Last partial update: July 2016 - Please read disclaimer before proceeding
Avoiding unplanned pregnancy
Unplanned pregnancy is common in women in general but especially in young women. It almost always is presents a very difficult problem for the woman concerned, who is confronted with, either terminating the pregnancy and suffering the associated the psychological trauma, which can go on for many years after the actual termination, or overcoming the difficulties of giving birth to and bringing up an unplanned child. (This is especially a problem for teenage pregnancies where 60 per cent of women who choose to become mothers have no male partner.)
While no exact figures exist, it is estimated that about 85,000 abortions occur in Australia each year (about one in five of all pregnancies).The majority occur in young women, with about 17 per cent in teenagers and 47 per cent in women in their twenties.
About 20 per cent of Australian women will become pregnant in their teenage years, with the rate being about 44 per 1000 female teenagers per year. While some of these are planned and wanted, about 53 per cent (or 23 per 1000) end in termination.
This teenage termination rate is the sixth highest amongst OECD countries and does not compare favourably with many other developed countries. For example, the rates for German (5.3 per 1000 per year) and Dutch (3.9 per 1000 per year) teenagers are less than a quarter of those for Australian teenagers. (1996 figures)
This is perhaps not overly surprising when you consider that about 50 per cent of first time sexual intercourse in Australia occurs without any contraception being used.
Interestingly, the situation does not improve greatly as women get older. The overall termination rate in Australian women aged 15 to 44 years is similar at about 20 per 1000 women per year. Overall, almost 20 per cent of Australian women will have an abortion at some stage in their lives.
From the above it is obvious that contraception use in Australia needs to improve.
Contraception is still mostly left up to women
Contraception in Australia is still mainly left up to the female. This is very understandable as it is primarily women who face the consequences. In order to avoid becoming pregnant, a woman must;
a. choose a reliable form of contraception that suits her
b. use it properly all the time.
(Contraception also often needs to help prevent sexually transmitted diseases.)
a. Choose a reliable form of contraception that suits her.
There are many different forms of contraception available. Most are very good at preventing pregnancies but none are perfect. For example, the oral contraceptive pill has, overall, about a 96% success rate. This means that if 100 women used the pill as a contraceptive for a year, about four would become pregnant.
All forms of contraception have side effects and problems related to their use and these will play an important part in the decision about which to choose. These will be discussed when each form of contraception is examined. (Also see the summary table below.)
b. Use it properly all the time
Failure of contraception is a big problem. In a recent study of Australian women seeking an abortion, about 14 per cent stated they were using the pill at the time. Most forms of contraception work well when used properly all the time. However, it is the nature of much sexual intercourse to be unplanned and at times even opportunistic, often depending on the mood of the participants. While, for some, this is part of what makes it exciting, it does not help with planning successful contraception. The main reasons that contraception fails is that it is not used properly. Studies have shown that about 50 to 75 per cent of women taking the pill miss at least one tablet per cycle and about 20 per cent miss two or more pills per cycle.
Compliance with taking the pill: Studies have shown that about 50 to 75 per cent of women taking the pill miss at least one tablet per cycle and about 20 per cent miss two or more pills per cycle. If you take the pill do not underestimate the difficulty in taking it properly. To help with this, two alternative methods of taking the pill have been developed; vaginal ring and patches applied to the skin, both of which are used weekly rather than daily. (See later for detailed information re these choices.)
Alcohol is the biggest risk factor for contraception failure. When you add alcohol (and sometimes other illicit drugs) into the ‘sex equation’, you are liable to get even more spontaneous and unplanned sexual activity happening; which in some people is the reason for its consumption.
Contraception that relies on taking the contraceptive measure at the time, such as the appropriate use of condoms, is much more difficult to put into practice when alcohol and other drugs use is involved. Barrier methods are essential for protection against sexually transmitted disease and should be used all the time by couples who are not in a long term relationship. However, alone, they are generally considered as being not reliable enough as a means of contraception for anyone having sex more than very occasionally and this is especially the case when the couple consumes alcohol before sexual activity; and in Australia that is most couples. Some other more effective form of contraception that is not administered at the time of sexual intercourse needs to be used also.
