Horror of horrors (when your birth control fails you)

Grace Sheehy

Horror of horrors (when your birth control fails you)

You take your birth control pill every day (well, most days). You always bring a condom (I mean, except when you forget). Your IUD is perfectly in place (fingers crossed). Sound familiar? Even those of us who use contraception regularly may not be using it perfectly. And while we may be okay doing this most of the time, contraceptive failure – the term for when your contraception just doesn’t do the job – can have pretty serious consequences, especially for young people.

A new report by the Guttmacher Institute explores contraceptive failure rates in countries in the developing world; among the findings was one that stood out to me: women under the age of 25 had the highest rate of contraceptive failure across all contraceptive methods, except for the contraceptive implant (which consist of small matchstick-sized rods inserted in your arm for up to 5 years). In fact, as many as half of unintended pregnancies occur among women who were using some form of contraception – as if we needed more proof that life isn’t fair. What’s so frustrating about contraceptive failure is that often people are using contraception the best way they know how. Yet, they still find themselves at risk of pregnancy, STIs and HIV. What gives? Is it that we’re irresponsible, not well-informed, or should we be more cognizant of the fact that even the most effective methods may not always work perfectly?

Contraceptive failure usually occurs due to either failure of the method or the user – essentially,

the contraceptive method doesn’t work as it should, or the user (you) doesn’t use it properly. A contraceptive method can fail to work properly because it’s defective or expired, while user failure is often due to a contraceptive method being used inconsistently or incorrectly. Condoms are particularly susceptible to both – while they can work incredibly well when used perfectly, the way that most people use them (called “typical use” in medical lingo) makes them around 82% effective. How to make sure your condom doesn’t fail you? Make sure it fits properly, since condoms may break if someone is wearing a size too small, or fall off if they’re wearing a size too big. When opening the packaging, be sure not to tear the condom itself, and when putting it on the penis, be sure to pinch the tip to leave some room at the top. More useful info on common condom problems can be found here.

In terms of user-dependent failure, the report found that young people may be especially at risk of contraceptive failure for a variety of reasons, including having frequent sex, being naturally fertile, and struggling with consistent and correct use. Essentially, not only are we at our most fertile (and frisky), but many of us are also stressed, sleep-deprived, overworked, and underpaid. All of these factors contribute to us maybe not being the greatest at taking that pill every day, or grabbing a condom every time – we’ve all been there, but we may not properly assess the risks each time. Young people often underestimate their fertility – say you have unprotected sex a bunch of times and don’t get pregnant, you may assume you’re just not that fertile, so why bother using contraception that is inconvenient and annoying every single time? The tough part is that not getting pregnant does not necessarily mean not being able to get pregnant – it just means you didn’t happen to get pregnant. Women in their 20s only have about a 20-25% chance of getting pregnant any given month, even at their most fertile, so not getting pregnant during a single sexual encounter isn’t necessarily indicative of your fertility. However, because our fertility can be so hard to predict, using a method of contraception every time is your best way to reduce your risk of pregnancy.

What can you do to avoid contraceptive failure and make sure you’re better protected? Here are a few key tips and things to keep in mind when using and choosing your birth control:

  • Make sure to follow the instructions for use carefully – as I mentioned, a significant number of contraceptive failures are due to people using their contraception wrong. So yes, try to take the pill at the same time every day, and make sure that condom is on correctly. Not totally sure if you’re doing it right, but too nervous to ask? Check out these great websites for tips and videos on how to properly use different types of contraception.
  • Check condoms for their expiry date and look closely for holes and tears. Try to prevent creating holes and tears or letting it get too close to long nails or jewelry. Using a water-based lubricant can also help prevent tears forming in the condom during sex, and make the whole “using condoms” thing much more pleasurable.
  • Double up your contraceptive method to reduce your vulnerability to contraceptive failure – for instance, use a condom and the pill, or a NuvaRing and withdrawal
  • Do your research. You can look up the efficacy of any contraceptive out there, so why not choose the most effective method and ease your worries? For instance, the IUD is incredibly effective, and you have less than a 1% chance of getting pregnant while using it.  You can keep it in for up to 12 years, which is a long time to not have to stress about being pregnant! If you find you’re having a hard time remembering to take the pill or use a condom, but aren’t ready for an IUD just yet, methods like the contraceptive vaginal ring (sold as the NuvaRing in Canada) are left in place for 3 weeks and are not user-dependent for perfect use (meaning, you can insert it and forget it, and since there’s no wrong way to insert it so it will be at its maximum efficacy).
  • Ask your doctor about any possible interactions between your birth control and any medication you are taking or being prescribed
  • Remember: there is a chance you can get pregnant (or an STI) every time you have sex. Make sure you’re not only using your contraceptive correctly but that you are also using it consistently – that means (wait for it): every time you have sex.
  • Talk to your sexual partner or partners. Make a plan for what you will do if your contraceptive does fail, and know your options. If you think you may be pregnant, take a test as soon as you can. The earlier you find out, the more time you have to assess your options and do what’s best for you.

If your contraception has failed and you notice quickly (for instance, the condom falls off or tears) you can still protect yourself from pregnancy by taking emergency contraception. You can buy emergency contraception from pharmacies and sexual health clinics, depending where you live, and can take it up to 120 hours after sex to reduce your risk of pregnancy significantly.

While we may or may not be having success in relationships, careers, and life in general, we can at least be proud of ourselves for having some contraceptive success under our belts. And don’t forget, the only contraceptive that prevents against STIs and HIV is a condom, and you should always talk to a medical professional about any sexual health concerns.