Awareness for the need for birth control has been an issue since the early 1900s when a nurse, Margaret Sanger, began distributing contraception information to women. Her vision and dedication to the family planning movement eventually evolved into what is now known as Planned Parenthood Federation of America. Today, in spite of the many choices available for contraception and family planning, in the United States more than 53% of pregnancies are unintended and there are 1.3 million terminations annually.

Choosing a birth control method is an individual choice based on efficacy, safety, and convenience (Table 3-1). As a woman ages her birth control needs change. What was once easy and effective may no longer be the best choice. If a particular method requires thought and planning on the user’s part, the rate of failure is much higher than one that is easier to use.

Selection is influenced by age, weight, marital status, and frequency of intercourse. When selecting a contraceptive method, one must consider several factors. A woman’s advanced reproductive age may preclude her from taking hormonal contraception. If she is obese or smokes, a hormonal contraception may not be the best choice because it increases her risk for developing thromboembolic disorders.

Cultural or religious beliefs must also be considered: Contraception may be contrary to a woman’s beliefs. Marital status must be considered. A woman who is in a mutually monogamous relationship may not need protection against sexually transmitted infections (STIs), whereas a woman who is active with multiple partners or whose partner is not mutually monogamous needs a barrier contraception to protect her from STIs.

Frequency of intercourse influences the type of protection needed. If a woman is infrequently active, she may prefer to use a method that is more episodic than long term. Cost is another important factor because many health insurance carriers do not cover birth control. Efficacy is equally important. Method failure leads to an unintended pregnancy.