2Ground Rules We respect: That any question is OK That it is OK to pass That we all have different points of viewEach other by listeningThe right to privacyThat we all need to be listened to
3Why Do Unplanned Pregnancies Happen? Embarrassed to talk about sex with partner or to get birth control suppliesNot knowing or understanding about using birth control to prevent pregnancyIndividual or religious beliefs about birth controlBirth control method not used correctly or consistentlySpontaneous act and not preparedUse of substances that affect decision making (alcohol/drugs)Difficulties accessing health careBirth control supplies are too expensive
4Contraceptive use among women of reproductive age: Results of a National Survey Contraceptive Methods15-1920-2930-39>40All WomenCondom74.355.548.842.554.3Oral contraceptive66.658.331.517.143.7Withdrawal17.312.010.38.111.6Male sterilization0.21.49.619.67.4Female sterilization0.00.716.46.0Rhythm1.52.83.06.63.5Contraceptive film184.108.40.206Natural family planning220.127.116.11.5Injection: DMPA18.104.22.168.0IUD0.55.80.82.3Levonorgestrel IUS22.214.171.124Morning after pill (Plan B)4.41.7Contraceptive Patch (Evra)126.96.36.199HysterectomyContraceptive SpongeContraceptive Ring (Nuva Ring)0.90.6Female condom0.4DiaphragmImplant0.1Cervical capBlack, A., Yang, Q., Wen, S.W., Laonde, A.B., Guilbert, E. & Fisher, W. (2009, July). Journal of Obstetrics and Gynecology,
6Unintended Pregnancies Per 1000 women during first year of use Adapted from Trussell et al., 2004
7Abstinence Abstinence means different things to different people Abstinence can mean not having any physical contactAbstinence can also mean having some physical contact but no sexual activity that involves the genitals (e.g., masturbation, sexual intercourse)How does it work?To be abstinent, you and your partner have to set some limits. These limits are different for everyoneYou can’t get pregnant or get a sexually transmitted infection (STI) if you are abstinent - with no genital to genital, skin to genital and body fluid to genital contactYou CAN get pregnant without having sexual intercourse if sperm is near the opening of the vagina. You can get some STIs by touching the genital area of your partner
8Male CondomProvides a barrier for skin to skin contact and body fluids which can help protect against pregnancy and STIAvailable at pharmacies, grocery stores and health clinicsUse a condom for oral, vaginal and anal sex or when sharing sex toysMost condoms are latex. Non-latex types include polyurethane, and polyisoprene (synthetic rubber)Check expiry date and keep in dark, cool placeDo not use with oil-based products like Vaseline, baby oil or hand cream. This increases the chance of the condom breakingUse a new condom every time you have sex. Never use two condoms at once
9Female CondomProvides a barrier for skin to skin contact and body fluids which can help protect against pregnancy and STIAvailable at pharmacies, grocery stores and health clinicsInserted prior to any vaginal contact. Can be inserted up to 8 hours prior to intercourseSoft thin plastic quickly warms to body temperature, which allows for natural feeling and sensitivitySafe to use for people with latex allergiesCan use water and/or oil based lubricantsDo not use with the male condom, this increases the chance that both will breakUse a new condom every time you have sex
10Contraceptive Spermicides Vaginal spermicides are products containing an ingredient (Nonoxynol 9) that kills sperm on contactCan be purchased at pharmacies and grocery storesInserted into the vagina before sex to help prevent pregnancyEffectiveness varies greatly. The failure rate is about 26%Spermicide should be used with a condom every timeIt is an effective method of birth control when used with condomsSpermicides can cause vaginal irritation which can increase the risk of getting STIs including HIV- Work to kill sperm before they reach the egg.- When used with a condom are 97% effective. Never use this method alone. Always use with a condom.- Foam needs to be inserted in the vagina about ½ hour prior to intercourse. A gel called Advantage 24 can be inserted up to 24 hours in advance.- You do not need a prescription. You can buy it at a drugstore/pharmacy over the counter. They cost $13-22 at the pharmacy and $10-15 at the THC/FPC.
11Hormonal Contraception (Pill/Patch/Vaginal Ring) How do they work?Stop the release of a mature eggThicken cervical mucus making it difficult for sperm to get to the eggChange the lining of the uterus making implantation difficult
12Things to Consider…With perfect use, hormonal birth control is 99% effectiveWith typical use, it is 92-97% effectiveMakes your period more regular, with less bleeding and painProtects you against some types of cancers (ovary and uterus)Does not protect you from sexually transmitted infections (STIs)
13Side Effects?Side effects that may occur during the first few months include :irregular bleeding, spottingNausea, mood swingsBloating, breast tendernessHeadachesMost symptoms are normal and will decrease or stop in the first 2-3 monthsIn rare cases, women using hormonal contraception can develop blood clots. Talk to your doctor about whether hormonal birth control is right for you
14Common myths and misconceptions about hormonal contraception It causes weight gainIt causes acneIt causes cancerIt causes infertilityIt causes birth defectsYou need to take breaks from itAll smokers should not be taking itAll women over age 35 should not use hormonal contraceptionNo need for condoms if are using hormonal contraceptionWRONG INFORMATION
15Birth Control Pills (BCP) Combined oral contraceptive pills contain two hormones; estrogen and progestinOne hormone pill is taken at the same time each day to prevent pregnancyTraditional cycles of BCP are 21 days of hormones followed by a 7 day hormone free breakNew regimes include:24 days of hormones followed by a 4 day hormone free break84 days of hormones followed by a 7 day hormone free break- The pill contains hormones that keeps the body from releasing an egg.- If used correctly is 98% effective in preventing pregnancy. No STI protection.- Take one pill at the same time every day.- Some females take the pill to regulate their menstruation (period), reduce cramps or decrease acne.- The cost is approx. $16.00 for a month supply, $7 at the THC or FPC and cheaper if you have a drug plan. Need a Dr. prescription.Ask the students:What kinds of things have you heard about the pill that concerns you?
