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Have a Little Faith in BC

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This is about science. It's about birth control. And it's about why a forum on Yahoo! Answers, a friend or two sharing their own experiences with a birth control method, or any intuitive feelings you may have about the effectiveness or safety of a birth control method just does not carry the same weight in terms of reliability that broad, peer-reviewed studies do.

Birth control methods, especially those that involve some type medication or device -- rather than those only based on behaviors, like withdrawal -- are studied via the scientific method. You can read all about the specifics of that method and how it works here.

The upshot of that article, for our purposes, is that there is a methodical and specific process, one based on tangible, documented facts and outcomes, that's involved in figuring out how well a birth control method works. Those effectiveness numbers we use when talking about birth control are not pulled out of thin air. They're a product of lots and lots of careful research, often over many years, sometimes done over decades. That research is how we're able to rank various methods in terms of how good they are at preventing pregnancy. That research is how we know, clearly, and without guessing or trying to figure out if someone is being truthful or not, if someone is educated or not, how effective a method is or is not.

Of course, there are qualities besides effectiveness that people often factor into their birth control choices. Some folks may find that they prefer a method that they can see working (like a condom) over an "invisible" method; something that they can't see (like an IUD). Or, maybe they find that they're only comfortable with a method where they understand very clearly how it works. People have all kinds of preferences around something as personal as birth control and that's totally okay.

However, even when people are apparently choosing methods that fit their own wants and needs, we still experience users coming to us who have little to no faith in those methods working. Or, often, they start to question the efficacy of their method after they've done something sexual. Many of our users have a lot of pregnancy worries to begin with, and those are only exacerbated when combined with a lack of understanding of how and why their birth control works (or what causes it to work less well).

I think a big part of the confusion often lies with effectiveness rates and what they mean for an individual user. So, let's tackle those first.

For those who may not know, efficacy/effectiveness -- words to express how well something works -- is generally represented as a percentage and is divided into two categories: perfect use and typical use. At its core, this is meant to tell you how effective a given method is a preventing pregnancy from occurring in one full year of use.

Understandably, quite a few folks get hung up on what "typical use" and "perfect use" of methods means. So, for a bit more detail, here's Heather:

"Effectiveness rates of contraceptive methods are all figured based on one full year of use, not for each single incident of sex or use of a method. Perfect, or proper, use of a method means that in one year, that method was always used, and always used following the directions for that method to the letter, without any errors or mistakes. Perfect use of most methods in one full year is unusual, except for methods like the IUD or implant where a user does not have to do anything. Typical use means that in one year, sometimes a method has not been used according to the directions, or was not always used. Typical use is called that because that is most typically how methods are used in a full year, since people aren't perfect, and most often, in a year, will tend to make a mistake now and then with a method."

Birth control methods have been studied long enough and widely enough that we have a clear picture of how effective they are for the average person. And, this same research helps us know about and guard against things that would make them less effective (like missing pills or putting on a condom in a way that increases odds of breakage). Those numbers, and the advice they generate, are what you need to trust when thinking about birth control. They are what you need to take into account when choosing methods in terms of how much protection you want, and how well you think you'll be able to use a method consistently and properly.

These numbers, and this information on use, from these studies, are the numbers you will find in sound health and contraception resources -- like medical textbooks and journals, fully moderated and fact-checked reproductive healthcare websites -- and they are the figures and instructions to use when choosing a method and using a method. Not crowdsourcing; not asking one or two friends or family members. Not your answer on an unmoderated website from a user where all you know about them is that their handle is lovestacos98756, so probably they like tacos.

In addition to providing a broad, rather than a narrow, picture of how a method works, these are replicable and verifiable numbers. If we do the homework, we can trace them back to their sources and see all of the steps involved in coming up with them. And that is something that is very hard, and most often impossible, to do with anecdotal information; information based only on personal accounts rather than on facts from broad, careful research.

That's not to say that first person anecdotes can't be helpful when making your decision. Sometimes it's useful to hear what others who've gone through getting the implant thought about the provedure, or how others felt about the after-effects of inserting an IUD. Listening to what friends or family members have and haven't liked about methods can help you figure out what you might or might not prefer.

In a similar vein, I'm not saying that you should just blindly trust every efficacy number you see. It's good to ask questions or ask for more detail about how your birth control works and how effective it is. We are, after all, big fans of research skills and critical thinking here at Scarleteen.

What we're not big fans of is the trend of people not trusting the methods they've chosen because they're lending more credence to anecdote than scientific data. We all know the story of a friend of a friends cousin who got pregnant using the implant. And even though this story is pretty much just that, a story, it somehow weighs more heavily in some peoples minds than the data says that getting pregnant on the implant is about as likely as getting attacked by a shark while living in Indianapolis.

I think a big reason for this is that we hear way more stories about birth control failing improbably than working properly. After all, nobody is going to come running up to their friends to say, "Did you hear that Jodi is still not pregnant while on Depo?"

Contraceptives doing their job is just business as usual; so it isn't normally deemed newsworthy, and it makes for some seriously boring gossip. But this means that, after a while, you can develop a skewed sense of how often a certain method fails because that's all, or most of what, you hear about it. If that happens to be the method you're using, you may start to find yourself doubting those effectiveness numbers. Because how can they be accurate if everyone who talks about using that method seems to have a horror story?