The best contraceptive choices for different age groups
The adolescent and younger women
- Condoms (male and female)
- The combined oral contraceptive pill (COCP)
- Alternative, more convenient systems to deliver pill hormones
- Vaginal rings
- Transdermal (skin) patches (
- Progestogen implants (inserted under skin) 'Implanon' – younger women seem to find this option less attractive as it Is associated with menstrual irregularities and mood disturbance)
Women planning pregnancy in the near future
- All the above methods are suitable for this group. The main concern is to avoid ling acting contraceptives that are difficult to reverse, the main one being injectable, progestogen-only contraceptives.
Women breastfeeding
- Breast feeding
- Breast feeding itself does usually stop periods and works reasonably as a contraceptive. (During the first six months it has a success rate of about 98% as long as the baby is being exclusively breast fed and periods have not recommenced. However, this is often a time that women definitely do not want to become pregnant and for these women it is often best to use another form of contraception.
- Minipill
- Male condoms
- IUDs
- Progestogen implants (inserted under skin) 'Implanon'
Younger women who do not wish to have another pregnancy
- Male or female sterilisation
- IUDs, especially progestogen-containing IUDs as they reduce menstrual bleeding (IUDs are less suitable for women who have not had a baby as they are more difficult to insert.)
- Progestogen implants (inserted under skin) 'Implanon'
- The combined oral contraceptive pill (COCP) The presence of oestrogen in the COCP makes this form of contraception a relatively more risky choice as women get older, especially if they have risk factors for cardiovascular disease (heart attacks / strokes) or clotting disorders. However, the COCP does help control hot flushes and reduces menstrual bleeding, which can be excessive at this time.
Women in their 40s and peri-menopausal women
- Male or female sterilisation
- Progestogen implants (inserted under skin) 'Implanon'
- IUDs, especially progestogen-containing IUDs as they reduce menstrual bleeding (IUDs are less suitable for women who have not had a baby as they are more difficult to insert.)
- Progestogen-containing IUDs (e.g. ‘Mirena’) - These work well, last a long time, contain no oestrogen, and act to significantly reduce menstrual bleeding. Their use in the United Kingdom has reduced the need for hysterectomy to control dysfunctional uterine bleeding by about 40%. Copper IUDs increase menstrual bleeding and thus are not often used in this age group.
- The COCP – For selected women, low-dose oestrogen COCPs are an option up to two years post menopause (use in women over 50 is not recommended). Smokers and woman at increased risk of cardiovascular disease should not take the COCP after the age of 35 years and for other women over the age of 50 years, the risks associated with taking the COCP is greater than its benefits (such as reduced risk of ovarian and pregnancy complications).
Note: Hormone replacement therapy, used for reducing menopause symptoms, is not effective as a form of contraception.
Contraception options – A quick summary |
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Hormonal methods – Combined oestrogen and progestogen |
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Type of contraception |
Effective-ness* |
Age group suitability |
Advantages |
Disadvantages |
|
Combined oral contraceptive pill (contains oestrogen and progestogen) |
99% (with perfect use)
92% (with typical use) |
Suitable for all women but lower dose pills should be used in older women. Slightly increased risk of clotting and heart attacks strokes prohibits use in some women (See notes on COCP) |
Does not rely on use at time of intercourse Reduced incidence of cancer (See section on COCP) |
No protection against STDs Medication side effects Rarely can affect future fertility Absorption and thus effectiveness can be affected by medications and gastrointestinal disease) Improper use (Over 50% of women have problems with forgetting to take pills.)
|
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Vaginal ring (NuvaRing) (contains oestrogen and progestogen) |
99% (with perfect use)
92% (with typical use) |
Suitable for all women
|
Ease of use (Inserted once per month.) Does not rely on use at time of intercourse. Contains a lower dose of hormones than the Pill Vomiting and diarrhoea do not increase risk of failure |
No protection against STDs Medication side effects (Similar to pill but less.) Slightly higher risk of clots than pill. |
|
Contraceptive patch (contains oestrogen and progestogen) |
97% (with perfect use)
90% (with typical use) |
Should probably not be used in older women as the oestrogen dose is higher than that in the COCP |
Ease of use (Applied once per week.) Does not rely on use at time of intercourse. |
No protection against STDs Medication side effects (Similar to pill) Skin rashes do occur. |
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Hormonal methods – Progestogen only |
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Type of contraception |
Effective-ness* |
Age group suitability |
Advantages |
Disadvantages |
|
Minipill |
97% (with perfect use)
94% (with typical use) |
Women who are breast feeding Women who are unable to take contraceptives containing oestrogen |
Does not rely on use at time of intercourse Can be used during breast feeding Few side effects |
No protection against STDs Periods can be irregular with spotting being common Improper use (Over 50% of women have problems with forgetting to take pills.)
