Why Accidents (The Pregnant Kind) Happen

Correction June 4, 2009

We said, "There are many [methods of birth control] — hormonal methods, such as birth control pills, the patch, a three-month shot, a ring that's placed over the cervix ... or there are barrier methods — IUDs, the cervical cap, the diaphragm, and male and female condoms." In fact, the birth control ring leaks small doses of estrogen and progestin directly into the bloodstream through the vaginal walls. Also, the IUD is not a barrier method.

A portrait of Joy Migala i i

hide captionJoy Migala, now 24, became pregnant more than a year ago.

Colin M. Lenton/Courtesy Joy Migala
A portrait of Joy Migala

Joy Migala, now 24, became pregnant more than a year ago.

Colin M. Lenton/Courtesy Joy Migala

Birth Control Methods

   

Barrier Methods

   

— The male condom is a thin latex or plastic sheath worn on the penis during intercourse. When used correctly, it is 97 percent effective.

   

— The female condom is a 7-inch-long polyurethane pouch with two flexible rings on either end. It is inserted into the vagina before intercourse. When used correctly, it is 95 percent effective.

   

— The diaphragm is a shallow, dome-shaped cup with a flexible rim made of latex. It is inserted into the vagina, and it covers the cervix. When used correctly, it is 94 percent effective.

   

— The cervical cap is a silicone cup shaped like a bowl with a little handle. It is inserted into the vagina and over the cervix. When used correctly, it's 91 percent effective in women who have not given birth; it's 74 percent effective in women who have given birth before.

   

— The vaginal sponge is a soft, saucer-shaped device about 2 inches in diameter and made from polyurethane foam. It is inserted into the vagina before intercourse and has a nylon loop for removal. When used correctly, it is 91 percent effective in women who have not given birth; it's 80 percent effective in women who have given birth.

   

Hormonal Birth Control

   

— There are different types of birth control pills, patches and shots that work by delivering hormones into the body that stop a woman's ovaries from releasing eggs. The pill is taken daily; the birth control shot prevents pregnancy for three months; and the patch is placed on the skin for three weeks in a row.

   

Most women take what are called combination pills that contain both estrogen and progestin. Both the combination pill and the progestin-only pill are more than 99 percent effective when used properly.

   

— The vaginal ring is a small, flexible ring a woman inserts into her vagina once a month to prevent pregnancy. It is left in place for three weeks and taken out for the remaining week each month.

   

— An IUD, or intrauterine device, is a small, T-shaped piece of flexible plastic that is inserted into a woman's uterus by a health care provider. It prevents pregnancy by blocking sperm from reaching the eggs, and can be effective for up to 12 years. Some IUDs also contain birth control hormones. Both types of IUDs are greater than 98 percent effective when used properly.

   

For a longer list of birth control options, visit Planned Parenthood.

   

Effectiveness rates are from the U.S. Food and Drug Administration.

The average American woman — if she wants only two children — has to spend a total of 30 years trying to avoid becoming pregnant.

Millions of women find that hard to do; more than half the pregnancies in the United States are unintended, according to the Guttmacher Institute, which conducts reproductive health research.

To avoid an unwanted or unintended pregnancy, contraception has to be used correctly and consistently. There are many methods available, but a lot of things — cultural mindset, ignorance and lack of access to medical care — make that harder to do.

Whose Responsibility?

Dr. Vanessa Cullins, the medical director of Planned Parenthood, says that all too often an unintended pregnancy is seen as the fault of the woman.

"Consistent and correct use of contraceptives is hard," Cullins says. "It should be a responsibility that society shares."

Instead, the health system often throws up barriers to contraception, especially for young women who are the most vulnerable. There are long waits to see a doctor, and providers may not always be up-to-date on the most modern methods. Insurers don't always cover birth control, or only cover a limited one-month supply.

And the methods are not always easy to use. For example, birth control pills have to be taken daily. And with the newer low dose formulations, the pills often need to be taken around the same time of day. A missed pill or two can result in an unintended pregnancy.

