The five best contraceptives backed by science

The right choice of contraceptive is crucial. Science can help you to choose one that's right for you.

1. Implant

Efficacy: Less than one pregnancy per 100 women using it for a year. What is it: A matchstick-sized rod inserted under the skin of the upper arm. It works by secreting the hormone progestin in small amounts. Advantages: The implant is considered one of the most effective birth control methods available to protect a woman from pregnancy for up to three years. One of the reasons it is effective is because a woman does not need to return to a health facility for a replacement for several years, unlike other contraceptive methods such as the pill or injection. Drawbacks: A health worker is needed to insert the device and recent research has found that the implant is less effective for people who take certain medications, for example, some HIV and tuberculosis drugs. Some women report heavy menstrual periods. Types: There are two brands currently available: Implanon and Nexplanon. Cost: According to the health department, Implanon costs R1 700 in South Africa's private sector but is free for all women in the public sector.

2. Intra-uterine device (IUD)

Efficacy: Less than one pregnancy per 100 women using it for a year. What is it: A T-shaped device inserted into a woman's uterus. There are two types of IUDs — one made from copper and another that secretes the hormone progestin. Advantages: The copper device can protect a woman from pregnancy for up to 12 years; the hormone versions last between three and five years, depending on the brand. Drawbacks: It has to be inserted by a qualified health professional. The hormonal versions should not be used by women with liver disease or breast cancer. Types: A common copper version is the ParaGard IUD. The Mirena secretes progestin and is effective for five years. Skyla and Liletta are other examples of hormonal IUDs and last for up to three years. Cost: The Mirena costs about R2 000 in South Africa's private sector, excluding the fee for inserting the device.

3. Injectable

Efficacy: Between six and 12 pregnancies per 100 women using it for a year. What is it: The injectable contraceptives usually contain the hormone progestin and are given as a shot in the arm every two to three months. Advantages: The user does not need to remember to take a pill at the same time every day as she would with contraceptive tablets, and it is private — there is no telltale packaging should the woman need to hide the fact she is on birth control. Drawbacks: It takes from one to three weeks after the first shot for the injectable to properly protect from pregnancy — the UK's National Health Service (NHS) recommends another form of birth control be used during this period, such as a condom. This method is only effective if a woman returns to a health facility every few months to receive a repeat injection. Types: Depo-Provera is the most common brand; a very similar option is called Sayana Press. Cost: The cost ranges between R90 and R250 for every top-up injection in private facilities, but is free for public health sector patients.

4. The pill

Efficacy: Between six and 12 pregnancies per 100 women using it for a year. What is it: There are a number of different types of contraceptive pills. Most contain the hormones oestrogen and progestin but some use progestin alone. If taken at the same time every day, without skipping a dose, the pill can be as effective as the implant. Advantages: The pill can also help certain women with hormonerelated acne and reduce the severity of menstrual cramps. Drawbacks: Research has shown that women often forget to take it regularly or struggle to get to a pharmacy every month for a repeat prescription, lowering the effectiveness significantly. Types: Yasmin is a common brand of birth control pill; many others are available including Levora, Camila and Jolivette. Cost: It can cost between R90 and R350 a month in South Africa's private sector. Public sector patients can get some brands for free.

5. Male condom

Efficacy: 18 pregnancies per 100 women using it for a year. What is it: A sheath made from latex (rubber), polyurethane or tactylon (both are types of plastic) which covers the penis during sex. Advantages: Latex condoms, when used correctly every time a person has sex, are 98% effective, according to a review by the NHS. Drawbacks: Users sometimes do not place condoms over the penis correctly, which increases the risk of pregnancy. Oil-based substances, often used for lubrication, such as moisturising cream or Vaseline, lower the efficacy of latex condoms. Some people are allergic to latex, which is the most common type of male condom available. Types: Choice is the government's branded condom. Many other types are available from retailers including Durex, Playboy, Rough Rider and Skyn. Cost: Condoms are freely available at many government facilities and cost between R20 and R120 for a box of three from a private pharmacy. —