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Contraception

Overview of contraception methods | Rongoā ārai hapūtanga

Key points about contraception

Contraception (rongoā ārai hapūtanga), or birth control, is a term for the various methods used to prevent pregnancy.
There are a lot of different contraceptive methods that can be used to prevent pregnancy.
Each type of contraception works differently, but generally they stop a sperm from meeting with an egg, which is how a pregnancy starts.
Some contraception works better than others and each method has its pros and cons.

Three Indian women laugh together on couch

There are a wide range of contraceptives you can choose from. This video provides an explanation of the common types so you can be more informed and choose the one that is right for you.

(Family Planning, NZ, 2015)

Contraception or birth control is a way to prevent pregnancy. There are different contraceptive methods and you may need different types at different stages of life. Some may be suitable for you but some may not. Only barrier methods (such as condoms) and abstinence (not having sex) also help prevent sexually transmitted infections (STIs).

Each type of contraceptive method works differently. Some use hormones and some provide a barrier. Generally, they stop a sperm from meeting with an egg, which is how a pregnancy starts. Some contraception works better than others, eg, the long-acting reversible (LARC) is 99% effective at preventing pregnancy.

Anyone of any age can get contraception from a nurse or doctor. If you want to get contraception, see your GP or visit a Family Planning clinic in your area(external link)(external link). If you are under 22 years old and are a New Zealand resident, your Family Planning clinic visit is free. Your visit will also be confidential.

Find out about fees and charges(external link)(external link) for Family Planning clinics in New Zealand.

There are a lot of contraceptive methods that can be used to prevent pregnancy. There are 2 main types of contraception – hormone methods and methods that don’t contain hormones.

Hormone-based methods include:

the progestogen-only pill (the mini-pill)
the combined oral contraceptive pill (the pill)
the injection (Depo Provera)
the implant (Jadelle), also known as the rods
an intra-uterine devices (IUD) that contain progestogen such as Mirena® or Jaydess®.

Methods that don’t contain hormones include:

condoms (over your penis or into your vagina)
copper IUD
fertility awareness
tubal ligation
vasectomy.

There are also 2 types of emergency contraception that can be used after sex after unprotected sex or if your usual type of contraception has failed and you don’t want to get pregnant. One method of emergency contraception uses hormones and one doesn't.

Read the table below to find out more about each type of contraception.

Method	Description
Long-acting reversible contraception (LARC)	There are 2 types of LARC in New Zealand: the implant – currently the Jadelle which can last for 5 years intra-uterine methods (some with hormones and some without – these can last for 5–10 years. LARCs are called ‘fit and forget’ contraception because you don’t need to remember them every day or every month. They are immediately reversible on removal. LARCs are the most reliable form of contraception available. Chance of getting pregnant: 1% or less Read more about LARC.
Contraceptive pills and injections	These contraceptives use hormones to prevent pregnancy. They include contraceptive pills and the Depo-Provera injection. Contraceptive pills There are 2 types of oral contraceptive pills: the combined pill (‘the pill’) the progestogen-only pill (‘the mini pill’). You must remember to take a pill every day. Chance of getting pregnant: 8% in general, but less than 1% if used perfectly. Depo-Provera injection The injection is given every 13 weeks (approximately every 3 months) Chance of getting pregnant: 1–3% Read more about contraceptive pills and injections.
Barrier methods	Barrier methods of contraception stop sperm from reaching the fallopian tubes. They also give some protection against STIs. However, they can interrupt sex and be fiddly to put on until you get used to them. You must remember to have them with you and use them every time you have sex. Condoms (sheaths) are the most effective barrier method. Diaphragms or caps are no longer recommended. Chance of getting pregnant: 2–21% depending on correct use Read more about condoms.
Emergency contraception	Emergency contraception can be used after unprotected sex or if your usual type of contraception has failed and you don’t want to get pregnant. However, it doesn’t protect you against STIs. The 2 forms of emergency contraception are the emergency contraceptive pill and the copper IUD. Emergency contraceptive pill This should be taken within 72 hours of unprotected sex. Chance of getting pregnant: 2% if you are of average weight and 6% if overweight Copper IUD This can be inserted within 5 days of ovulation (day 19 of a 28-day cycle) and is recommended for women over 70kg. Chance of getting pregnant: less than 1% Read more about emergency contraception.
Fertility awareness or natural family planning	Fertility awareness means working out ‘safer’ times to have sex. You need detailed advice on this method as it takes commitment and great care. Chance of getting pregnant: 2–24% Read more about fertility awareness.
Sterilisation	Sterilisation is a permanent method of contraception. In women, it is an operation called tubal ligation or sterilisation. Clips are put on the (fallopian) tubes to stop the egg getting to the womb. In men, it is an operation called a vasectomy. Under local anaesthetic the tubes (vas deferens) that carry sperm to the penis are cut so there is no sperm in the fluid they are in (the ejaculate). Although it can sometimes be reversed it should be considered permanent. Chance of getting pregnant: less than 1% Read more about tubal ligation and vasectomy.
Abstinence	Abstinence (not having sex) is the only 100% way of preventing pregnancy and STIs. Vaginal sex is the only way you can get pregnant, but STIs can be transmitted through vaginal, oral and anal sex. Abstinence is an option for people who don’t want to have sex because they don't feel ready, don't want to use other forms of contraception or for religious or any other personal reasons. Chance of getting pregnant: 0%
Withdrawal method	The withdrawal method is sometimes called ‘coitus interruptus’. It means pulling the penis out of the vagina before ejaculation. It takes a lot of self-control and can fail if the penis is not withdraw fast enough or some sperm leak out before ejaculation. This is not a very reliable contraceptive method. Chance of getting pregnant: 25%

