The pill is the most widely used form of birth control in the United States, but it’s not the most effective. According to a new 24/7 Wall Street analysis of data from the Centers for Disease Control and Prevention (CDC), that title goes to the implant, a form of long-acting reversible contraception that many women just aren’t using.

The implant, which is a matchstick-sized rod, is inserted under the skin of a woman’s upper arm, where it’s effective for up to four years. It releases progesterone, a hormone that prevents a woman’s ovaries from releasing eggs and blocks sperm from reaching the eggs. And it’s highly effective — just 0.05 percent of women who use the implant have an unintended pregnancy. It’s even more effective than male sterilization (0.15 percent failure rate), IUDs (0.2-0.8 percent), and female sterilization (0.5 percent).

But, according to CDC data, just 1.3 percent of women who use birth control opt for the implant. That’s a massive difference from birth control pills, the method chosen by 26 percent of women who use birth control. However, the pill has a failure rate of 9 percent, which is huge compared with that of the implant.

So why aren’t more women using the implant? Jessica Shepherd, MD, an assistant professor of clinical obstetrics and gynecology and director of minimally invasive gynecology at the University of Illinois College of Medicine at Chicago, tells Yahoo Beauty that many women just don’t know about it. “Many people aren’t aware of all the options that are on the market,” she says.

Brett Worly, MD, an ob-gyn at the Ohio State University Wexner Medical Center, tells Yahoo Beauty that cost also used to be an obstacle. Before the Affordable Care Act, the implant was one of the more expensive birth control options available to women, and as a result, many didn’t choose it. But under the ACA, the implant is fully covered by most insurance plans. However, with the ACA in jeopardy, the implant may go back to being prohibitively expensive for many in the future.

Sherry A. Ross, MD, an ob-gyn and the author of She-ology: The Definitive Guide to Women’s Intimate Health. Period., tells Yahoo Beauty that many women are concerned about experiencing side effects. She lists irregular bleeding and spotting in the first few months as the biggest potential side effects. “A small number of women will have longer and heavier periods, which can be disruptive and annoying,” she says. Less common side effects include nausea, headaches, breast tenderness, weight gain, decrease in sex drive, pain at the insertion site, and discoloration or scarring of the skin over the implant, Ross says. There’s also an ick factor: Some women may not be OK with the idea of having a foreign object in their arm, Worly points out. And if a woman is planning to try for a pregnancy in a few months, a long-acting reversible contraception method like the implant doesn’t quite make sense.

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