Talk:Comparison of birth control methods/Archive 1

Scope of article

Is this page intended only to show effectiveness of various methods? Or is it envisioned to expand to compare other things such as side effects, convenience, etc.? Lyrl ^Talk _Contrib 01:29, 17 July 2006 (UTC)

I've no idea. Certainly original wording was of being a comaprison of risks, yet in fact only shows failure rates.

• In favour of more info would be that it becomes a quick ready-comprison chart (difficult to do if having to read through lots of separate full articles). But it needs to be brief, else will never fit on a page. Perhaps just using summarised info as currently found in the BirthControl infobox templates ? This articles title is about "comparison", not "relative contraceptive effectiveness rates".
• Against - It will end up duplicating info included already in each article (via the infobox template and the rest of the article's description). Unless extraordinary care is taken, the necessary crude summarisation (eg for COCP risks "DVTs") is so brief as to be lacking in balance (eg when the DVT scare came out about 3rd generation COCPs having higher rates of DVTs of 25-20 per 100,000 - those who immediately stopped, against media advice, and subsequently became pregnant through other-methods failures were at even higher risk rates of DVT of 60 in 100,000) - yet fuller explanations may end up getting too long to fit onto a single table in this page.

As the article/table stands at the moment, it would be a candidate for merger suggestion with Pearl index... David Ruben ^Talk 02:18, 17 July 2006 (UTC)

I have several concerns on the article in its current state.

• It only discusses Pearl Index method for calculating pregnancy rates. While a majority of studies use Pearl Index, many studies use life table rates that do not have some of the problems PI does.
• It makes birth control recommendations (via the color-coding).
  • An encyclopedia should not give medical advice.
  • The recommendations do not take into account individual characteristics (e.g. a person who can remember to use condoms at every act of intercourse, but can't remember to take a pill daily, could have a lower actual failure rate with condoms vs. pill - even though the perfect use rate of the pill is lower than that of condoms).
• It groups together a number of only very loosely related methods under Natural Family Planning. Observational and lactational methods should be broken apart from the Rhythm Method.

I also share David's concerns on duplicate information and summaries not giving the topic a good coverage. However, there did seem to be support for an article similar to this in the following discussing: Talk:Birth control#Effectiveness of birth control section Lyrl ^Talk _Contribs 22:16, 18 July 2006 (UTC)

May I suggest a comparison of the cost of the various methods? —Preceding unsigned comment added by 124.104.22.78 (talk • contribs) 01:15, 15 June 2007

In general, I think that's a good idea, but I'm not sure from what perspective to start such a section - retail cost, wholesale cost, cost to the user (which may be subsidized)? Lyrl ^Talk _C 12:16, 16 June 2007 (UTC)

Lea's shield

I have serious doubts about the failure rates associated with Lea's shield. I've read the FDA Summary of Safety and Effectiveness (http://www.fda.gov/cdrh/pdf/P010043b.pdf) and they talk about 9% and 14% rates (with and without spermicide). In fact, the low indexes I have found are at http://www.contraceptiononline.org/contrareport/article01.cfm?art=210, and they talk about 4 and 6%, but correcting the statistics because of a supposed bias associated with few nulliparous users. Anyway, it seems that till now the data is scarce, so if we choose to say 4% I would add a note about low sample used. --213.194.135.44 15:21, 5 August 2006 (UTC)saragc

Delete for now?

There seems to be very little interest in working on this page. I propose deleting it for now and concentrating on improving the birth control article. When that article has sufficient information to need a spin-off, I think we could re-create a much better version of this page. Lyrl ^Talk _Contribs 01:33, 25 July 2006 (UTC)

No - I really like the list for allowing comparison of effectiveness rates and banding into highj/medium/low effectiveness rates (agree "not recomended" is poor phrasing in an encyclopedia), just not sure if article title correctly reflects the current content (vs perhaps Comparison of birth control effeciveness or better Birth control (effectiveness)) or whether table should be expanded to meet full meaning of article title (i.e. other comparisons than just effectiveness - various approaches as previously discussed but no consensus on). Likewise table as it currently stands best here or in Pearl index article. If we can get a few more editors to suggest where we go from here than perhaps can tag article, vote/consensus and make a change. But work-in-progress, even if goal not entirely clear is not a reason for deletion; well perhaps it is if one is a deletionist, but I'm more a weak inclusionist :-) David Ruben ^Talk 02:06, 25 July 2006 (UTC)

Comment - I'm the original author of the page, so I won't take a stance here :-) . I'd just like to clarify that I compiled it simply because I wished to see an overview of birth control methods by using some information from the "fact boxes" on most of the birth control method articles here as a base. That way, I figured me and others could avoid navigating through dozens of articles if just being on the look after basic facts and references. I now understand the problem with heavily summarizing the subject, but if it helps to include other measures for efficiencies and other important properties, I'm all for including such here. My intended scope was anyway just that; a side-by-side overview of the "fact" boxes on most of the birth control articles. If another article covers such a summary, I admit this may not fill much use. If not, I believe it does, but feel free to vote it away if you feel like. ;-) I'd hope for people to do consider fixing it up if merely finding it to be lacking, though. I am in no way an expert on sexuality matters, so maybe I had no clear view of what's important, and you do. -- Northgrove 21:31, 9 August 2006 (UTC)

One more thing, the Pearl Index used was simply chosen because it seemed to be most prevalent and easiest to find agreeing figures on from various sites, as well as being formerly documented well on Wikipedia. I applied no thought to the PI itself and its accuracy when using it. -- Northgrove 21:40, 9 August 2006 (UTC)

Merge - I would suggest merging it with Birth Control. Also, I think that maybe it's ok to stick with colors and ranges, but not with labels "high/low", because I think that is quite subjective, isn't it? It strikes me as odd to have withdrawal as a low risk method, together with condoms, for instance. And I would suggest also to use the same source for all the failure rates of the different methods, for instance the ones given by FDA. In this way, it doesn't matter so much the accuracy of the data, because you can always make a comparison between them. If we use different sources, this can be seriously distorted. 81.32.8.78 20:10, 12 August 2006 (UTC)saragc

i vote for a merge with pearl index, as it's stubby and this article is only a comparison of effectiveness of different forms of birth control. i think there is no way to concisely summarize the comparative risks of bc in tables/boxes in an informative way. all the risks are too complicated, too enmeshed in controversy and opinionated risk-benefit calculations. plus, the categories bear comparison to each other, and then methods within categories bear comparison to each other--bc doesn't lend itself to a handy pocket guide/simple comparisons or decisions, i don't think... Cindery 22:13, 6 September 2006 (UTC)

Effectiveness calculation

The stats are presented as "chance of getting pregnant in a year". As well as being dependant on the method, this obviously depends on how many times you have sex during the year. Is there a standard assumed in these stats? Any allowance for variance of frequency around the menstrual cycle? It would be nice to be able to say, if you have sex once, using method X, at point Y in the cycle, the chance of pregnancy is 1 in n. The small amount of info about "Effectiveness calculation" suggests the stats are not that precise and simply based on a sample of couples in a marriage-like relationship who reported back at the end of the year. I might hazard a guess that such couples average 2 or 3 times a week. Clearly, your mileage will vary if you're at it twice a day, or twice a year for that matter. However, sociologically, the numbers for a per-copulation rate would be so small people could be misled into thinking them negligible. Suppose a method has a 10% annual failure, based on say 120 copulations per annum. Some arithmetic leads me to a per-copulation failure rate of under 1-in-a-thousand. A lot more people would take those odds. jnestorius^(talk) 07:55, 27 January 2007 (UTC)

Pregnancy rates based on where a woman is in her menstrual cycle are discussed at fertility awareness. During the least fertile portions of the menstrual cycle, couples could go twice a day or more and have a less than 1% chance of pregnancy per year. On the most fertile day, a single act of intercourse results in pregnancy about 2/3 of the time. This is a huge variation in fertility. Combined with the fact that most women do not track their fertility signals, I believe that makes any "sex per year" stats completely useless for birth control purposes. I think we're stuck with the "couples reporting back at the end of the year" method (though note actual studies typically have followup at least monthly). Lyrl ^Talk _C 15:50, 27 January 2007 (UTC)

Failure rates involving another statistic (sex frequency) is confusing

The failure rates reported here don't take sex frequency into account. They are based on how many women (in real life) become pregnant during a year, when using certain forms of contraception. They therefore don't represent absolute truths about the chance of getting pregnant. Instead, these failure rates indicate the chance of getting pregnant during 'typical use', compared to all the women in the studies that were taken into consideration. If your sex life resembles the 'typical sex life' of these women, your chance of getting pregnant during one year's use of a particular method will be the same as reported here.

NB Recent Dutch research showed about 60% of people in a steady relationship had sex once a week or less. 'Typical use' is therefore probably not based on 120 occurrences of intercourse. Not in the Netherlands anyway... —The preceding unsigned comment was added by 193.67.185.234 (talk) 16:06, 23 February 2007 (UTC).

Agreed, and changed the title (it seemed more like a response then a statement.) This is very confusing because although this article assumes there is some constant number, unusually feisty people or even people that don't know much about other relations might not know the real chances for them. Also, a side-effect of not knowing the exact statistic is the sex frequency of these groups could be differant, which means this entire article could be off. Simplifying it to per experience, or a solid number close to to experiences per year, or at least letting everyone know what that number is so they can figure it out for themselves. MikedaSnipe 03:41, 2 May 2007 (UTC)

During the least fertile portions of the menstrual cycle, couples could go twice a day or more and have a less than 1% chance of pregnancy per year. On the most fertile day, a single act of intercourse results in pregnancy about 2/3 of the time. (See fertility awareness) This is a huge variation in fertility. Combined with the fact that most women do not track their fertility signals, I believe that makes any "sex per year" stats completely useless for birth control purposes. Lyrl ^Talk _C 00:45, 4 May 2007 (UTC)

Very confused by table sorting

If you go to this section, with the table, and you look at the fourth column titled Perfect-use failure rate (%), and you click on the button underneath the word "failure" that sorts the methods, we see that there are two different sorting methods and four different displays (with each of the two methods displayed from top to bottom or vice versa, for four displays in total). Just watch for where Lea's shield is sorted and you will see what I mean; either all the methods are sorted by color with Lea's shield at the opposite end (top or bottom), or with it integrated and the colors sorted slightly differently. I am very confused by this and would appreciate it if someone could explain. Better would be if someone would write an explanation and include it in the article.

