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Chapter Thirteen Contraception and Abortion. Agenda  Discuss History and Considerations Associated with Methods  Discuss Contraception Methods  Discuss.

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Presentation on theme: "Chapter Thirteen Contraception and Abortion. Agenda  Discuss History and Considerations Associated with Methods  Discuss Contraception Methods  Discuss."— Presentation transcript:

1 Chapter Thirteen Contraception and Abortion

2 Agenda  Discuss History and Considerations Associated with Methods  Discuss Contraception Methods  Discuss Abortion

3 Class Exercise: Contraception Values Clarification  Complete the handout entitled “Contraception Values Clarification.  After you have completed the handout, discuss your response in small groups.

4 Introduction  Majority of U.S. pregnancies are not planned and most are a result of not using contraception  Factors increasing motivation to use contraception:  good communication with partner,  lower cost,  effectiveness rates,  frequency of intercourse,  motivation to avoid pregnancy,  side effects,  openness about sexuality

5 Contraception: History Contraception in Ancient Times Contraception in the U.S.: 1800s and Early 1900s Contraception Outside the U.S.

6 Contraception in Ancient Times  Ancient Greeks: magic, superstition, herbs  Egyptians: fumigating female genitalia, tampon soaked in herbal liquid & honey, inserting a mixture of crocodile feces, sour milk, & honey  South Africa: insert vegetable seed pods  Africa: insert a grassy cervical plug  Persia: insert alcohol soaked sponges  Greece: insert empty pomegranate halves

7 Contraception in the U.S.: 1800s and Early 1900s  Concern in early 1800s was to curb poverty by controlling fertility  1873 Comstock laws prohibited dispersing information about contraceptives, including by doctors

8 Contraception use is affected by  Social issues – e.g. desired family size  Economic issues  Knowledge & misinformation  Religion  Gender roles & power – in some areas, men make the contraceptive decisions; for some it is the responsibility of both

9 Choosing a Method of Contraception FDA Approval Process Lifestyle Issues

10 FDA Approval Process  The U.S. Food and Drug Administration (FDA) must formally approve the method  10-14 year process to develop a new contraceptive drug  Drug company submits a new drug application demonstrating safety in animal tests & a desire to conduct human trials

11 FDA Approval Process  3 phases  Phase 1: 20-80 volunteers to test effectiveness  Phase 2: several hundred to test effectiveness, side effects, risks  Phase 3: hundreds to thousands are tested for generalization  Animal trials are conducted throughout the process

12 Class Discussion: Lifestyle Issues Associated with Contraceptive  The following factors seem to be associated with choosing a contraceptive method:  Own health & risks  Number of sexual partners  Frequency of intercourse  Risk of acquiring a STI  Responsibility level  Method cost  Advantages & disadvantages of the method  Discuss influence of each.

13 Contraception Methods

14 Barrier Methods: Condoms and Caps  Prevent sperm from entering the uterus  Barrier Methods:  Condoms  The Diaphragm  The Contraceptive Sponge  The Cervical Barriers

15 Condoms  1850 – latex condoms available in the U.S.  $10-$15/dozen  Non-expired condom is rolled onto an erect penis (foreskin pulled back), ½-inch empty space at the tip  Water-based lubricants for latex condoms  Condom grasped at base when withdrawing  Latex condoms have lower rates of slippage & breakage, and offer better STI protection

16 Condoms  In 1994, female polyurethane/nonlatex condoms were available  $2 each  7 inches long with 2 flexible rings  Inner ring squeezed and inserted close to the cervix  Outer ring lies outside the vagina  Adequate lubrication is necessary

17 Condoms  Effectiveness rates  Latex condoms: 85-98%  Female condoms: 79-95%  Latex & polyurethane protect against STI transmission  Lambskin condoms block sperm, but contain holes large enough for viruses to pass through  Heat can damage condoms

18 Condoms  Advantages:  STI protection  Encourages male participation  Inexpensive  No prescription necessary  Can reduce premature ejaculation  Can reduce postcoital drip  No medical side effects

