What is the difference between perfect and typical use and what that means for you
Is one of your top priorities for your birth control method not getting pregnant? It’s a common, and valid, concern.
While you can never really be sure of not getting pregnant (I’ve even been told a story by a lady who had a tubal ligation and her husband had a vasectomy and they got pregnant… WHUT?), knowing what the effectiveness statistics mean and what you can count on as your effectiveness rate will help.
So how do you start making sense of the effectiveness statistics?
The ideal thing to do would to be looking up your chosen method of birth control, find a large study (to ensure that there are those similar to you in the sample), and take into account how well you can practice the method. This would help you know whether you are on the typical use side, or the perfect use side.
I’m guessing you don’t have an interest in doing that. For one thing, you may not even understand peer-reviewed scientific studies and might not be able to take into account how they were getting their statistics, what exactly were the rules they used, etc.
So what is a good place to start? I think the guttmacher institute has a relatively complete list here…
There are a couple of issues with this list, in my opinion. One being that the pill is only listed as combined and not progesterone only (which is less effective and has a higher typical use failure).
In addition, different pills can have different effectiveness, and vary depending on things like weight, but I would say for obvious reasons they do not list that here (I mean, there would be 100s more of statistics there are so many different hormonal combinations).
It’s also beneficial to note that there are varieties of the sympto-thermal method, some more or less effective (though the percentage is a very small change, never less than 98% perfect use).
Whoa. Big discrepancies between perfect and typical use!
The methods with wider discrepancies in actual verses typical use can be for a few reasons:
1.) Without the method one time, there is nothing else to stop a pregnancy from happening (any non-hormonal method, other than the copper IUD, fits in here).
2.) People are generally not educated on proper use of the method (such as the female v. male condom, withdrawal, many fertility awareness based methods). This tends to happen because they are dismissed as ineffective or too hard to practice.
3.) Not using it, by definition, leads to a huge pregnancy chance. This one is exclusive to fertility awareness based methods. By definition, the times that you are “using” the method are the fertile times in your cycles when you have a large chance of conception. For instance, if you are a condom users and you don’t use a condom one time and aren’t in your fertile time (most of the cycle) the chances of pregnancy are slim, if we choose to not use fertility awareness correctly, we are deliberately having sex when pregnancy is most likely.
4.) There are some that are just easier to mess up. Withdrawal comes to mind ;)
How can we asses our values and find the best effectiveness to fit with those?
Now that you have a base point, you can rule out methods that don’t work for you for other reasons (other things people may look for in birth control include: convenience, availability for intercourse, how often they need to think about it, whether intercourse is inhibited by a barrier/withdrawal, cost, environmental impact, partner acceptability, moral acceptability, side effects, etc.).
What are your options? Can they be combined? How well can you practice them? Looking at this list and assessing your values and ability is imperative.
I will use myself as a (very personal) example. Because I care strongly about my health I would cross off each one other than: sterilization, copper IUD, barrier methods, withdrawal, and fertility awareness based methods. Sterilization would be out due to a desire to reproduce in my lifetime, and the expense; the copper IUD has undesirable side effects and is pretty scary in terms of inflammation, ectopic pregnancy risk, copper overload, and it’s expensive; barriers are ok, but since I hate trash condoms are not something I particularly think fondly of, diaphragms have too low of an effectiveness AND you have to use spermicide which would be unacceptable to me health-wise; withdrawal is nice, but isn’t something I wouldn’t like to do all of the time; and I think you may know how I feel about fertility awareness ;) I am happy with the lack of side effects, the cost, and the benefits that accompany it’s use (Empowerment? Health monitoring? Making my life super easy when I decide to conceive? Sign me up!)
So, you line up our personal values with your birth control choices. What is the effectiveness of the method you are ok with using? Are you ok with that level? Do you have confidence that we can practice the method correctly and consistently? If you can not now, can you learn to practice it is such a way? Can you double up on two methods that you find acceptable in order to increase effectiveness if you can not risk a pregnancy?
Truly assessing your ability to use a method correctly, whether you can accept that amount of fallibility, and how to eliminate your weaknesses
Let’s go over another couple of examples. Let’s say that you like withdrawal because it is always available, free, doesn’t have side effects, your partner is cool with it, and 4% failure is good enough for your situation. You must examine your and/or your partner’s ability to correctly use the method, and if you can not use it well, can you learn?
In the case of withdrawal I would suggest someone without experience practice with a condom before they try the real deal. If you can not correctly use the method, does a 22% failure sound ok to you? If not, you best use another method!
What about doubling up? Sometimes this can be to our benefit. Maybe you are so set on not having a baby you would like to use the sympto-thermal method of fertility awareness (you awesome person, you) with abstinence from intercourse during your fertile times and withdrawal at all other times. That is greatly increasing your effectiveness. Check out this fun (but not actually accurate scientifically) way of look at what a back up can do for you.
A lot people believe that there is no sense looking at perfect use statistics, because that is not “how things are used in the real world”.
This is absolutely not the case. It also drives me nuts when people say this. NUTS.
Perfect use statistics are gleaned from studies, studying average, real world people, that just so happen to use a method, well, “perfectly.” That means that they are using the method exactly as outlined in any instructions and they always use it.
Typical use statistics are based on people who do not use the method perfectly. There would be no way to get a perfect use statistic if there were not people that used the method correctly each time.
So can you actually get that perfect use number? YES. Let me repeat, YES!
This is why it is imperative to know our ability and willingness to use a method effectively. We can all be “perfect users”.
Check out the instructions for your method of choice. Do you actually know them are are you using them? If so, you will have that perfect use effectiveness.
We have choices, we must arm ourselves with information to better find something that is congruent with our lifestyles and beliefs.