Also, could someone explain the default sort, before any buttons are pressed? Thanks! Joie de Vivre ^T 12:35, 16 June 2007 (UTC)

Local availability

A user had recently noted that the Prentif cervical cap is not available in the United States. This is true. The contraceptives Jadelle and Lunelle are also not available in the United States, and there are many countries where the ring and the patch, for example, are not available. I do not believe there is enough room in the table to provide availability data on every contraceptive for every country, or even for five or six "world regions". There is also not a good reason to provide information for the United States without providing information for other parts of the world, so I have removed the note about U.S. availability. The topic of availability can be covered in the individual articles. Lyrl^Talk _C 14:09, 13 April 2008 (UTC)

Seems reasonable, it was getting cumbersome as you note. In a similar vein - I note there has been a trend of late to put brand names on the contraceptives. (Today sponge, Prentif cap) Don't think that is such a good move, unless there are wide differences in effectiveness of different brands (in which case should list separately). Rather than getting tied up in details of different brands, think more useful to focus on comparison of the techniques in general, e.g. use (typical values for sponge, rather than any particular one). (Using specific brands moves it closer to advertising.) I don't think there is a particular problem with noting example brands in parenthesis, like Mirena or Coper T to help clarify the item, but using the brand as the front part of the item title seems less desirable. Zodon (talk) 18:14, 13 April 2008 (UTC)

The other brands have not been tested as well. Additionally, Contraceptive Technology, the source of most of the numbers in the table, only lists brands available in the United States. Today is the only brand of contraceptive sponge marketed in the U.S., so the Contraceptive Technology listing for "contraceptive sponge" cites only a study of the Today brand. This confusing U.S.-centric labeling of the table meant that specifying the brand in the table got overlooked. The contraceptive sponge article cites studies of the other brands; I don't have access to the full text of these studies and am unsure of judging how authoritative they are. It's nice to be able to cite a authoritative secondary source who judged the study's results reliable before including them here.

Similarly to the sponge, the 18th edition of Contraceptive Technology listed effectiveness the only brand available in the U.S. (Prentif) under "cervical cap". The U.S. distributor of Prentif went out of business in 2005, so the brand is no longer available in the U.S. - and not listed in the 19th edition of Contraceptive Technology. FemCap is now available in the U.S., and Oves in Europes, but there is currently a dispute over the content of the cervical cap article and no effectiveness rates are listed. Apparently the study of FemCap was not judged authoritative by Contraceptive Technology: they did not include it in their 19th edition, published just last year. For other brands of cap available in Europe - Dumas and Vimule - no effectiveness studies have ever been done. Lyrl^Talk _C 19:41, 13 April 2008 (UTC)

Propose change initial sort/coloring to typical use

For most users of these methods, the typical use information is more relevant than the ideal use. So it doesn't make much sense to emphasize the ideal use characteristics at the expense of the typical use ones in the table. This is particularly evident in the current sorting of such methods as IUD and female sterilization. Because of small differences in ideal use effectiveness, they are listed after several methods which in practical use have 10 times their failure rate. For practical purposes, ordering and coloring by typical use would make more sense. e.g. something on the order of

• green = typical use failure rate less than 1%
• yellow = up to 10%
• orange = up to 20%
• pink = 21%+

(Or perhaps add another color, so green = <1%, unspecified color = 1-9, yellow = 10-20 (basically the 15-16 clump), orange = 21-30, pink = 30+) Zodon (talk) 09:14, 20 April 2008 (UTC)

Is there a way to color for both numbers? One color in the typical column and one in the perfect use column (the names might have to be left white in such a setup)? I don't have an opinion on the initial sort criteria, but I do think both numbers are useful.One person may be unable to remember to take a pill at the same time every day, but have no trouble remembering to use a barrier method at each act of intercourse; such a person might be interested in the typical use information for the pill and the consistent use information for a barrier method.

I'm not sure about us making the judgment that one number or the other is more relevant for "most users". Unfortunately the initial sort forces that judgment to be made, but it would be nice if the coloration system at least could be more neutral. Lyrl^Talk _C 22:06, 20 April 2008 (UTC)

 Done I've coloured Typical & Perfect use values separately (this edit) as per key currently in table (up to 1%, up to 5%, up to 10% and over 10%). Of course not having a single colour for a method means teh method name & type should nolonger be coloured. The previous hidden values needed to be shown greyed out (either no Perfect use value so copy the Typical use for sake of having some value to sort, or in FA, no Typical use value, so value used was that in article. David Ruben ^Talk 23:11, 20 April 2008 (UTC)

I've then split off into purple values over 20% and then rearranged the order the table is initially shown with (i.e. by Typical values) - partly because of the above points but also from copyediting decision that Typical-values are the left-hand (ie first) of the two columns of values and so takes visual presidence. Items with same Typical-values are then sorted by Perfect-use values and finally alphabetically. David Ruben ^Talk 23:33, 20 April 2008 (UTC)

Neat - this way works even better than what I had in mind. Thanks. Zodon (talk) 05:48, 22 April 2008 (UTC)

Ditto to Zodon: nice job, thank you, David. Lyrl^Talk _C 21:35, 22 April 2008 (UTC)

I changed all the colors so that they would be a reverse spectrum from blue to red (rather than the way they were previously: green, yellow, orange, red, purple). I also added grey for "no data" and thistle (purple) for "see footnote" (when the sources conflict, or any other reason a clear answer cannot be given). Whistling42 (talk) 02:11, 25 April 2008 (UTC)

Sortable table provides one round of correct sorting, another of incorrect sorting

Try this: visit the comparison table, and click the button to sort by "perfect use" rates, once. Only once. See the two "no data" items at the top, there? OK, now click it again: what's happening is that it is being sorted in a different way. I don't know the name for it, but if you look at the very top of the block of blue items in "perfect use", and start moving your eyes up line by line, you will see it go from 2 to to 20 to 26. Clearly it is being sorted in a way that make mathematical sense, but is useless for this comparison. Is there a way to make the sortable table not do this? (I asked over at Help talk:Sorting as well.) Thanks! Whistling42 (talk) 02:44, 25 April 2008 (UTC)

It worked with this version - but adding in text of "no data" (rather than previous imperfect copied data with caveats) seems to have broken sort system. Also even on 1st click, the "no data" entries come to top of list which is unlikely. Personally I'ld suggest going back to previous "all cells have a number" :-) David Ruben ^Talk 03:51, 25 April 2008 (UTC)

But for those three cells, there is either no data (and thus no number), or there is a wide range of data (and thus no clear choice on which number to use). Feel free to check out Help talk:Sorting (section) for a suggestion which I didn't quite understand. Whistling42 (talk) 03:57, 25 April 2008 (UTC)

This problem has been solved, thanks to EncMstr. (Thanks!) Whistling42 (talk) 18:22, 25 April 2008 (UTC)

Sorting order

I put the fertility awareness item back to sorting with the Contraceptive Tech typical use effectiveness. Now that adding other text won't mess up the sort order, no reason we can't use an authoritative comparative review source (where available) for sort order, while also noting ranges of values. Zodon (talk) 17:13, 25 April 2008 (UTC)

I reverted this change: "no data" means "there is no data", not "we're going to list it here, because we can deduce that it is at least this effective". The "sort" button for typical-use values is right there, if someone wants to see that value, they can. The value you proposed putting under "Perfect use" is not accurate. This could easily confuse readers (who may not bother to read the footnote).

There is a very wide range of values for the typical-use effectiveness rate for fertility awareness: the sources range from less than 1% to over 25%. That range nearly spans the entire range of efficacy for all methods, from the most effective to the least. It doesn't "mess up the sort order" to leave one item out of one sort range; it is clearly marked with a different color. When the available research produces such conflicting results, the article should clearly reflect that. Whistling42 (talk) 18:20, 25 April 2008 (UTC)

Note that Contraceptive Technology is considered by many to be "The most authoritative source we know for comparing the effectiveness of various methods of birth control" [1]. All but one study of fertility awareness was available when the latest edition was published; the authors reviewed the studies and found them to not meet "modern standards of design, execution, and analysis". The source used by Cont Tech (the CDC's National Survey of Family Growth) has its own problems, so the fertility awareness article goes into more detail. But Hatcher et al believe the NSFG number is more reliable than the studies, and they are the authority. In an overview article such as this I think it may be best to just cite Cont Tech and use their number, leaving caveats to the individual articles (see Depo-Provera as another example of where the Cont Tech typical effectiveness may not tell the whole story). Lyrl^Talk _C 12:55, 26 April 2008 (UTC)

I think that if there are any situations where CT does not tell the whole story, this chart should reflect that in some way, whether with a footnote, a separate color, instructions to read the footnote instead of giving a number, a combination of two or all three. Whistling42 (talk) 12:03, 27 April 2008 (UTC)

Why was the addition of Trusell to the sources giving 25% failure rate removed from note 5?

Some of the sources given in note 5 do not say what note 5 says they do. For instance, Shao-Zhen Qian, et al. does not say what the failure rate is in typical use. The use they studied includes: having to pass a test about the method to be accepted into the study, having a trainer continuously working with and monitoring the couple, and monthly review sessions with the researchers. Nowhere is it indicated that support of this level is available to the typical user, either in China or worldwide.

