In England and Wales, about 30% of all pregnancies are unintended, and around 20% of all pregnancies end in abortion. In the US, which has one of the highest rates of unintended pregnancy in the developed world, about half of all pregnancies are unintended. Of these, approximately 40% end in abortion. Between 2008 and 2014, the abortion rate declined from 19.4 to 14.6 in 1000 women aged 15-44 years, with the US Centers for Disease Control and Prevention reporting its lowest number of abortions in 2014. Although the overall abortion rate in the US has declined, this is not seen across all population groups, with higher rates of unintended pregnancy and abortion in disadvantaged groups. This disparity suggests that there is limited access to contraception for some women and adolescents, and points to the importance of addressing birth control with all patients at risk of unintended pregnancy.
Availability of contraceptives differs between regions, and local guidelines should always be consulted.
For updates on diagnosis and management of coexisting conditions during the pandemic, see our topic 'Management of coexisting conditions in the context of COVID-19'.
- Initial counselling
- Barrier methods
- Barrier methods: the diaphragm and cervical cap
- Barrier methods: the female condom
- Barrier methods: the male condom
- Barrier methods: spermicide
- Behavioural methods
- Behavioural methods: lactational amenorrhoea
- Behavioural methods: periodic abstinence
- Behavioural methods: withdrawal
- Hormonal contraception
- Combined hormonal contraceptives (oestrogen/progestogen)
- Contraindications to oestrogen-containing contraceptives
- Combined hormonal contraceptives: oestrogen/progestogen pills
- Combined hormonal contraceptives: oestrogen/progestogen patch
- Combined hormonal contraceptives: oestrogen/progestogen vaginal ring
- Progestogen-only contraceptives
- Progestogen-only contraceptives: progestogen-only pill
- Progestogen-only contraceptives: progestogen implant
- Progestogen-only contraceptives: progestogen injection
- Intrauterine devices (IUDs)
- Intrauterine devices: copper IUD
- Intrauterine devices: progestogen IUD
- Sterilisation: female sterilisation
- Sterilisation: male sterilisation
- Non-contraceptive benefits of hormonal contraceptives
- Emergency contraception
- Emergency contraception: progestogen-only emergency contraception
- Emergency contraception: ulipristal
- Emergency contraception: copper IUD
- Emergency contraception: oestrogen/progestogen emergency contraception
Johns Hopkins University
AB has received research support from Bayer Pharmaceuticals.
Dr Anne Burke would like to gratefully acknowledge Dr Ruth Lesnewski, a previous contributor to this topic.
Associate Professor of Family and Community Medicine
Associate Professor of Obstetrics and Gynecology
Family Medicine Department
University of New Mexico
LL declares that he has no competing interests.
Assistant Clinical Professor
UCSF and UCD
SG has served as an Implanon training specialist for Organon Inc.
Consultant in Sexual and Reproductive Health
Lewisham Primary Care Trust
Waldron Health Centre
LB was a member of the group that produced the 2006 Faculty of Sexual and Reproductive Health guidance on the management of women with vaginal discharge presenting in non-GU setting.
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