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15 Types of Birth Control (Contraception) and How to Choose

Birth control is a subject that pops up in the news fairly often. Some of the stories are political and others are health-related, but there’s one important aspect of birth control that almost never gets mentioned: the cost.

Cost may seem like a non-issue since the Affordable Care Act (otherwise known as Obamacare) currently requires nearly all health insurance plans to cover the cost of any birth control prescribed by a woman’s doctor. However, the future of this provision is now in doubt. The Guttmacher Institute reports that the Trump administration has already made it easier for employers to refuse to cover birth-control methods in their health plans if they object to these methods on religious or moral grounds. So far, the courts are blocking this regulation from being enforced, but that ruling could be overturned.

On top of that, there are still many Americans who don’t have health insurance. According to the Kaiser Family Foundation, roughly 13% of non-elderly American adults were uninsured in 2018, and most of them had been without coverage for over a year. If half of those people are female, fertile, and heterosexual, that’s about 13.6 million women who have to handle the cost of birth control on their own.

If you’re one of these women, or if you’re a man concerned about unwanted pregnancy, the cost of contraception is something you can’t afford to ignore. Here’s what you need to know to weigh the dollar cost, effectiveness, health risks, and ease of use when deciding which method is best for you.

Types of Birth Control

Today, there are more birth control options on the market than ever before. There are barrier methods that block sperm, spermicides that halt their movement, and hormonal methods that prevent an egg from being released. There are also surgical methods that can permanently sterilize either a man or a woman. And, of course, there’s the oldest and simplest method: abstinence, or not having sex at all.

Each of these methods has different pros and cons. Some are costlier than others, while some are harder to use. Some methods can cause health problems such as headaches or mood swings in certain people. Some methods have health benefits aside from preventing pregnancy, such as helping to clear up acne or relieve menstrual pain.

In addition, some methods of birth control work better than others. Health experts generally measure the effectiveness of a method in terms of the number of women who get pregnant each year while using it. For instance, if 10 out of 100 women get pregnant using a particular method each year, that means the method is 90% effective. That doesn’t mean you have a 10% chance of getting pregnant each time you use it; it means 10% is your chance of getting pregnant over the course of a whole year if you use that method and nothing else.

All of these factors come into play when you’re choosing a birth control method. Here’s a look at how the costs and benefits stack up for 15 different methods, listed in alphabetical order.

1. Abstinence

The simplest way to prevent pregnancy is not to have sex. That doesn’t mean no sexual activity at all. There are various forms of what Planned Parenthood calls “outercourse” that don’t pose a risk of pregnancy, such as kissing, massage, dirty talk, and pretty much anything else that doesn’t involve penetration.

Oral sex doesn’t lead to pregnancy, either, and neither does anal sex (as long as no semen gets spilled into the vagina). However, these forms of sex can spread sexually transmitted diseases (STDs). That means they’re only truly “safe” if both partners are disease-free and sleeping only with each other.

Cost

Free

Effectiveness

In theory, abstinence is 100% effective at preventing pregnancy. However, you must be careful to avoid getting any semen on or near the vagina. If just a few drops fall on or get transferred by hand to the vagina, pregnancy can occur. Planned Parenthood offers more details on which specific activities are entirely risk-free.

Health Risks & Benefits

Abstinence poses no specific health risks or benefits aside from preventing pregnancy.

Ease of Use

Abstinence doesn’t involve any drugs, devices, or tricky methods to master. All it requires is willpower — and for many people, that’s the tough part. Fighting your sex drive (and another person’s) isn’t easy, and you only have to give in to temptation once to get pregnant. That’s why Planned Parenthood says even people who plan to be abstinent should probably keep condoms (discussed below) on hand just in case.


2. Birth Control Pill

Birth control pills are small tablets a woman takes every day to prevent pregnancy. They work by delivering hormones that stop the ovaries from releasing eggs and also thicken the mucus in the cervix, making it harder for sperm to get through. Most birth control pills contain two hormones: estrogen and progestin. There are also progestin-only pills, sometimes called “minipills,” that work for women who can’t take estrogen.

“The Pill,” as it’s commonly known, is the most popular form of birth control in the United States. According to the Guttmacher Institute, it was used by 9.6 million American women in 2014, or about 16% of all women ages 15 to 44.

Cost

Birth control pills come in packs of 28 for a four-week supply. For a woman without insurance, each pack costs somewhere between $20 and $50, according to CostHelper. That adds up to a yearly cost of $260 to $650. However, most health insurance plans cover 100% of this cost, as long as you get your prescription from an in-network doctor.