Similar levels of support would ensure almost perfect use for methods like DMPA, CIC, patch or ring (which require monthly or less frequent action), and would undoubtedly improve success in other methods that require user actions. To make a meaningful comparison between method effectiveness they must be provided similar levels of support, and corrections made for special support that is not uniformly available. If some method receives special support for typical users, that should also be noted.

The broad range indicated in note 5 appears to be in part the difference between typical use and near-perfect use. (It is not clear that the figures reflect typical use.) As with any method who's effectiveness depends on user actions, it is possible to get better than typical results. That is one of the messages of typical use vs. perfect use. So far, I still favor use of Contraceptive Technology. If you wish to reject Contraceptive Technology and their definition of typical use, please suggest an alternative definition for typical use and indicate why it is superior (with sources, of course). Thanks. Zodon (talk) 04:57, 27 April 2008 (UTC)

As far as support, women who learn in a classroom will almost always have a followup visit a month later included in their teacher's fee; in some organizations (such as the Couple to Couple League) the teaching fee includes unlimited followup for one year after the class. So I don't know that PMID 17314078 (I believe the only study published after the 2007 edition of Contraceptive Technology was released) presents a completely unrealistic typical failure rate. Unfortunately, that study was done in Germany. Compared to populations of other countries, Germans seem to experience a significantly lower typical failure rate with all methods of birth control. So I also wouldn't want to present that study as applicable to the entire world.

For fertility awareness in this article, I would like to see the chart use the Contraceptive Technology number, with a brief footnote such as David had made in this diff. Lyrl^Talk _C 13:29, 27 April 2008 (UTC)

4 May revert

DavidRuben added the 25% number to the fertility awareness line with a short footnote, and both Zodon and I have expressed support for that format. Why this number was removed from the article I'm not sure.

I have also de-integrated the references for effectiveness from the references for the remainder of the article; both the integration and the large number of calls to the Contraceptive Technology citation made the information more difficult to navigate.

Lastly, I have removed the specific methods of fertility awareness for which we do not have effectiveness data; a blank line in a table is of no use to readers. Lyrl^Talk _C 20:44, 4 May 2008 (UTC)

User dependence

Some of the material in User Dependence section doesn't make sense. It seems to imply that barrier methods are more user dependent than hormonal methods, and that therefore the spread between typical and perfect use effectiveness is larger.

However, looking at the data it isn't clear that that is true. E.g. for hormonal contraceptives with daily to monthly action required the spread is about 8% (typical is 26x the perfect use). For the condom the typical is only 7x the perfect use (though admittedly the absolute difference is 13%), however several of the other barrier methods show even less spread (diaphragm or cap about 8% absolute difference, 2x relative difference).

Seems like things may be a little more complicated than the section suggests. Perhaps a reference or two, or some revision is in order. Zodon (talk) 10:27, 23 May 2008 (UTC)

There also seems to be some overlap between the user dependence and the ease of use sections. Perhaps some of the material should be merged? Zodon (talk) 02:26, 24 May 2008 (UTC)

A merge sounds good. I've looked around a little for sources: this one seems to just classify methods as "user-independent" and "user-dependent", without the middle category currently described in this article. Although this source expresses a belief that lower frequency of required actions will increase user compliance, it only talks about hormonal methods (pill vs. ring or patch vs. shot). A rewrite to conform to sources would probably shorten that section, making it a good candidate for merging. Lyrl^Talk _C 02:44, 24 May 2008 (UTC)

Proper use of female condom?

I'm confused by this edit. It's not immediately obvious to me what the requirements for proper use of a female condom during intercourse are that distinguishes it from diaphragms, caps, and sponges. Lyrl^Talk _C 02:47, 24 May 2008 (UTC)

The difference that I had in mind was that with the other methods (diaphragm, cap, sponge), no particular user action is required during intercourse. Once you have the method properly inserted the only other action/preparation needed is possibly adding spermicide. However with the female condom, care must be taken that the penis is inserted inside the condom. When I asked a family planning physician about why is the female condom less effective than the male condom, she said that one of the reasons is that sometimes the penis gets misdirected outside the condom. (I have no citation for that, but that is what gave me the idea for the change.)

So the others female barrier methods are sort of insert and forget, the female condom requires action/care during intercourse to use it properly. I hope that makes it clearer what I was trying to say. Sorry it wasn't clear, I will try to think how to clarify the text, or if you have suggestions how to make it clearer. Zodon (talk) 06:16, 25 May 2008 (UTC)

The above is also why in the table entry for Female condom I added "+ penile covering" to delivery, and had changed the User action column to "During sex," and set it to sort with the male condom.

I didn't see your revision of the table putting the female condom back to before sex until today. (i.e. I was unaware of it when I made the edit you asked about above, didn't mean to work at cross purposes.) I understand why saying "Before sex" seems natural, and saying "During sex" is unexpected. But after thinking about it, it seemed that the level of interruption/care/etc. required for the female condom is more similar to the male condom (both require some care during sex) than it is to the diaphragm, etc. It seemed worth making that distinction in the table. (So there is some care required during sex, but not as much as with withdrawal.)

I had considered something like "Before and during sex," but thought that would be even more confusing; "During insertion," was ambiguous (it meant insertion of penis, but could be confused with insertion of female condom). I haven't come up with a compact phrasing that I though was great, open to ideas.

I tried putting it back to During sex and adding a footnote to explain the unexpected value. Does that help any? Zodon (talk) 07:30, 25 May 2008 (UTC)

The penis can also go on the wrong side of the diaphragm; more likely in certain positions and if the diaphragm isn't a good fit, although a few couples have anatomy that makes this particular failure mode likely even with good fit and careful insertion of the penis. Sponges (and sometimes caps) can become displaced over several hours; if one was not inserted immediately before intercourse some practitioners recommend checking to make sure the device is placed correctly before penetration occurs.

So while I can see a note about taking care during initiation of intercourse (penetration?), I'm currently not convinced the female condom is unique in this regard. Lyrl^Talk _C 12:01, 25 May 2008 (UTC)

The context of the items in question is ease of use/user dependence/when is user action required. One disadvantage sometimes mentioned for the male condom is that putting them on interrupts sex, so requiring user actions during sex may be regarded differently than requiring actions before sex ease of use standpoint. Therefore it seems reasonable to distinguish those methods that require action during intercourse from those that don't. Admittedly, how much action is required may also be significant, but I don't have references for that, and any evaluation of that nature would require citations, or be WP:OR.

Here is an example of use instructions for the female condom which say that part of proper use is during intercourse: Engender Health - Female Condom Instructions "Once you begin to engage in intercourse, you may have to guide the penis into the female condom." (Presumably this would be after the stage where a male condom would have been applied.)

The instructions that I am familiar with for use of the diaphragm, sponge and cap are all along the lines of insert device (w/ spermicide, etc.) before intercourse. Add extra spermicide and check position before (or between) intercourses. Remove it so long after intercourse. The instructions in the wikipedia articles for these methods are along these lines, and a brief search didn't turn up anything much different. Is there some user action that is routinely recommended during intercourse? If so, then I agree we should update the items here to indicate that action is required during intercourse. We should probably also update the articles about the individual methods as well.

If for the other methods this is a possible failure mode, but it is not under direct user control, then it seems a different thing from the female condom - where it is under user control and preventing it is part of the regular instructions for use. Zodon (talk) 05:44, 27 May 2008 (UTC)

The position a couple chooses for intercourse is something they can control. While there are sources that talk about the diaphragm not working for "some sexual positions, penis sizes, and thrusting angles and techniques"[2] or advise "If you change positions, you may want to check to see that the diaphragm is still covering the cervix" [3], you are correct that these are not nearly as prevalent as the "guide" recommendation in female condom instructions. But, many or most couples have to guide the penis in to begin intercourse when not using a female condom [4], [5].

So, two things: first, I'm not convinced the guiding bit of FC use is anything other than par for the course for most couples having intercourse. Second, stopping to verify the correct position of a diaphragm or cap seems like it would "interrupt" more than incorporating guidance into an act of intercourse. Such an evaluation could not be put into the article without sources, but we don't have a source that explicitly says diaphragms are less bother than female condoms, either, which is what the current formatting of the table implies.

For the "ease of use" section I've tried to reword it to prevent the confusion I mentioned when starting this discussion. Lyrl^Talk _C 16:30, 27 May 2008 (UTC)

Any thoughts on my comments above? Also, any thoughts on the level of detail for use instructions in this article? It strikes me as unsymmetrical to explain that the FC must be removed before standing up, but to not mention that the male condom needs to be held onto when disengaging for the same reason (preventing slippage that could lead to semen in the vagina). Lyrl^Talk _C 11:52, 28 May 2008 (UTC)

The part about needing to remove FC before standing was along the lines of part of why it is different from the other female barriers (which must be left in for some time after sex). It also occurred to me (after I logged off) that mentioning the need to withdraw promptly after sex and hold onto the male condom would make sense as an ease of use matter.

As far as thoughts on your comments of 27 May, I am still thinking about them. It still seems to me that the female condom has some fundamental usability differences from the other "female barrier methods," (not necessarily better or worse, just different) and I am not yet persuaded that the differences are insignificant. I need some time to read the references you posted and check some articles on female barrier method use/failure/user reactions to see if they lent more clarity to my thoughts. Zodon (talk) 22:51, 28 May 2008 (UTC)

User action and sorting

After thinking about the discussion on female condom usage, I'm leaning toward grouping all barriers and withdrawal together for user action in the table. While the different methods require different actions, which actions are more or less difficult or bothersome is going to vary from user to user. I haven't come across any good discussions of typical or most common attitudes on these actions, so any judgments on sorting order made by editors would be bordering on original research. Just saying they all require action for every act of intercourse (not specifying timing of action) gets around this issue. Not having to have footnotes explaining the sorting order also simplifies the table.