|
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Implanon (Progesteron rod inserted under the skin) |
Over 99% |
Suitable for all women |
Very effective Ease of use Does not rely on use at time of intercourse
|
No protection against STDs Unpredictable bleeding pattern |
|
Progesterone Intrauterine device |
99% |
Women who have had a baby. Especially useful for older women who have problems with excessive blood loss with menstrual periods |
Ease of use once inserted. Periods less painful and lighter |
Generally not suitable for use in women who have not had children Risk of infection which can affect future fertility. Risk of ectopic pregnancy. Requires two medical appointments to insert. Can be expelled occasionally |
|
Barrier methods |
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Type of contraception |
Effective-ness* |
Age group suitability |
Advantages |
Disadvantages |
|
Male Condoms |
98% (with perfect use) 85% (with typical use) |
Suitable for all women |
Protection against STDs No side effects |
Relies on proper use at time of intercourse |
|
Female condoms |
95% (with perfect use)
79% (with typical use) |
All women although may be harder to use in six months after having a baby. |
Protection against STDs No side effects. More natural feel than male condom. |
Relies on proper use at time of intercourse |
|
Diaphragms |
94% (wiyh perfect use)
84% (with typical use) |
All women Need to be used with spermicidal gel |
No side effects |
No protection against STDs Needs to be inserted well ahead of time of intercourse to be effective. Insertion can be inconvenient / difficult. Needs to be used with spermicidal gel to be effective. Improper use. Imperfect protection even when used properly. |
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Intra Uterine Devices |
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Type of contraception |
Effective-ness* |
Age group suitability |
Advantages |
Disadvantages |
|
Copper Intrauterine device |
95% to 98% |
Women after they have had a baby Not suitable for women who have heavy, painful menstrual periods. (Other restrictions See notes on IUDs.) |
Ease of use once inserted.
|
Generally not suitable for use in women who have not had children Risk of infection which can affect future fertility. Risk of ectopic pregnancy Requires two medical appointments to insert. Periods more painful and heavier. Can be expelled occasionally
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Progesterone Intrauterine device (See above) |
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Other less effective methods |
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Spermicides alone or Natural methods or Withdrawal (coitus interruptus) |
These methods are all too unreliable to be recommended as adequate forms of contraception. |
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*% of women who avoid pregnancy each year with continuous use of this form of contraception for the whole year. (For example, a score of 96% means that 4 out of every 100 women using that form of contraception would get pregnant each year.) Some forms of contraception are not used perfectly in many situations and thus the typical figure quoted may well be a more appropriate one to base your contraceptive decision on. |
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Contraception while breast feedingBreast feeding itself does usually stop periods and works reasonably as a contraceptive. (During the first six months it has a success rate of about 98% as long as the baby is being exclusively breast fed and periods have not recommenced. However, this is often a time that women definitely do not want to become pregnant and for these women it is often best to use another form of contraception. Pills containing oestrogen are not useful as they will cause milk flow to stop and most women opt for a progesterone only pill, the minipill, which is discussed above. A very small amount the progesterone does enter the breast milk and will thus be consumed by the baby. It is very unlikely that tis would cause the baby any problems at the time of consumption or in the future but this aspect of the minipill has not been formally studied. There are other ways of delivering progesterone only contraception, including Depo Provera (long acting) injections and the Implanon rod that is inserted under the skin. The effects of progesterone ingestion by babies, via the use of Depo Provera as a contraceptive for their breast feeding mothers, has been studied well studied and has not shown any adverse side effect on the babies at the time of ingestion or later in life. While it may be reasonable to extrapolate these results to other forms of progesterone-only contraception, approval for their use in breast feeding women has not been formally given in Australia. Despite this, as stated above, the contraceptive most commonly used by breast feeding women in Australia is the minipill. |
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Emergency contraception – Reassurance if you are uncertain.