Effectiveness

According to Planned Parenthood, the Pill is 99% effective when used perfectly. That means taking it every day without fail and avoiding other drugs that can interfere with its effectiveness, such as certain antibiotics and herbal remedies. However, many women slip up at least occasionally when using the Pill, so its real-world effectiveness is only 91%.

Health Risks & Benefits

The hormones in the Pill can cause side effects such as nausea, headaches, breast tenderness, and bleeding between periods. For most women, these problems go away within a few months. It can also cause changes in sex drive, which can be longer-lasting.

The Pill can slightly increase your risk of more serious health problems, including heart attack, stroke, blood clots, and cancers of the breast, liver, and cervix. The risks are higher for women over 35, smokers, and women with specific health problems, such as diabetes, high blood pressure, or high cholesterol. However, minipills don’t pose the same risks.

On the plus side, according to the National Cancer Institute, the Pill significantly lowers the risk of ovarian, endometrial, and colorectal cancer. Other health perks include preventing acne, ovarian cysts, bone loss, and iron deficiency. It also makes menstrual periods regular and can reduce bleeding, cramps, and premenstrual syndrome (PMS). It’s even possible to eliminate periods altogether by taking the Pill on a three-week cycle.

Ease of Use

One perk of the Pill is that you don’t have to mess around with anything right before or during sex. The downside is that you must remember to take it every day, which can be a problem if you’re busy or absent-minded. The minipill is even trickier to manage because you must take it at the same time each day. Using a tool such as an alarm or a reminder app can help with this.

The Pill also requires a prescription, so you have to see a doctor for an exam before starting it. Once you have the prescription, you must remember to refill it regularly so you don’t run out and miss a dose.


3. Condoms

A condom is a thin, stretchy sheath that fits over the penis to catch sperm. It can be made of latex, lambskin, or various types of plastic. Condoms have been around for thousands of years; there are mentions of their use in ancient Crete, Egypt, and Rome.

A more modern innovation is the internal or female condom, a plastic pouch that tucks into the vagina. A small ring at the closed end fits over the cervix, while a larger ring at the open end stays outside the woman’s body. According to Planned Parenthood, the only brand currently sold in the United States is the FC2 female condom.

Cost

Condoms are available at any drugstore for anywhere from $0.30 to $2 apiece. If you use two of them per week, that works out to between $31.20 and $208 a year. Because they’re available over the counter, they aren’t covered by most insurance plans. However, you can get free or discounted condoms at some doctors’ offices and health clinics.

Female condoms are harder to find. Planned Parenthood says you can buy them at health clinics (including Planned Parenthood health centers), online through the FC2 website, or in some drugstores with a prescription. The good news is that if you buy them with a prescription, health insurance will usually pay for them. Without insurance, they’ll cost you about $30 for a pack of 24, or around $130 per year.

Effectiveness

According to Planned Parenthood, condoms are 98% effective at preventing pregnancy if you use them perfectly. That’s because about 2% of condoms break during use. However, they can also fail if you don’t put them on correctly or use them every time, so for typical users, they’re only 85% effective. Internal condoms are slightly less effective: 95% with perfect use and 79% with typical use, according to Planned Parenthood.

The American Pregnancy Association says that using a separate spermicide with condoms increases their real-world effectiveness to over 95%. However, that also adds roughly $0.60 to the cost per use.

Health Risks & Benefits

Standard condoms have no real health risks. Internal condoms can cause irritation for some people, but adding extra lubricant usually takes care of that. Also, if you use a separate spermicide with a condom, it can cause irritation if you’re sensitive to it.

One major perk of condoms is that they’re the only birth control method, aside from abstinence, that also works against STDs. According to the Centers for Disease Control (CDC), they work best at stopping STDs that spread through bodily fluids, such as HIV, gonorrhea, and chlamydia. For infections that spread by skin-to-skin contact, such as herpes and genital warts, a condom doesn’t always provide enough protection. Only latex and plastic condoms reliably prevent STDs; natural lambskin ones block sperm, but they contain small pores that can allow viruses through.

Ease of Use

The biggest drawback of using a standard condom is that you have to interrupt sex to put it on. In addition, many men find that wearing a condom during sex reduces sensation — though that can be a plus if you want to make lovemaking last longer. Finally, you have to store and use condoms correctly for them to work. Planned Parenthood has more information on how to store condoms and how to put one on.

