If you're failing less, then you're succeeding more, right? That's exactly what appears to be happening with birth control in the United States, according to a new study released by the Guttmacher Institute.
Contraceptive failure rates for all of the most common contraceptives (think: the pill, condoms, and IUDs) fell from 2006-2010, according to the most recent data collected for the Center for Disease Control and Prevention's National Survey of Family Growth.
Overall, the one-year failure rate for forms of contraception dropped from 12 percent in 2002, the last time the data was collected, to about 10 percent. For some methods, the drop was much larger; others saw smaller declines. The decliner was more pronounced if you look back to 1995, when the overall failure rate for all methods was nearly 15 percent.
It's not clear what's causing the improvement, says Kathryn Kost, a co-author of the report. Kost says possible explanations include women moving from less effective birth control options to more effective ones; more consistent and correct use of available methods (check out this handy comparison chart here;) and what she describes as "major public health efforts" in recent years to improve public knowledge about contraception.
The option the study found least likely to fail was long-acting reversible contraceptives, or LARCS, like IUDs, which had about a 1 percent failure rate. But even less-reliable options, like condoms, saw their failure rates fall significantly over the long-term, from 18 percent in 1995 to 13 percent in the latest survey.
Kost says the improvement in the success rate of male condoms is important because unlike other forms of birth control, condoms also help prevent sexually transmitted diseases, and are one of the few contraceptive methods readily available to men.
"We should probably be exploring men's role in these improvements," she says.
Whatever the reason, Kost says, the bottom line is clear: "We're seeing declines in abortion rates; we're seeing declines in birth rates. So we know that American women are not getting pregnant unintentionally at the same levels that we had been observing."
The analysis did find disparities in the effectiveness of contraceptives for some groups of women. African American and Latina women had higher contraceptive failure rates compared with white women, and low-income women had a higher rate of failure than those earning at least 200 percent above the federal poverty level. The study did not adjust for poverty when assessing racial and ethnic disparities, but noted that poverty is likely a factor.
Dr. Molly Findley is an obstetrician-gynecologist who practices in New York City, and a former LARC fellow with the American Congress of Obstetricians and Gynecologists.
She says low-income patients in particular may struggle to get consistent reproductive health care because of lack of insurance, access to healthcare providers, or other barriers.
"Their childcare falls through; they can't come to the appointment. The bus is late. They missed their appointment because their mom got sick and they have to go to the hospital with their mom," Findley says. "There's so many different reasons why my patients have a hard time accessing the healthcare they need and deserve."
Findley calls the overall decline in birth control failure rates "heartening." She points to the growing use of long-lasting methods, which she says allow women to choose contraceptives that may better fit their needs.
"Women who know themselves, women who have a lifestyle that says, 'Yeah, I can take a pill every day; I can remember that.' Those are the women that are continuing to use birth control pills. So those are the women who are good at it," she says.
"And the women who have a lifestyle that's hectic, that doesn't let them to remember to take a pill every day, they have more options that they can use now."
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