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Evaluating Contraceptive 

Effectiveness and Safety


The decision to use contraception and the  choice of one method over another depend primarily on two practical matters: 

  • How well it works (its effectiveness) and 

  • Its health risks (its safety). 

Evaluating these two issues is complicated. No one contraceptive method is always best or safest. 

When evaluating effectiveness and safety, remember that information from various sources may be biased. The  popular media, for instance, are eager to report the  latest news about the real or suspected  hazards of a contraceptive method . Yet the  story is usually condensed to a few paragraphs in the newspaper or is crammed into less than sixty seconds of TV or radio broad cast time. Scientific accuracy or caution is  often lost in a process of oversimplification, misinterpretation, and unwarranted conclusions. In addition, much of the  research on the  effectiveness and safety of birth control methods is paid for by the drug companies that manufacture them. These companies have an obvious interest in presenting their merchandise in a way that will boost sales. 

All scientific studies are not  equivalent in their applicability to you. In general, studies about people close to your age, cultural background, and socioeconomic status are more meaningful than studies about other groups. For example, if you are a twenty two year old single Bangladeshi woman, you cannot put faith in the findings of a study about thirty five year old married women in American. 

Understanding some other aspects of evaluating effectiveness can also be helpful.

First, it is  important to distinguish between two factors: theoretical versus actual effectiveness. The theoretical effectiveness of  particular method is how it should work if used correctly and consistently, without human error or negligence. The actual effectiveness is what  occurs in real life, when inconsistent use or improper technique ( user failure ) combines with failures of the  method alone. For example, if  couple runs out of condoms on a week long camping trip yet continues to have intercourse, the woman's subsequent pregnancy is not  counted as a method failure.  But if she used a contraceptive foam exactly according to instructions, her pregnancy qualifies as a method failure. 

Second, for most types of contraception, the longer a person uses a particular method, the more effective it  becomes. The reason is that people improve their technique and  become more accustomed to using the method regularly. 

Third, effectiveness' rates for almost every no surgical contraceptive method vary depending on whether a couple uses the method to prevent pregnancy or to  delay (space ) pregnancy. Failure rates are generally 50 to 100 percent higher for delay compared to prevention, since there seems s to be less consistency in method use. 

There are other  difficulties in assessing the safety of contraceptive methods . 

First there are often wide differences in the  frequency of side effects reported by different investigator. Their results reflect differences in  research design, choice of control group, different characteristics in the  populations  studied ) such as age , health, socioeconomic status ), and  the methods investigator use to identify a problem (self-administered questionnaire, personal interview, laboratory testing ).

Second, there are some relative aspects to the safety question. How important is avoiding pregnancy? Are  the side effects of a contraceptive  method more or less serious than the risks of pregnancy and childbirth? How do the risks of a contraceptive method compare to other health risks ( such as the risk of getting cancer of having high blood pressure ) or to risks of everyday life? 

These question will be addressed in more detail as we review the safely  and side effects of each method of contraception.  

Sexual Physiology

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