The ideal contraception method for you depends on factors such as:

your health
whether you take medicines that may interact with the method
whether you smoke
how reliable you need your contraception to be
how often you have sex
how many sexual partners you have
your preference
whether you want to have children in the future.

Talk with your healthcare provider about the best form of contraception for you. Your nurse or doctor will ask you few questions about your health and family history. They will also ask you some personal questions, such as your sexual relationship with your partner/s and to check you aren’t being pressured into having sex when you don’t want to.

They will also talk about how to prevent STIs, eg, using condoms, and will do screening for STIs if you are sexually active. All appointments are confidential and you are welcome to ask your nurse or doctor anything you would like to know.

You can also read more about how to choose the right contraception.

Family Planning NZ(external link)(external link) provides useful information and resources about contraception on their website. They also have clinics you can visit to talk to someone so you can make informed choices about your sexual and reproductive health. Visit their website(external link)(external link) or make an appointment by filling out the appointment form(external link)(external link).

The following links provide further information about contraception. Be aware that websites from other countries may have information that differs from New Zealand recommendations.

Contraception your choice(external link)(external link) Family Planning NZ
What is contraception?(external link)(external link) Family Planning NZ
Overview of contraception and sterilisation(external link)(external link) HealthInfo Canterbury, NZ
Your contraception guide(external link)(external link) NHS, UK
Contraception methods(external link)(external link) Patient Info, UK

Note: In New Zealand, visit your family doctor or Family Planning. Cervical screening is done every 3 years unless you have had an abnormal result.

References

NZ Aotearoa’s guidance on contraception(external link)(external link) Ministry of Health, NZ, 2020
Contraception – which option for which patient?(external link)(external link) BPAC, NZ, 2019
Contraception – general overview(external link)(external link) Patient Info, UK

Clinical resources

Contraception – which option for which patient?(external link) BPAC, NZ, 2021
Condoms – advising on the options(external link) BPAC, NZ, 2021
Oral contraceptives – selecting a pill(external link) BPAC, NZ, 2021
Depot medroxyprogesterone acetate (DMPA injections)(external link) BPAC, NZ, 2021
Long-acting contraceptives – implants and IUDs(external link) BPAC, NZ, 2021
NZ Aotearoa’s guidance on contraception(external link) Ministry of Health, NZ, 2020
Educational series on long acting reversible contraception [PDF, 528 KB] Research Review, NZ, 2020
Sexual health theme – what’s new in contraception?(external link) BPAC, NZ, 2019
Breakthrough bleeding with CoC – mechanism, management, etc(external link) Patient Info, UK, 2014
Information for health professionals(external link) Auckland Sexual Health Service, NZ

(external link)Family Planning – a global handbook for providers(external link) This resource was developed through worldwide collaboration between the Johns Hopkins Bloomberg School of Public Health, the World Health Organization (WHO), the United States Agency for International Development (USAID), and more than 30 other organisations around the world (see collaborating and contributing organizations(external link)). It offers clinic-based healthcare professionals in developing countries the latest guidance on providing contraceptive methods.

Read more: Handbook, resources and toolkits(external link) available on a dedicated website with many resources available in a range of languages, including Arabic, Farsi, Hindi and French.(external link)

Practice points from Jaydess® or Mirena® – comparing contraceptives(external link) (Goodfellow MedCase, 2020)

LARCs are the most effective reversible contraception available:

Recommend LARCs as first-line options for women of all ages, including adolescents and nulliparous women.

Jaydess^® is indicated for contraception only; it is less likely than Mirena^® to cause amenorrhoea.

Mirena^® is indicated for contraception, treatment of idiopathic menorrhagia, and prevention of endometrial hyperplasia, making it a useful option in women with PCOS or obesity.

LARCs are fully funded and insertion costs may be subsidised or free – check your Health Pathways(external link) for subsidised insertion options.

Continuous OC pill regimens are safe and acceptable (Goodfellow Gem, 29 January 2020)

Traditional oral contraceptive (OC) regimes consist of a 7-day break after 21 days of pill taking. Symptoms such as headaches and bleeding during the break are often unwelcome. The break also risks ‘escape ovulation’ and subsequent pregnancy. Shortening the pill-free interval or eliminating it is acceptable and safe.Tailored regimes include 21/4, 63/4 or 365/365 (daily pill-taking). See Effect of missed combined hormonal contraceptives on contraceptive effectiveness – a systematic review(external link) Contraception, 2013 and Safety and bleeding profile of continuous levonorgestrel 90 mcg/ethinyl estradiol 20 mcg based on 2 years of clinical trial data in Canada(external link) Contraception, 2010