The female condom can be put on ahead of time so it doesn’t interrupt sex. However, many women find it awkward to insert. Planned Parenthood says it gets easier after you’ve had a bit of practice.


4. Contraceptive Implant

A birth control implant is a small, thin rod about the size of a matchstick. It’s implanted under the skin of the upper arm and steadily releases progestin, the same hormone found in the Pill and the minipill. The implant can prevent pregnancy for up to five years.

Cost

The most common type of contraceptive implant, Nexplanon, is listed for around $985 on Drugs.com. In addition to this cost, you must pay for an appointment to have a doctor or nurse insert it. All told, the cost can come to as much as $1,300, according to Planned Parenthood.

However, since the implant is good for up to five years, its yearly cost can be as low as $260. In addition, if you have health insurance, it will usually cover the full cost.

Effectiveness

Planned Parenthood says the contraceptive implant is more than 99% effective against pregnancy. Once it’s in place, there’s nothing else to remember or do, so it’s impossible to use incorrectly.

Health Risks & Benefits

Most women have no trouble adjusting to the implant. However, some experience side effects such as irregular bleeding, headaches, breast tenderness, nausea, weight gain, or changes in sex drive. In most cases, these go away within a few months, though spotting between periods can last up to a year.

On the plus side, most women experience lighter periods while on the implant, and it can also ease cramps and PMS symptoms. After a year, about one in three women stop getting a period altogether.

Because the implant releases only progestin, it’s safe for women who can’t use estrogen. However, women who have had breast cancer shouldn’t use the implant as it could increase their risk of getting it again. It can also slightly increase the risk of ovarian cysts.

Also, like most methods, the implant does not provide any protection against STDs.

Ease of Use

You need to see a doctor to have a birth control implant inserted. The process is fairly painless; you should only feel a slight sting as the doctor gives you a numbing shot. When the shot wears off, the arm may ache a little, and it can feel tender for a few days and look bruised for up to two weeks.

As long as the implant is inserted within five days of your period, it’s effective immediately. That means once the process is complete, you’re all set — you don’t need to do a thing about birth control for up to five years. If you decide you want to start a family during that time, you can have the implant removed, a process that’s similar to the insertion and can cost around $300. Once it’s removed, you can become pregnant right away.


5. Contraceptive Patch

A birth control patch is a small patch that releases hormones to prevent pregnancy. You apply it to the skin of your upper arm, abdomen, buttocks, or back and leave it in place for a week before replacing it with a new patch.

After every three weeks of wear, you remove the patch and go patch-free for a week, during which time you get your period. After that, you apply a new patch. Alternatively, you can skip the patch-free week and skip your period as well.

Cost

The latest version of the patch, Xulane, costs about $87 for three patches, according to Drugs.com. That works out to a yearly cost of $1,044 — roughly three times as much as the Pill. However, like other methods that require a prescription, it’s fully covered under most insurance plans.

Effectiveness

Like the Pill, the patch is about 99% effective if you use it perfectly, according to Planned Parenthood. However, if you forget to change your patch on time, it can’t protect you as well. It’s also possible, though rare, for the patch to fall off. For these reasons, the patch is only about 91% effective in the real world.

Health Risks & Benefits

Some women find the patch a bit irritating to their skin, but this problem usually isn’t serious. Other side effects of the patch are similar to those of the Pill. It’s safe for most women, but not for women over 35 who smoke or women with specific health problems such as migraine headaches, severe diabetes or liver disease, uncontrolled high blood pressure, heart problems, or a history of breast cancer.

Ease of Use

The trickiest thing about using the patch is remembering to change it on time. For some women, this is harder than remembering to take a pill each day, which can become a part of their daily routine more easily. It also requires a bit of work to get the patch; you must see your doctor for an appointment, get a prescription, and fill the prescription on time every month.


6. Contraceptive Shot

The birth control shot is an injection of progestin given by a nurse or doctor once every three months. It’s also known by its brand name, Depo-Provera, or DPMA for short.

Cost

According to Planned Parenthood, a Depo-Provera shot can cost up to $150, for an annual cost of $600. Most insurance plans cover this cost in full. However, you will still have to pay your copay for the office visit, which will most likely be between $20 and $40. So even with insurance, this method will cost you at least $80 a year.

Effectiveness

Depo-Provera is more than 99% effective as long as you get your shot every three months on the dot. If you forget to renew your shot or get it late, it becomes less effective. Planned Parenthood says about 6% of all women using the birth control shot become pregnant each year.