19 Condoms  Disadvantages:  Reduces spontaneity  Can reduce sensation  Female condoms can be difficult to use, uncomfortable, noisy  Female & male condoms should never be used together  Popular in some countries, not used in others

20 The Diaphragm  Not widely used, almost 0% in 2002  Made of latex or silicone  Many sizes and shapes; a fitting by a health care provider is necessary  $20-$35 diaphragm, $13 spermicidal jelly/cream, office visit charge  They can last for many years

21 Diaphragms come in a variety of different shapes and sizes and must be fitted by a health-care provider.

22 The Diaphragm  Diaphragm rim is covered in spermicidal jelly & a tablespoon of jelly is placed in the dome; it is folded in half and inserted into the vagina with the front rim tucked under the pubic bone  It should not be felt & should cover the cervix  It can be inserted up to 6 hours prior to intercourse  Left in for at least 6-8 hours, no more than 24  After use it is washed with soap & water

23 Instructions for proper insertion of a diaphragm.

24 The Diaphragm  84-94% effective, lower for those who have given birth  Advantages:  Increases spontaneity  Some STI & PID protection  Reduces risk of cervical dysplasia & cancer  Does not affect hormonal levels  Relatively inexpensive

25 The Diaphragm  Disadvantages:  Physician fitting and prescription  Insertion & removal involves touching the genitals  Increased risk of toxic shock syndrome and urinary tract infection  Postcoital drip  Low usage outside the U.S.

26 The Contraceptive Sponge  The Today contraceptive sponge was taken off the market for a decade due to issues with the manufacturing plant; reintroduced in 2005  Available over the counter in one size  The sponge covers the cervix & contains spermicide; it blocks, absorbs, & deactivates sperm  One box of 3 sponges is $13

27 The Today contraceptive sponge was back on the market in late 2005 in the United States.

28 The Diaphragm  Sponge is moistened with water to activate the spermicide, folded in half, & inserted to cover the cervix  Can be inserted up to 24 hours in advance, with intercourse occurring as many times as desirable in that time period  Must be left in at least 6 hours after intercourse  75-89% effectiveness rates

29 Instructions for proper insertion of a contraceptive sponge.

30 The Diaphragm  Advantages:  No prescription necessary  Can have intercourse several times within 24 hours  Increase sexual spontaneity  Do not affect hormonal levels  Disposable

31 The Diaphragm  Disadvantages:  Increased risk of toxic shock syndrome & urinary tract infection  Cannot be used while menstruating  Requires touching of the genitals  High expense if frequently used  Some men can feel it  Low usage rates in other cultures

32 The Cervical Barriers  Thimble-shaped, silicone barriers that fit over the cervix  Block entrance to the uterus & deactivate sperm with the spermicide  Fitting by a health care provider is necessary  Two types:  FemCap  Lea’s Shield

33 The FemCap is a silicone cup shaped like a sailor’s hat that fits securely over the cervix.

34 Lea’s Shield is a silicone cup with a one-way valve and a loop for easier removal.

35 The Cervical Barriers  $15-75 plus cost of spermicide  Left in place for 8 hours after intercourse  After use, it is washed with soap & water  Not to be used during menstruation  86% effectiveness rate, lower for those who have had children

36 The Cervical Barriers  Advantages:  Left in place for up to 48 hours  Do not affect hormonal levels  Immediately effective  Not permanent  One-way release valve in Lea’s Shield reduces risk of toxic shock syndrome

37 The Cervical Barriers  Disadvantages:  Abnormal Pap smears  Increased risk of urinary tract infections  Increased vaginal odors  Cervical damage  Increased postcoital drip  Fitting is necessary  Some male partners feel it & may dislodge it

38 The Cervical Barriers  Widely used in England  Lea’s Shield is available over the counter in Germany, Austria, Switzerland, & Canada

