A medical exam and prescription are required. The pill can then be purchased from the pharmacist at your drug store.

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Norplant

This highly effective method consists of thin capsules of flexible material that are implanted in the upper arm through a small incision just below the surface of the skin. No special planning is required before sex. The implant can be left in place for up to five years, but can be removed at any time before that when protection is no longer needed.

Norplant offers no protection against sexually transmitted diseases, including HIV/AIDS. Norplant is expensive (must be paid for ahead of time), but the average cost over several years of use is low. This method may cause menstrual irregularity.

Premature removal of the implant may be required if an irritation occurs in the upper arm where Norplant has been placed.

• Effectiveness when used consistently and correctly--99.9%

Norplant must be inserted and removed under local anesthetic by a doctor.

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Depo-Provera

This method of birth control involves receiving an intramuscular injection every three months. These injections block ovulation. Depo-Provera is safe, convenient and highly effective if taken on schedule.

Depo-Provera offers no protection against sexually transmitted diseases, including HIV/AIDS. This method may cause menstrual irregularity, spotting between periods, or no periods at all. Possible side effects of this method include weight gain and an increased rate of bone loss (higher risk of osteoporosis).

The effects of this method cannot be reversed immediately. Ability to conceive a child may be delayed, and side effects must be tolerated for 6 to 8 months following the last injection.

• Effectiveness when used consistently and correctly--99.5%

This method requires a doctor's prescription.

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SPERMICIDAL METHODS

Spermicidal preparations-foam, film, jellies, creams, suppositories or tablets-are inserted into the female's vagina shortly before sexual intercourse and are effective for only a short period of time. The spermicidal chemicals in these products destroy sperm. Side effects, if any at all, are minimal. When used in combination with a latex condom, the effectiveness of this method of birth control increases substantially.

Film
(VCF--Vaginal Contraceptive Film)
Protection begins 15 minutes after insertion and lasts for no more than one hour.

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Foam

Foam forms an anti-sperm barrier between the vagina and the entrance to the womb. It is quick and easy to use and provides contraceptive protection immediately upon insertion.

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Jellies and Creams

Protection is immediate and lasts for one hour if used alone, 6 to 8 hours if used with a diaphragm or cervical cap.

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Suppositories and Tablets

Protection begins 10 to 15 minutes after insertion and lasts for no more than one hour.

It is important not to confuse spermicidal creams and jellies with those that are only lubricants. (Nonoxynol-9 is the active agent in most available spermicidal products.)

On its own, this method provides some limited protection against sexually transmitted diseases. When used in combination with a latex condom, it serves as the best protection against these diseases, including HIV/AIDS.

These products must be inserted correctly just before each act of intercourse, and so may interrupt the mood.

With the exception of film, spermicidal preparations may be messy.

Any spermicidal products may cause allergic reactions or genital irritation.

A pre-existing vaginal infection may interfere with the effectiveness of these products.

• Effectiveness of foam when used alone--65-85%
• Effectiveness of film, jellies, creams, suppositories or tablets when used alone--79%
• Effectiveness of any spermicidal method when used in combination with a latex condom--99%

Spermicides are readily available, without a prescription, in drug stores and at family planning clinics.

CONDOMS

Male Condom

Also known as a "rubber" or "sheath", the condom is a protective covering of latex or animal membrane that fits over the penis and prevents semen from entering the vagina.

A condom is used only when needed (before each act of intercourse). Using the condom, in combination with a spermicidal product containing nonoxynol-9, raises the effectiveness of this method significantly and provides the best available protection against HIV/AIDS and other sexually transmitted diseases.

This method will be ineffective if used incorrectly or if a breakage occurs. Petroleum jelly or mineral or baby oils will dissolve latex and destroy condoms and diaphragms. Some males report decreased pleasurable sensation using this method.

• Effectiveness when used alone--88%
• Effectiveness when used in combination with spermicidal product --99%

Condoms are readily available in drug stores, supermarkets and in vending machines.

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Female Condom
("intra-vaginal pouch")

The female condom is a loose fitting, plastic pouch that lines the vagina. It has soft rings at each end. Like the male condom, it prevents semen from entering the vagina and is for single use only. Using the condom in combination with a spermicidal product containing nonoxynol-9 raises the effectiveness of this method significantly.

A partner's cooperation is not essential with this method; the female inserts the condom herself up to eight hours before sexual intercourse. This method has no serious side-effects and poses no risk to future ability to have children.

The female condom is made of plastic and provides protection against sexually transmitted diseases, including HIV/AIDS.There is a risk of breakage.The outer ring of the condom may get pushed inside the vagina during sex.The female condom is noisy and often moves about during sex.Vaginal or penile irritation may occur.

• Effectiveness when used alone--79%
• Effectiveness when used in combination with spermicidal product-85--95%

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BARRIER METHODS

Cervical Cap, Diaphragm, Sponge, Lea Contraceptive

Cervical Cap and Diaphragm

These are both flexible rubber barriers used with spermicidal cream or jelly. The barrier blocks and the spermicide destroys the sperm. Both cap and diaphragm may be inserted a short while before intercourse for some spontaneity. The diaphragm requires repeat spermicide applications for each act of intercourse. The cap may be left in longer and does not require repeated applications of spermicide.

