Availability and access to birth control options are directly related to a woman’s health, well-being and quality of life. It empowers women to take control over their body and future, which is why giving visibility to different methods and developments is key.
As you probably know, contraceptives can be divided into two main groups: hormonal and non-hormonal. The first include widely used methods, such as the pill, and research on them continues to show promising innovation, but there have also been important advances in non-hormonal alternatives. Not all women can or want a birth control that alters their hormonal balance, and there are many options available beyond the traditional male condom.
What is non-hormonal birth control?
Non-hormonal contraceptives are methods that prevent pregnancy without intervening in the body’s hormonal cycle. Because they do not contain synthetic hormones such as estrogen or progestin, they can be used in women who cannot use hormonal contraceptives due to health reasons. Some women choose to use these kinds of contraceptives because they can be more cost-effective or because they want to avoid possible side effects hormonal contraceptives.
There is a wide range of hormone free birth control alternatives for women to choose from, and their choice will depend mainly on what better suits their lifestyle. It is important to know what options are available, and the differences that exist between them to better decide what works for you.
These can vary in cost, effectiveness, and duration, and include a range of barrier methods that prevent sperm from reaching the uterus, IUDs, or sperm-killing options. Usually, more than one of these can be used at the same time to further reduce the risk of pregnancy.
What is the difference between hormonal and non-hormonal contraceptive?
The main and most obvious difference is in their composition and how they work. As we already cover here, hormonal contraceptives include synthetic hormones, progestin with or without estrogen, that interfere with the menstrual cycle by preventing ovulation to avoid pregnancy.
On the other hand, non-hormonal methods also aim to prevent pregnancy, but do so by physically preventing sperm from fertilizing an egg.
Some other key differences are:
| Non-hormonal birth control | Hormonal birth control | |
|---|---|---|
| Effectiveness | It can vary depending on the specific method and correct use of it. | Most methods are more than 99% effective when used properly. |
| Protection from sexually transmitted infections (STDs) | Not all non-hormonal birth control options protect from STDs, but some barrier methods, particularly condoms, are the most effective in preventing STDs. | Do not prevent STDs |
| Price and availability | These tend to be more accessible to the public, as most do not require a medical prescription, except for the copper IUD. | Need to be prescribed by a gynecologist or medical professional. |
| Duration | Most have a one-time effect, except for the copper IUD and permanent solutions. | Most are designed to be used long term, and they are effective while they are being used. |
Types of non-hormonal birth control
When considering which hormone free birth control method to use, there are different variables to consider. Do you simply want to avoid pregnancy? Are you concerned about contracting a sexually transmitted disease? Are you unable to afford a more expensive alternative? The following is a list of the most effective non hormonal birth control options, along with their advantages and disadvantages.
The male condom is probably the best-known method. It is a sheath, usually made of latex, that acts as a barrier when placed over the penis, collecting the sperm, and preventing it from entering the vagina, and making its way to the uterus. When used correctly, about 18% of women become pregnant during the first year of using them. Some of its advantages are that it is one of the most effective ways to prevent STDs and it is affordable and accessible. On the other hand, some of its disadvantages are that it may break or slip during sexual activity, or it may cause an allergic reaction or skin irritation.
The female condom is similar to a male condom, it is a soft, loose-fitting polymer sheath that acts as a barrier when inserted into the vagina, collecting the sperm, and preventing it from entering the vagina, and making its way to the uterus. Thanks to a thin outer ring, it stays put outside the body, covering the vaginal opening. When using female condoms, about 21% of women become pregnant during the first year of using them. Some of its advantages are that it is another of the most effective methods against STDs, it is accessible and offers autonomy to the woman. Nevertheless, these are more expensive than male condoms and, depending on the material, can cause skin irritation or rashes.
The Copper Intrauterine Device (DIU) is a T-shaped device, made of plastic and copper that is inserted into the uterus. The copper in the IUD creates an environment which is toxic for sperm, preventing it from being able to swim and fertilize the egg. Also, the device itself causes the cervical mucus to thicken, acting as a plug in the cervix, which prevents the passage of sperm and traps them. Its effectiveness is one of the highest, with only 0.2% – 0.8% of women becoming pregnant during the first year of using it. In fact, its main advantages are that it is very effective, requires low maintenance and can be removed at any time. It’s a long-term alternative (it can last between three to ten years, depending on the brand). It also has some disadvantages: it needs to be placed and removed by a medical professional. It can affect menstrual flow and, in some cases, cause cramping. There are some risks related to insertion of an IUD, as well as the risk of displacement of the IUD over time. It is important to note that, it does not offer protection against STDs.