39 Hormonal Methods for Women: The Pill, the Patch, and More  Changing hormonal levels can deter production of ova, fertilization, and implantation

40 Hormonal Methods for Women: The Pill, the Patch, and More  Combined-Hormone Methods  Birth Control Pills  Hormonal Ring  Hormonal Patch  Progestin-Only Methods  Subdermal Implants  Hormonal Injectibles

41 Combined-Hormone Methods  Combination of estrogen & progesterone  Can repress ovulation and thicken cervical mucus

42 Birth Control Pills  Federally approved in 1960  Most popular contraceptive in the U.S. and around the world  Most studied type of medication  Combination birth control pills are $12-25 per month  Designed to mimic a menstrual cycle, with 21 days of hormones and one off week  Bleeding is medically induced

43 Birth Control Pills  Some take 2 to 3 packs of active pills in a row to reduce the number of menstrual periods  Seasonale – 84-day active pill with 7-day placebo  Reducing periods can help those with heavy bleeding and cramping  60% of women prefer to not have a period

44 Birth Control Pills  Increase in estrogen & progesterone prevent the pituitary from sending hormones to ripen the ovaries  Cervical mucus thickens & endometrium buildup is minimal  The body is tricked into thinking it is pregnant  May experience other signs of pregnancy that usually disappear within a few months

45 Birth Control Pills  Initially prescribed a low-dose estrogen pill; increased if breakthrough bleeding occurs  Monophasic pills contain the same dose of hormones in each pill  Multiphasic pills vary in hormone amount  Triphasil pills have 3 sets, each week the hormonal dosage increases  92-99.7% effective  Need to take it each day at the same time

46 Birth Control Pills  Advantages:  High effectiveness rate  Doesn’t interfere with spontaneity  Reduced menstrual flow, cramps, & PMS  Increased menstrual regularity  Reduced risk of ovarian cysts, uterine & breast fibroids, facial acne, ovarian & endometrial cancers, PID, benign breast disease

47 Birth Control Pills  Disadvantages:  No STI protection  Female’s responsibility; taken daily  Can be expensive  Lower effectiveness if overweight  Not appropriate for smokers  Used throughout the world, although not popular everywhere; some places have it over the counter

48 Hormonal Ring  NuvaRing introduced in 2003  Plastic ring inserted into the vagina once a month for 3 weeks, removed for 1 week  Affects the body as combination pills do  Body heat & moisture activate a constant dose of estrogen & progesterone; lower dose than pills  $30-35 per month  99.7% effective

49 The NuvaRing is inserted deep into the vagina; moisture and heat cause it to time-release hormones that inhibit ovulation.

50 Hormonal Ring  Advantages:  High effectiveness  Doesn’t interfere with spontaneity  Reduces menstrual flow, cramps, PMS  Increases menstrual regularity  Protection from ovarian & endometrial cancer and ovarian cysts  Fertility restored upon removal

51 Hormonal Ring  Disadvantages:  Comfortable touching genitals  No STI protection  Side effects that typically disappear with regular use: breakthrough bleeding, weight change, breast tenderness, nausea, mood changes, changes in sexual desire, increased vaginal irritation & discharge  No data on cross-cultural use

52 Hormonal Patch  Ortho Evra patch is a thin, peach colored sticker attached to the skin with time-released hormones  Placed on buttock, stomach, or upper torso for 3 weeks, no patch for the 4 th week  Affects the body as combination pills do  $30-35 per month  99.7% effective, lower if weigh more than 198 pounds

53 The Ortho Evra patch is worn on the buttock, abdomen, or upper torso for three weeks each month.

54 Hormonal Patch  Advantages:  High effectiveness  Doesn’t interfere with spontaneity  Reduces menstrual flow, cramps, PMS  Increases menstrual regularity  Protection from ovarian & endometrial cancer and ovarian cysts

55 Hormonal Patch  Disadvantages:  No STI protection  Side effects similar to hormonal ring  Skin irritation  Change in vision, discomfort to contact wearers  Collects lint  Nearly impossible to conceal from partner  No data on cross-cultural use

