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Contraception - some numbers

Many people accept that a contraceptive method is a bit like adverts seen for wood varnish on the TV - it does just what it says on the tin! We all accept that there will be some failures, but what are the relative failure rates for different methods? Bandolier has been digging for useful evidence on contraceptive methods.

Failure rates

Evidence on failure rates is hard to come by. A series of estimates are summarised in a cost effectiveness paper [1], and the results are given in the Table both as the annual percentage of failure, and as the number of women (out of 10,000) who would become pregnant in one year using particular methods. Information on the combined oral contraceptive pill from a summary of clinical trials [2] is also given.

Annual failure rates for contraceptive methods given both as a percentage failure in one year, and in the number of pregnancies per 10,000 women over one year

Method Failure rate (%) Pregnancies per 10,000 women per year
None 85.00 8500
Cervical cap 30.00 3000
Sponge 30.00 3000
Spermicides 21.00 2100
Female condom 21.00 2100
Periodic abstinence 21.00 2100
Withdrawal 20.00 2000
Diaphragm 18.00 1800
Male condom 12.00 1200
Oral contraceptives 3.00 300
Progesterone-T IUD 2.00 200
Copper IUD 0.40 40
Injectable contraceptive 0.30 30
Tubal ligation 0.17 17
Combined oral contraceptive 0.08 8
Vasectomy 0.04 4
From [1] except combined oral contraceptive, calculated from [2].
Now this information on failure rates is probably less than perfect (for instance there was no definition of oral contraceptive). But it is the best we have been able to find; if you know of better data, let us know. We were also perplexed as to how to use the information about Persona, which is claimed to be 94% effective. Does this mean that if 10,000 women not using contraception would have 8,500 pregnancies, with Persona this would be 8,500 x 0.06 = 510?

Economic analysis

The economic analysis is interesting, but with a US slant the numbers are of little relevance to the UK. The conclusion was that over five years the copper-T IUD, vasectomy, contraceptive implant and injectable contraceptive were the most cost-effective options.

Combined oral contraceptive

A review of clinical trials with the combined oral contraceptive of 30µg ethinyloestradiol and 150µg desogestrel [2] does not say it is systematic, but implies that it contains all the trials. Trials vary from small (200 women) to huge (>10,000), with wide rates of irregular bleeding and adverse effects. It is possible to perform an overall average, and this shows the following in cycle 6:

  • breakthrough bleeding - 1.1%
  • spotting - 3.3%
  • amenorrhoea - 2.9%
  • nausea - 1.5%
  • headache - 2.9%
  • breast tenderness - 3.6%
  • nervousness - 3.9%


When choosing a contraceptive method, women and men need good advice on both the effectiveness and the problems to make a properly informed choice. More and better information than this may be available, but Bandolier was not able to find any. Perhaps we didn't try hard enough, but we thought, perhaps naively, that this would be easy. It wasn't.


  1. J Trussell, JA Leveque, JD Koenig et al. The economic value of contraception: a comparison of 15 methods. American Journal of Public Health 1995 85:494-503.
  2. K Fotherby. Twelve years of clinical experience with an oral contraceptive containing 30µg ethinyloestradiol and 150µg desogestrel. Contraception 1995 51:3-12.

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