Health Risks & Benefits

The shot has the same health risks and benefits as other methods that use progestin, such as the minipill and the contraceptive implant. In addition, Planned Parenthood notes that it can cause temporary bone thinning, which becomes more severe the longer you use the shot. Bone density usually returns to normal after you stop using the shot unless you’ve already reached menopause. Still, the shot is not recommended for women who know they have fragile bones.

Ease of Use

Using the birth control shot takes a bit of planning. You only have to get it four times a year, but you have to get it on time. For many women, it’s not easy to schedule a doctor’s appointment on precisely the right date. Even if you have no trouble getting an appointment, it can be harder to remember to renew a shot every three months than to take a pill every day.

Another drawback of the shot is that if you want to start a family, it could take a while. It can take up to 10 months longer to become pregnant after your last shot than it would with a shorter-acting method.


7. Diaphragm or Cervical Cap

Diaphragms and cervical caps are small cups made from silicone that cover the cervix, keeping sperm out. The main difference between the two is their shape. A cervical cap is shaped like a sailor’s hat and fits snugly over the cervix, while a diaphragm is broader and shallower, covering both the cervix and the area around it. Both are typically used in combination with a spermicide.

Cost

Diaphragms typically cost around $80 and last up to two years. The only type of cervical cap sold in the United States is the FemCap, which costs $90 and is also good for two years. To get either method, you’ll first need to see your doctor for an exam, which adds anywhere from $50 to $200 to the cost. However, if you have insurance, it will generally cover these expenses.

Both diaphragms and cervical caps are most effective when used along with spermicidal jelly or cream. These cost between $0.60 and $3 per use, and since they’re available over the counter, insurance doesn’t cover this cost. If you have sex twice a week, that’s an additional cost of $62 to $312. All told, you’ll pay around $230 per year for this method without insurance.

Effectiveness

A diaphragm is 94% effective against pregnancy if it’s used perfectly, according to Planned Parenthood. However, it’s less effective if it isn’t inserted properly, if it’s used without spermicide, or if it’s removed too soon. That makes its real-world effectiveness about 88%.

Cervical caps don’t work quite as well as diaphragms. According to Planned Parenthood, they’re 86% effective against pregnancy for women who have never given birth. For women who have had a child, the effectiveness drops to 71%.

Health Risks & Benefits

Diaphragms and cervical caps are safe for most women. However, women who are allergic or sensitive to silicone or spermicides can’t use these methods. There’s also a very small risk of a rare, serious condition called toxic shock syndrome (TSS). Women who have had this condition before shouldn’t use a cervical cap or a diaphragm.

Ease of Use

Planned Parenthood says it takes a little practice to learn how to insert and remove a diaphragm or cervical cap correctly. The device plus spermicide must be in place before sex, and it must stay in for at least six hours afterward. However, it must be removed within 24 hours (48 for a cervical cap) to prevent TSS.

Another downside of the cervical cap is that it’s not safe to use during a woman’s menstrual period, so you’ll need a backup method for those times. A diaphragm is safe to use at any time.

Cervical caps and diaphragms are also harder to get than some other contraceptives. You have to see your doctor for an appointment, get a prescription, and take it to a drugstore or clinic to fill it. Getting reimbursement from your insurer adds a third step, which isn’t always straightforward. Some insurers treat this method as a “health device” rather than a medication, so submitting a claim for it requires extra paperwork.


8. Fertility Awareness Methods (FAMs)

A woman is most likely to get pregnant right after ovulation, or the point each month when the ovaries release an egg. This usually happens near the middle of her menstrual cycle. Fertility Awareness Methods, also known as FAMs, help you figure out when ovulation is likely to occur. You can then either avoid sex during that time (a method called natural family planning) or use a backup birth control method on those days.

There are several different ways to predict ovulation. You can track your menstrual cycle on a calendar, measure your body temperature, check the color and texture of your cervical mucus, or do all three. Planned Parenthood explains in detail how each of these methods works.

Cost

FAMs are practically free. The only tool you need is a thermometer, which most people already have. If you don’t, you can pick one up for as little as $5 at a drugstore. Charts for keeping track of your cycle are available for free from Planned Parenthood and Taking Charge of Your Fertility.

