AUSTIN (KXAN) — Retired labor and delivery nurse Diane Powell got married in 1969. It had been less than 10 years since birth control pills were first approved for use but they still weren’t as prevalent as they are today. She remembers a conversation about them soon after her wedding.

“My mother-in-law asked me if I was taking birth control pills, and I said, ‘Yes, I am. I have one semester to go, and I have to graduate or my dad will kill me!’ She was very timid, and then she said, ‘Can I just look at them?’” Powell recalled.

“She looked at them almost longingly, as I recall. It’s kind of a funny moment between us,” Powell said.

Methods of birth control have been used since ancient times. Many modern-day methods of birth control still used today were introduced in the 20th century and have continued to evolve. Old methods are being updated and are growing in effectiveness. New, more convenient methods are being introduced.

Today, birth control has become less of a novelty. The most recent data from the CDC’s National Survey of Family Growth on birth control use said almost all women have used a method of contraception at least once in their life. But many people still have questions about it, especially with the recent overturn of Roe v. Wade by the Supreme Court.

The science

One common way birth control can be categorized is hormonal vs. non-hormonal methods. Hormonal methods imitate the body’s natural hormones with a synthetic version. What is actually occurring in the body when these “pseudo-hormones” are released? Well, it depends on the method, according to 20-year-practicing obstetrician-gynecologist Dr. John Thoppil.

Hormonal methods

  • Combined-hormonal methods – The pill: When someone says they are on the birth control pill, what they probably mean is they are on a combined-hormonal birth control pill. Estrogen and progesterone are the hormones that determine ovulation and the menstrual cycle, and what makes the pill unique is that it contains both of these hormones, but a synthetic version, to “trick” the body into having a regular monthly menstrual cycle.

“Those primarily work by suppressing ovulation. So it actually does change your hormone levels. It suppresses your natural hormones, and stops the surge of hormones that makes you ovulate,” Thoppil said.

  • Progesterone-only methods: There are quite a few progesterone-only birth control methods. These methods include a progesterone-only pill, an arm implant and hormonal IUDs. Dr. Thoppil said the progesterone-only methods may inhibit ovulation occasionally for some women, but the main way it works is by causing cervical mucus to thicken, creating a physical internal barrier to keep sperm out.

Non-hormonal methods

  • Non-hormonal methods include condoms, withdrawal, calendar method or the diaphragm. “All of those are non-hormonal, but they’re also less effective. Those are some of the highest failure rate methods,” said Dr. Thoppil. However, an extremely effective non-hormonal method is the copper IUD, Thoppil said. “It’s sitting in the uterus and creates inflammation that keeps sperm from functioning and moving in the correct direction. It inhibits sperm from fertilizing properly.” The copper ions from the IUD cause malfunction of sperm. The most effective non-hormonal method is female sterilization or a vasectomy, which are meant to be permanent, so they usually can’t be reversed.

Planned Parenthood lists 18 birth control methods on its website. People can also take its quiz to see what method may be best for them.

The data

The National Center for Health Statistics, which is a part of the Centers for Disease Control and Prevention, has conducted the National Survey of Family Growth, or NSFG, every 5 years since 1973. Statistician Dr. Joyce Abma has worked on the NSFG team since 1993.  Dr. Abma has co-authored reports that contain contraceptive use information since 1997.

Dr. Abma said the survey nationally represents men and women of reproductive age. The most recent report was published in October 2020 and covered the data from 2017-2019.

1Includes persons of other and multiple race and origin groups, not shown separately.
2Significant linear trend across all four age groups.
3Significantly different from non-Hispanic black women and Hispanic women.
NOTES: The population size referenced for women aged 15–49 is 72.7 million. Analyses of education are limited to women aged 22–49 at the time of interview. Less than high school is no high school diploma or GED. Access data table for Figure 1 at: https://www.cdc.gov/nchs/data/databriefs/db388-tables-508.pdf#1.
SOURCE: National Center for Health Statistics, National Survey of Family Growth, 2017–2019.

Dr. Abma said one thing the reports in this series tend to point out is that contraceptive use is virtually universal. The most recent report, which is a snapshot of what women used in the month the survey was conducted between the years 2017 and 2019, shows 65% of women used some form of contraception.

“That means 35% were not. You might wonder, ‘Who are those people?’ Well, they were either trying to become pregnant or currently pregnant, just had a baby or were not having sex,” Abma said. About 7% of people interviewed for the survey were at risk of unintended pregnancy.

According to Abma the percentage of people who had ever used a birth control method in their lifetime is 89%. Excluding people who have never had sex from that figure, it goes up to 99%. So among women who’ve had sex at least once in their lives, or are sexually active, 99% have used a method of contraception, which is why Dr. Abma considers contraceptive use virtually universal.