Usually a woman is aware that she is not covered regarding contraception when she has had sexual intercourse. This opportunity to prevent unplanned pregnancy should not be ignored with the hope that all will be well. Emergency contraception is freely available in Australia from pharmacies and a doctors prescription is not needed. It works for up to five days following the unprotected sexual intercourse and has almost no side effects. (It is NOT just a morning after pill.)
What is emergency contraception?
Emergency contraception is basically a special dose of the hormone progesteron that a woman can take to reduce the chance of becoming pregnant following unprotected sexual intercourse. This includes rupture of condoms or taking the pill incorrectly as well as having intercourse without any contraception. It is important to realise that, while pregnancy is more likely when sex occurs at certain times during the menstrual cycle, a woman can become pregnant at almost any time, even when sex occurs during menstruation. Thus, emergency contraception needs to be considered any time unprotected intercourse occurs.
Emergency contraception comes pre-packaged and consists of two pills containing a large dose of a progestin hormone. There are two brands, Postinor-2 or Levonelle-2, and both are available over-the-counter from any pharmacy. It does not require a doctor’s prescription.
The two pills are usually taken by 12 hours apart, with the first one being taken as soon as possible after the unprotected sexual intercourse occurred. (Recent evidence has shown that taking both together is equally effective.) The closer emergency contraception is started to the episode of unprotected sexual intercourse the more effective it is. However it will work up until about 5 days after. Thus, the term ‘morning after pill’ that is commonly used to describe emergency contraception is quite misleading.
Emergency contraception works in two ways.
- In women who have not yet released an egg (ovulated) during the cycle, it acts to delay ovulation until after the sperm from the sexual contact has gone, thus preventing egg fertilisation.
- Where ovulation has already occurred, it is thought to act by prevent preventing the fertilised egg from implanting in the uterus.
Overall, it prevents about 87% of pregnancies; although if it is taken within 24 hours of intercourse, the success rate is around 99%. It causes few side effects, although irregular bleeding (often as spotting) can occur and about 2% of women will get some nausea. The menstrual period following taking emergency contraception should occur at the expected time and if it doesn’t or is delayed, a pregnancy test should be done. The woman should continue her usual form of contraception, including the COCP (the pill), during the cycle that the emergency contraception is taken in.
Most women can take emergency contraception safely, although prior medical advice should be sought if the woman has had a hormone-dependent cancer and it should not be taken when a woman is already pregnant. A very small amount of the medication (about 0.1%) will enter breast milk in lactating women. Some medications will also reduce its effectiveness. (Talk with your doctor.)
The cost is in the region of $20 to $30.
Medical practitioners can provide this form of medication from samples they have of the mini-pill, but the progesterone dose in the mini-pill is quite small and two doses of 25 tablets are required to replicate the dosage provided in the commercially available emergency contraception preparations.
Further information
Other sexual health information for parents and adolescents on this web site
Preventing teenage pregnancy
See section 'preventing teenage pregnancy'Contraception for adolescents and teenagers. There is a separate section in the web site devoted to preventing teenage pregnancy.
See section 'preventing teenage pregnancy'
Unplanned pregnancy - What are the options?
See section 'Unplanned pregnancy options'
Sexually transmitted diseases and their prevention
This focuses on Chlamydia and Genital Hepres, the two most common sexually transmitted diseases in young people. Other diseases such as HIV/AIDS are also covered.
See section 'Sexually Transmitted Diseases and their prevention'
Further reading regarding teenager sexual health
Sexwise by Dr Janet Hall. Published by Random House Australia. (What every young person and parent should know about sex. Dr Hall empowers her readers by telling them the facts - and giving it to them straight.)
Unzipped by Bronwyn Donaghy. Published by Harper Collins (A book that deals frankly and sympathetically with the crucial role that love and emotions play in every aspect of adolescent sexuality.)Further titles regarding puberty and adolescent sexuality are available on the Children’s Hospital at Westmead web site. www.chw.edu.au/parents/books. (Both the above books are mentioned on this web site and are recommended by staff at this hospital.)
Further information on sexual health
Sexual health information
www.shinesa.org.auFamily Planning NSW
https://www.fpnsw.org.auThe Resource Center for Adolescent Pregnancy Prevention web site
(A good USA site that provides information and skills for both adolescents and for educators about preventing unwanted teenage pregnancies.)
www.etr.org/recapp