A related issue is the description of user action for LAM and fertility awareness. The current description for LAM says "every 4-6 hours", but that's a minimum. The actual guideline is "on demand", which for infants is commonly every two hours or less. The current description for fertility awareness says "daily", which I think is meant to imply once per day, but charting can require action several times a day. Taking a temperature in the morning, then using the thermometer's memory to recall the temp and record it before bed, for instance. With mucus observation, it's recommended to be aware of sensation throughout the day, and in addition look at one's toilet paper after every act of urination: that's probably at least four times a day for most people, plus again the recording. When I originally wrote the "ease of use" section, I was using "daily" in the sense of "at least once per day", not the current sense of "exactly once per day".

I think for both the text in the "ease of use" section, and the sorting order in the table, it would be nice to treat LAM and FA consistently. Either list them both as "daily" (in the sense of "at least once per day"), or specify for both of them a higher frequency ("on demand, min. every 4-6 hrs" for LAM and "observation throughout day" or something similar for FA?) Lyrl^Talk _C 03:21, 1 June 2008 (UTC)

I based the sort order in the column on time - how frequent for the items that require regular action, how close to sex for the other items. (So withdrawal closer to culmination of sex, then condoms, then the methods that could be inserted before and removed after sex.) So while it was inspired by the ease of use sections, the order was based on something that was more objective (time). ("When" could be regarded as implicitly included in the title.) I agree, without some data wouldn't go into trying to order by difficulty/intrusiveness the various items are. (Since male condoms are frequently commented on as interrupting sex, felt confident putting them in separate category from cap/etc. Was debating having 2 groups - "during sex" and "before/after sex")

When I read something that says daily, I assume mean basically once per day. So I was a bit surprised when I read in the LAM article that it requires action every 4-6 hrs. Hence the change. Probably good to update it with the typical frequency rather than the minimal (I based change on what I found in the Wikipedia article on LAM). Wasn't aware that FA also requires multiple actions/day. I think important for clarity to differentiate methods that require actions once/day vs those requiring attention every few hours. (e.g. big ease of use/compliance difference having to take a pill once a day vs. doing it 4x/day. Sure you get a reminder with LAM, but need to know what getting into. Don't necessarily need to specify exactly how frequent the action is in each case in table, a category for multiple times/day would suffice.) So think should keep differentiation between pill and (presumably) calendar methods that really are once/day action and ones that require more frequent action.

I still favor differentiating methods that require action "during sex" from those that just require before/after (assuming there are any of the latter). But until I do some more reading, lumping them together is okay. However I am a little unsure about the phrasing "Every act of intercourse." If a couple has sex multiple times in succession, do all of those methods require action for each time? (I know condoms (m & f), withdrawal and spermicide do, but do the sponge/diaphragm/caps all require actions for each time?) Zodon (talk) 08:01, 1 June 2008 (UTC)

While cap/etc. can be inserted before sex, many couples prefer to insert during foreplay, at the same point a male condom would be put on. I like the idea of distinguishing potential differences, but I think the variety of ways to use these methods makes it too complicated to reduce to table format.

With diaphragms, it is recommended to add additional spermicide into the vagina before every 2nd, 3rd, etc. act of intercourse. Sponges and caps do not require additional action, but I'm afraid trying to distinguish them would make the table so much more wordy it would interfere with readability.

I think once/day is a good representation for calendar methods, but perhaps symptoms-based fertility awareness and LAM could both say "throughout day"? Lyrl^Talk _C 13:56, 1 June 2008 (UTC)

Femcap should be inserted at least 15 minutes before any sexual arousal (Contraceptive Tech.). So some methods need action before sex. But moot since not differentiating in the table at this point.

In my comment above about the current phrasing - wasn't thinking of trying to distinguish the methods, wanted to seeing if we could come up with a phrasing that more neatly cover the variety of methods in the group. (Some require action before, some during, some several hours after, some at each act, some just before/after whole series.)

"Throughout day" sounds reasonable phrasing for the table entry on LAM & fertility awareness. Zodon (talk) 19:09, 1 June 2008 (UTC)

Revert 20-June

I'm confused about the reasoning behind many of the edits made today to the table. They seem, to me, to make the table less useful and accurate. I have reverted them for now, and invite discussion here:

• The column titles on the bottom of the table were removed. The table is long, and it increased usability to not have to scroll back to the top of the table to check titles or to sort by one of the columns.
• The brand names were made sortable. This seems more likely to confuse readers than to help them.
• The colors were removed from the "action required" column. An edit summary said that the colors were for effectiveness, which is a legitimate labeling concern. But they made it easy to see the different frequencies required by different methods. Perhaps the color labeling needs to be changed, or different colors be used in this column than in the effectiveness column. Removing them altogether does not seem like the best course of action.
• Breastfeeding was changed to "multiple times per day" which may be misleading: it is the frequency of suckling, not how many times it is done, that suppresses ovulation. For contraceptive purposes, it is more important to spread feedings throughout the day than to feed many (multiple) times.
• Fertility awareness was changed to "daily". This is not true of methods that include cervical mucus: that requires paying attention to vulvar sensation throughout the day, as well as visual observation at every act of urination. It may also not be true even of temperature-only methods, since many users take their temperature in the morning, but do not record it until the evening (so two actions/day).
• Copper intrauterine device was changed to 10 years. This is the approved term of Paragard in the United States; the WHO has determined Paragard is safe and effective for at least 12 years, while other brands of copper IUD are only approved for 5 years.
• Barrier methods were changed to "prior to intercourse", except for the male condom which was change to "prior to penetration", and withdrawal was changed to "during intercourse". Because frequency of required actions is related to the difficulty of using a method, distinguishing the terminology used for barrier methods from that used for withdrawal implies one is easier to use than the other. The sort order was also changed to imply that withdrawal requires more frequent action than barrier methods, and that male condoms require more frequent action than other barrier methods. Lacking a source for these claims, listing them all as "every act of intercourse" and sorting them together is more NPOV and avoids OR.
• NuvaRing was changed to 1x per month. The ring must be removed after three weeks, then a new one inserted a week later. That is two actions per month, not one.
• The delivery method for withdrawal was changed from "withdrawal" to "physical separation". While this does make the presentation seem more formal, I feel it makes it less accessible to readers.

I appreciate all the time this user spent trying to improve the table, and I have left a number of the cleanup edits they made. I hope if my reasoning on the reverts is incorrect that other editors will explain my mistakes to me. Lyrl^Talk _C 02:37, 21 June 2008 (UTC)

On the coloring of the Frequency of Use column. The blue color was used to indicate items that were "non-user dependent" (from the user dependence section). As these methods for the most part correspond to the methods that have both perfect use and typical use failure rates of <1%, the same light blue color was used. (I think introducing more colors would make it more confusing.) I think it helps differentiate the items, and assuming that the "non-user dependent" item is verifiable, it shouldn't be OR. I have added a note to the explanatory material for this columns color coding, which might help.

While I support the change of differentiating methods that require action during intercourse from those that require action before intercourse, I haven't come up with references to support that change. (See User action and sorting and Proper use of female condom?).

I reversed one other change from the edits. I put Unprotected intercourse back to sorting with the other methods whose frequency of use is at every act of intercourse. I changed the text to match that (perhaps that helps clarify). To use "no method" you must have intercourse (otherwise it would be abstinence), and you can't withdraw/etc., so user action (or inaction to not use some other method) is required at each act of intercourse. Zodon (talk) 05:27, 21 June 2008 (UTC)

Note - I was writing the following edit explanation when Zodon posted the above comment (I received an "Edit conflict"). I am posting this so that not too much time will pass between my edit to the article, and the posting of the comment below. I have not yet read Zodon's comment but will tomorrow (I must leave now.) The rest is the comment as it was written:

Here is another partial revert with new changes and explanation.

• "Withdrawal" -> "Physical separation". The "Delivery" column is meant to be a brief description. The description is that the couple must physically separate. It's reasonable to think that at times, the female might be atop the male partner when the male is nearing ejaculation, and the male might alert the female to the impending ejaculation and inform the female that it is time for her to dismount. To suggest that the male is always on top and must "withdraw" is POV. "Physical separation" is more NPOV than "withdrawal" as a description. The word "withdrawal" is already used in the second column as the common name; there is no concern about confusion. If the description of "physical separation" is unsatisfactory, I am open to using a different description, such as "genital uncoupling".

• Colors in final column: I simply disagree, the re-use of the coloring meant to indicate effectiveness, for a small group of methods that must be replaced infrequently or never is confusing. Removed for the time being, I suggest the use of some sort of gradient in that column.

• "Action required" for no method: sorting it this way does not make sense. Users of an IUD, implant, sterilization, etc must also take "no action" at every act of intercourse; the question is "how often must you use this method"; the answer is not "never (must action be taken)" or "with each act of intercourse, no action must be taken" but "null" is the answer, as no method is used. Thus, it should be separated from the others.

• LAM: "Throughout day" -> "Every few hours". The mother must awaken during the night to breastfeed the baby or babies during the first several months, and LAM is only good for six months. Whereas Fertility Awareness does not require the user to awaken at night to perform tasks. Changing wording and sorting for these two accordingly.

• "Charting (fertility)" -> "Observation and charting", per your description.

• "5–12+ Years" -> "5 to 12+ years" for clarity (note change in capitalization of word "years").

I remain open to discussion. - 66.30.20.71 (talk) 05:58, 21 June 2008 (UTC)

The LAM change to every few hours seems reasonable to me. (I originally had 4-6 hours, since that is the required frequency. Hence the 4 hours in the sort field.) The point about it being through the night as well as in daytime vs. fertility awareness, which doesn't appear to require action quite so frequently seems reasonable. However, I think it boils down to how often women of reproductive age have to go to bathroom, which I don't have statistics for.

