Research published June 16 in JAMA Network Open indicates that when patients receive high-quality counseling and timely access to their preferred contraceptive method, the effectiveness of various birth control options becomes remarkably similar. The study, conducted by the HER Salt Lake Contraceptive Initiative, challenges the premise that implants and other long-acting contraception methods are far and away the most effective choice.
The HER Salt Lake Study Findings
The research team from the University of Utah tracked more than 4,000 participants across four family planning clinics in Salt Lake City. The study focused on individuals aged 16 to 45 with incomes below the federal poverty threshold who sought to prevent pregnancy for at least one year. Participants were given a choice among seven reversible methods: copper IUDs, hormonal IUDs, contraceptive implants, injections, oral contraceptive pills, vaginal rings, and male condoms.
According to the results, pregnancy rates were consistently low across nearly all methods when support and access were prioritized. Over a three-year follow-up period, the annual pregnancy rate per 100 participants was:
- Hormonal IUDs: 0.7
- Contraceptive Implants: 0.8
- Copper IUDs: 1.1
- Injectable Contraceptives: 1.1
- Vaginal Rings: 1.4
- Oral Contraceptive Pills: 1.6
- Male Condoms: 2.6
This data deviates from the findings of the 2012 Contraceptive CHOICE Project, which reported that short-acting methods like the pill or ring had failure rates approximately 20 times higher than those of IUDs or implants.
Jessica Sanders, a reproductive health researcher at University of Utah Health, suggests that the "failure" of shorter-term methods is often a result of systemic barriers rather than the method itself. "A missed refill, a delayed appointment, out-of-pocket costs or an unavailable method creates that gap—it’s not necessarily on the person," Sanders noted. When these barriers are removed through comprehensive counseling and reliable access, users are better equipped to maintain their chosen method effectively.
Prioritizing Patient-Centered Care
The study highlights the importance of person-centered contraceptive counseling, which prioritizes a patient’s values and lifestyle over a one-size-fits-all approach. Katharine White, chief of obstetrics and gynecology at Boston Medical Center, emphasizes that clinicians should move away from the assumption that only long-acting methods are viable for patients.
"This shows that patients actually don’t have to choose between something that they like and something that they need," White said. By focusing on open-ended questions—such as what a patient values most in their birth control—providers can foster greater trust and improve long-term adherence.
Understanding Contraceptive Effectiveness
The study’s findings suggest that effectiveness is not solely an inherent property of the device or medication but is heavily influenced by the support structure surrounding the patient. Anu Manchikanti Gómez, a sexual and reproductive health equity researcher at the University of California, Berkeley, noted that the HER Salt Lake initiative provides evidence that ideal support increases the real-world effectiveness of shorter-term methods.
For patients, this means that the "best" method is the one that fits their personal needs, aligns with their goals, and is accessible enough to be used consistently. As the research demonstrates, when the healthcare system removes obstacles to access, patients can successfully utilize a wide range of contraceptive options to meet their reproductive health goals.