When it comes to preventing the spread of babies, the options available might overwhelm and confuse. For those who like sex but aren’t ready to start a family, here are 13 of the ways one can lower the risk of pregnancy. Each of these methods is covered, free of deductible, under the Affordable Care Act.

Typical use of prevention methods as defined by the Centers for Disease Control and Prevention (CDC) includes inconsistent and incorrect use to the extent observed in a 2011 study published by the National Center for Biotechnology Information.

The failure rate of each method is defined as the number of pregnancies per 100 women that occurs within the first year of use.

Intrauterine Device (IUD)

As its name implies, an IUD is a small, T-shaped object that a doctor inserts into the uterus. IUDs come in two types – one that releases the hormone Levonorgestrel and another that is wrapped in copper.

Levonorgestrel falls under the class of synthetic hormones called progestins, which mimic the function of naturally occurring progesterone. In simple terms, women can manipulate their progesterone and estrogen levels to help prevent pregnancy.

The CDC reports Levonorgestrel IUDs can remain in the uterus for up to five years and have a typical use failure rate of 0.2 percent.

Copper IUDs work by causing the uterus and fallopian tubes to produce a fluid that damages sperm. Dr. Dennis Garcia, a practicing physician and the senior medical director of WSU Health and Wellness Services, said this “foreign-body reaction” is an inflammatory response that is 99 percent effective in preventing pregnancy.

The CDC reports copper IUDs can remain in the uterus for up to 10 years and have a typical use failure rate of 0.8 percent.

Garcia stressed that women cannot remove IUDs and instead must have a doctor perform the procedure.

Progestin implant

Another option is the subdermal implant, which is a single thin rod that a doctor inserts beneath the skin of a woman’s upper arm. Like some IUDs, the implant contains a progestin that is released into the woman’s body over the course of about three years.

Progestin implants have a failure rate of 0.05 percent, which is the lowest of any method of pregnancy prevention, according to the CDC.

Implants  cost more initially than other prevention methods, but Garcia said its cost-to-effectiveness ratio is reasonable given the long course of its use.

Progestin injections

Commonly known by the brand name Depo-Provera, this injection contains a progestin hormone that helps to prevent pregnancy. A doctor can inject the hormone in the arm, buttocks or thigh.

Garcia said many women choose this method for its convenience as it requires only one injection every three months.

One of those women is Alicia Gates, a freshman majoring in nutrition and exercise physiology who has used the injection method for about two years. Gates said the method is extremely convenient but poses several side effects.

“You’re literally just so mean to everybody,” she said, noting the influx of hormones affected her mood early in the treatment.

Other side effects include weight gain as well as severe calcium deficiency, which can decrease bone density. Garcia said the problem can be mitigated through the use of calcium supplements.

Dual-hormone pill

Known widely as ‘the pill,’ many oral contraceptives contain a combination of progestin and estrogen or estrogen-mimicking hormones. Prescribed by a doctor and taken at the same time each day, the pill is one of the more common forms of pregnancy prevention.

Garcia said there are about 30 types of oral contraceptive, each of which contains a different combination of hormones. He said women can typically find one to which they respond well.

“I really like to start off with the pill because it allows the patient to see how they’ll do with the hormones,” he said. “The nice thing about birth control pills is that you can stop taking it when you want to.”

Gates said it can be difficult to take the pill consistently.

“It’s so easy to forget,” she said.

The pill is not recommended for smokers, those older than 35 years, and those with a history of blood clots or breast cancer. Garcia warned that oral contraceptives might interfere with antibiotics like penicillin.

Progestin-only pill

Unlike the dual-hormone pill, the ‘mini pill’ contains only one type of hormone, a progestin. It, too, is prescribed by a doctor and taken at the same time each day. It is typically considered by women who prefer oral contraceptives but respond poorly to estrogen.

Patch

Women wear the skin patch on the lower abdomen, buttocks, or upper body. Prescribed by a doctor, the patch releases progestin and estrogen hormones into the bloodstream.

The patch is typically replaced once per week for three weeks in a month, and then removed during the fourth week to allow for a menstrual period.

The CDC reports a typical use failure rate of 9 percent, which might be higher for women who weigh more than 198 pounds.

Ring

The contraceptive ring is placed in the vagina and releases progestin and estrogen hormones. Similar to the patch, the ring is worn for three weeks in a month, removed during the fourth week, and then replaced with a new ring.

Many reports to the Food and Drug Administration indicate severely detrimental side effects of the contraceptive ring. Some have requested a recall of the product.

The CDC reports typical use failure rate of 9 percent.

Diaphragm or cervical cap

Either of these objects can be placed inside the vagina to block sperm from coming into contact with the cervix.

The cervical cap is a thimble-shaped cup that is often inserted with a spermicide. A doctor can provide a proper fitting as diaphragms and cervical caps vary in size.

The CDC reports a typical use failure rate of 12 percent for both of these methods.

Male condom

In addition to helping prevent pregnancy, the male condom is partially effective at stopping the spread of HIV and other STDs. Most are made of latex or a synthetic type of rubber. “Natural” or “lambskin” condoms also help prevent pregnancy but might not protect against STDs.

Neither male nor female condoms are to be used with oil-based lubricants, which deteriorate and weaken latex and increase the risk of failure. Oil-based lubricants include massage oils, baby oil, lotion, and petroleum jelly. The CDC recommends water-based lubricants like KY Jelly, which is intended for use in sexual intercourse.

According to the CDC, the male condom has a typical use failure rate of 18 percent.

Female condom

Like the male version, the female condom helps prevent sperm from entering a woman’s body. Packaged with lubricant, the female condom is available at drug stores and can be inserted up to eight hours before sex.

Garcia said female condoms are about as effective as male condoms.

The CDC reports the female condom has a typical use failure rate of 21 percent, but might help prevent STDs.

Spermicides

These products work by killing sperm and are placed in the vagina no more than one hour before sex. Available in several forms – foam, gel, cream, film, suppository, or tablet – spermicides are left in place at least six to eight hours after intercourse.

Spermicides can be used in addition to a male condom, diaphragm or cervical cap and can be purchased at drug stores.

Spermicides have a typical use failure rate of 28 percent, according to the CDC.

Fertility awareness

Garcia calls this the “rhythm method.” By understanding her own pattern or ‘rhythm’ of fertility, a woman can anticipate the days on which she is least likely to get pregnant.

A woman’s fertility pattern is the number of days in a month when she is fertile (able to get pregnant), the number of days when she is infertile, and the number of days when fertility is unlikely but possible.

For women with regular menstrual cycles, fertility lasts about nine or more days each month. To avoid pregnancy, women use a barrier method such as a condom or refrain from sex on those days.

Failure rates vary, but the CDC reports a typical use failure rate of 24 percent.

Emergency contraception

Emergency contraceptives like Plan B are used after no birth control is used during sex and when birth control fails as in a condom breaking.

“The morning-after pill is not a viable form of birth control,” Garcia said. “If someone is needing the morning-after pill on a regular basis, they really should be using another form of birth control.”

The sooner a woman takes the morning-after pill after sex, the greater likelihood it will work.

Some emergency contraceptive pills are available over-the-counter.