I disagree with "Physical separation" for withdrawal. Withdrawal is a much more common term for the method, and seems more descriptive. The description in the wikipedia article on the method says nothing about physical separation, only that "the penis is removed from the vagina prior to ejaculation" (i.e. withdrawn). Without citations, the business of positions and physical separation mentioned above sounds like WP:OR.

I reverted your removal of the colors on two grounds. The primary one was that the document was inconsistent (since I added explanation of the coloring, which you presumably didn't see since we were editing at the same time.) The other is that as I understand it, while discussion is going on, it is better to avoid changes to the document itself (aside from reverting to the prior consensus version) until consensus is reached (and the consensus version prior to today had the colors). (If my adding the explanation of the colors was inappropriate, my apologies.)

The other change I made was to move LAM back to sorting at 4 hours (because that is required frequency), and moving symptoms based to sorting at 6 hours, which has the same result as the change you had made, but keeps LAM with a verifiable sort frequency.

I do not agree with some of your other changes, such as changing the frequency for no method, but I am not well enough versed in wiki-etiquette to be sure about the best course, so I am leaving your changes temporarily. But I would encourage discussion here and waiting for consensus before making further revisions in material under discussion that move away from the version prior to the 20th. Zodon (talk) 07:39, 21 June 2008 (UTC)

Regarding coitus interruptus: The word "withdrawal" is already used in the method's row as a "common name", readers are already aware of what the method is commonly called, there is no need to repeat the word twice. Whether to include it under "Delivery" is a stylistic difference, not one of necessity. The "delivery" column is not the place for the common name; it is a place for a neutral physical description. If we were to repeat the word as you suggest: the article would contain a statement that "withdrawal" (i.e. the male pulling his penis out of his partner's vagina) is what always happens; and it would imply that the "alert and dismount" scenario never occurs. That is OR. The most neutral physical description is that the genitals are uncoupled prior to the male's ejacuation. Wikipedia should not be speculating as to who is on top or who performs the uncoupling.

I have already said my piece as to how I feel about the coloring: re-using the coloring looks strange, particularly for only one group of methods rather than the entire column. The highlighting is arbitrary; we should use a gradient of an entirely different color or in grey, to denote frequency of use. Also, the "no method" situation as regards to how to treat it in the final column is unresolved, so I will wait for other editors on this. 66.30.20.71 (talk) 13:14, 21 June 2008 (UTC)

One change I just made was to reword the NuvaRing "User action required" to be consistent with the rest of the column. "3 weeks in/1 week out" is confusing; even though I know what the NuvaRing is and how it is used, I was still confused by that statement. I changed the phrasing to read "Two actions per month", to align with the frequency given for other methods. If the reader wants to know the specifics of exactly when in the month those actions must be taken, they can visit the article. This level of flexibility in phrasing is similar to the amount of flexibility involved in the usage of the phrase "Every act of intercourse" to refer to actions taken [before vs during vs between] acts of intercourse, so I think it is acceptable.

Another change I just made was to expand the adjectives "oral" and "surgical" with appropriate nouns; "oral medication" and "surgical procedure" are complete phrases and are much simpler to understand. 66.30.20.71 (talk) 13:16, 21 June 2008 (UTC)

"Physical separation" is not a term used to describe coitus interruptus. A Google search of the two terms returns only 34 hits. None of those hits describe the execution of the birth control method as "physically separating". I believe that in the context of this table, listing "physical separation" as a delivery method for coitus interruptus would be OR.

Marginally better results are found with "disengagement". This Google search gives 469 hits. Of the first twenty hits, fifteen are not talking about sex or birth control, two are referring to fruit flies, and three use "disengage" to describe the execution of the birth control method. In the context of this table, I do not see a justification for using a very rare description when a common one is available.

"Withdrawal" means the penis is withdrawn from the vagina, which is what happens when the partners pull apart, regardless of which one is on top. I do not see the "man on top" implications 66.30.20.71 sees with the term "withdrawal".

I agree with Zodon on the use of colors to indicate user dependent vs. user independent methods. These are common terms used to describe birth control methods, and it is a useful distinction to make in the table. Because the user independent methods have very low failure rates, it keeps the table simpler (and thus easier to use) to re-use the light blue color from the effectiveness column.

I can see Zodon's point about needing to distinguish unprotected sex from abstinence. But, abstinence is not included in the table; in its current form I think distinguishing from sterilization, etc. is the more important goal. In that comparison, I agree with 66.30.20.71 that unprotected sex requires less action than sterilization, etc. Lyrl^Talk _C 14:55, 21 June 2008 (UTC)

The "Implementation" column (previously "Delivery") is being used as a place for descriptions, not terms. Therefore, I do not think it is important whether the phrase is used as a specific term.

In the case of coitus interruptus, the implementation of the method involves disengagement of the genitals. This can just as easily be accomplished by the female disengaging hir vagina from hir partner's penis, as by the male disengaging hir penis from hir partner's vagina. Therefore, we must be neutral, and refer only to the fact that coitus interruptus is accomplished by uncoupling the genitals. We should not speculate in a description as to who performs the action. 66.30.20.71 (talk) 15:22, 21 June 2008 (UTC)

I have renamed the "Delivery" column as "Implementation"; to encompass non-drug methods. For example, while an implant is indeed a "delivery" system for contraceptive hormones, breastfeeding is not exactly a "delivery" system for LAM. I think "implementation" covers both drug and non-drug methods more clearly. 66.30.20.71 (talk) 15:35, 21 June 2008 (UTC)

Frequency of use for "No method"

Users of IUD, implant, etc. would still be said to be using that method even if they don't have intercourse. It would not be reasonable to describe somebody as "using no method" if they weren't having sex. Saying no action is required (putting it down below sterilization, etc.) glosses over all the actions that are required in order to have sex.

If you want to look at it in terms of sorting method as "nul" - since it won't let me split the method out of the table, the reasonable things to do seem to be sort it at one end or the other. Since there are two groups (those requiring action associated with sex, and those requiring action on a calendar basis), it seemed reasonable to group it with the methods it is most like (those associated with sex) and sorting it at the end of those methods.

In response to Lyrl's observation about distinguishing No method from Sterilization, etc., I don't see how sorting no method next to sterilization and the other user independent methods helps to distinguish it from those methods. It was basically in order to distinguish it from the user independent methods that I made it sort with the methods requiring action at every instance of sex. Zodon (talk) 03:37, 25 June 2008 (UTC)

Withdrawal description

"Editors should provide a reliable source for quotations and for any material that is challenged, or the material may be removed." I challenge the use of "physical separation" or "disengagement" to describe the birth control method of "coitus interruptus". While defining coitus interruptus as "male disengaging hir penis from hir partner's vagina" would be POV, this is not what the table says: I challenge the assertion that the word "withdrawal" implies who is withdrawing from whom: no sources have been provided for this claim. Lacking such sources, the POV tag needs to be removed. Lyrl^Talk _C 17:30, 21 June 2008 (UTC)

I challenge the use of "withdrawal" as a descriptive phrase for every instance of coitus interruptus; on the grounds that it is commonly interpreted to mean "the male withdrawing hir penis from hir partner's vagina". I very much doubt that you can provide a reliable source that will demonstrate that every act of coitus interruptus is performed this way.

Really, now, Lyrl, this doesn't seem fair. It seems that you are singling out this one description while leaving others (such as "penile application" for condom) alone. Why is it more appropriate to use the word "withdrawal" as a description when the word "withdrawal" is already used in the row? The repetition alone should indicate that we can branch out with the phrasing. Seriously, you seemed to understand the purpose of the rephrasing over at Coitus interruptus; why not aim for more factual standards here? 66.30.20.71 (talk) 18:46, 21 June 2008 (UTC)

I think that as we work on the article, all the editors are coming across things that can be improved. I changed "charting (statistical)" to "calendar-based", you changed "charting (fertility)" to "observation and charting", you have a good point about "penile application" not reflecting common descriptions of condom use, inspiring me to change it to "placed on erect penis". We bring up issues, talk about them, and in the end the article is better for it. That one issue is currently under discussion doesn't necessarily mean it is being "singled out"; in the case of withdrawal's "implementation", it got caught up in a number of controversial edits made at the same time, which cast light on that issue. You had added the description "penile application" as part of a series of uncontroversial edits; their overall uncontroversial nature caused the details of those edits to not be scrutinized.

"Spermicide" and the methods used "with spermicide" have the word "spermicide" duplicated in the "type" column. Duplication is not desirable, but sometimes it works out to be better than alternatives. I believe that duplication of "withdrawal" is less undesirable than the alternative descriptions we have discussed. Lyrl^Talk _C 00:55, 22 June 2008 (UTC)

Do you understand why I find the word "withdrawal" to be insufficient as a descriptive phrase? I feel it adds a certain statement about how "normal people" have sex, which is to say a passive female with an active male, the male is on top and he "withdraws" his penis from her. I disagree with the idea that there is no inherent meaning of which genitals are being "withdrawn", the word itself has a meaning where something is "within" something else and is then removed: a penis, an army, a vote, a statement, etc. I am sure you must be aware that people have sex in a wide variety of different ways, there are female dominants who are always "on top", as it were... I just don't think it gives a full picture to say that "withdrawal" is an appropriate description of what happens between all who use this method. Can you explain what problem you have with "physical separation" or "genitals are disengaged"? Is there any variation on this type of phrasing that you would find acceptable? Why or why not? Thanks, 66.30.20.71 (talk) 13:13, 23 June 2008 (UTC)

We've established that we disagree on the connotations of "withdrawal". Given your interpretation of the word, I understand your objections to it. But I believe your interpretation is incorrect.

