwanted pregnancy or sexually transmitted infections (STIs). But with so many effective options out there, how do you decide which one is right for you?
We’ll get into what each birth control method does and how to use it, but first, a word on effectiveness.
Perfect use vs. typical use
Most of the stats you see on how well a birth control method works refer to “perfect use” or “theoretical use,” which is how well it would work at preventing pregnancy if it were used correctly every single time.
But that’s not necessarily how it works in real life, says Dr. Colleen Krajewski (a.k.a. Dr. K), assistant professor at the University of Pittsburgh School of Medicine in Pennsylvania and medical advisor to Bedsider.org, an online birth control support network. “There’s no [sense in] discussing perfect use in clinical practice,” she says.
“Typical use” stats are the ones to pay attention to. These are determined by experts who study the effectiveness of a given birth control method in real life. Typical use stats are mostly a result of human error—for example, using a condom incorrectly or forgetting to take your birth control pill at the same time every day. “There are a lot of reasons that birth control methods can fail,” says Dr. K.
The bottom line? Pay attention to stats about actual effectiveness and make sure to take the proper precautions accordingly.
Note: In this article, we are primarily discussing intercourse involving a penis and vagina that can result in pregnancy. Check here for information on STI prevention for everyone and LGBTQ+ family planning.
Made of a variety of materials, including latex or polyurethane, condoms cover the penis to block sperm from entering the vagina and help prevent the spread of most STIs.
Note: Condoms aren’t a perfect fix for preventing all STIs. Skin-to-skin contact before, during, or after condom use may still result in the spread of certain STIs like herpes simplex virus (HSV) and human papillomavirus (HPV). It’s important to get regularly tested for STIs if you’re sexually active, and to be upfront with your sexual partners about your health—even if those conversations might feel uncomfortable or awkward.
Condoms are 87 percent effective at preventing pregnancy with typical use. They’re also helpful for reducing the risk of STI transmission.
Almost anywhere. At the drugstore, health clinics, your student health center, and online.
The average price is approximately $1 per condom, but your student health center or local family planning clinic may offer them for free.
Because they protect against most STIs as well as pregnancy, “you can pretty much [use a condom with any other form of birth control]—except another condom,” says Dr. K, as the increased friction can increase the risk of tears. Note: If you opt for lambskin or polyurethane condoms due to a latex allergy, keep in mind that they aren’t as effective at preventing STIs.
The inverse of external condoms—internal condoms are inserted inside the vagina (instead of covering the outside of the penis) to block sperm and STIs.
Internal condoms are about 79 percent effective with typical use.
Check your campus health center, drugstores (with a prescription), online, or your nearest Planned Parenthood.
Note: Internal condoms are a lot harder to find in stores than the external condoms. This is partly because the Food and Drug Administration (FDA) currently approves just one type of internal condom for use (the FC2 Female Condom®), and you must have a prescription in order to buy it in a drugstore.
Around $2 each.
Internal condoms can be used just like external condoms. If you have a vagina and have sex with people with penises, they can offer more autonomy, since you won’t have to rely on your partner to be the one to use protection.
Shaped like a spongy little button with a string attached, the sponge physically blocks the cervix and also kills sperm. You can have sex multiple times while it’s in for up to 30 hours, unlike condoms, which have to be replaced after each time you have sex.
Sponges are 73–86 percent effective with typical use. They do not protect against STIs.
While not as common as condoms, you can sometimes find birth control sponges at your campus health center, in some drug stores, or online.
$4–$6 per sponge.
Like the female condom, the sponge gives more autonomy to people with vaginas when it comes to their birth control. However, it doesn’t protect against STIs and isn’t the most effective method for preventing pregnancy.
The birth control pill prevents pregnancy by adding a daily dose of hormones into your system that prevent the ovaries from releasing eggs.
The pill is 93 percent effective at preventing pregnancy with typical use. It doesn’t protect against STIs.
Typically, the pill is prescribed by your health care provider. You can also get prescriptions from Planned Parenthood or other public clinics. If needed, you can try getting them online via telehealth services like Pandia Health and PRJKT RUBY.
Under the current health care law, insurers are required to cover prescription birth control—in other words, you shouldn’t have to pay anything (but always be sure to double-check with your provider to avoid surprises at the pharmacy counter).
Without insurance, the pill could cost anywhere from $10 to $113 per month. If cost is a barrier, explore prescription savings clubs via pharmacies at large retailers such as CVS, Target, Walgreens, and Walmart, or online retailer options like Amazon. There are many birth control pill options available; your prescriber may also be able to adjust the prescription to a lower-cost generic option.
Because it works by impacting your body’s hormonal cycles, the pill needs to be taken at the same time every day for it to work optimally. Oral contraceptive pills may provide other benefits, such as improving acne or easing painful periods.
Learn what to do if you forget to take your birth control pill
“I take the pill at the same time every day, with two alarms on my phone that go off as reminders.”
—Second-year graduate student, University of Delaware, Newark
The emergency contraception (EC) pill, aka the “morning-after pill”, is like a super-concentrated version of the pill that blocks a pregnancy before it can start. “It’s an over-the-counter medication that’s very safe—it’s not a bad idea to keep it in your medicine cabinet just in case,” says Dr. K.
EC is 85–99 percent effective if used within 3–5 days after sex with typical use. It’s best to use EC as soon as possible after you’ve had unprotected sex or in the event that another birth control method fails (e.g., a condom breaking). It doesn’t protect against STIs.
Get it at your student health center, local drugstore or health clinic, or online via PRJKT RUBY without a prescription.
Note: EC is legal in the US, but when Roe v. Wade was overturned by the Supreme Court in 2022, it gave certain states the ability to uphold laws allowing pharmacies—or, in some cases, individual pharmacists—to refuse to give out EC. This might make it difficult to access EC depending on where you live.