Effectiveness

According to Taking Charge of Your Fertility, a couple using FAMs perfectly and abstaining from sex on fertile days has only a 2% chance of conceiving over the course of a year. However, the site admits that using this method perfectly is pretty rare. Planned Parenthood says that, in reality, FAMs are anywhere from 76% to 88% effective, depending on which method you use. The symptothermal method — tracking periods, temperature, and cervical mucus all at once — has the best chance of preventing pregnancy.

Health Risks & Benefits

FAMs pose no health risks for either partner.

Ease of Use

FAMs require more work than any other birth control method. You must be diligent about tracking your fertility symptoms every day without fail and avoiding sex (or using a backup method) during fertile periods. If you have irregular periods, this method won’t work well no matter how careful you are. FAMs are unlikely to work for teenagers, breastfeeding mothers, women approaching menopause, women who have just quit using a hormonal method of birth control, and women who take medications that affect their menstrual cycles.


9. Intrauterine Device (IUD)

An intrauterine device, or IUD, is a small, T-shaped device that fits inside the uterus. It works by altering the way sperm cells move, preventing them from joining with an egg. A small one- to two-inch string hangs down from the end of the device into the vagina. This string is used to remove the device when it expires.

There are two types of IUDs. Copper IUDs, such as Paraguard, contain copper, a substance that deters sperm and prevents them from reaching the egg. Hormonal IUDs, such as Mirena and Skyla, release progestin to prevent pregnancy in the same way as the minipill, implant, or shot.

Cost

According to Planned Parenthood, an IUD can cost as much as $1,300. That includes the cost of the device itself and the fee to have it inserted by a doctor or nurse. However, if you have insurance, it will typically cover the entire cost.

Even without insurance, an IUD can be very cost-effective over the long term. A copper IUD lasts for up to 12 years, so the cost per year is only around $108, even without insurance. A hormonal IUD lasts for three to six years, so the cost per year can be anywhere from $217 to $433.

Effectiveness

Both copper and hormonal IUDs are more than 99% effective, according to Planned Parenthood. Once the device is in place, there’s no way to use it incorrectly; it keeps working until it expires.

A copper IUD can also be used as emergency contraception. Having a copper IUD inserted within five days after unprotected sex reduces the risk of pregnancy by 99.9%.

Health Risks & Benefits

Having an IUD inserted is more invasive than most other methods of birth control. Most women experience pain or cramping during the procedure, and some also have dizziness or nausea. It’s also common to have cramps or backaches for a few days afterward.

Many women have cramping and spotting between periods for the first three to six months after getting an IUD. A copper IUD can continue to make periods heavier and cramps worse the entire time it’s in use. A hormonal IUD, by contrast, often makes periods lighter and less painful. Some women stop having a period altogether while using a hormonal IUD.

In rare cases, an IUD can cause serious problems. For instance, the insertion process can lead to an infection that must be treated immediately to prevent long-term damage. It’s also possible for the IUD to push into the wall of the uterus, potentially causing damage. If this happens, you may need surgery to remove it.

It’s very rare to get pregnant while using an IUD. However, if it does happen, it’s more likely to be an ectopic pregnancy, or one in which the fertilized egg implants somewhere outside the uterus. This condition is life-threatening, and the only way to treat it is to terminate the pregnancy.

Ease of Use

An IUD is one of the easiest methods of birth control to use. Once it’s in place, it keeps working for years with no effort on your part. It’s also fully reversible. You can have the IUD removed at any time and become pregnant right away.

The biggest problem with using an IUD is that it’s possible, though rare, for the device to slip out of place. If this happens, you’ll need to have it removed right away. As a result, while using an IUD, you should check from time to time to make sure the end of the string is in place and the same length as usual.


10. Morning-After Pill

Accidents happen. A condom can break, a woman can forget her Pill, or a couple can just get carried away and have sex without protection. For situations like this, there’s the morning-after pill. Taken after unprotected sex, it prevents pregnancy by delivering a whopping dose of hormones at once.

There are two types of morning-after pill. Ella, which is available only by prescription, can be taken up to five days after unprotected sex, and it’s just as effective on the fifth day as it is on the first. Other brands — such as Plan B One-Step, Next Choice One Dose, Take Action, and My Way — are available over the counter. These can also be used any time within five days after unprotected sex, but they work better the sooner they’re taken.

The morning-after pill is not the same as the abortion pill. It can’t end an existing pregnancy; it can only prevent conception by preventing the ovary from releasing an egg.

Cost

According to Planned Parenthood, a single dose of Ella costs about $50 if you buy it at a drugstore, plus whatever it costs to see your doctor for a prescription. You can also order Ella online for $90, which includes the medical consultation and shipping cost. Over-the-counter pills such as Plan B can cost anywhere from $15 to $50. Some insurance plans cover this cost, but others don’t.

