If you’ve watched a zombie movie with your friends, you’ve probably talked about what kinds of weapons you’d be packing in case of a zombie apocalypse. The Centers for Disease Control and Prevention even has a list of supplies you’ll need for a zombie preparedness kit, which includes smart choices like water, duct tape, and bleach. (I would add toilet paper to that list. How you’ll miss it when you’re on the run!) But how many of you have discussed birth control?
Even if your greatest dream is to have a baby, you must admit that the zombie apocalypse is the worst time to be pregnant, give birth, and raise a child. Fleeing and hand-to-hand combat can be a drag while pregnant, and childbirth can kill you, especially without access to trained personnel or hygienic supplies. And if you do manage to birth a baby into this cruel new world, diapers can distract from more pressing duties, and the infant’s cries can attract undead attention.
When you’re in hardcore fight-or-flight mode, taking a pill at the same time every day might be difficult, and besides, a supply of pills can take up valuable backpack real estate. Plus, even if you find an abandoned pharmacy to raid, birth control pills and condoms come with expiration dates and can be affected by high temperatures. The same goes for contraceptive patches and rings. For these reasons, you need a contraceptive method that’s well suited to the zombie apocalypse. Besides abstinence, what are your options?
In The Walking Dead, Lori discovered that she was pregnant, which in this zombie-filled hellscape was met with dread rather than joy. In desperation, she obtained a handful of morning-after pills with the intent to abort. Reproductive-health advocates howled in protest — the morning-after pill, or emergency contraception, is completely different from the abortion pill, and has no effect on an existing pregnancy!
However, it might be useful to have some emergency contraception on hand, so you’ll have it ready to go if you’ve engaged in unprotected intercourse. If you don’t have it stashed in your backpack, you’ll need to raid a pharmacy ASAP, as it loses effectiveness the longer you wait.
Emergency contraception is safe, with no reports of complications during its 30-year history.
Plan B and Next Choice can be taken up to three days after intercourse, and ella is effective for up to five days.
Emergency contraception must be stored at room temperature, so its shelf life might decrease in the absence of air conditioning.
Plan B and Next Choice are only 89 percent effective, and ella is only 85 percent effective. Better than nothing, but does the zombie apocalypse call for more reliable methods?
It should not be used as a regular method of birth control, so if you and a sweetie are boarded up in a secure location, you’ll want more reliable options.
Side effects are rare, but can include irregular bleeding for a day or two, dizziness, headaches, or vomiting.
Plan B and Next Choice are less effective in overweight individuals (BMI between 25 and 30), and ella might not be effective in those with a BMI above 35.
No STD protection.
The diaphragm isn’t used much these days, and it works better when paired with spermicide, but if you want to be prepared for the zombie apocalypse, you might want to make an appointment for a fitting. You can carry it with you in a discreet case and use it on an as-needed basis.
Despite our admonition that condoms can be affected by heat, it’s still important to try to pair a diaphragm with a condom. Not only will this pairing increase the effectiveness of your birth control, but also, the infectious agent responsible for triggering the zombie apocalypse isn’t the only pathogen you have to worry about. If you’re able to grab some intimate time with a fellow survivor, a condom will help protect you from other microbes, such as those that cause HIV, chlamydia,gonorrhea, or syphilis — all of which can seriously impair your health if left untreated. If a condom’s color is uneven or has changed, or if it is brittle, dry, or very sticky, it might be expired or damaged.
It doesn’t interfere with hormone levels.
If you take good care of your diaphragm, it should last you about two years. (But watch out for holes, weak spots, cracks, or wrinkles.)
While it’s not an “official” medical use of the diaphragm, many women report using them as menstrual cups! Disposable pads will take up way too much space in your bag, and you’re not going to be able to clean and dry reusable cloth pads while you’re on the run. Perhaps you could grab some tampons from an abandoned drugstore every month — or you could just use your diaphragm or a menstrual cup to last you through the zombie apocalypse and save you multiple trips into drugstore deathtraps.
It is one of the least effective contraceptive devices — even when used with spermicide, 6 out of 100 women using it correctly and consistently will be pregnant at the end of the year. “Typical use” efficacy is much lower, with 16 out of 100 women becoming pregnant after a year. However, using it in tandem with condoms can significantly boost efficacy — my back-of-the-envelope calculations indicate that, with typical use, the trio of the condom, diaphragm, and spermicide will leave only 2 out of 100 women pregnant after a year.
If you’re unable to use your diaphragm with spermicide, it might be even less effective, but the question of efficacy without spermicide has not beensufficiently studied.
