Article Figures & Data
Tables
Method Women with Unintended Pregnancy Within 1 Year of Use (%) Women Continuing Use at 1 Year (%) Typical Use Perfect Use None 85 85 Spermicide 29 18 42 Withdrawal 27 4 43 Cervical cap Parous 32 26 46 Nulliparous 16 9 57 Sponge Parous 32 20 46 Nulliparous 16 9 57 Diaphragm 16 6 57 Condom Male 15 2 53 Female 21 5 49 Combined pill and minipill 8 0.3 68 Evra patch 8 0.3 68 NuvaRing 8 0.3 68 Depo-Provera 3 0.3 56 Lunelle 3 0.05 56 Intrauterine device Copper T 0.8 0.6 78 Mirena 0.1 0.1 81 Norplant and Norplant-2 0.05 0.05 84 Female sterilization 0.5 0.5 100 Male sterilization 0.15 0.10 100 -
Reproduced with permission from Hatcher R, Trussell J, Stewart F, et al. Contraceptive Technology 18th ed. Ardent Media, Inc, New York, NY, 2004.4
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Method Women with Unintended Pregnancy Within 1 Year of Use (%) Women Continuing Use at 1 Year (%) Women with Unintended Pregnancy Caused by Unprotected Intercourse on Days Known Fertile Days (%) Typical Use With Barrier Backup * Perfect Use Calendar Rhythm † 25 0.1–9 Standard days ‡ 12 5.7 4.8 46 § 7.8 Basal body temperature 1 Cervical mucous TwoDays 13.7 6.3 3.5 52.7 ‖ 7.3 Billings Ovulation ¶ 10.5–22.3 NT 0.5 30.4–99.5 15.4 Creighton/NaProEducation Technology 17.1 ** NT 0.5 79.8–88.7 12.8 Symptothermal ¶ 0.2–20 †† 0.45–2.3 * 0.3 51.7–92.5 8.96 Lactational amennorrhea ‡‡ 2 NA NA -
↵* Fertility awareness-based methods defined more specifically as natural family planning do not report this data because it is considered abandonment of the method. Data is included where available.
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↵† Estimated (definitive data not available).
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↵‡ Limited to women with <2 cycles in 1 year outside of the 26- to 32-day range.
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↵§ Twenty-eight percent discontinued because of 2 cycles outside 26- to 32-day range or 1 cycle longer than 42 days.
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↵‖ Because of secretions >14 days or cycles <5 days (these are indicators of other potential health concerns), 15.7% asked to leave by study protocol. This loss also included women with cycles >42 days (n = 30) because of the cost of follow-up as well as women who failed to log symptoms for at least 12 cycles (n = 12).
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↵¶ Typical use variable by study. More recent international studies show progressively lower unintended pregnancy rates and higher continuation rates.
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↵** Overall pregnancy rate. Studies included women wishing to achieve pregnancy and made no attempt to distinguish planned vs unplanned pregnancies. Pregnancies resulting from intercourse on days known to the couple as fertile were counted as achieving related. Avoiding related pregnancies were 3.2% overall.
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↵†† Lower typical failure rate with double-check method compared with single-check method.
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↵‡‡ Perfect-use rate is for first 6 months only. LAM is ineffective as birth control if not used properly.
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NT, not taught; NA, not applicable; LAM, Lactational Amennorrhea Method.
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- Table 3.
Percentage of Original Study Group Discontinuing Various Fertility Awareness-Based Methods at 12 Months or 13 Cycles by Study6,10,11,21
Reason SDM (%) TDM (%) CrM (%) BOM (%) Completed study 45.6 52.7 — — Eliminated by study protocol 28.0 15.7 — — Told risk of pregnancy would be high 0.2 — — — Did not like the method 0.2 1.8 0.7 — Did not trust the method 1.7 1.8 0.7 — Partner did not like the method 2.1 2.0 0.7 3.0 * Planning pregnancy 2.1 2.2 — 5.0 * To use other FABM — — 0.7 — To use artificial method — — 4.5 20.1 * Difficulty avoiding genital contact — — 0.7 — Other voluntary reason 4.0 10.4 4.6 1.0 * Lost to follow up 7.1 4.4 — 16.3 * Pregnancy 9.0 10.4 — † 16.0 * Medically induced infertility — — 0.3 — Unknown — 0.2 — — -
Data not reliably available for Rhythm, Basal Body Temperature, and Symptothermal methods.
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↵* Billings Ovulation Method–India trial: data reported at 21 ordinal months. Overall discontinuation rate at 12 months was 24%. Individual reasons were not reported for this time frame.
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↵† Creighton Model did not remove participants from study for pregnancy because studies were designed to evaluate both pregnancy-achieving and pregnancy-avoiding behaviors.
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SDM, Standard Days Method; TDM, TwoDays Method; CrM, Creighton Model; BOM: Billings Ovulation Method, —, data not available.
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Organization Website Book/Home/Online Course Method Georgetown Institute of Reproductive Health http://www.irh.org Refer to website Standard Days and TwoDays Methods Couple to Couple League International http://ccli.org The CCL Home Study Course, ∼$75 Symptothermal Method The Billings Ovulation Method Association http://www.boma-usa.org The Billings Method, ∼$20 Billings Ovulation Method American Academy of FertilityCare Professionals http://www.aafcp.org Refer to website Creighton Model One More Soul http://www.omsoul.com Search for providers of multiple methods Marquette University Institute for Natural Family Planning http://www.marquette.edu/nursing/NFP/Model.shtml Marquette Model * Northwest Family Services http://www.nwfs.org/nfp.htm Refer to website Symptothermal Method * Family of the Americas Foundation http://www.familyplanning.net Ovulation Method * -
Information from reference cited above and indicated websites.
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↵* Not specifically discussed in the text.
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CCL, Couple to Couple League.
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Clinical Recommendation Evidence Rating References Modern FABMs of family planning have similar unintended pregnancy rates in self-selected users compared with other conventional methods. B 4– 17, 20, 21, 27– 34 Couples interested in using FABMs of family planning should be referred to an instructor certified in the patient's method of choice for adequate instruction. C 4– 17, 20, 21, 27– 34 Frequency of intercourse is not decreased among couples using the modern FABMs of TwoDays and Standard Days methods compared with those using conventional family planning methods. B 58 Women who are physically separated from or lack the support of their male partner are less likely to use the methods properly and more likely to discontinue use of an FABM. C 17 -
FABM, fertility awareness-based method.
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