Effectiveness

Planned Parenthood says Ella lowers your chances of becoming pregnant after unprotected sex by about 85%. Over-the-counter pills such as Plan B reduce the chances of pregnancy by 75% to 89% if taken within three days after unprotected sex. After three days, these pills are less effective, according to Planned Parenthood.

Health Risks & Benefits

Planned Parenthood calls the morning-after pill “super safe.” A few women experience side effects such as cramps, nausea, or vomiting, and your next period after taking the pill can be different than usual (earlier, later, lighter, heavier, or more spotty).

Ease of Use

The morning-after pill is easy to get and easy to use; all you have to do is swallow a pill. However, it’s only recommended as a backup method of birth control for emergencies. Taking it on a regular basis will make your menstrual cycle unpredictable.


11. Spermicides

Spermicides are chemicals that prevent pregnancy by stopping sperm from reaching an egg. They do this in two ways: by blocking the entrance to the cervix and by slowing sperm down. You can use a spermicide by itself or in combination with a barrier method such as a condom or diaphragm.

Cost

Spermicides come in many forms, including creams, gels, foams, films, and inserts called suppositories. The cost varies depending on the type you choose, but Planned Parenthood says it can be as little as $0.60 per dose. If you use spermicide twice a week, that works out to only $62.40 a year.

You can get spermicides without a prescription at many drugstores and supermarkets or buy them online. However, insurance usually doesn’t cover the cost.

Effectiveness

Used by itself, a spermicide is less effective than most other methods of birth control. Planned Parenthood says it’s only 82% effective if you use it perfectly — and since that’s hard to do, its real-world effectiveness is more like 72%. However, adding a spermicide can greatly increase the effectiveness of barrier methods such as condoms.

Health Risks & Benefits

For most people, spermicides have no side effects. However, the active ingredient in most spermicides, called nonoxynol-9, can cause irritation or a burning sensation for some people. This, in turn, can make it easier for STDs, including HIV/AIDS, to spread. Irritation is most likely to occur if you use a spermicide several times a day.

Ease of Use

You can insert a spermicide before sex so it doesn’t interrupt lovemaking, but timing is important. Some forms of spermicide need 10 to 15 minutes to dissolve before they’re effective. Also, many spermicides only stay effective for about an hour after insertion. If you want to have sex again after that, you must insert another dose.

Spermicides can also be messy or difficult to use correctly. It’s important to insert a spermicide deep enough that it completely covers the cervix. The woman must squat or lie down to insert it, and some types require an applicator that’s hard to get the hang of. Spermicides can leak out for some time after sex, and the smell and taste can be unpleasant.


12. Sponge

A contraceptive sponge is a barrier method and a spermicide all in one. It’s a small, round, squishy sponge that’s inserted into the vagina to cover the cervix. It also contains a spermicide to slow the movement of sperm. You can use the sponge by itself or as a backup method with condoms.

Cost

The only sponge sold in the United States today is the Today Sponge, which you can buy without a prescription in drugstores or online. It costs between $10 and $15 for a pack of three sponges, each of which is good for up to 24 hours. If you go through two sponges per week, you’ll spend $520 a year on this method. Because sponges are sold over the counter, most insurance plans don’t cover the cost.

Effectiveness

The sponge is more effective for women who have never given birth. For them, it’s about 91% effective with perfect use and 88% effective with real-world use, according to Planned Parenthood. For women who have given birth, these numbers drop to 80% and 76%.

Health Risks & Benefits

The sponge is safe for most women to use. However, it contains nonoxynol-9, which can cause irritation for some women or their partners. It can also slightly increase your risk of TSS, especially if you leave it in too long. Women with a history of TSS shouldn’t use this method.

Ease of Use

The sponge has to stay in place for at least six hours after sex, but it should never be left in for longer than 30 hours. It’s also not safe to use a sponge during your period. In addition, some women find the sponge awkward to insert and remove, at least at first. On the plus side, a single sponge provides protection for up to 24 hours, no matter how many times you have sex during that time.

Another drawback of the sponge is that it’s not so easy to find. Although it’s sold over the counter, many stores don’t carry it. You can also get it from family planning centers and on the Today Sponge website.