56 Progestin-Only Methods  Do not contain estrogen and can be used by women that cannot take estrogen, such as those who are breastfeeding & smokers  Over time, may eliminate periods  May cause slight weight gain, bloatedness, & breast tenderness

57 Progestin-Only Methods  Minipill/POPs (progestin-only pills)  Inhibit ovulation and thicken mucus  Fewer side effects than combination pills  92-99.7% effective  More expensive than combination pills  Can cause irregular bleeding  Higher rate of ectopic pregnancies if get pregnant while taking the minipill

58 Subdermal Implants  Constant dose of progestin is time released for up to 5 years  Norplant is no longer available  Jadelle is FDA approved but not marketed in the U.S.  2 silicone cylinders implanted in the forearm in a 10 minute procedure; $500+  Implanon is a single-rod approved in 2004  Fertility restored upon removal

59 Subdermal Implants  Suppresses ovulation, thickens cervical mucus, unreceptive endometrium  99.95% effective, decreases after the 3 rd year  Lower effectiveness rates if over 154 pounds  Advantages:  Effective, long-lasting, reversible  Simple implantation procedure  No estrogen side effects  Decreased menstrual flow, cramping

60 Subdermal Implants  Disadvantages:  Expensive implantation fees, arm pain, painful removal, possible scarring  Irregular bleeding, cramping  Headaches, nausea, dizziness, weight change, rash, acne, hair growth or loss  Vision problems  Popular in South Africa

61 Hormonal Injectibles  Depo-medroxyprogesterone acetate (Depo- Provera) – synthetic progesterone  Most popular non-oral contraceptive  Injected into the arm or buttock muscle every 3 months  $30-125 per injection  Works within 24 hours  Fertility resumes 10 months after last injection

62 Hormonal Injectibles  97-99.7% effective  Advantages:  Long lasting injection  Moderately expensive  No estrogen  Decreased menstrual flow & cramping  Decreased risk of endometrial & ovarian cancers  Allows for spontaneity

63 Hormonal Injectibles  Disadvantages:  Office visits every 3 months  Irregular bleeding  Fatigue, dizziness, weakness, headaches  Appetite increases  Decrease in bone density  Risk of liver, cervical, and breast cancers  Long return to fertility  Low usage rates in many countries

64 Chemical Methods for Women: Spermicides  Spermicides come as foams, gels, suppositories, creams, foaming tablets, films, and capsules  Inserted into vagina with applicator or finger 10-30 minutes prior to intercourse  $5-10 over the counter  Can also help reduce STIs  Likely to see microbicides introduced that will protect from HIV & other STIs

65 Chemical Methods for Women: Spermicides  71-82% effective  Effectiveness is reduced if tampons or douches are used within 6-8 hours  Foam is more effective than other varieties  Advantages:  Over the counter  Provide lubrication  Some protection from STIs  No serious side effects

66 Chemical Methods for Women: Spermicides  Disadvantages:  Used each time  Increased postcoital drip  May produce allergic reactions, skin irritations  Increased risk of urinary tract infections  Unpleasant taste  Widely used in some countries, and not used much in other countries

67 Intrauterine Methods for Women: IUDs and IUSs  Intrauterine Device (IUD)  ParaGard Copper T – can be left in for 12 years  Intrauterine System (IUS)  Mirena – IUD that contains time-released progestin; can be left in for 5 years  Most IUD & IUS users are 35 or older  $150-300 plus office visit

68 Intrauterine Methods for Women: IUDs and IUSs  IUDs & IUSs create a slight infection in the uterus that obstructs sperm mobility  Progesterone from the IUS also affects the endometrium, hampering implantation  Health care providers insert the IUD  Each month the woman must check for the string to assure it is still in place  99.2-99.9% effective, lower if never pregnant

