The air in the bedroom felt suffocating as I watched the timer, muted and off-camera during a work call. I felt my heart beating in my ears. The timer dinged as my co-workers continued chatting in the background, all of us equally unaware that my life was about to change. I looked down at the pregnancy test resting on the desk. Two pink lines. It felt like the breath had been knocked out of me and I blacked out from sheer panic. Only when a coworker said my name did I snap out of it, squeaking out an answer before I placed myself back on mute, sobbing hysterically, cursing obscenities, and eventually, throwing up from stress.
“How could this happen? We’ve been using Phexxi,” I thought to myself. Phexxi is an FDA-approved, non-hormonal birth control method, marketed as a reliable, hormone-free alternative to the pill. It’s a contraceptive gel that you insert into the vagina (using a pre-filled applicator similar to a tampon) any time between an hour and immediately before intercourse. Made up of lactic acid, citric acid, and potassium bitartrate, Phexxi is designed to lower the pH of the vagina and make it harder for sperm to move. This reduces the chance of the sperm fertilizing an egg during ovulation. At the time, it was also my and my husband’s birth control of choice.
Between our sons’ therapy sessions, educational support meetings, and multiple surgeries, our two beautiful boys kept us busy. We had decided that two kids were enough and our family was complete, but after 15 years of hormonal birth control, I had also decided to discontinue the pill due to unwanted side effects. I tried a copper IUD after the birth of our second child but I bled every day for months until it was removed. My midwife then mentioned Phexxi and we started using it in July 2022.
For more than a year, we followed the instructions closely. We never had any problems, until that October day in 2023.
Initial claims made by Evofem Biosciences, the manufacturer of Phexxi, stated the contraception had an effective rate of 99 percent when used as directed. But Planned Parenthood found that Phexxi is only 86 percent effective overall because people can make mistakes administering it, and that means 14 out of 100 people get pregnant while using the product. The Food and Drug Administration issued a letter in November 2023 that stated, “These claims [made in promotional material] create a misleading impression by overstating the efficacy of Phexxi. The 99 percent pregnancy prevention rate claimed in the brochure is based on efficacy ‘per act of sex’ which is not a validated measure to demonstrate the efficacy of contraceptive products.” Since then, Evofem Biosciences has updated their website and states an efficacy of 86 percent under typical use and 93 percent when used as directed.
But it’s not just Phexxi users that experience birth control failure. The 2019 study “Global Contraceptive Failure Rates: Who Is Most at Risk?” found that across multiple birth control methods, younger contraceptive users had failure rates 10 times higher than older users.
Kaitlynne Garner, 28, of Edinburg, Virginia, had been using birth control pills for more than a decade when she and her fiancé found out they were expecting their first child in April 2023. “I was mostly nervous but also excited,” Garner tells SheKnows. “I looked at it almost like it was meant to be.”
Garner says she was diligent, using a phone alarm to remind her to take Tri-Sprintec, and she avoided food and beverages that contained ingredients that may affect the efficacy, such as charcoal or grapefruit. Her doctor was never able to figure out how she became pregnant on birth control.
Christina Walz-Rios from Knoxville, Maryland, is a retired maternal and child health specialist. For almost 20 years, she worked with high-risk military families enrolled in a new parent support program. She estimates that she worked with around a dozen women who had unplanned pregnancies while using contraception during her career.
“The birth control pill is only 99 percent effective,” said Walz-Rios. “So, if you fall in that 1 percent, then it’s 100 percent of your life.” Women who go on birth control don’t get the full picture, she adds. There’s a lot of misinformation out there, and contraceptive users may assume that birth control is guaranteed to work. That may not always be the case.
The issue has become more pressing in recent years. As more women lose access to reproductive options like abortion, understanding the full picture of birth control efficacy is critical when it comes to preventing unplanned pregnancies. Too often, we get the information too late.
After the initial shock of my own pregnancy wore off, I feverishly started researching Phexxi to understand what had happened. I uncovered women on TikTok sharing similar stories, which led to an Rolling Stone article in which users claimed they had gotten pregnant while using it just as I had. Complaints about Phexxi on WebMD stared back at me as I blinked back tears. Several posts on Reddit all came to the same conclusion: don’t use Phexxi. I wish I had done more research before using the product because all the red flags were there. But Phexxi’s flashy “Welcome to My Vagina” commercials, featuring Annie Murphy from Schitt’s Creek, delivered enticing promises. Between those commercials, the pamphlet laying in my doctor’s office, and a quick conversation with my midwife, I was confident the product was for me.
A year later, I was left feeling betrayed by a contraceptive that hadn’t worked. I spent the better part of my pregnancy angry and resentful because I had lost autonomy over my body. During the first 17 weeks of the pregnancy, I would get angry at the thought of eating. This feeling was not to be confused with morning sickness — I was hungry and rarely nauseous, but the mere idea of cooking meals and eating left me seeing red. Toward the end of my pregnancy, I tripped on a toy and sprained my ankle, and I was diagnosed with polyhydramnios, or excessive amniotic fluid. But the pregnancy didn’t affect just me, it affected my whole family’s dynamic. We had to make adjustments to our small home that would accommodate our growing family. We watched as our two boys struggled with room sharing, and it was increasingly evident at how miserable they had become toward each other. We’d been so busy teaching our boys to advocate for themselves that I never advocated for myself. I didn’t stop to ask questions and empower myself when it came to my reproductive system. At 33 years old, I never imagined experiencing an unplanned pregnancy — but now, every time I look at the face of our youngest, I fall in love. An unplanned pregnancy left my…