13. Sterilization

If you’re absolutely sure that you don’t want to have kids, or that you don’t want any more than you have already, you can have an operation to make sure you never will. For men, this is a simple procedure called a vasectomy that blocks or cuts the vas deferens, the tube that carries sperm. Women can choose a procedure called tubal ligation that cuts and ties off the fallopian tubes, which carry eggs. Alternatively, women can get a small implant called Essure that blocks off the fallopian tubes so sperm can’t reach the egg.

Cost

According to Planned Parenthood, a vasectomy can cost up to $1,000 without insurance, while a tubal ligation costs as much as $6,000. However, both procedures are permanent, so this cost is spread out over the rest of your fertile life. For instance, if a woman has her last child at age 35 and then has her tubes tied, and she reaches menopause 20 years later at age 55, her birth control cost works out to $300 per year.

Most insurance plans are required to cover the cost of sterilization for women, according to HealthCare.gov. However, they’re not required to cover the cost of a vasectomy for men.

Effectiveness

Planned Parenthood says a vasectomy is nearly 100% effective at preventing pregnancy. Female sterilization is also more than 99% effective, according to Planned Parenthood.

However, a vasectomy doesn’t work right away. It takes about three months after the procedure for a man’s semen to become completely sperm-free. Essure also takes at least three months to become fully effective because the body needs time to grow tissue around the inserts.

Health Risks & Benefits

A vasectomy is a very safe procedure. The most common side effects are mild pain and bruising after the operation, which go away after a few days to a week. More rarely, the procedure can cause an infection that can be treated with antibiotics.

Tubal ligation is a more complex procedure. It requires anesthesia and making a small cut in the abdomen. Some women have complications such as infection, bleeding, or a reaction to the anesthetic, though these problems are rare. Afterward, women can experience pain, cramping, nausea, or fatigue for a few days to a week.

Sterilization with Essure is simpler and can be performed under local anesthetic. Some women feel pain during the procedure, but most recover quickly and can go back to their normal activities the same day. In rare cases, women have back or abdominal pain for the first year after the procedure. There’s also a very small risk of other complications, such as injury to the uterus or fluid buildup in the bloodstream.

Ease of Use

Both male and female sterilization require an operation, though vasectomy is the simpler of the two. After a vasectomy, a man must have his semen tested regularly over the course of the next few months until his doctor tells him it’s free of sperm. Likewise, three months after Essure sterilization, a woman must return to the doctor for a test to make sure her tubes are completely blocked. If they’re not, there’s a slight risk she might have to repeat the procedure.

The biggest downside of sterilization is that you can’t change your mind about it. It’s possible to reverse a vasectomy, but the procedure is expensive, complicated, and doesn’t always work. Tubal ligation is even harder to reverse, and with Essure, it’s nearly impossible. So this birth control method is only for people who are 100% sure they don’t want to have children in the future.


14. Vaginal Ring

A vaginal ring, or NuvaRing, is a small, flexible ring that fits inside the vagina and releases hormones to prevent pregnancy. Like the patch, it works on a month-long cycle. You can use it for three weeks and leave it out during the fourth week while you get your period, or you can leave it in for a whole month and skip your period completely.

Cost

Drugs.com puts the average cost of the NuvaRing at $519 for three rings, which are good for a total of three months. That works out to $2,076 per year, more than any other method. However, most insurance plans cover the cost in full.

Effectiveness

According to Planned Parenthood, the ring is 99% effective if you use it perfectly. However, it doesn’t work as well if you fail to change rings on time, and some drugs can also interfere with its effects. So in reality, it’s only 91% effective.

Health Risks & Benefits

Because NuvaRing contains estrogen, it has the same health risks and benefits as the Pill and other methods using estrogen. It can occasionally cause vaginal irritation.

Ease of Use

The ring works steadily for a full month, so there’s nothing to remember during that time. However, some women find it hard to remember to switch rings on schedule. The ring is reversible, so you can get pregnant right away after you stop using it.


15. Withdrawal

Withdrawal, or pulling out, is exactly what it sounds like: during sex, the man pulls his penis out of the woman right before ejaculation so that no sperm enter the vagina. Unfortunately, in practice, this isn’t always easy to do.

Cost

Free

Effectiveness

It’s possible for a few sperm to escape into the vagina before ejaculation. So even if a man always manages to pull out in time, withdrawal is only 96% effective, according to Planned Parenthood. That said, withdrawal is very difficult to do correctly, so its real-world effectiveness is only 78%.