Another non hormonal contraceptive is the Spermicide, which is a chemical designed to prevent fertilization, which a woman puts into her vagina before having sex. It works in two ways: blocking the entrance of the cervix and preventing sperm moving well enough to reach the egg or even killing the sperm. It can be used in several forms: cream, gel, film, foam, and ovules (soft pills that melt in the vagina). Its effectiveness is lower, with around 28% of women becoming pregnant during the first year of use. One of its advantages is it can act as a lubricant, but it also has some disadvantages that need to be kept in mind: if used by itself, it may not prevent pregnancy as well as other non-hormonal birth control alternatives. It is recommended for use with other methods, such as the cervical cap or diaphragm, to reduce the risk of pregnancy. Also, it does not offer protection against STDs.
The Diaphragm is a shallow cup, shaped like a dish and made of silicone, that is inserted in the vagina and covers the cervix, acting as a barrier. It’s normally used with a gel that kills sperm (spermicide) and the woman should leave it for at least 6 hours after having sex, but not more than 24 hours. This method is more effective, with around 12% of women becoming pregnant during the first year of using it. An advantage of this method is that the diaphragm is reusable, and it can last up to two years, if cleaned and maintained properly, but it requires adjustment and can sometimes cause irritation and increase the risk of urinary tract infections. It also does not offer protection against STDs.
Just like the diaphragm, the cervical cap is a silicone cup that covers the cervix and prevents sperm from passing through, and it should be used with spermicide to be more effective. The two main differences between the diaphragm and the cervical cap, are the shape and duration of use: cervical caps are smaller and shaped like a thimble and a woman can leave it inside for up to 2 days. In the case of the cervical cap, between 17 – 23% of women may become pregnant during the first year of use. The risk of pregnancy also depends on if you have given birth before, or not.
It is reusable and it can last up to two years, depending on the brand. This method also has some disadvantages, such as the increased risk of urinary tract infections, and that it is not recommended for those who are allergic to silicone. It also needs to be fitted by a clinician. (before purchasing a cervical cap, a healthcare professional should measure the size of the woman’s cervix so that the cap size fits correctly). It does not offer protection against STDs.
The sponge is a single-use disposable piece of polyurethane foam, which contains a spermicide, that’s put in the vagina to cover the opening of the uterus (cervix). Each sponge comes in a single size, and normally has a fabric loop attached to it to make it easier to take out. Its effectiveness is similar to the cervical cap, with 12% – 24% of women becoming pregnant during the first year of using this method. It prevents sperm from reaching the egg in two different ways, by killing the sperm, and blocking their passage to the uterus. Nevertheless, these are associated with a high risk of vaginal irritation, and it does not offer protection against STDs. It is also important to note that each sponge can only be used once.
Vasectomy is one permanent birth control method for men who do not want to have children. It involves a surgical incision to cut the ends of vas deferens (the tubes through which the sperm travels). It has an effectiveness of 99.9%, which makes it a very successful birth control method. This is one of its advantages, besides the fact that the surgery and recovery are quick and simple. On the other hand, it is irreversible, which makes deciding to undergo this procedure is a very serious decision. A vasectomy is not effective immediately (the use of an additional contraceptive method is recommended for the next three months after the surgery), and it doesn’t offer protection against STDs.
Tubal Ligation (or female sterilization) is a permanent birth control method for women who do not want to have children. This consists in a surgical procedure which involves cutting or blocking the fallopian tubes, to prevent woman’s eggs from fertilization by sperm. Like a vasectomy, tubal ligation also has a high effectiveness, of over 99%. It is important to note that this type of surgery does not affect a woman’s hormonal cycles or period, and it doesn’t cause menopause. Also, studies have shown that tubal sterilization can even reduce the risk for ovarian cancer. This method is an irreversible and permanent way to prevent pregnancy, and it doesn’t offer STDs protection. The surgery involved is usually safe and not complicated, but there are always risks associated with medical procedures.
According to the United Nations, approximately 972 million women worldwide use some form of contraception, hormonal or not, during their reproductive age. This number has grown constantly since the 1990s yet, every year almost half of all pregnancies continue to be unintended. More visibility and access to sexual health care and contraceptive options that cater to the different needs of women is fundamental to turn around this number.
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