Both of the above barrier methods offer some protection against sexually transmitted diseases. Both require professional instruction about insertion and removal. Wait at least six hours before removing diaphragm after sex. They may move during intercourse.They may cause allergic reactions, urinary tract infections and (in very rare cases) toxic shock syndrome.They cannot be used during your periods (or with any vaginal bleeding or discharge), nor for a short time after childbirth, abortion or miscarriage.Cervical cap use may lead to abnormal Pap smears and unpleasant odours. Do not wear it longer than 48 hours.

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Sponge

The sponge is a barrier method containing spermicide. It is ready to use and easy to insert, up to 24 hours ahead of intercourse.

The sponge must be left in at least six hours after intercourse, but for no longer than 24 hours. It cannot be reused.It may cause an allergic reaction.

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Lea Contraceptive

Lea Contraceptive is a reusable one-size-fits-all, silicone barrier device that must be folded and placed to fit snugly in the vagina like a tampon. Its one-way valve allows secretions to flow out without letting sperm up. The shield must be left in place for at least eight hours after intercourse, but for no longer than 48 hours.

When used with spermicidal gel, Lea Contraceptive is an effective barrier method for women who have not had children.It can be difficult or messy to insert and remove, although an attached loop is used to gently remove the contraceptive.The contraceptive must be washed with soap and water after each use and replaced altogether after six months.

• Effectiveness of barrier methods-- 80%

• Cervical Cap and Diaphragm: $30-$45
• Sponge: $8.99 for a package of four
• Lea Contraceptive: Approximately $60

Cervical Cap and Diaphragm: Available only from a specialist; a doctor's referral is needed.
Sponge: Available over the counter at a drugstore.
Lea Contraceptive: Available without a prescription at your local pharmacy.

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Intra-uterine Device
(IUD)

The IUD is a specially shaped piece of plastic wrapped in copper that must be inserted into the uterus by a doctor. There is no special preparation needed, nor is it felt or noticed during sex. The effectiveness of this method is increased if the IUD placement is checked regularly and if partners use condoms or spermicide during the female's fertile days.

There can be possible discomfort during insertion of the IUD. Especially in the first few months after insertion, there may be heavier cramps and bleeding during your period, and spotting between periods. The IUD offers no protection against HIV/AIDS and other sexually transmitted diseases, and may make users more susceptible to chlamydia and gonorrhea. In rare cases, infections associated with use may lead to pelvic inflammatory disease, tubal pregnancies and infertility. Also in rare cases, the IUD may move, possibly puncturing the uterus and becoming ineffective as a birth control method. The IUD must be replaced every two and a half to five years.

Many women are not good candidates for IUDs. You should not use an IUD if you have multiple sex partners, are concerned about your ability to have children in future, or are allergic to copper. Women who have had at least one pregnancy tolerate IUDs better than those who have not. Your doctor will speak to you about side effects and danger signs.

• Effectiveness when used alone--94%
• Effectiveness when used in combination with a condom or spermicidal product 98--99.9%

Cost: Approximately $25-$50

A medical exam and doctor's prescription are required.

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STERILIZATION

Sterilization involves medical operations that can be performed on males (vasectomies) or females (tubal ligations). Vasectomies are safer, simpler procedures compared to tubal ligations. Sterilization poses no known long-term health risks.

Vasectomy

The tubes through which sperm travel from testes to penis are cut and blocked. The male still ejaculates and experiences orgasm, but fertilization cannot take place. A vasectomy is done under local anesthetic in a doctor's office.

Tubal Ligation

The female's fallopian tubes are closed so that an egg cannot travel from the ovaries and meet sperm. There are various methods of tubal ligation; all are done in hospital under local or general anesthetic.

Although they are highly effective as birth control methods, male and female sterilization should both be considered to be permanent. The possibility of reversing these procedures, especially tubal ligation, is very low.

In rare cases, medical complications may occur due to surgery: in males that could involve some temporary swelling and discomfort; in females, complications, if any, may be a bit more severe.

• Effectiveness of sterilization in preventing pregnancy: 99%

Cost: Surgery is covered by Health Insurance.

Discuss this option with your doctor.

NATURAL FAMILY PLANNING

Calendar Method

A female charts her menstrual cycle to determine her fertile periods and avoids unprotected intercourse during these times. Charting is done by calendar, mucus and temperature readings. There are no side effects. This method is often acceptable to partners with religious or moral concerns about birth control.

This method has a high risk of failure; both partners must be able to make the commitment to the conscientious use of the charting procedure and to periods of abstinence (usually for a minimum of seven days during ovulation) for this method to be effective.

This method offers no protection against HIV/AIDS and other sexually transmitted diseases. You should seek professional instruction in observing and charting fertile times. Irregular menstrual cycles, or stress, fevers and vaginal infections may make accurate observation difficult.

• Effectiveness when typically used -- 80%

Cost: minimal (for charting supplies) or none

Withdrawal

Using this method, a male withdraws his penis from the female before he ejaculates. Failure rate is high with this method because "control" is not always possible during sexual intercourse, and also because some sperm can come out prior to ejaculation. At best, effectiveness could only be considered to be 79% using withdrawal as a method of birth control.

Breast-Feeding

While Breast-Feeding may protect against pregnancy by suppressing ovulation in the female, it is unreliable as a birth control method, because fertility may return to the female even before her periods resume.

Douching

Douching has no effect as a birth control method; it may be used only to cleanse the vagina.

Effectiveness of birth control using chance (no method): 15%. In other words, if you are sexually active and use no method of birth control, you have an 85% chance of becoming pregnant! If you don't wish to be pregnant, ACT NOW to choose a method of birth control that is right for you.

For more information:
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