Health Risks & Benefits

None

Ease of Use

The biggest advantage of this method is that it’s free and always available; there is nothing to buy or use. The biggest downside is that it’s really hard to do correctly. The man must be able to tell exactly when he’s about to climax and have the willpower to pull out in time. And even if he succeeds, it can put a bit of a damper on the pleasure for both partners.


Choosing the Best Birth Control for You

The perfect method of birth control would be 100% effective against both pregnancy and STDs, completely free of side effects, easy to use, and cheap. Unfortunately, there’s no such thing. Each method has its pros and cons, so choosing the best method for you is a question of figuring out what matters most to you.

Here are a few questions to consider:

Do You Have Health Insurance?

By law, most health insurance plans are required to cover any form of birth control approved by the Food and Drug Administration and prescribed by a woman’s doctor. That means if you have insurance, any prescription method is likely to cost you little or nothing out of pocket.

If you don’t have insurance, you’ll have to foot the entire bill for your birth control, so over-the-counter methods are often a better deal. However, there are ways to save on the cost of prescription drugs, so cost doesn’t have to be a complete dealbreaker.

Pro Tip: If you don’t have access to health insurance, consider a program like the Discount Drug Network.

Could You Lose Your Insurance?

Even if you have insurance right now, there’s no guarantee you’ll have it next year. If you quit your job to become a freelancer, for instance, you’ll have to either pay for your own health insurance or make do without insurance.

However, you won’t have to do without birth control if you take advantage of the insurance you have now to get a long-term method such as an implant or an IUD. Then, even if you lose insurance a month after getting the device, you’ll be protected for years to come.

Are You in a Monogamous Relationship?

If you’re only sleeping with one person, and that person is only sleeping with you, and if you know you’re both disease-free, then the only thing you need your birth control method to do is to prevent pregnancy. However, if you’re currently playing the field, you also need to worry about protecting yourself from STDs. For that, your only real choices are condoms and abstinence.

How Big of a Problem Would Pregnancy Be for You?

For some women, getting pregnant would be a complete disaster. For others, it would be inconvenient, but not the end of the world. The more concerned you are about pregnancy, the more important it is to choose a method that’s highly effective. That could mean getting an implant or an IUD, or it could mean combining two different methods, such as the Pill plus condoms, to minimize your risk.

Do You Plan to Have Children One Day?

If you definitely don’t want kids, ever, sterilization is the best way to guarantee you’ll never have to worry about pregnancy. If you do want kids, but not for several years, an IUD or implant can give you years of protection with no fuss. And if you know you want to start a family within a year or so, it’s important to choose a method that’s reversible and will allow you to get pregnant as soon as you stop using it.

Do You Have Any Special Health Risks?

Some birth control methods, particularly those that use hormones, aren’t suited for everyone. If you’re a woman over 35, you smoke, or you have any long-term health conditions, look carefully at the risks of different birth control methods and choose one that’s safe for you.

How Organized Are You?

If you’re the kind of person who sticks to a schedule and never forgets an appointment, you should have no trouble remembering to take a daily pill, change a patch every three weeks, or schedule a shot every three months. However, if you’re the type who’s always missing trains and forgetting family birthdays, you could be better off with a method you can “set and forget,” such as an implant or an IUD.

If you’re still not sure which method is right for you, check out Planned Parenthood’s birth control quiz. It asks you a series of questions about your health, your relationships, and what you want most from your birth control, then presents you with a few options that could be good choices for you.


Final Word

Even though it takes two people to make a baby, nearly every birth control method out there is for women. For men who want to prevent pregnancy, the only real options are abstinence, condoms, and vasectomy.

However, as Vox reports, there are several new birth control methods for men in development. These include a male birth control pill, a hormone-based gel, and a non-surgical alternative to vasectomy that’s easy to reverse. Another product currently being tested is the Bimek SLV, a male implant that can block the passage of sperm with the click of a switch. It’s possible that in 10 years, men could have as many choices for birth control as women do now.

For now, though, if you’re a man who doesn’t want to get your female partner pregnant, you’ll need to make your birth control decisions jointly with her. Look at all the options together and choose the one that works best for both of you.

Which method of birth control do you think is the best value? Are there any methods you would never consider?

Amy Livingston
Amy Livingston is a freelance writer who can actually answer yes to the question, "And from that you make a living?" She has written about personal finance and shopping strategies for a variety of publications, including ConsumerSearch.com, ShopSmart.com, and the Dollar Stretcher newsletter. She also maintains a personal blog, Ecofrugal Living, on ways to save money and live green at the same time.

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