My problem with substituting separation or disengagement is that these terms are not used in medical descriptions of this method. At least in internet pages indexed by Google, "physical separation" is not used at all to describe this method. In a table where this description stands alone, rather than as part of a prose description, I prefer to adhere as closely as possible to the phrasing used by authoritative sources. Should a medical source be found with one of these phrases or another alternative phrase, I would be much more inclined to modify the description. Lyrl^Talk _C 00:12, 25 June 2008 (UTC)

Comparison table - Methods Not Listed

I removed the Male contraceptive methods from the list in Methods not listed. The reason given for creating the listing was to alert readers to the existence of other forms. However none of the male methods mentioned are available outside of research setting (per the article on male methods), so they are irrelevant to the table.

I think that the whole Methods not listed sub-section is essentially a see also list, which should be removed because the other methods are already much more adequately covered by the birth control navbox at the end of the article.

Thought I would leave it a little to get feedback from other eds. Zodon (talk) 17:58, 21 June 2008 (UTC)

I think we basically agree with each other. I'm also not sure the new section "not listed" belongs in this article; most of the listed methods are experimental. All methods currently discussed on Wikipedia can be navigated to from birth control and through Category:Methods of birth control. I do not see a need for this article to also be a navigation portal: I would prefer to limit its scope to common and well-studied methods which can be integrated into the article, instead of having to be listed at the end. Lyrl^Talk _C 18:15, 21 June 2008 (UTC)

I re-added heat-based contraception to the list of methods not listed; as it is available to anyone with access to tight-fitting underwear or hot water. Heat-based contraception, a behavioral method, is no less "real" than breastfeeding to prolong postpartum infertility. 66.30.20.71 (talk) 18:51, 21 June 2008 (UTC)

My statement above was repeating what wikipedia says about the methods. At this point the articles that are being linked to say it is less available. Male contraceptive says "The only forms of contraceptives currently available to men are condoms, the withdrawal method, and vasectomy." The article on Heat-based contraception lists the method as "Experimental." They also lack WP:RS to establish the existence/effectiveness/safety of the method. By comparison LAM is documented in contraceptive tech and the article on it has other references.

The main question is whether this "Methods not listed" listing should be created.

• See also sections (which this is) are discouraged in articles in project medicine, it is better to integrate the references into the article WP:MEDMOS.
• If left in and filled in consistently, it will wind up being largely a repeat of the birth control navbox, which is already readily available to the interested reader.

I think the whole section and its contents doesn't add anything useful for the reader and should be removed. Zodon (talk) 00:41, 22 June 2008 (UTC)

All methods currently discussed on Wikipedia can be navigated to from birth control and through Category:Methods of birth control (while Zodon mentioned the navbox, it does not currently include experimental methods). I do not see a need for this article to also be a navigation portal: I would prefer to limit its scope to common and well-studied methods which can be integrated into the article, instead of having to be listed at the end. Some of the methods in the "not listed" (like essure) may have enough available information to add to the table. It may be desireable to integrate heat-based contraception into the text of the article even though lack of data prevents its addition to the table. With two editors opposed to the section, I have gone ahead and removed it.

I would like to hear other editor's opinions on mentioning heat-based contraception in the text of the article, possibly highlighting the convenience of not requiring a doctor's appointment and the lack of standardized instructions or information on effectiveness. Lyrl^Talk _C 00:58, 22 June 2008 (UTC)

Covering heat based contraception

In response to Lyrl's question. The wikipedia article on the method is not particularly informative and lacks references. It is hard to comment on something without reliable information about it.

If it is a hot topic (e.g. covered in the press or by hearsay), then perhaps noting the limited information about it might be helpful. Without reliable sources on safety and effectiveness it seems like the only useful things we could say about it are that it hasn't been adequately studied to establish safety and effectiveness. Zodon (talk) 03:02, 25 June 2008 (UTC)

combining

i have a question that my health teacher back in high school could not answer and no one yet has. is it better to combine strategies of birth control? for example, using pulling out and a condom and the pill. does the likelihood of pregnancy go down? and is there a good calculation? is there a best combination? i know wikipedia isnt yahoo answers, but i think this might be relevant enough information to include in the page. —Preceding unsigned comment added by 69.140.203.144 (talk) 22:20, 15 July 2008 (UTC)

Combining methods is generally better than single method, as long as they are used properly. In particular, condoms provide protection against STDs, while most of the other methods provide little protection. So even with highly effective methods (like IUD, sterilization, etc.) it may be desirable to use a condom as well.

However the combination you mention might not make much sense, the pill and condom together might be effective enough that withdrawal might make little additional difference. Some of this information is already on the page - combining spermicide and condom (Kestelman and Trussell). I recently saw an article that considered the tradeoffs of advocating use of condoms as well as highly effective methods. Zodon (talk) 09:30, 16 July 2008 (UTC)

Found the article that talked about dual protection: Cates, W and Steiner, M (2002). "Dual Protection Against Unintended Pregnancy and Sexually Transmitted Infections: What Is the Best Contraceptive Approach?". Sexually Transmitted Diseases. 29 (3): 168–174.{{cite journal}}: CS1 maint: multiple names: authors list (link) Zodon (talk) 18:43, 16 July 2008 (UTC)

Essure

shouldn't Essure sterilization be listed on the table, and mentioned (w/ link) in the article ??? —Preceding unsigned comment added by 216.81.197.249 (talk) 18:49, 22 July 2008 (UTC)

REAL failure PROBABILITIES?

I really HATE all these Pearl indices and specified "failure rates" in the article because in my view, they do not really represent the information you want to get: The real question about failure is: "If I have sex now and apply method X, what is the probability of a pregnancy?" Simpler put, instead of Pearl index, the equation would be: number of pregnancies divided by number of sexual intercourses with the birth control method applied. I simply cannot make any sense out of "failure rates per year" or "pregnancies per year" (aka Pearl index) because there is no information about the typical sex life of the involved people: Sex once a day or sex once a month -- or what is "typical"? I've been searchin the web a while for now and unfortunately cannot find any numbers on the probability of failure of a given method. Any information on this? 93.135.62.39 (talk) 23:38, 5 June 2009 (UTC)

The average couple's sex life is twice a week, if that helps. A "failure per act of intercourse" statistic would be meaningless because of the way the menstrual cycle works: some days, a single act of intercourse could have a 70% chance of pregnancy. Other days, a couple could go at it like bunnies and have a less than 1% chance of pregnancy. You might also find this useful: Fertility awareness#Intercourse timing. Lyrl^Talk _C 13:36, 7 June 2009 (UTC)

The average sex life figure helps in case it is correct. Concerning the other statement: I disagree; this is not an argument. With the same "argument" any statistic on failure rate (including Pearl index) could be rejected. The reason for doing statistics is to average out all the other factors. Of course, the indiviual failure rate of sex in a certain night is the product of the fertility (both partners), the inherent failure rate of the birth control method(s), the experience of the involved partners (in correctly applying the method(s)) and so on. But still, I insist, that the number "pregnancies per intercourse" is more usable than "pregnancies per year" (aka Pearl index). 93.135.40.116 (talk) 19:42, 11 June 2009 (UTC)

But what are the REAL failure rates?

First, failure rates are reported very differently from one source to another. Wikipedia's article on condoms gives "10–18% per year", not "15% per year", as this article does.

Second, the per-year failure rate is not that useful. This article is more realistic:

• Spermicides 99.997%
• Withdrawal 99.99%
• Periodic abstinence 99.98%
• Female condom 99.92%
• Diaphragm 99.46%
• Male condom 99%
• Pill 92%
• Patch 92%
• 3-month injectable 60%
• 1-month injectable 60%
• IUD Copper-T 21%
• Female sterilization 14%
• Male sterilization 4%
• IUD Mirena 3%
• Implant 1%

They extrapolate the failure rate over 30 years of use, instead of just 1. So a condom's real failure rate during a lifetime of use is 1-(1-15%)³⁰ = 99.2%.

Of course this is an oversimplification. They say 21% failure rate for the copper IUD, extrapolating from the same 0.8% rate that we state, 1-(1-0.8%)³⁰=21.4% In reality, the cumulative rate for 12 years is 2.2%, according to Wikipedia's article, so a more realistic 30-year rate would be 1-(1-2.2%)^30/12 = 5.4%, right?

I think these kinds of measurements would serve the reader better than the inaccurate and misleading 1 year rates. For each method, take the longest-lived trial you can find, and extrapolate to 30 years for realistic comparisons. 96.224.69.49 (talk) 04:17, 23 July 2008 (UTC)

The rates used here are generally from Contraceptive Technology, considered by many to be the authoritative source in the field (see fourth paragraph under #Sorting order for reference). This page is a summary, the pages on the individual devices give further details on various estimates.

The method employed in the calculation you mention makes some unreasonable assumptions, e.g. assuming that the FIRST year (not 1 year) failure rate will continue for subsequent years. For many methods, the failure rate decreases in subsequent years, for instance users get better at using method with practice. And for a few methods, the failure rate increases after the first year.

It assumes that women use one method for life - not a particularly realistic assumption, at least not in the US. For instance the percentage using female sterilization increases steadily with age (and very few US women start out by using sterilization).

The analysis ignores the effects of pregnancy (intended or unintended), certainly if it were correct in its projections one would expect users of less effective methods to spend a significant amount of time being pregnant (and therefore unable to conceive). (e.g. a woman using no method might have 10 lifetime pregnancies, if all went to term that would be 7.5 years pregnant, and potentially 5 years using LAM. Significantly reducing the exponent in the calculation.)

The calculation is misleading in that it disguises the distinctions between lower effectiveness methods. For instance, no method would have a failure rate of 99.99999999999999999999998% (as above, you have to leave in an absurd number of non-significant figures to distinguish from 100%). A woman using no method would expect multiple pregnancies in a lifetime, even the least effective method listed here will reduce the number significantly, by suppressing the difference in number of expected pregnancies, this presentation is misleading.

