More than half of women who Obtained an abortion last year were using contraception

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Over half of women who got an abortion last year were using at least one form of contraception, according to information published by the British Pregnancy Advisory Service, a United Kingdom charity that offers reproductive health services, including abortions.

What’s more, nearly a quarter of women were using either hormonal contraception such as birth control pills or a long-acting contraceptive method such as an IUD. Both are among the more effective kinds of contraception, with long-acting contraceptives regarded as the most effective.

The statistics talk to a dirty little secret that is not much of a secret at all: Contraception–which runs the gamut from condoms to birth control pills and patches to IUDs, implants and injections–usually works, but it doesn’t always work.

When used flawlessly, contraception can be 98% or 99% effective. Though those figures are commonly bandied around, it is less effective in real life use, with problems such as human error and difficulty renewing one’s supply getting in the way, reproductive health experts told MarketWatch.

For women in their twenties–of which there were about 61 million in 2012–the consequences of contraceptive failure are swift and have immediate implications for their lives.

Moreover, many types of contraception can mask the signs of pregnancy, which poses a problem for women in regards to discovering the illness in time to create a decision like abortion, they said.

“Our data shows women cannot control their fertility through contraception alone, even when they are using some of the most effective methods,” said BPAS Chief Executive Ann Furedi. “Abortion is birth control that women need when their routine method lets them down.”

Though contraceptives do have a risk of failure, they are effective, experts highlighted. Better contraceptive use has helped contribute to a declining U.S. abortion rate, which reached a record low in 2014, according to the non-partisan Guttmacher Institute.

Contraceptives have also become far more affordable for U.S. women since the Affordable Care Act was passed, with the requirement that many health plans cover them.

Related: Birth control pills are the infrequent prescription drug that’s actually become cheaper

But access to contraception and abortions are equally threatened amid efforts to repeal the Affordable Care Act and defund Planned Parenthood, which offers reproductive health services to women together with abortions.

Read: Fearing changes under President-elect Trump, women are becoming IUDs and stockpiling Plan B

Despite the reassurance of infallibility, it’s still important that women have access to contraception, have the ability to choose the type that best works for them and use it consistently, experts said.

“No method of contraception is foolproof, and that’s what we have to tell patients,” said American Congress of Obstetricians and Gynecologists President Dr. Haywood Brown. But “we also do not want to frighten people. We need them to know they are doing the right thing.”

The BPAS data did not break down into groups beyond use of contraceptives, but experts said it’s very likely that all of the woman who reported using contraception are not necessarily using it faithfully.

Of those with unintended pregnancies, 5% used contraception correctly and consistently, while 41% used contraception inconsistently or incorrectly, according to 2008 Guttmacher Institute statistics.

Long-acting contraceptives are considered the most effective, including implants, IUDs and permanent sterilization, which have failure rates below 1%.

But they could still fail in various ways. IUDs can be in the wrong place or perhaps get pushed out, which is more likely to occur immediately after a woman gets one but can occur later, too. And since IUDs can last up to 10 decades, a woman may forget to get the device replaced.

Even permanent sterilization fails in rare cases, experts noted.

Any contraceptive that’s user-controlled, or require a woman to do something daily, has the highest possibility of failure, said Dr. Maria Rodriguez, an assistant professor in Oregon Health & Science University’s Department of Obstetrics and Gynecology.

Guttmacher

Male condoms, which have an 18% failure rate, may well be the best-known example of contraceptive failure.

But there are also many ways that human error can influence a birth control pill, which has a 9% failure rate, particularly if the pill is one with a lower dose of hormones.

1 common problem happens when a woman doesn’t take the pill at the exact same time daily, experts said.

Missing doses is another issue. Even if the missed doses occurred earlier in the week, by way of instance, the woman will need emergency contraception, ACOG’s Brown said.

Birth control pills “really just keep ovaries from presenting a follicle, but follicles are still in a stage of growth,” Brown said. “If you miss one pill, two pills in a week, you run the chance of ovulating.”

Skipped doses can also occur when a woman has run out of tablets and needs a new supply.

Many health insurance plans only allow for a month’s worth at a time, which means a woman should resupply fairly often, said Dr. Philip Darney, professor and director of the Bixby Center for Global Reproductive Health at the University of California, San Francisco. “It only takes missing a few birth control pills for a individual to become pregnant.”

Likewise injectable contraceptives like Pfizer Inc.’s

PFE, -0.09%

 Depo-Provera requires resupply every three months, the patch each week and the vaginal ring each month, he noted. The contraceptives have failure rates of 6 percent, 9% and 9% respectively.

Other medications can also interfere with the birth control pill’s effectiveness. They include an antibiotic for tuberculosis and seizure medications, which may also be used for bipolar disorder and other ailments, Rodriguez said.

“Contraception, and women’s health in general, is siloed in the mainstream idea of healthcare,” she said. “Their internist, if they have seizures, or neurologist, is not always considering contraception. It should be part of the overall health care we provide to women, whether they’ve complicated conditions or not.”

For women who are concerned about their contraception failing, symptoms may include missing a period, irregular bleeding, nausea, unexplained fatigue, bloating or weight gain and breast tenderness. They should visit their doctors or take a pregnancy test, experts said.

But it’s also important that women understand that contraception is fallible. Patients who have been using contraception when they got pregnant tend not to believe that it’s possible, and often delay coming to the physician consequently, experts said.

Those patients often feel betrayed by their contraception, Darney said, making it especially important to get a variety of contraceptive choices available and continue to make progress on developing new types.

The BPAS data, published July 7, surveyed the 60,592 women who had an abortion at BPAS clinics this past year.

Contraceptive manufacturers include Pfizer, Merck & Co.. Inc..

MRK, -0.83%

Bayer AG

BAYRY, -0.55%

Allergan

AGN, -0.61%

Johnson & Johnson

JNJ, -0.44%

Teva Pharmaceutical Industries Ltd..

TEVA, -1.61%

and Church & Dwight Co.. Inc..

CHD, -1.17%

This story was first published on August 2.

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