This paper provides a structured overview of the major categories of contraception: barrier methods, intrauterine devices, hormonal methods, surgical sterilization, and behavioral approaches. Drawing on Trussell's (2007) statistical data, it compares typical-use and perfect-use failure rates across all major methods. The paper also examines the historical development of hormonal contraceptives, the cultural and medical barriers to adoption of various methods, and the role of patient education in determining real-world effectiveness. A brief section addresses abstinence-based sex education, citing research suggesting it is less effective than comprehensive approaches at reducing unintended pregnancy and the spread of sexually transmitted infections.
Contraception is the term for medical strategies employed to prevent a woman from becoming pregnant after sexual intercourse. These strategies are loosely grouped into five categories: barrier methods, intrauterine devices, hormonal methods, surgical methods (also known more commonly as sterilization), and behavioral methods. This paper provides a brief survey of what each strategy entails, noting the most common or popular methods within each category as enumerated in Trussell's (2007) statistical survey of contraception. Each method is then discussed in greater detail, noting not only medical safety — measured in terms of risks or contraindications — but also statistical effectiveness as reflected in Trussell's data, reproduced below as Figure 1.
Barrier methods are the simplest mechanical means of preventing a sperm cell from fertilizing an egg cell during coitus — the process by which a fertilized egg implants itself on the uterine wall, where it can be nourished and develop into a fetus. Barrier methods prevent fertilization by presenting a physical barrier that separates sperm from egg. The best-known barrier method is the latex condom, but other technologies — including the cervical cap and the diaphragm — also qualify, because they operate on the same basic principle: providing a technologically designed barrier to conception.
Intrauterine devices (IUDs) are similarly technological but operate by a somewhat different mechanism. They are implanted into the woman's cervix and interfere with the ability of a fertilized egg to implant on the uterine wall and receive nourishment. The fertilized egg, having failed to find a place to implant due to interference from the device, eventually passes through the cervix and is expelled from the body without pregnancy occurring — despite fertilization having taken place.
Hormonal methods follow initial research conducted in the 1950s and 1960s by Dr. Carl Djerassi, a Stanford University medical researcher who encountered significant opposition on moral grounds for his work in reproductive technology — an area in which religion has traditionally held strong teachings. As a result, he was compelled to conduct much of his research and development in Mexico, where morally motivated research regulations were more permissive. Djerassi identified hormones released by the female endocrine system in response to conception — hormones naturally designed to prevent further conception — and theorized that administering a certain combination of those hormones would persuade a woman's body that it was already pregnant. He subsequently developed the first contraceptive pill, based on manipulation of the female hormonal and endocrine system's own natural method of blocking conception.
The first generation of these pharmaceuticals contained astonishingly high levels of hormonal content compared with today's formulations. It turned out that the body's ability to detect such hormones is far more sensitive than was originally theorized, and a small amount administered pharmaceutically goes a long way. Over the past fifty years, new delivery methods have been developed for administering the same hormonal combination without oral ingestion — so other hormonal methods now include injections and implants, which differ in their delivery mechanism but operate on the same principle Djerassi originally theorized: using the body's natural hormonal methods of blocking conception to achieve family planning goals.
Surgical contraceptive methods are more drastic because they imply sterilization of the patient. The two most common procedures are tubal ligation — in which a woman's Fallopian tubes are surgically "tied off" to prevent eggs from being released during ovulation — and vasectomy — in which a man's vas deferens is severed or tied off surgically, preventing active sperm from being released during ejaculation. Other forms of total sterilization, such as hysterectomy or orchiectomy (total castration), are more radical procedures normally performed only in response to life-threatening illness, not as a routine contraceptive option. Tubal ligation and vasectomy are also noteworthy for being potentially reversible: although the protection they provide against unwanted pregnancy is nearly total, there is at least a chance in most cases that the procedure can be surgically reversed if pregnancy later becomes desirable.
"Abstinence, withdrawal, and fertility-awareness approaches"
"Trussell failure-rate data for typical and perfect use"
"Education gaps, cultural resistance, and abstinence debate"
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