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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.

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Contraception or birth control is a way to prevent pregnancy. Contraception stops a sperm from meeting with an egg, which is how a pregnancy starts. There are different types of contraception. No form of birth control is 100% effective, No form of birth control is 100% effective. Each type of contraception works differently – some are more effective than others.

There are 2 main types of contraception – those that contain hormones and types that don’t contain hormones. For more detailed information, see What are the different types of contraception?

The ideal contraception method for you depends on many factors including how well they work, convenience, your health, fertility plan, side effects and sexually-transmitted infection (STI) protection. Some may be suitable for you but some may not. Each has their pros and cons. For more detailed information, see Which contraception is best for me?

Video: Contraception – an introduction

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. It may take a few moments to load.

(Sexual Wellbeing Aotearoa, NZ, 2015)

Anyone of any age can get contraception from a nurse or doctor.

If you want to get contraception, see your GP or visit a Sexual Wellbeing Aotearoa clinic in your area(external link).

If you're under 22 years old and are a New Zealand resident, your clinic visit for contraception is free. Your visit will also be confidential. Find out about fees and charges(external link) for Sexual Wellbeing Aotearoa clinics in New Zealand.

Image credit: Healthify He Puna Waiora

There are 2 main types of contraception – hormone methods and methods that don’t contain hormones.

Here is a brief summary of each type of contraception and the chance of getting pregnant. For detailed information on each, click on the links below.

Contraception that contain hormones

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.
Combined oral contraceptive pill (the 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%.
Implant (Jadelle): The implant lasts for up to 5 years. Chance of getting pregnant: 1% or less.
Intra-uterine devices (IUD) that contain progestogen such as Mirena® or Jaydess®. Mirena® is effective for 5 years, while Jaydess® is effective for 3 years. Chance of getting pregnant: 1% or less.

Contraception that don’t contain hormones

Condoms: You must remember to have them with you and use them every time you have sex. Chance of getting pregnant: 2–21% depending on correct use.
Fertility awareness 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%.
Tubal ligation This is an operation where clips are put on the (fallopian) tubes to stop the egg getting to the womb. Chance of getting pregnant: less than 1%. It should only be considered when you are sure that you do not want to have a child in the future.
Vasectomy. A vasectomy is a small surgical procedure to block the tubes that carry sperm. Chance of getting pregnant: less than 1%. It should only be considered when you are sure that you do not want to have a child in the future.
Withdrawal method: The withdrawal method is sometimes called ‘coitus interruptus’. It means pulling the penis out of the vagina before ejaculation.
This is not a very reliable contraceptive method. Chance of getting pregnant: 25%

Emergency contraception

Emergency contraception can stop you getting pregnant after unprotected sex (sex without contraception or when contraception might have failed). It is not intended for ongoing or regular use as a main form of birth control.

There are also 2 types of emergency contraception – the emergency contraceptive pill and the copper IUD.

The emergency contraceptive pill (also called the morning after pill) must be taken within 72 hours of unprotected sex.
The copper IUD can be inserted up to 5 days after unprotected sex, or within 5 days of your earliest expected date of ovulation. It is recommended for women over 70kg. Chance of getting pregnant: less than 1%.

Read more about emergency contraception.

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.

Sexual Wellbeing Aotearoa(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 or make an appointment by filling out the appointment form(external link).

Contraception topics
Sexual health overview

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

Choosing your contraception(external link) Sexual Wellbeing Aotearoa
Protected&Proud(external link) a contraception platform that supplies unbiased, accessible and understandable information that increases awareness of the most effective contraception choices in Aotearoa
What is contraception?(external link) Sexual Wellbeing Aotearoa
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

Apps

Women's health apps

Resources

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

References

NZ Aotearoa’s guidance on contraception(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
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 Africa, Americas and the Caribbean, Arab world, East and Southeast Asia and Oceania, Europe and Central Asia, South Asia.

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