16Birth Control PatchHormonal contraceptive patch worn on the skin that contains two hormones; estrogen and progestinA patch is worn for one week at a time. A new patch is put on once per week for three weeks. The fourth week is a hormone free breakThere might be a higher risk of getting pregnant for women who weigh more than 195 lbsMay cause skin irritation- Works like the pill.- Approximately 98-99% effective.- Wear one patch for a week, then change it every week for 3 weeks. The 4th week you wear no patch and get your period.- Good for people who forget to take a pill everyday.- About $17 a month with a prescription or $10 at the THC/FPC.
17Vaginal Contraceptive Ring Hormonal contraceptive ring is worn inside the woman’s vagina. It contains two hormones; estrogen and progestinA ring is worn for three weeks (21 days). The ring is removed for one week. The fourth week is hormone freeMay cause vaginal discharge or irritation- Works like the pill and the patch.% effective.- Insert the ring inside the vagina for 3 weeks, then remove it and use nothing for 7 days while menstruating.- Good for people who forget to take a pill everyday.- The cost is about $24 a month with a prescription and $10 at the THC/FPC.
18Continuous and Extended Use of Hormonal Contraception Traditional use (28 day cycle)21 days of active hormones followed by7 days of hormone free pills or hormone free break(period begins during the hormone free break)Continuous useuninterrupted use of hormonal contraception. No planned hormone free breakExtended useprolonged use (2 or more cycles) of hormonal contraception with planned hormone free breaks, no longer than 7 daysWhich products can be used for continuous or extended use?any combined hormonal product with < 50 ug ethinyl estradiolMost types of birth control pills, vaginal ring, contraceptive patch
19Emergency Contraception (Morning After Pill, Emergency Contraception) Used to prevent pregnancy after unprotected sex or contraceptive failure (ie. condom breaking or forgetting to take birth control)If taken within 24 hours of unprotected sex prevents 95% of possible pregnanciesCan be taken up to 120 hours (5 days) after unprotected sex preventing 58% of possible pregnanciesDoes not affect a pregnancy that has already implantedAvailable by prescription from a doctor, sexual and reproductive health clinic or some pharmacies (call ahead to see if they offer this service)- Prevents the ovaries from releasing an egg or prevents implantation of the fertilized egg on the uterus lining.% effective – can be taken up to 5 days after unprotected sexual intercourse; most effective within the first 24 hours – minimal side effects.- Take 2 hormone pills that are like the BC pill.- Cost is $15 at THC/FPC, $28 at family Dr., $28-40 without prescription at the pharmacy (usually a pharmacist consultation is need). Soon some pharmacies may offer EC without consultation soon.
20Birth Control Injection (Depo- Provera®, “The Shot”) Progestin injection into arm or hip every 12 weeks by a health professionalIs 99.7% effectiveStops body from releasing an egg each monthAfter 12 months of use, 55% of women stop having periods. After 24 months, 68% of women stop having periodsMay cause irregular spotting/bleeding and delay the return of regular cycles after stopping injectionsCan increase bone mineral loss. Getting regular weight bearing exercise and Calcium+ and Vitamin D in your diet is important- Inhibits the release of an egg.- 99.7% effective.- Receive an injection (shot) every 3 months in your arm or hip.- Good for people who forget to take a pill every day. Most will stop having periods after 6 months – 1 year of use.- While on Depo Provera, the strength of your bones can be reduced. This is proven to reverse after you come of this method. While you take it , you need to make sure there is enough calcium and Vit. D in your diet to keep your bones strong.- Should not use this method if you are planning to get pregnant quickly after you stop taking Depo. Can take 1-2 years to get pregnant.- Costs $21 at the THC/FPC or $36 with a prescription for a 3 month supply.
21Copper IntraUterine Device (IUD) Long-acting contraceptive; can be left in place for 3 to 5 years98.7% effectiveDoes not contain hormonesCopper affects how sperm move and helps prevent embryo implantationNeeds to be inserted by a trained health professional
22Mirena IntraUterine System (IUS) Contains a hormone called levonorgestrel (progestin)99% effectiveLong acting contraceptive, can be left in place for 5 yearsHormone acts on the lining of the uterus and thickens the cervical mucus making it difficult for sperm to reach the egg. May prevent ovulationDecrease in menstrual blood loss by 74-97%Needs to be inserted by a trained health professional
23Diaphragm and Cervical Cap F e m a l e b a r r i e r m e t h o d ss e x u a l i t y a n d u . c aDiaphragm and Cervical CapWhat are they?• Intravaginal barrier methods that are used together with a spermicide• The diaphragm is a latex dome with a flexible steel ring around its edge (a non-latex diaphragm is also available)• The cervical cap is thimble-shaped silicone cap• Positioned into the vagina (diaphragm) or over thecervix (cervical cap) before intercourse• Must be left in the vagina for 6–8 hours after intercourseCervical CapDiaphragmHow do they work?• A pelvic examination by a qualified health care professional is required for fitting diaphragms andcervical caps• Inserted into the vagina and fit over the cervix• When positioned properly, they block the entry to the uterus so sperm cannot enter and fertilize the egg• Spermicide should be reapplied for each repeated act of intercourseFailure rate: per women per year
24Key Messages Hormonal birth control does not protect against STIs Use a condom AND another form of birth controlTalk to your partner about your sexual history and safer sex practices
25Where can I go for help? School Counsellor Teacher School Nurse Walk in ClinicFamily DoctorSexual Health Clinic