Birth Control Methods Chart

A revised version of the Birth Control Methods Chart was posted in August 2024. 

Designed for providers to help clients consider their birth control options, this revised chart takes client autonomy into account and presents methods that clients can start and stop on their own and those that require provider involvement (prescription or procedure). The chart highlights method characteristics, including use and frequency, so clients can make informed decisions, based on their own preferences. 

Note: Within each table, the methods are listed in order of pregnancy risk, and side effects are alphabetized within each method.

This framework offers providers multiple ways to center a client’s specific preferences and is aligned with the Providing Quality Family Planning Services in the United States: Recommendations of the U.S. Office of Population Affairs (Revised 2024).¹ For more information, click on the drop-downs below.

Client Autonomy

The RHNTC found that the client autonomy framework maps to the top three commonly reported contraceptive values—side effects and safety, method effectiveness/reliability, and ease, duration, or frequency of use—in a systematic review of 423 original research articles from 93 countries.

To address client autonomy, the chart's contraceptive methods are grouped into five categories: 1) clients can start and stop on their own; 2) requires provider to start with a prescription (clients can stop on their own); 3) requires provider for clients to start and stop (reversible methods); 4) requires provider to perform procedure (permanent methods); and 5) emergency contraception. Methods are listed in order of effectiveness within each table. 

The most autonomous methods have fewer side effects and require more frequent use, while the least autonomous methods are the most effective and easiest to use. While tiered contraceptive effectiveness has contributed to provider bias, clients also highly value effective methods. 

Counseling Starting Points

The birth control methods chart gives providers multiple starting points to center a client’s preferences, including: number of pregnancies expected, use & frequency, period changes, potential side effects, and other considerations. Each category is defined below, along with additional information to address nuances within each category. 

• Number of Pregnancies Expected is the number of pregnancies that occurred during one year of constant use of a given method per 100 people (the Pearl Index). This calculation allows providers to understand how effective a contraceptive method is at preventing pregnancies with real-world use.
• Use & Frequency includes information on how to use each method and how often it should be used.
  • Within the chart, asterisks have been used to denote products that have not been approved by the FDA for extended duration, including the use of the non-hormonal copper IUD for EC. However, there is an abundance of evidence available to support extended use for these methods demonstrating their safety and efficacy.
• Period Changes include the potential impact of a contraceptive on menstruation. Unpredictable spotting (as opposed to just spotting) was added for the implant, as breakthrough bleeding is the most common complaint.
• Potential Side Effects includes the most common reactions to each method and are listed alphabetically for each method.
• Other Considerations include a wide range of additional information that providers may find useful in counseling clients.
  • Discretion: Four methods (implant, hormonal IUD, copper IUD, and shot) were highlighted for their potential to be used discreetly, but felt by partners to improve counseling for clients facing reproductive coercion.
  • Prevents STIs: Two methods (internal condoms and external condoms) protect people from STIs.
  • Requires a cooperative partner: Indicates the need to engage a sexual partner who is not the client being counseled to successfully use the contraceptive method.
  • Weight vs. body mass index (BMI): Weight is used instead of BMI to alleviate the need to calculate a client’s BMI when counseling. BMI is used once for the patch because there is currently only BMI data on efficacy for the patch.
  • Delay in fertility return: Only included for the shot as most other methods will not delay fertility. 

The RHNTC drew inspiration from Partners in Contraceptive Choice and Knowledge (PICCK) and Illinois Contraceptive Access Now (ICAN!) when developing this chart.

Data Sources

Data was drawn primarily from:

Bradley SEK, et al., Effectiveness, safety, and comparative side effects. In: Cason P, Cwiak C, Edelment A, et al. [Eds.] Contraceptive Technology. 22nd edition. Burlington, MA: Jones-Bartlett Learning, 2023.

Centers for Disease Control and Prevention. U.S. Medical Eligibility Criteria for Contraceptive Use, 2024. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. 2024. Available at: https://www.cdc.gov/reproductivehealth/contraception/mmwr/mec.html

Centers for Disease Control and Prevention. U.S. Selected Practice Recommendations for Contraceptive Use, 2024. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. 2024. Available at: https://www.cdc.gov/reproductivehealth/contraception/mmwr/spr.html

Additional resources included the American Academy of Family Physicians, American College of Obstetricians and Gynecologists, American Academy of Pediatrics, Clinical Training Center for Sexual and Reproductive Health, Providing Quality Family Planning (QFP) Services in the United States: Recommendations of the U.S. Office of Population Affairs, Reproductive Health Access Project, the U.S. Food and Drug Administration (FDA), and the World Health Organization. 

Readability

Per Title X grantee feedback, the RHTNC has prioritized plain language. Readability scores for the chart equal 7.1 (derived from the Flesch-Kincaid Grade Level, which estimates the grade level required to understand the text) and 52.2 (derived from the Flesch Reading Ease Score; scores are reported between 1 and 100, with 100 being the highest readability score).

Reference

1. Romer, Sarah E. et al. Providing Quality Family Planning Services in the United States: Recommendations of the U.S. Office of Population Affairs (Revised 2024). American Journal of Preventive Medicine, Volume 0, Issue 0. November 2023. Available at: https://www.ajpmonline.org/article/S0749-3797(24)00310-6/fulltext
   *Providers of reproductive health services include licensed physicians, nurse practitioners, midwives, nurses, and medical aids, in addition to non-medical personnel such as counselors, social workers, health educators, and community health workers. Providers may provide care in varied settings, both within and beyond the formal health care system.