Alas, the responsibility for contraception primarily falls on women. So, Cullins says, "correct and consistent condom use requires that women be true to themselves and honest about the fact that they are having sex — if they want to avoid becoming pregnant."

Situational Decisions

That was something 24-year-old Joy Migala found easy enough to do when she was 18, fell in love as a high school senior, and embarked upon her first sexual relationship.

Sex, she says "was just on the radar, and it happened." At first, she and her boyfriend used condoms, but Migala wasn't entirely comfortable with that. "Probably two months after we started having sex, I was able to tell (my mother) that I wanted to go and get birth control," Migala says.

Once a young woman owns up to her sexuality, there are many birth control methods to choose from: hormonal methods such as birth control pills, the patch, a shot or a ring that is placed over the cervix. Barrier methods include IUDs, the cervical cap, the diaphragm, and male and female condoms.

Different methods, Cullins says, are suitable at different times in a woman's life.

"During college, it might be easier to use birth control pills," she says. "Once you get out and start your career, you may find that it's difficult to take your pill every single day."

So young women starting a career might want to opt for a contraceptive injection that only needs to be administered every three months. She might decide to go with an IUD because she doesn't have plans to become pregnant for several years. Cullins suggests that women try several methods until they find the one they're comfortable with.

Magical Thinking

The summer before she went off to college, Migala didn't trust herself to remember to take a pill every day, so she chose the patch. It's a hormonal birth control method that's worn on the body and has to be changed once a week. After several years, Migala realized that she didn't like the side effects she experienced, such as weight gain and feeling highly emotional. So she switched to the pill.

But things weren't going well with her boyfriend. Migala says they had become too dependent upon each other and decided to break up, but remain friends. For a time, she didn't really date, and as a consequence she saw no reason to continue taking birth control pills.

Her ex-boyfriend kept in touch. "It was platonic. There was nothing happening," Migala says. Except one night, they ended up sleeping together.

"A pattern was set," she says, and they continued to sleep together. Sometimes they used condoms; sometimes they didn't. Migala tried to keep a chart of when she was fertile so she would know when to use a condom. Then she got pregnant.

It was a classic case of magical thinking. That's what Sarah Brown of the National Campaign to Prevent Teen and Unplanned Pregnancy calls it.

"You either say, 'I'm not planning to get pregnant, and therefore I'm going to be very careful,' or, 'I am planning to get pregnant,' " says Brown. "If you are the middle, in a fog and magically thinking," Brown says, "you're planning to get pregnant."

Just as women often plan to have a baby, Brown says they have to plan to not have a baby. That can be difficult, she says, because the old pattern for women — going to school, getting married and having a baby — has been tossed away.

Some of that is a good thing because women now have greater education and job opportunities. But it's not clear anymore where pregnancy fits into that, Brown says, especially since nonmarital childbearing is so common. "I think people aren't exactly sure what the plan is anymore."

The last U.S. census found a 40 percent increase in out-of-wedlock births. The increase was among all women of childbearing age, but it was greatest among young women in their 20s. Seven out of 10 unintended pregnancies occur in young women between the ages of 20 and 29.

There's something else women should think about, says Cullins of Planned Parenthood: Get emergency contraceptives before a mishap occurs, not after.

"I definitely recommend that all sexually active women have emergency contraception on hand, because you don't know when an accident is going to occur," Cullins says. "Keep it in your drawer (or) in your purse, where you can easily get to it if that condom breaks."

It took Migala two weeks of waiting for a menstrual period that never came, and several home-bought pregnancy tests to realize that the fertility method she was using didn't work. After a conversation with her mother and the ex-boyfriend, who both said they would accept whatever decision Migala made, she decided to have an abortion. It was a painful decision, but she doesn't regret it.

"I just don't think I fully grasped the weight of the decisions I was making," Migala says, "and the impact that they would have on my life."

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