No basis is given for the claim that the first year failure rates used here are inaccurate. They come from a highly respected source. The source given for the calculation here is not reliable WP:RS, and the presentation suggested is quite misleading. Zodon (talk) 06:34, 23 July 2008 (UTC)

Examples of how failure rates change after first year: Vasectomy 0.15% first year, 0.01% per year for next 4 years, Copper IUD: 0.8%, 0.2, 0.6, 0.2, 0.3, Tubal ligation: 0.4, 0.133, 0.133, 0.133, 0.0667 (Trusell et al, 1995)

So the above probability estimates are overinflated, e.g. if the above effectiveness holds true for the other 25 years, the estimate for Vasectomy effectiveness, e.g., would be off by an order of magnitude. (0.4% not 4%). [Edited to clarify].

Something like the expected number of lifetime pregnancies for each method might be more interesting and less misleading. (e.g. similar to the horizontal scale on figure 4 in Trusell et al 1995)

Trusell et al 1995: "Economic value of contraception" (PDF). American Journal of Public Health. 85 (4): 494–503. April 1995. Zodon (talk) 08:16, 23 July 2008 (UTC)

The method employed in the calculation you mention makes some unreasonable assumptions

As I said immediately afterwards, and demonstrated with an example.

Examples of how failure rates change after first year: Vasectomy 0.15% first year, 0.01% per year for next 4 years, Copper IUD: 0.8%, 0.2, 0.6, 0.2, 0.3, Tubal ligation: 0.4, 0.133, 0.133, 0.133, 0.0667

As I said, listing only the first year rates from a single source is inaccurate and misleading.

Something like the expected number of lifetime pregnancies for each method might be more interesting and less misleading.

That's what I'm asking for. If you don't intend to ever have kids, and only use condoms as birth control, you're probably going to get pregnant anyway... eventually. The 99% figure is an oversimplification, but finding a reliable source for the actual number would be a more useful metric than the rate for just the first year. 96.224.69.49 (talk) 03:24, 24 July 2008 (UTC)

That "single source" (Contraceptive Technology) contains a review with 55 pages just summarizing hundreds of research articles that were reviewed and analyzed by experts in the field to derive those failure rates. If that is "inaccurate," what would you suggest as a more comprehensive or accurate source? Zodon (talk) 06:51, 25 July 2008 (UTC)

Your own source says that the rates vary from the first year to subsequent years. It is inaccurate to list only the first year as if that rate continued forever. This article needs more realistic long-term failure rates in addition to the yearly rates. 96.224.66.8 (talk) 23:19, 27 July 2008 (UTC)

It is standard in birth control literature to list the failure rate for the first year when doing an overview or comparison to other methods. More in depth information is certainly available and encyclopedic, but it belongs in the individual method articles, not here. Lyrl^Talk _C 23:17, 28 July 2008 (UTC)

No. A comparison of the long-term failure rates of different birth control methods belongs in Comparison of birth control methods. 71.167.70.116 (talk) 00:05, 7 August 2008 (UTC)

Does anonymous have a rationale for deviating from the professional literary standard in an encyclopedia article? Lyrl^Talk _C 21:54, 7 August 2008 (UTC)

If somebody comes up with well sourced information on longer term failure rates presented in a way that allows clear and meaningful comparison, why shouldn't it be here? While first year failure rates are frequently used, they aren't the only measure used to compare contraceptives. Trusell et al 1995 used estimated number of pregnancies that would be prevented in 5 years of use, among other metrics. I don't see why we can't/shouldn't use other measures in this article. If somebody wants to include some other measure/comparison, it would be easier to consider it if we have a concrete proposal with reliable data and citations.

In the abstract, I don't feel comfortable saying no we shouldn't have anything but first year failure rates here, or yes we should have other things. Zodon (talk) 01:53, 8 August 2008 (UTC)

I don't agree with the point of view to use the over-all failure rates based on the reproductive part of life (30 years). If you use a perfect method (99% safety), in the end 3 in 10 women will be pregnant (unintended of course) during their reproductive life - that's simple statistics (Hulka JF. "A mathematical study of contraceptive efficiency". Am.J.Obst.Gyn. 104:443-47, 1969). So this 30-year failure rate is useless. In fact, the one year calculation is more informative, because many woman try to achieve at least one pregnancy during their lifetime :-)

But one point you mentioned could be improved: Nobody knows where the sources of the failure rates, and they differ from study to study. I think it would be useful if anyone could provide some references for the data. I'm very sorry because I haven't got the time for that at the moment. 15 August 2008 —Preceding unsigned comment added by 193.175.73.206 (talk) 14:00, 15 August 2008 (UTC)

Sources already listed Comparison_of_birth_control_methods#References_for_effectiveness_rates Zodon (talk) 20:44, 15 August 2008 (UTC)

Sorting of methods labeled as "Every act of intercourse"

In the column titled "User action required", methods which are noted as used at "Every act of intercourse" are sorted as ((00.023)). There is a hidden note in the article which reads: "Note on frequency of action for barrier methods. Those requiring action during intercourse sorted lower number, sorted all such items together. Sorted less frequent than daily because daily sex not typical." I don't understand what "sorted lower number" means, if the writer is present would they please explain? Also, I don't understand how the number ((00.023)) was chosen (i.e. why the "Every act of intercourse" methods are sorted somewhere between daily and weekly).

My guess is that the frequency with which a person engages in intercourse is highly individual. I know committed couples who have sex almost every day, who use condoms as their birth control, and I know young people, both female and male, who have sex relatively infrequently (perhaps once every few months), who also rely on condoms for birth control. So, to sort condoms as being used "less than once per day, but more than once per week" wouldn't be at all accurate for those in either group.

Since the "Every act of intercourse" methods are the only type of method where its frequency of use is determined by the user's sex life, I want to suggest that they could be sorted either all at the top or all at the bottom, perhaps in italics, to avoid inferring what a "normal" frequency of intercourse is. 66.30.20.205 (talk) 22:42, 5 January 2009 (UTC)

I think you're suggesting that because we can't sort them correctly for everyone, we should deliberately sort them incorrectly to try to get readers to see them as a separate class. Trying to make them distinct makes sense to me. I'm not sure sorting all at the top or all at the bottom would achieve that effect; for the average reader, I think it would introduce more confusion than the current setup. Lyrl^Talk _C 01:39, 6 January 2009 (UTC)

I started the user action required column, and put in the comment you were asking about, so I will try to explain. The comment meant that those methods requiring action closer to intercourse were given smaller numbers.

• Originally the "every act of intercourse" methods were further divided. (See for instance this version.) So methods that could be put in place hours in advance of sex and left until later were given larger numbers than those that required action in the middle of sex (e.g. withdrawal). (One of the advantages sometimes mentioned for some methods is that can put it in and don't have to worry about it during sex.)
• The odd phrasing of "lower number" is because the table may be sorted ascending or descending, so can't say sorted before or after. (No claims made that it is good English.)
• That subdivision was questioned (see #User action and sorting and diff), and while I still think the division might be useful, I haven't come up with citations to back that up.
• Why it is sorted between daily and weekly: Since I don't know of a way to make it sort into a separate table when sort on that column, it has to sort someplace. Although frequency of sexual activity varies widely, average for sexually active individuals seems to be more than once a week, but less than several times per day. So put it between daily and weekly. (Based on averages, not on "normal," just as the rest of the table is based on averages.)
  • Putting it with the user independent methods didn't make much sense (i.e. sorting largest numbers), since the perfect vs. typical use efficacy and ease of use are significantly different from the user independent methods.
  • While it could be put before the methods like LAM, which require action several times/day, that level of frequency is probably not typical of large segments of the population.
  • So aiming for the average seemed to minimize possible confusion.
  • The specific number 00.023 is pretty arbitrary - under the coding scheme used for the column this would sort between daily items (00.01) and weekly items (00.07). Since there are currently no methods that require action every other day, I just chose 2. As noted above, in an earlier incarnation there was further division of these items, so used to be 00.021, 00.022, etc. I am guessing that 00.023 was a common value, so when the subdivision was removed they made them all that value.

Hope that helps. Zodon (talk) 08:23, 6 January 2009 (UTC)

I thank you very much for that in-depth explanation, Zodon. Clearly you have put quite a bit of thought into the placement of these items, and I respect that effort. However, I feel that this information has not really answered my question. You said, "... average for sexually active individuals seems to be more than once a week, but less than several times per day...". What source, if any, are you using to inform this perception? If it is simply a guess, I think that that would fall short of Wikipedia standards. (See also my comment below.) 66.30.20.205 (talk) 13:38, 6 January 2009 (UTC)

Lyrl, I am glad to hear that making this group of items distinct makes sense to you. Luckily, I do not think that the methods available for doing so would involve "deliberately sorting them incorrectly", manipulating readers, or otherwise defying Wikipedia's overall goals of providing correct and neutral information.

It appears that there is no "correct" method of sorting, because usage rates vary so widely. In fact, I would say that semi-arbitrarily choosing a sorting for these methods is less accurate than setting the per-intercourse methods apart as a class. Usage rates for the other methods do not vary at all, thus, they are in a separate class. (See also my comment below.) 66.30.20.205 (talk) 13:38, 6 January 2009 (UTC)

I have tried out a new scheme for the sorting of items used with "every act of intercourse". The items are sorted at top and given a pink color. In conjunction with notes in and below the key table, these modifications should clarify to readers the purpose for the sorting. (Also, I have given the non-user-dependent methods a color of their own--purple--and I have changed the colors to ensure that the brightness and saturation is uniform throughout the colors, so that all that changes is the hue). I am interested to hear your feedback on these changes and am open to further changes. 66.30.20.205 (talk) 13:38, 6 January 2009 (UTC)

Frequency of sexual intercourse was not "just a guess," I checked various sources. Human sexual behavior#Social norms and rules indicates (with source) that married Americans average 2-3 times/week. The Kinsey Institute FAQ indicates from 69 to 112 times/year (depending on age) as average for people in the US.[6] Another source gives an average for adults of 62 times per year "a little over once per week."[7] Although significant decline is noted for those above reproductive age, that has little bearing on birth control.

