The most effective methods are those that are long acting and do not require ongoing health care visits.[1] Surgical sterilization, implantable hormones, and intrauterine devices all have first-year failure rates of less than 1%.[2] Hormonal contraceptive pills, patches or vaginal rings, and the lactational amenorrhea method (LAM), if adhered to strictly, can also have first-year (or for LAM, first-6-month) failure rates of less than 1%.[27] With typical use, first-year failure rates are considerably high, at 9%, due to inconsistent use.[21] Other methods such as condoms, diaphragms, and spermicides have higher first-year failure rates even with perfect usage.[27] The American Academy of Pediatrics recommends long acting reversible birth control as first line for young individuals.[28]