There are four leading birth control methods that people use: female sterilization (used primarily among older women at the end of their reproductive years), the pill (used by a larger age range at the younger end of the spectrum), the IUD (which is gaining popularity) and the condom (often used in addition to another method).

Abma said the study shows the trends of sterilization, the pill and the condom remain consistent over the years. There isn’t much change in use over the last 20 years. These are the methods women in the United States continue to use most commonly.

However, the most significant change started in 2011 when modern, hormonal IUDs were developed. Before then, only copper IUDs were used.

“In 2011, it started to become more common. For example, in 2002, only 2% of women were currently using an IUD. By the year 2017, 10%, were,” Abma said. “That’s a pretty significant change in terms of how these things tend to remain stable.”

“Other things that were very interesting were new hormonal methods being introduced. Things like the Depo-Provera shot and the contraceptive ring or patch. Those started to be introduced in the early 2000s,” Abma said. “These methods gained popularity between 2005 and 2010 and were commonly used among teenagers and young adults. These methods did not replace the use of the pill but supplemented it.

* Percentage does not meet National Center for Health Statistics standards of reliability.
1Significant linear trend.
2Percentages for age groups 20–29 and 30–39 were higher than percentages for age groups 15–19 and 40–49. Differences between percentages for other age groups were not statistically significant.
NOTES: Women currently using more than one method are classified according to the most effective method they are using. Long-acting reversible contraceptives include contraceptive implants and intrauterine devices. Access data table for Figure 3 at: https://www.cdc.gov/nchs/data/databriefs/db388-tables-508.pdf#3.
SOURCE: National Center for Health Statistics, National Survey of Family Growth, 2017–2019.

With the IUD being a Long Acting Reversible Contraceptive that lasts up to five years, it is appealing to the user for convenience purposes, and practitioners know this method is highly effective because there is very little room for error, according to Abma.

“It has a very low failure rate. It’s almost as low as female sterilization. So that’s one reason that practitioners have been promoting IUD, because it is so effective, whereas the condom has a higher failure rate. Natural family planning methods also have pretty much higher failure rates. They’re just harder to use correctly. And then the method itself, even if you do use it perfectly, isn’t failsafe,” Abma said.

Here is the most common method of birth control for each age group

  • Teens: condom
  • Teens/young adults: condom and pill
  • Young adults and middle age reproductive ages: IUD (or LARCs)
  • Oldest reproductive ages: female sterilization

“In summary, these days we really have a lot more options to choose from than they did up to about 1980. Due to the development of all different methods,” Abma said.

The access

The right to contraception was established in a 1965 Supreme Court case, Griswold v. Connecticut, where the court found a constitutional right to privacy protected a woman’s ability to take birth control. 

Most health insurance plans must cover the full range of prescription birth control methods for free with no copay, coinsurance or other out-of-pocket costs, even if people haven’t met their deductible. Under the Affordable Care Act, most insurance plans must cover doctor visits related to birth control. 

In Texas, the following cannot be provided to a minor without parental consent:

  • Preventive Care Visit
  • Pap Test
  • Urinary Tract Infection treatment
  • Prescriptive Birth Control (pills, shot, implant, IUD)

According to Planned Parenthood, minors in Texas cannot get access to certain types of birth control without parental consent. In Texas, the following can be provided to a minor without parental consent:

  • Information about birth control
  • Condoms
  • Contraceptive foam or film
  • Pregnancy tests
  • Diagnosis and treatment for certain sexually transmitted diseases

Anyone 17 or older can buy the morning-after pill (Plan B, One Step or Next Choice) over the counter at a drug store, Planned Parenthood health center or another health clinic. Those under age 17 can only get the morning-after pill with a prescription from a health care provider, or ask a friend or family member 17 or older to buy it for them.

What’s next after Roe v. Wade?

In response to Roe v. Wade being overturned — and the suggestion in Justice Clarence Thomas’ opinion that the court reconsider Griswold v. Connecticut because a similar precedent was used in that case — the Right to Contraception Act was proposed in Congress.

This bill proposes protecting a person’s ability to access contraceptives and to engage in contraception, and protect a health care provider’s ability to provide contraceptives, contraception and information related to contraception. On July 21, the House of Representatives passed the act 228-195. It is now on the way to be voted on by the Senate. 

Retired OBGYN Don Smith said that considering the overturn of Roe v. Wade by the Supreme Court, he would like to think that birth control appointments will increase among doctors’ offices.

“I don’t know how optimistic I should be though,” Dr. Smith said. “We’re still going to have unintended pregnancies. We have always had a percentage of pregnancies that have been unintended for all of my career.”