69 Insertion of an IUD.

70 Intrauterine Methods for Women: IUDs and IUSs  Advantages:  Least expensive method over time  Allows for spontaneity  Decreases menstrual flow (Mirena)  Long lasting effects

71 Intrauterine Methods for Women: IUDs and IUSs  Disadvantages:  No STI protection  Risk of uterine perforation and PID  Irregular bleeding  Painful insertion & removal  Increased menstrual flow and cramping  May be expelled from uterus  May cause discomfort to the partner  Widely used through most of the world

72 Natural Methods for Women and Men  Natural Family Planning and Fertility Awareness  Withdrawal  Abstinence

73 Natural Family Planning and Fertility Awareness  Involves a woman charting her menstrual periods and determining ovulation by daily monitoring of basal body temperature and checking cervical mucus  Body temperature rises 0.4-0.8°F before ovulation & remains elevated until menstruation  Cervical mucus is thin, stretchy during ovulation

74 Natural Family Planning and Fertility Awareness  Abstinence is practiced during ovulation  Or a form of birth control is used during ovulation (fertility awareness)  Mostly used by women spacing pregnancies that are not as concerned about prevention  Ovulation kits can also be used  75-99% effective

75 Natural Family Planning and Fertility Awareness  Advantages:  Useful if other methods are not acceptable for religious reasons  Inexpensive  Educates about the menstrual cycle  Encourages partner communication  No side effects

76 Natural Family Planning and Fertility Awareness  Disadvantages:  No STI protection  Restricts spontaneity  Low effectiveness  Takes time & commitment  Several cycles need to be recorded before it is reliable  Widely used in many countries, particularly Catholic countries

77 Withdrawal  Also called coitus interruptus  Just before ejaculation, the male withdraws his penis and ejaculates outside of the woman  73-96% effective  Sperm may remain in urethra from previous ejaculations & impregnate without the male ejaculating inside of the woman

78 Withdrawal  Advantages:  Useful if other methods are not acceptable for religious reasons  No costs  Good if couples aren’t concerned about prevention

79 Withdrawal  Disadvantages:  No STI protection  Low effectiveness  May lead to premature ejaculation  May be stressful  Requires trust & restraint  Widely used in many countries

80 Abstinence  Refraining from sexual intercourse  100% effective  Protects against STIs

81 Permanent (Surgical) Methods  A woman may be fertile until 50-51 years  A man may be fertile most of his life  Sterilization in one of the safest & most effective contraceptive methods  Surgery that is typically irreversible  Two types:  Female Sterilization  Male Sterilization

82 Female Sterilization  Also called tubal sterilization or getting “tubes tied”  A small incision is made under the navel or lower in the abdomen  Both Fallopian tubes are blocked through cauterization, rings, bands, clips, plugs, or clamps, or the tubes may be cut  This procedure uses general anesthesia as outpatient surgery or after childbirth

83 Essure is a permanent method of contraception.

84 Female Sterilization  A woman still ovulates, but the egg can’t enter the uterus  $2000-5000  Risks: anesthesia side effects, bleeding, infection, injury to other organs  Reduces risk of ovarian cancer  Most widely used birth control method in the world

85 Male Sterilization  A vasectomy impedes the travel of sperm through the vas deferens  Cheaper, safer, & simpler than tubal sterilization  Two ¼ to ½ inch incisions are made in the scrotum and the vas deferens is snipped, clipped, or cauterized under local anesthesia  20 minute procedure  The man ejaculates semen without sperm

86 In a vasectomy, each vas deferens is clipped, cut, or cauterized. A vasclip uses a flexible plastic clip to block the vas deferens.

