Five powerful criteria for making an informed contraceptive choice.

When it comes to birth control, it can be frustrating that there is no “magic bullet.” Every method seems fraught with issues. So in addition to having to cope with side effects, inconvenience and risks, we’re also tasked with making a decision that usually feels like we’re reaching for the option that sucks the least.

While it’s true there is no perfect birth control method, our choice becomes easier when we get clear on the ranking of our personal values.

Below we’ve outlined five criteria to consider when choosing a contraceptive method and included the top choices in each category. Please note that we’re focusing on contraception here, not STI protection. So when we’re ranking condoms we’re not factoring in their value as a safer sex barrier.

Efficacy (Value = Not Getting Pregnant)

While efficacy is usually the primary consideration when choosing a birth control method, everyone has a different level of “wiggle room”. Age, relationship status, financial stability and a host of other criteria can factor into the weighting of this particular quality. Generally speaking, anything over 98% effective in typical use is considered the best choice for those who value efficacy above all other qualities. The top choices in this category are: the pill (and related hormonal methods), the IUD, tubal ligations, vasectomies and FAM.

Convenience (Value = Spontaneity)

Although a method may have a high “perfect use” efficacy rate, that doesn’t mean much if you’re not actually using it correctly. You'd be surprised how many people report condoms being their primary form of contraception, but then frequently don't use them due to inconvenience - which most certainly reduces their efficacy! That’s why it’s important to find a contraceptive method that actually fits your lifestyle. For example, diaphragms and cervical caps need to be inserted prior to intercourse and left in after intercourse to be effective. FAM requires partner communication to determine fertility risks and navigate alternative sexual practices. If spontaneity is high on your list of values, then you’ll want to find a method that doesn’t require pre-planning. The top choices in this category are: the pill (and related hormonal methods), the IUD, and surgical methods (tubal ligation and vasectomy).

Minimal Side Effects (Value = Health)

Unfortunately many of the most effective and convenient options listed above come with potential health risks. Pill users often experience changes in mood, libido, and weight. There are also more life-threatening side effects like an increased risk of stroke.  The copper IUD can lead to heavier and more painful periods, and there is a small risk it can perforate the uterus or be expelled. A tubal ligation is a surgical procedure, which means it comes with the associated risks. If you’re looking for a side effect-free form of contraception, the top choices are: FAM, condoms, diaphragm/cervical cap, and withdrawal.

Cost (Value = Affordable)

Depending on where you live and your health care situation, you may need to pay out of pocket for your contraception. Some methods have a monthly or per use cost, whereas others have a higher upfront cost, but that investment lasts for years. If you’re having sex frequently, it may make sense to choose a method with a low price tag per use. But keep in mind that if there is a method you really like, there is probably a way to get it at an affordable price. In addition to private health care plans, some methods of contraception may be available at a reduced cost through clinics or University resource centres. And if you want to learn FAM, you can save money by working with a student in training. So, if there’s a method of contraception that fits your other values but it’s out of your budget, it’s worth shopping around. The top choices in this category are: withdrawal, condoms, FAM apps, the copper IUD ($50 when Kim got it put in in 2012).

Partner Reliance (Value = Control)

Those of us with a womb carry the lion’s share of the burden of an unplanned pregnancy. Thus, feeling in control of pregnancy prevention is often a high priority. Birth control methods such as condoms or withdrawal can feel less reliable since we are not the ones ultimately responsible for ensuring their perfect use. For this reason, we may value methods that are fully within our control. The best options in this category include: the pill (and all other forms of hormonal contraception), IUD, FAM and tubal ligations.

This list of criteria certainly isn’t exhaustive – there are lots of individual values that may contribute to your decision-making process, such as environmental concerns, reproductive health issues (like PCOS or painful periods), and fertility preservation. We’d love to hear what else factors into your decision-making process. Please hop on over to our FB page to share what method of contraception you're using and why!

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Kim & Amy Sedgwick love to discuss sex, periods, and all the other things we’re not supposed to talk about. The co-founders of Red Tent Sisters, they’ve been featured in every major Canadian news outlet and have become a trusted resource for people seeking natural (effective!) birth control, a more joyful sex life, and an empowered journey to motherhood.