The cost of birth control--and who should pay for it--has been the subject of a heated national debate in recent weeks. One method of contraception, "the pill," has gotten most of the attention, but in reality, couples have multiple options when it comes to preventing conception, from condoms to IUDs to sterilization. And while the cost often takes a back seat to other factors, such as effectiveness, the price of birth control can ultimately play a major role in whether it's used.
Choosing the most money-smart method isn't as easy as crunching numbers because costs depend on a variety of factors, including how long you want the birth control to last, how often you need it, and how generous your insurance policy is. It's also not always easy to get a decent long-term estimate of costs; the FDA's otherwise useful guide to birth control makes no mention of money at all. By running a few numbers, we were able to generate a guide for people who want to consider the health of their bank account when making their birth control decision.
Someone turned off by the constant money drain of single-use methods such as condoms might be happier with an IUD, which comes with a larger initial price tag but lasts longer. Similarly, being too frugal and opting for a "free" but relatively ineffective method, such as fertility awareness or withdrawal, can easily lead to accidental pregnancy. A couple using no birth control has an 85 percent chance of becoming pregnant in one year. The Agriculture Department estimates that on average, middle-income couples spend around $12,500 per year, per child.
Here's a guide to the costs of 12 popular methods of birth control:
Birth Control Pills: The "pill," introduced in the early 1960s, uses hormones (estrogen and progestin) to prevent pregnancy. Users have to take one pill a day and need a prescription from their doctor. On average, 5 out of every 100 women who rely on birth control pills get pregnant each year. The Cost: According to Planned Parenthood, birth control pills cost between $15 to $50 a month, depending on health-insurance coverage and type of pill. On an annual basis, that means the Pill costs between $160 to $600.
Birth Control Patch: This hormone-based method goes on the skin and works the same way as the pill. Each patch lasts for one week and, like the pill, users also face a 5 percent chance of pregnancy. The Cost: The same as the pill-on average, between $15 to $50 a month, or between $160 to $600 a year.
Cervical Cap: Women insert this barrier method, along with spermicide, before they have sex. By covering the cervix, it prevents pregnancy. According to the FDA, it is not as effective as hormonal methods: 17 to 23 percent of women who rely on the cervical cap might become pregnant within one year. The Cost: The American Pregnancy Association reports that one cervical cap, which lasts up to two years, costs between $15 and $50. Caps also require spermicides, which cost between $7 to $17 per package. Annually, users can expect their costs to average a relatively inexpensive $35 to $60 per year.
Condoms: Condoms, which also reduce the chance of spreading sexually transmitted diseases, are effective about 85 percent of the time, according to the American Pregnancy Association. Using spermicide along with condoms increases that rate to 95 percent. The Cost: Some health clinics distribute condoms for free. Otherwise, on average, they cost between 20 cents and $2.50 each. For couples that use them twice a week, that averages around $150 a year.
Diaphragm: This rubber or silicone disk covers the cervix during sex. The FDA reports that for every 100 women who use a diaphragm, about 15 might get pregnant in one year. Some women also report that they find it difficult or annoying to use every time. The Cost: Diaphragms require a doctor's exam, which can cost anywhere from $20 to $200. Planned Parenthood estimates that the cost for the diaphragm itself, which lasts up to two years, falls between $15 to $75. It's also used with spermicide. In total, users can expect to pay around $60 a year, excluding the initial doctor's visit.
Fertility-Awareness: By charting their ovulation schedules, women can calculate when they are most likely to get pregnant-and most likely not to. Of course, this method requires careful note-taking and the self-discipline to avoid intercourse, or use an alternative method, during fertile periods. Women's bodies can also go off-schedule without warning. Planned Parenthood estimates that out of every 100 couples who rely on fertility awareness, between 12 and 25 will become pregnant. The Cost: Free. Websites such as "Taking Charge of Your Fertility" explain how to use the method.
IUDs: This T-shaped device, which in some cases also contains hormones, is placed in the uterus by a healthcare provider. It lasts up to 12 years and is 99 percent effective. The Cost: While the upfront cost is a whopping $500 to $1,000, the fact that it lasts so long means that the average annual cost can be under $100-cheaper than condoms. The cost goes up for users who rely on the IUD for shorter periods.
Shot (Depo-Provera): Getting a hormone injection every three months prevents women's ovaries from releasing eggs. It's also about 99 percent effective, according to the FDA. The Cost: Each shot costs between $35 and $75, and sometimes comes with an additional doctor's visit fee of $20 to $40. That means each year, users can expect to pay between $220 and $460.
Sterilization: This permanent birth control method only makes sense for people who are finished building their families. For both men and women, it is 99 percent effective. The Cost: Vasectomies costs between $350 to $1,000. Sterilization for women costs between $1,500 and $6,000. But since it's permanent, the cost per year over the long term is lower. For example, if a 35-year-old women gets sterilized, it prevents her from getting pregnant for the rest of her fertile years. Spreading the cost of a $4,000 procedure over 20 years brings the annual expense down to $200. Similarly, if her partner gets a $600 vasectomy, the annual cost averages just $30 over 20 years.
Vaginal Ring (NuvaRing): Similar to the birth control patch or the pill, the ring releases hormones that prevent women's ovaries from releasing eggs. Users insert the ring themselves, and each ring stays in for three weeks. It is about 95 percent effective, like other hormonal methods. The Cost: Between $15 and $50 per month, the same as other hormonal methods. Since it requires a prescription, users might also have to pay for an office visit, which can cost between $35 to $200. Excluding that visit, the ring costs between $160 to $600 per year.
Vaginal Sponge: This soft, disk-shaped device covered in spermicide is inserted prior to intercourse and covers the cervix. After use, it is discarded. No prescription is needed. The FDA estimates that for every 100 women that use this method, between 16 and 32 will become pregnant in a year. The odds might be higher for women who have given birth, since childbirth stretches the cervix. The Cost: A pack of three sponges costs about $15. For a couple that uses two sponges per week, the annual cost averages out to about $500 a year.
Abstinence: "If you do not want to get pregnant, do not have sex," the FDA's brochure on birth control suggests. Abstinence is 100 percent effective, but also not realistic for many couples. The Cost: completely free.
The Winner: The diaphragm. With an annual cost of just $60 and an efficacy rate of 85 percent, the diaphragm is the most cost-effective method of preventing pregnancy. While the method fell in popularity after the introduction of the pill, various forms of it have been used for centuries.
Note: Selecting a form of birth control--or deciding to use any at all--is obviously a very personal decision and based on more important factors than money. This guide is intended to help people make informed decisions, not to suggest that money be the sole determining factor when selecting their method.