87 Male Sterilization  After surgery, sperm for 20 more ejaculations remains  Sperm counts are checked 2-3 months later to check sterility  $300-750  Risks: swelling, bruising, internal bleeding, infection  99-99.9% effective

88 Permanent (Surgical) Methods  Advantages:  High effectiveness  Permanent  Allows for spontaneity  Disadvantages:  Expensive, irreversible surgery  No STI protection  Widely used throughout the world

89 Abortion The Abortion Debate Why Do Women Have Abortions? Abortion Procedures Reactions to Abortion Teens and Abortion Cross-Cultural Aspects of Abortion

90 Class Exercise: Abortion  A fertilized egg is a human being from the moment the sperm and egg unite.  The rights of the fetus always take precedence over the rights of the mother.  Parental consent should be required for teenagers seeking abortion.  Spousal consent should be required for married women seeking abortion.  I support a woman’s right to choose in any and all circumstances.  I support a woman’s right to choose if the pregnancy resulted from a rape.  I support a woman’s right to choose if the pregnancy resulted from contraceptive failure.

91 Exercise (cont.)  I believe abortion is justified if the woman feels that she is not ready for this child.  I believe abortion is justified if a serious birth defect has been detected via amniocentesis.  I believe abortion is justified if the couple already has 5 children and the woman unexpectedly becomes pregnant again.  I believe abortion is justified if parents of two boys discover they are pregnant again with a third boy, and they were really hoping for a girl.  I believe abortion should be legal.  There should be a mandatory 24-hour waiting period for all women seeking an abortion.  Adoption could solve the problem of “unwanted children.”

92 The Abortion Debate Pro-Life versus Pro-Choice Historical Perspectives Legal versus Illegal Abortions

93 Pro-Life versus Pro-Choice  Pro-life supporters: an embryo at any stage of development is a person and aborting a fetus is murder  Pro-choice supporters: it is a woman’s choice and the government should not control her body  No gender differences in abortion attitudes

94 Historical Perspectives  Abortion has been practiced throughout time in many societies  Religion has determined attitudes for most of western history  In 1965, all U.S. states banned abortion with some exceptions  Illegal (back-alley) abortions were often performed in unsanitary conditions and produced many complications, even death

95 Historical Perspectives  In 1973, Roe v. Wade protected a woman’s right to have an abortion in the 1 st trimester  2 nd trimester abortions regulated by states  3 rd trimester abortions can be limited or banned by states, unless a woman is at risk  In 1992, the Supreme Court gave states the right to restrict abortions through waiting periods, mandatory counseling, parental consent, public funding limitations

96 Historical Perspectives  In 1994, Supreme Court barred anti-abortion demonstrators from getting within 36 feet of an abortion clinic  Louisiana has the most restrictions  New York, California, & Washington state have been most protective of their abortion laws

97 Legal versus Illegal Abortions  Since legalization in 1973, deaths from abortion decreased significantly

98 Video: “If these Walls Could Talk”

99 Why Do Women Have Abortions?  Baby would interfere with life goals  Lack financial resources  Poor relationship with the father  Don't want others to know they had sex  Partner and/or family pressure  Fetal deformity or risk to mother’s health  Rape  54% of women who had an abortion used contraception when they became pregnant

100 Abortion Procedures  One of the most common surgical procedures in the U.S.; most performed in abortion clinics  Surgery involves risks  Most serious risks are uterine perforation, hemorrhaging, cervical laceration, infection, complications with anesthesia, death  Risks increase with the use of general anesthesia and the further along the pregnancy is

101 Abortion Procedures  First-trimester Surgical Abortion  Second-trimester Surgical Abortion  Medical Abortion  Mifepristone (RU-486)  Methotrexate

102 First-Trimester Surgical Abortion  Vacuum aspiration – before 14 weeks gestation  Usually an outpatient surgery with local anesthesia  88% of abortions  Woman lies on examining table, feet in stirrups  Speculum is placed in the vagina, cervix is anesthetized, & dilation rods open the cervix

103 First-Trimester Surgical Abortion  A cannula that is attached to a vacuum aspirator is put into the cervix, the content of the uterus is emptied  Takes 4-6 minutes, with a few hour stay after  After she needs to rest, bleeding and cramping is likely  Risks: excessive bleeding, infection, uterine perforation