But we are always going to hear stories about how a given method failed, sometimes even hundreds or thousands of them. That's because -- as we see reflected clearly in the data from studies we are talking about -- NO method, not a single one, is 100% effective. And all currently available methods are very widely used, some by millions of people each year, so while they most certainly are working for a big lot of people, they are also failing for a lot of people, just nothing close to as many as they are effectively working for.

Those effectiveness rates from studies, shown in percentages, reflect how many people a method works or fails for accurately: it's not like they say they work for everyone: they don't.

For instance, the pill has been found, through study, to be over 99% effective in perfect use, and 92% effective in typical use. That means that for every 100 people each year using the pill typically, it will fail for 8 of them; for every 100 people using it perfectly, it will fail for less than one (in the case of the pill, that works out to a failure for about every one in 2,000 users). In the United States alone, about 1.5 million people use the pill each year. If everyone for whom it failed posted about it on the internet in some way, saying it didn't work? That'd be about 120,000 people: that's a LOT of people. It's no wonder people see a lot of anecdotes saying something doesn't work, because for a lot of people each year, every single method fails.

But what often gets missed, left out, or goes unnoticed or unmentioned is that every single method we have that people can currently use works, without failing for WAY more people than those it fails for. Every method. Going back to the pill as an example, if everyone who the pill did not fail for posted online that'd be, at a minimum, 1,380,000 people. Now that is a lot of people. Way more than 120,000.

And that is the reason the plural of anecdote is not data (as the saying goes). Anecdotes tell us about an individual experience, but they can't tell us whether or not (or to what extent) that experience is something we can generalize about (and that's assuming that every anecdote you encounter is 100% true and accurate, and you can be sure quite a lot of them are not). They can't give us a sense of what the actual odds of a given event (like getting pregnant while on the implant) are.

That's why we have processes like scientific research in the first place. Because when you're making decisions that effect you health and well-being, you want as much reliable, verifiable information as possible.

So, how can you go about picking a method that will quell your worries? Research! (The real kind, not just hopping around on Google or asking a couple friends.)

Something like Birth Control Bingo is a good place to get started, because you can use your own preferences to narrow down your search. But you may also want to check out other reliable resources such as Planned Parenthood, Family Health International, Contraceptive Technology, the ARHP or Answer: the kind of sources we also always double-check or update our information with.

The next step is to talk to a qualified healthcare provider about the method(s) you're interested in. It can help to have a few questions prepared ahead of time, just so you don't forget any important points while you're at the appointment. Some possible questions might be:

  • What are the most common side effects of this method?
  • Will this method interact with my other medications (if you take any) or my health conditions (should you have any) in any way I need to be aware of?
  • How often does this method fail? When it fails, what is the most common reason why?
  • How do I use this method properly?
  • What are the best backup methods to use with this method? (Hint: dual contraception, using two methods, not just one, is the very best way to prevent pregnancy, and also can really help you chill out about all this since you don't have to rely on just one method being effective.)
  • How easy is it to stop or change the method if I don't like it? Are there any long term side effects of using it?

There are a few reasons I'm advocating doing your own research before going to the appointment. One is that, even though most healthcare providers are reliable and impartial when discussing issues like birth control, some still have outdated/inaccurate notions about certain methods. So, researching your choice in advance can give you info about a method that you can then cross reference with what your provider is saying. If they say something that sounds very different from what you've been reading, it's okay to ask them about it. And, likewise, it can be helpful to use the appointment as a way of double checking the things you've read by running them past your healthcare provider.

The other reason I suggest prior research is that we see users coming to us who are using a method they aren't happy with, often partially because they were not really engaged in the decision to use it. They just took whatever was recommended without asking questions or asking to have all their options explained to them. Being actively involved in choosing your method means you are less likely to, two months down the road, be displeased with the protection you've ended up with.

And, after all of this, if you've done your research, and talked to healthcare providers, and are using a method that is 98 or 99% effective and you still don't trust that it's working? Then it's probably time to sit yourself down for a little internal question and answer time. That level of anxiety or distrust around birth control, the kind that dismisses or discounts the facts, is often a sign that something else is up. Are you feeling guilt about being sexually active and that's convincing you you'll get pregnant as "punishment" for doing something wrong? Is something else up between you and your partner(s) that might be manifesting itself as a pregnancy worry? Would you just feel better also using a backup method? Is this kind of sex even something you really want to be doing and feel ready for at this time in your life? Or, do you think you might be dealing with an overall anxiety issue that needs to be addressed by a professional?

It's to your benefit to work out what the cause might be, and what steps you need to lower your levels of stress, be that seeking counseling or only engaging in sex with a risk level that you're okay with. Because, very often, these fears can be traced back to someone not being ready or not wanting to engage in a certain type of sex. Many folks assume that, if they want to have fun, pleasurable sexual experiences, they will have to take on some risk of pregnancy, regardless of how okay with that risk they may be. But the good news is that this is simply not true. There are many types of sexual behavior that DON'T carry a pregnancy risk. So, if you're finding that your doubts about your contraception are linked to discomfort with with types of risk you are taking, you might want to look into those no pregnancy risk options.

And, by all means, read up (again, from reliable sources only please) on the history and study of birth control. It's interesting reading, and it may help give you a stronger understanding of how birth control works.

Because it DOES work. Seriously: it does, and when you are using your method properly, it will be as effective as the studies done with it have shown. And the sooner you allow yourself to accept that fact and feel comfortable with it, the more comfortable you'll be when you engage in sexytimes.

So go ahead, have a little faith in BC.

written 28 May 2014 . updated 28 May 2014

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