If your doctor prescribes it, it should be covered by insurance. Without insurance, it will run you $35–$70.
When a condom breaks or another birth control method fails. Remember, it doesn’t protect against STIs.
“My partner and I [try to] use condoms as perfectly as possible, [but we’re] prepared to use emergency contraception in the event of failure.”
—Second-year undergraduate, Portland State University, Oregon
The IUD is a tiny T-shaped device inserted into the uterus by a health care provider. It prevents pregnancy by disabling sperm’s ability to swim. There are two main types of IUDs: copper (no hormones) and progesterone (commonly called the “hormonal IUD” because it uses the hormone progesterone to keep your ovaries from releasing eggs and to block sperm from getting into the uterus). With the latter, you may experience lighter or even no periods.
IUDs are 99 percent effective against pregnancy with typical use. An IUD doesn’t protect against STIs.
You need a health care provider to get an IUD. If you don’t have a regular gynecological care provider (or aren’t comfortable going to one), check a local health clinic like Planned Parenthood.
Since the IUD doesn’t pump hormones throughout your entire body (the progesterone from the hormonal IUD stays in the uterus, and the copper IUD doesn’t use any hormones at all), it’s a good option if you’ve experienced bad side effects from the pill. “I’d [recommend] it for anybody who wants to prioritize pregnancy prevention,” says Dr. K. Depending on which kind you get, the IUD will prevent pregnancy for 3–12 years.
About the size of a matchstick, the implant is inserted under the skin in your upper arm and prevents pregnancy by releasing progesterone into your body.
The implant is 99 percent effective with typical use. It doesn’t protect against STIs.
Like the IUD, the implant must be inserted by a health care provider.
Under the Affordable Care Act (ACA), the implant should be fully covered by insurance (but always be sure to double-check with your health care provider). If you don’t have insurance, it can cost anywhere from $450 to $850.
If you like the idea of the IUD, but the insertion or removal process freaks you out, the implant is a great alternative.
The ring is a flexible little circle you insert into your vagina—sort of like slipping in a tampon. It uses hormones to prevent the ovaries from releasing eggs and to thicken cervical mucus (which helps to prevent sperm from entering the uterus).
The ring is 91 percent effective with typical use. It doesn’t protect against STIs.
You need a prescription. Talk to your provider.
It’s typically covered by insurance, but out of pocket, the ring can range from $30 to $75 per month.
The ring is a great middle ground between the IUD and the pill.
Like the pill and the ring, the shot prevents pregnancy using progestin, a synthetic hormone that keeps your ovaries from releasing eggs. Once you get the shot, you’re protected from unplanned pregnancy for three months.
The shot is 96 percent effective with typical use. It doesn’t protect against STIs.
After an initial exam, a health care provider can administer the shot. Ask your provider or inquire at your local health clinic.
Without insurance (which will cover the cost under the ACA), each shot can cost up to $150.
If you struggle to remember to take your birth control or don’t want to have to think about your birth control every day, the shot is a great alternative. One caveat: It does have potential side effects associated with weight gain. “If you’re someone who struggles with your weight and with your appetite, the shot is probably not for you,” says Dr. K.
You don’t engage in any type of sexual activity 100 percent of the time.
There’s only one way that’s 100 percent effective at preventing both pregnancy and STIs—when practiced 100 percent of the time, abstinence is 100 percent effective.
If anything other than having a zero percent chance of an unwanted pregnancy or STI worries you, it’s an option to consider. At the end of the day, it’s important to do what’s right for you.
Free!
1. Identify your priorities
There isn’t one best birth control method for everyone. Knowing what your priorities are and what you’d be willing to compromise on can help you make a decision. For example: Is pregnancy prevention your number-one priority? Do you want to regulate the timing of your menstrual cycle? Ask yourself questions to figure out what is most important to you. Talking this through with an experienced health care provider is a great way to understand and consider your options.
2. Be ready, whatever your relationship status
Even if you’re not in a long-term relationship, it can still make sense to think about long-term birth control. The IUD and implant are long-term birth control options that work for many people. Plus, it can be pretty empowering to have agency over your body and the decisions you make about it.
3. Make conversation, not assumptions
Conversations with your partner are key to healthy sexual and nonsexual relationships. When we make assumptions or avoid uncomfortable topics, it leads us down a one-way street toward relationship conflict. Talking about birth control, sexuality, boundaries, and other sensitive topics strengthens trust and allows you to build a stronger bond with your partner.
4. Make sure you get the facts
There’s a lot of misleading info out there, so make sure you’re only getting your info from reliable sources. When you’re looking for information, talk with a health care professional or refer to online resources shared by Planned Parenthood, the CDC, or Bedsider.
Find your local health center and other places to get birth control (including online options)
Personalized chat/text guidance: Planned Parenthood
Pick the best birth control method for you: Planned Parenthood
Reproductive rights for minors: Guttmacher Institute
Article sources
In the original version of this article, Bedsider.org provided images and elements of the text.
Colleen Krajewski, MD, MPH, assistant professor at UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania; medical advisor to Bedsider.org.
Bedsider.org. (n.d.). The National Campaign to Prevent Teen and Unplanned Pregnancy. http://bedsider.org/
Guttmacher Institute. (2023, February 1). Emergency contraception. https://www.guttmacher.org/state-policy/explore/emergency-contraception
National Women’s Health Network. (2018, February 13). Update on Internal (Female) Condoms. https://nwhn.org/female-condoms/
Planned Parenthood. (n.d.). How do I buy internal condoms? https://www.plannedparenthood.org/learn/birth-control/internal-condom/how-do-i-buy-internal-condoms
Planned Parenthood. (n.d.). IUD. http://www.plannedparenthood.org/health-info/birth-control/iud
