The five best contraceptives backed by science

1. Implant
Efficacy: Less than one pregnancy per 100 women using it for a year.

What is it: It is a matchstick-sized rod inserted under the skin of the upper arm. It works by secreting the hormone progestin in small amounts.

Advantages: The implant is considered one of the most effective birth control methods available protecting a woman from pregnancy for up to three years. One of the reasons it is effective is because a woman does not need to return to a health facility for a replacement for years, unlike other contraceptive methods like the pill or injection.

Drawbacks: A health worker is needed to insert the device and recent research has found that the implant is less effective for people taking certain medications, for example, some HIV and tuberculosis drugs.  Some women report heavy menstrual periods.

Types: There are two brands currently available: Implanon and Nexplanon. 

Cost: According to the health department, Implanon costs R1 700 in South Africa’s private sector but is free for all women in the public sector. 

2. Intra-uterine device (IUD)
Efficacy: Less than one pregnancy per 100 women using it for a year.

What is it: A T-shaped device inserted into a woman’s uterus. There are two types of IUDs – one made from copper and another which secretes the hormone progestin.

Advantages: The copper device can protect a woman from pregnancy for up to 12 years; the hormone versions last between three and five years, depending on the brand. 

Drawbacks: It has to be inserted by a qualified health professional. The hormonal versions should not be used by women with liver disease or breast cancer. 

Types: A common copper version is the ParaGard IUD. The Mirena secretes progestin and is effective for five years. Skyla and Liletta are other examples of hormonal IUDs, they last for up to three years. 

Cost: The Mirena costs about R2 000 in South Africa’s private sector, excluding the fee for inserting the device. 

3. Injectable 

Efficacy: Between six and 12 pregnancies per 100 women using it for a year. 

What is it: The injectable contraceptives usually contain the hormone progestin and are given via a shot in the arm every two to three months.

Advantages: The user does not need to remember to take a pill at the same time every day as she would with contraceptive tablets, and it is private – there is no leftover packaging should the woman need to hide the fact she is on birth control. 

Drawbacks: It takes between one and three weeks after the first shot for the injectable to properly protect from pregnancy — the United Kingdom’s National Health Service (NHS) recommends another form of birth control be used in this period, such as a condom. This method is only effective if a woman returns to a health facility every three months to receive a repeat injection.

Types: Depo-Provera is the most common brand; a very similar option is called Sayana Press.  

Cost: The cost ranges between R90 and R250 for every top-up injection in private facilities, but is free for public health sector patients. 

Read our op-ed on access to contraception in Tanzania here.

4. The pill
Efficacy: Between six and 12 pregnancies per 100 women using it for a year.

What is it: There are a number of different types of contraceptive pills. Most contain the hormones oestrogen and progestin but some use progestin alone. If taken at the same time every day, without skipping a dose, the pill can be as effective as the implant.

Advantages: The pill can also help certain women with hormone-related acne and reduce the severity of menstrual cramps. 

Drawbacks: Research has shown that women often forget to take it regularly or struggle to get to a pharmacy every month for a repeat prescription, lowering the effectiveness significantly. 

Types: Yasmin is a common brand of birth control pill; many others are available including Levora, Camila and Jolivette. 

Cost: It can cost between R90 and R350 a month in South Africa’s private sector. Public sector patients can get some brands for free. 

5. Male condom
Efficacy: 18 pregnancies per 100 women using it for a year

What is it: A sheath made from latex (rubber), polyurethane and tactylon (both are types of plastic) which covers the penis during sex. 

Advantages: Latex condoms, when used correctly every time a person has sex, are 98% effective, according to a review by the NHS.

Drawbacks: Users sometimes do not place condoms over the penis correctly, which increases the risk of pregnancy. Oil-based substances, often used for lubrication, like moisturising cream or vaseline, lower the efficacy of latex condoms. Some people are allergic to latex, which is the most common type of male condom available. 

Types: Choice is the government’s branded condom. Many other types are available from retailers including Durex, Playboy, Rough Rider and Skin.

Cost: Condoms are freely available at many government facilities and cost between R20 and R120 for a box of three at a private pharmacy. 

Sources: Centre for Disease Control 2014 family planning effectiveness report; Planned Parenthood; National Health Service 2013 contraceptive guidelines; Marie Stopes.

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Amy Green
Amy Green reported on health issues at the M&Gs health journalism centre, Bhekisisa, from 2013 to 2016.

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