The sources I found dealing with outside the USA gave similar figures. For instance, this survey[8] estimated that globally people have sex on average 103 times per year.[9]

Since the effectiveness rates in the table are based on average behavior (if you have sex less often you will be less likely to become pregnant with most any method that has a non-zero failure rate, and typical failure rate is based on average usage), it is unclear why average behavior should be used for effectiveness, but not for user action required.

The revision which changed the sort order and introduced using colors to indicate the order has several problems.

• Sort order
  • As noted above, it is misleading since if the "user action required" column is interpreted as frequency of action, it puts the items further from the average frequency of this behavior.
  • The note is incorrect in saying methods requiring action at every intercourse sort at the top, if you click sort again they sort at the bottom. (That is why the comment said smaller number, can't say top or bottom because it depends on whether you sort in ascending or descending order).
• Color
  • The change does not "Ensure that colour is not the only way used to convey important information."Wikipedia:Colours
  • The colors are confusing - more colors means more to keep track of. Since user independent methods also have low failure rates (under 1%), using the same color for both reduced the number of indicators to keep track of without introducing much confusion. (The purple color introduced bears little similarity to the blue, and even less under some forms of color-blindness.)
• The pink color introduced is hard to tell from the "red" used for "higher risk," but most of the methods involved are not in the "red" coloring for effectiveness. (The original coloring went from green for safer to red for less safe.) Coloring the daily use methods with a redish color may make them appear to be less safe than the numbers indicate.
• The more colors problem becomes even more pronounced when you look at it in monochrome (e.g. monochrome display or printer) or with a colorblind filter.

I am reverting the change for reasons indicated, but can get to it from the link above for purposes of discussion, etc. Zodon (talk) 03:57, 7 January 2009 (UTC)

On the recoloring to the more pastel hues - it also made the items less distinct for non-color blind viewer. Having just gone through and reverted the changes I appreciate all the work it was to recolor the whole thing. Might save work to propose and discuss coloring changes on talk page before doing them. Zodon (talk) 05:08, 7 January 2009 (UTC)

Comparison - cost, method use

The idea of expanding the comparison to include costs has been talked about under scope of article. There was also some talk on the birth control article about including information on relative rates of method use (Talk:Birth control#Stats on usage).

A recent Trussell, et al. article inspired me to consider adding some coverage of the topics.

• James Trussell, Anjana Lalla, Quan Doan, Eileen Reyes, Lionel Pinto, Joseph Gricar (2009). "Cost effectiveness of contraceptives in the United States". Contraception. 79 (1): 5-14. PMID 19041435.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Since costs vary significantly by country (e.g. USA medical costs typically much higher than in other countries), and contraceptive method use also varies by country, should coverage be on a country basis? Would it be appropriate to add coverage of costs, cost effectiveness and use for USA to this article? Would it be better to start a fresh article for contraceptive use in the United States? (If a new article, what should it be called?)

As the current table is growing rather large I figure the way to do it is to start a fresh table, possibly including column on typical use effectiveness from the current table, and then including costs (possibly divided by method, failure, side effects), and usage (possibly divided by age group). Thoughts? Zodon (talk) 06:48, 7 January 2009 (UTC)

I agree, a separate area makes more sense than trying to fit more into the table. Have you considered a prose discussion section instead of a table? Lyrl^Talk _C 20:48, 10 January 2009 (UTC)

I figured there would be prose discussion, but thought a table would be the clearest presentation of basic information. (With possibly graph for the numerically disinclined.) Rather than saying "in USA most common method is sterilization (x%), followed by ...," a table seems more succinct. Table also allows sorting by use, cost, effectiveness, etc., as desired.

Table seemed like obvious way to present it, but certainly open to other presentation styles. Do you see particular problems with tabular presentation, or superior merit to prose? Zodon (talk) 04:22, 11 January 2009 (UTC)

I'm just used to seeing more prose in an encyclopedia, I think. A table sounds like it would work well. Lyrl^Talk _C 13:59, 11 January 2009 (UTC)

Discontinued methods

Recently several methods were deleted with the claim that they were unavailable. I have reverted the deletions because for some there is no evidence to substantiate the claim Combined injectable contraceptive, Jadelle (various references seem to still indicate availability), some of the other methods (various caps) were available until recently, and citations still indicate that they may be available (ceasing manufacture doesn't mean unavailable), or citation for unavailability only covers limited area. Also, as the caps are good for several years there are probably people still using them.

Since parity had a significant impact on the effectiveness of the Prentif cap, unless there is evidence that FemCap is not likewise affected, it might be well to retain the Prentif data. Zodon (talk) 03:41, 18 February 2009 (UTC)

Yes, I deleted these methods. There are many unavailable methods which we do not list: we do not list the discontinued Dalkon Shield, nor do we list the historic stem pessary or the Grafenberg ring. Listed in this chart are methods which are currently available for new use. If a user is still using a device which is no longer available, this means that they have already visited with a health care professional, or at least have had access to the packaging inserts, making them aware of how well their method works.

I appreciate your point about the Prentif data, but I think that including it in the chart as an obtuse warning about the FemCap would be WP:OR and therefore inadvisable. Any potential user of the FemCap must be fitted by a health care provider, who can discuss whatever effect parity may have on its effectiveness.

I view the scope of this article as listing comparison of methods now available, not methods which may have been available in the past. I do not think it is useful to retain discontinued methods for direct comparison with available methods, I think it will simply confuse readers as to which methods are actually available. I think the chart is most useful for people who are interested to read about modern methods. If you disagree, please explain why we need information on discontinued methods in the chart for direct comparison with available methods. Perhaps we could create an "availability" column, and/or gray out discontinued methods.

I think that the discontinued methods should not remain as they are, with no indication that they are not available. I think there should be a change. I think removing the information altogether is the best, least confusing approach. Please respond with your thoughts on these or any other ideas you have. Thanks, Whatever404 (talk) 13:28, 18 February 2009 (UTC)

The assertion that Combined injectable contraceptive, Jadelle are no longer available is not supported by statements or references in the corresponding articles. It may be the case that they have been discontinued, but then the articles should be updated (with sources). The table (and the navigation template) currently don't assert availability, just that these are birth control methods and some information about their characteristics (which is supported by references in this and linked articles). If there is someplace a statement about availability that you feel needs citation, please indicate where it is, so we can see about fixing/sourcing it. (e.g., Jadelle is listed in use in USAID contract in 2007, about.com lists CIC available in several countries (date unspecified)).

As it stands, the comparison does not say that these are currently available methods. We could consider changing it to be available methods - but that is a major enough change that requires discussion and careful consideration, especially since this topic has been discussed before #Local availability.

• Since availability varies considerably by locality, it would be challenging to provide the information. The table is already fairly full, and including the information in the existing table would probably make it harder to use.
• This is an encyclopedia, not a marketing guide or medical advice site. It covers history as well as current, etc. While declining in popularity, the cervical cap has been a widely recognized contraceptive, and the Prentif data is widely used in such comparisons. Though the device may not be available, it has been used as representative of that class of devices. (Data appears to be of better quality than that for the FemCap. Has been in Contraceptive Tech for fair while.)
• As far as Lea's Shield - I don't know the details on it. The company still has a web site, etc., so unavailability may be temporary. I would not object to it's removal (assuming there isn't evidence that it will be reintroduced soon), since it is a relatively new device, doesn't have historical import that Prentif/Cervical Cap did (and covered in same article).
• The Dalcon shield, Grafenberg Ring and Stem pessary are all variants of devices listed here. (IUD and cervical cap). (Reasonable to compare/cover the gamut, but don't have to give whole history of effectiveness of each type of device here.)

So I don't think we should use current availability as a defining criterion for the table. (I think of it more as representative examples of methods.) Also, I don't see how to comprehensibly add such a large body of information to the existing table.

Which isn't to say that availability should not be covered - for instance Emergency contraceptive availability by country. If want to add availability - suggest we do it separately (could do in a separate table in this article, standardize the coverage in the individual method articles (maybe even a table or an infobox), do more lists like for EC, ...) Zodon (talk) 05:57, 19 February 2009 (UTC)

Navigation template

Since you suggested centralizing discussion of deletion both for {{Birth control methods}} and the comparison table here, above considerations apply to template, but there are some additional ones. Not sure how one would cover availability on template - short of splitting into localized versions, which would mean a lot more templates on the articles, or a much more complicated template. WP:Navigation templates are for navigating between related articles. Whether these devices are available in a particular area at a particular time does not change their relatedness.

Cervical cap is a more general and probably more widely recognized name than FemCap, so I think the cervical cap article should continue to be listed by it's primary name.

The template does miss some methods that have articles, and I have been thinking that some additional navigation aid would be helpful (though how to do that is probably best left for a separate discussion). Zodon (talk) 05:57, 19 February 2009 (UTC)

Coitus interruptus - Double entry in table

Coitus interruptus is listed in to the methods table at both 0.04% (top) and 27.4% (mid-table) effective, is this an error, or can this be explained. - Thanks —Preceding unsigned comment added by 90.201.118.109 (talk) 23:23, 3 July 2009 (UTC)

Herbal medicine

Sterilisation can be also be done by smoking the body with Erythrophleum chlorostachyum, or by consuming plant substance of cymbidium madidum, petalostigma pubescens, Eucalyptus gamophylla. Noted in the book by Jennifer Isaacs Add in article —Preceding unsigned comment added by 81.243.190.151 (talk) 12:31, 13 July 2009 (UTC)