For women who don't have regular access to affordable birth control -- or who find themselves in an emergency -- the birth control black market is just a click away.
On Craigslist in New York City, a two-month supply of Yaz birth control pills is available for $60. A year's worth of Ortho-Cyclen can be found for $50 in Los Angeles. And emergency morning-after pills, such as the over-the-counter Plan B, are available for $15, a considerable markdown from the $48 prices in pharmacies.
Such online listings demonstrate a continued need for affordable and easily accessed contraception, says Dr. Vanessa Cullins, vice president for medical affairs at Planned Parenthood Federation of America.
"We need to look at alternative avenues to provide birth-control services and viable options to women having to come into an office to be seen for each and every pill-refill visit," she says. "When women are pushed against a wall, they will take action on their own."
Dr. Cullins says that birth control pills and emergency contraception are very safe to use for nearly all women. Her primary safety concern for women who acquire their pills through back channels is the possibility the pills might have been tampered with or that the medication might have expired.
Pricing Prescription Birth Control
For sexually active women and men who use contraceptives, the personal cost of birth control ranges from $10 to $100 or more a month. That's not terribly high, but in tough economic times, when discretionary income shrinks, the impact of that price tag is magnified. A 2009 study by the American College of Obstetricians and Gynecologists showed that one-third of women using birth control were more mindful of their contraception because of economic concerns. For women using hormonal methods, 13% reported being worried that they might not be able to pay for it.
Anna Balkrishna, 33, who works in television in New York City, recalls going to Planned Parenthood when she didn't have health insurance several years ago because it was the most affordable option. At $20 for a monthly pack of pills, she says the price was right. Balkrishna's annual cost -- $240 -- is typical for many women.
But for many other women -- even those with insurance -- that annual cost is much higher. Using the NuvaRing or getting Depo-Provera shots can add up to from $480 to $900 each year, depending on insurance coverage. Equally steep is an IUD, at least up front. The cost of the device plus an office appointment for insertion runs in the range of $600 to $700 total. Brands like Mirena last up to five years, bringing that total cost down to just dollars a month over time. But that's a commitment not all women are ready to make.
Alexandria Bullock, 25, a category manager for a marketing company in Boise, Idaho, likes the flexibility of a once-a-month program. She recently started using the NuvaRing and pays $25 for the device, which is inserted monthly and deploys time-release hormones. While it's a cost she can afford today with her salary of around $35,000 per year, it hasn't always been like that.
"I can't imagine trying to pay for it making less than I do," she says about the $300 annual cost. "The cost did change the kind of birth control I use. I was on the Spintec pill until I was out of college. Now that I have a full-time occupation, I can afford the NuvaRing."
The Cost of Alternatives
For low-income women and those without insurance, these options are simply out of reach financially and underscore the problems of affordability and access for those least able to afford unwanted pregnancies. In the United States, there are 62 million women of child-bearing age, nearly two-thirds of whom are sexually active and do not want to become pregnant. Planned Parenthood provides health services to more than 5 million people worldwide each year, 75% of whom are at or below the poverty line. And fully 35% of all the health services provided by the 95-year-old organization are for contraception.
Over-the-counter drugstore alternatives -- mainly spermicides and condoms -- are not cheap, especially for repeat customers. At around $5.50 for one Today cap (a spermicide-soaked insert), the contraceptive puts an economic fine point on whether a partner is "sponge-worthy." Other spermicide treatments like contraceptive gel cost around $1 to $2 per application.
A three-pack of name-brand latex condoms rings up at just over $2 apiece. Natural skin condoms can cost more than $4 each. Condoms are also the only method that also protect against STDs, and public health officials recommend using condoms for safe sex even when using another contraceptive method. That puts the cost of every round of intercourse in the neighborhood of $3 to $8. And that can really add up.
As with most things, buying in bulk brings down the price. On Amazon.com, a top-rated seller is Trojan Twisted Pleasure: For a case of 36, they're just 57 cents each. Compare that to other alternatives for men: Sterilization or a vasectomy cost well over $1,000.
Jake D. (not his real name), 35, is an actor in New York City and either buys condoms at a chain drugstore or gets them for free at a clinic. He estimates he spends between $20 and $30 a month. Jake says that his birth control cost has gone down over the years, not because he is buying fewer condoms, but because he doesn't feel the need to buy a toothbrush, gum, and milk to obscure the Trojan box.
"I thought the cashier wouldn't realize I'm buying them if they were mixed in with some other random things," he recalls. "It used to cost me a lot more."
The Cheapest Contraceptive
The most cost-efficient method turns out to be a diaphragm, according to an analysis in U.S. News and World Report. The cup-shaped rubber device, which a woman inserts with a spermicide before intercourse, costs around $60 per year to use (not including the appointment to get it fitted).
Abstinence and fertility-awareness are free, strictly speaking in dollars and cents, as is the prophylactic of last resort: the pull-out method. However, that method is also the least effective. As many a mother has reminded her daughters and sons: All it takes is one swimmer.
Not Just for Birth Control
Many women take hormone-based pills for other health issues, such as ovarian cysts and endometriosis. Amy Hawley, 33, who works as a university academic adviser in Miami, saw her pill bill skyrocket from $10 to $50 a month when she moved from New Jersey to Florida in 2010 for a new job.
Under her new regional insurance plan, she was shocked to see her bill increase by 400%. Even more surprising, she says, is that the generic version cost more than the name brand. After getting a new prescription, her cost dropped to $30. It still adds up to $360 a year -- almost a dollar a day.
Who Pays for It?
Hawley she says she foots the bill as the pill is part of her health care regimen. For other women, the answer is less clearly defined. Long threads on a variety of Internet forums are dedicated to discussing who should pay for birth control. The chorus tends to agree that for committed couples the duty is shared -- or that it should be free altogether.
Balkrishna says when she was single she paid for it herself, but she expected her boyfriend to share the cost when she was in a relationship.
"The pill is much cheaper than condoms over a month. It's like having a monthly transit pass," she says. "You can swipe all you want for the same price."
Jake says he would pay half of the birth-control bill if he was in a long-term relationship, but for now, he thinks the guy should pick up the full tab for buying condoms. "It's a man's responsibility to be prepared," he says.
As for resorting to discounted goods on Craigslist, NuvaRing-user Bullock says it seems too sketchy to her.
"I would be really wary of buying birth control there," she says. "It could be tampered with. It just feels too risky for something as important as birth control."
Catherine New is a personal and consumer finance reporter for DailyFinance.com and Aol Huffington Post.