Washing and drying it after every use might be difficult when you’re on the run from zombies.
Insufficient protection against STDs. Furthermore, spermicide might increase HIV risk.
If these zombies die of starvation within a couple of months, as in 28 Days Later, then the birth control shot might be right for you. If you can find an abandoned Planned Parenthood health center to raid, locate the Depo-Provera and find a health care professional to administer an intramuscular shot.
Continuous pregnancy protection for three months!
After a year of regular Depo-Provera shots, most people experience lighter periods — or no periods.
It’s more than 99 percent effective!
During the first three months, users can experience irregular or prolonged bleeding.
Possible side effects include irregular bleeding or spotting, headache, or nausea.
Depo-Provera needs to be stored between 68 and 77 degrees Fahrenheit, so if that abandoned Planned Parenthood building wasn’t sufficiently insulated, excessive heat or cold could render your dose ineffective.
No STD protection.
Birth control implant
If, on the other hand, this zombie apocalypse has no end in sight, like the one in The Walking Dead, you’ll want something that can last for years. So, the second you see that ominous news feed with footage of flesh-eating fiends and warnings of an unidentified pathogen sweeping the nation, you might try to make an emergency appointment at your local Planned Parenthood for a birth control implant. A skilled provider can perform a minor outpatient surgery that places a matchstick-sized implant under your skin.
Protection lasts for three years.
Most users experience lighter and fewer periods.
The implant is a highly effective form of birth control with a failure rate of 0.05 percent.
Possible side effects include irregular bleeding, headache, and nausea.
If you don’t have insurance, it can cost a few hundred dollars — but if you got it, spend it, as money will be meaningless in the zombie apocalypse!
If you’re unable to get it removed after three years, it will stop working, but still might interfere with your period.
No STD protection.
Intrauterine device (IUD)
If you have your doubts that civilization will rebuild itself in three years, you might want something that lasts even longer than an implant. The hormonal IUD Mirena lasts for five years, and a copper IUD (Paragard) can last for 12 years! IUDs prevent sperm from meeting the egg.
IUDs are more than 99 percent effective, making them one of the best forms of birth control. Over the course of a decade, only 2 copper IUD users out of 100 will become pregnant. Over a period of five years, only 5 to 8 Mirena users out of 1,000 will become pregnant.
The copper IUD doesn’t interfere with hormone levels.
Hormonal IUDs can reduce menstrual cramps and make periods lighter.
Paragard can also increase risk for anemia, which might be a problem when your access to iron-rich food sources is sporadic.
Possible side effects of the copper IUD include heavier periods and worse menstrual cramps. One review, which only looked at women who hadn’t had children, found three studies of Paragard side effects; when the results of these studies are combined, 18 percent of users had Paragard removed after 12 months due to bleeding or pain. However, women who have already carried a pregnancy to term are at lower risk for these side effects when using Paragard.
Rarely, an IUD can move out of place, in which case it will need to be put back into place by a medical professional — who might not be easy to locate when all lines of communication are down. A study published earlier this year, which didn’t differentiate between users who had and hadn’t given birth, found that Paragard was expelled within 12 months 6 percent of the time, while Mirena was expelled within 12 months 3 percent of the time.
Rarely, an IUD can puncture the uterine wall (0.3 percent of the time in this study), but this injury often heals without treatment. Still, better to have access to trained personnel!
Rarely, an infection might develop around the IUD, especially within the first three weeks after insertion.
A checkup within three months after insertion, and regular checkups after that, is highly recommended to ensure the IUD is in place. Of course, access to regular medical care might be interrupted during the zombie apocalypse.
If you are one of the rare IUD users who becomes pregnant, the presence of the IUD can increase risk for miscarriage or infection.
Like the implant, it can be pricey without insurance — but you won’t miss that money in the zombie apocalypse, when those dollar bills are best re-purposed as toilet paper once you’ve used up your last roll.
No STD protection.
Perhaps the women of zombie lore are getting contraception from the same place that supplies them with the razors and waxes that keep their apocalyptic armpits silky smooth. But most likely, you’ll need to plan ahead to ensure that an unintended pregnancy isn’t another horror to deal with on top of everything else.
To learn about these and other types of birth control, make an appointment at your local Planned Parenthood, where a health care provider can review your options with you and help you find something appropriate for your lifestyle and preferences.
And, in case it’s not apparent, the zombie apocalypse will almost certainly remain the stuff of comic books, movies, and television — not real life. You don’t need to make your birth control decisions under the assumption that the end of civilization is nigh! Instead, you can make them in consultation with a health care provider, obtain prescriptions as needed, and have injections administered by a professional.