104 Second-Trimester Surgical Abortion  Between 14-21 weeks  11% of abortions  Reasons for a late abortion: medical complications, fetal deformity, divorce/marital problems, miscalculation of due date, financial or geographic problems

105 Second-Trimester Surgical Abortion  Dilation & evacuation procedure: 13-16 weeks  Similar to vacuum aspiration, but in a hospital under general anesthesia  15-30 minute procedure  More complicated than 1 st trimester, with more pain, blood loss, & cervical trauma

106 Second-Trimester Surgical Abortion  Induced labor procedure used in late 2 nd trimester  Needle inserted into amniotic sac and drains the fluid; the sac is injected with saline or prostaglandin  Fetus is delivered 19-22 hours later  Can be painful emotionally & physically  Risks: nausea, diarrhea, cervical problems, uterine rupture, risk of death

107 Second-Trimester Surgical Abortion  Hysterotomy – used in emergency situations  Abdomen is opened to remove the fetus  Similar to a cesarean section, with a 5-7 day hospital stay  Hysterectomy – removal of the fetus and uterus  Rarely used

108 Medical Abortion  Two drugs:  Mifepristone (RU-486)  Methotrexate  They are used with a prostaglandin to produce contractions and expel the contents  2-3 office visits are required; $350-650  Advantages over surgical abortion: no anesthesia; it seems more like a miscarriage  Increased risk of bacterial infection

109 RU-486  An antiprogestin that inhibits progesterone production, breaking down the uterine lining  3 RU-486 pills are taken; 2 days later the prostaglandin is taken, which produces uterine contractions  95-97% effective  Can be used up to 9 weeks gestation  Mifepristone produces bleeding within 4-5 hours, and it continues for up to 13 days

110 Methotrexate  Methotrexate produces bleeding that may last 1 month or more  It is injected and ceases the development of the zygote cells  The prostaglandin produces contractions and expels the uterine contents  Can be used up to 9 weeks gestation

111 Reactions to Abortion  Women’s Reactions  Physiological Symptoms  Psychological Symptoms  Men’s Reactions

112 Women’s Reactions  Physiological symptoms:  Surgeon General’s report found physiological health consequences (infertility, miscarriage, premature birth, low birth weight) no more common in women who have had abortions compared to the general population of women  Immediately following the procedure: cramping, heavy bleeding, nausea

113 Women’s Reactions  Psychological symptoms:  A woman’s feelings are often correlated with her society’s views on abortion  There is little known about reactions to medical abortions  Many women cycle through feelings of relief, happiness, shame, guilt, fear of disapproval, regret, anxiety, depression, doubt, anger, sense of loss, sadness

114 Women’s Reactions  10% of cases a woman has severe feelings  Factors in severe psychological symptoms:  Young  Lack family or partner support  Persuaded to have an abortion or difficult time making the decision  Strong religious & moral background  Medical or genetic reasons for abortion  History of psychiatric problems

115 Men’s Reactions  Abortion may cause couples to break up or may increase communication in a relationship and strengthen it  Supportive partners are more positive following the procedure  Men can feel sadness, a sense of loss, fear for partner’s well being, isolated, angry  Men lack counseling services to help them through this time

116 Teens and Abortion  Some states require parental notification or consent  In lieu of that, they may request a judicial bypass option  In states without mandatory parental involvement, 75% of minors involve at least one parent in the process

117 Cross-Cultural Aspects of Abortion  About 40% of worldwide pregnancies are unplanned  20% are aborted  Lowest abortion rates are in Ireland, Netherlands, Belgium, & Spain  Highest abortion rates are in Cuba, Vietnam, Romania, & India  1.3 million abortions each year in the U.S.

118 Cross-Cultural Aspects of Abortion  25% of countries have strong restrictions on abortion  20 million unsafe abortions occur each year by taking drugs, inserting objects into the vagina or flushing it with liquids, or forcefully massaging the abdomen  Medical abortion is widely used outside the U.S.

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