1. Chapter 6 Contraception and Abortion ©2012 McGraw-Hill Companies. All Rights Reserved.

2. 2  Definition:  Conception: the fusion of an ovum and sperm that creates a fertilized egg, or zygote  Contraception: blocking conception through the use of a device, substance, or method  Modern contraception methods are much more predictable and effective than in the past  Many contraceptive products play a role in the prevention against sexually transmitted diseases 2

3. 3 ©2012 McGraw-Hill Companies. All Rights Reserved.  Types of contraception:  Barrier, hormonal, natural, and surgical methods  Factors affecting choice  Advantages and disadvantages Effectiveness Convenience Cost Reversibility Side effects and risks Protection against STDs  Effectiveness  Contraceptive failure rate  Continuation rate 3

4. 4 ©2012 McGraw-Hill Companies. All Rights Reserved.  Estrogen and progestins taken orally  Mimics the hormonal activity of the corpus luteum  Corpus luteum secretes high levels of progesterone and estrogen to suppress ovulation  Combination pill  Most common  1-month packet containing estrogen and progestin  Extended-cycle pill  Lybrel  “Minipill”  1-month packet containing progesterone  Advantages  Disadvantages  Effectiveness: When taken as directed, the failure rate is 0.3% 4

5. 5 ©2012 McGraw-Hill Companies. All Rights Reserved.  Thin 1 ¾- inch square patch  Releases estrogen and progestin slowly into the bloodstream  Prevents the same way as combination OCs  Worn for 1 week, replaced on the same day for 3 consecutive weeks. Fourth week no patch  Advantages  Disadvantages  Effectiveness: When taken as directed, failure rate is 0.3% 5

6. 6 ©2012 McGraw-Hill Companies. All Rights Reserved.  The NuvaRing  Molded with progestin and estrogen  2-inch ring slowly releases the hormones  During fourth week, remove the ring and use a new ring after the fourth week  Advantages  Disadvantages  Effectiveness: When taken as directed, the failure rate is 0.3% 6

7. 7 ©2012 McGraw-Hill Companies. All Rights Reserved.  Implanon (2006)  Hormonal method - progestin  Single implant  Effective for 3 years  Inhibits ovulations and affects the development of the uterine lining  Advantages  Disadvantages  Effectiveness: Failure rate is 0.1%, the most effective method of contraception and the most discrete 7

8. 8 ©2012 McGraw-Hill Companies. All Rights Reserved.  Depo-Provera  Hormonal treatment  Injectable progestin every 12 weeks  Advantages  Disadvantages  Effectiveness: When taken as directed, the failure rate is 0.3% 8

9. 9 ©2012 McGraw-Hill Companies. All Rights Reserved.  T-380A (ParaGard) 10 years of protection  Copper  Levonorgestral (Mirena) 5 years of protection  Releases small amounts of progestin  Not exactly sure how it prevents pregnancy  Advantages  Disadvantages  Effectiveness: 0.8% failure rate for ParaGard, and 0.2% failure rate for Mirena 9

10. 10 ©2012 McGraw-Hill Companies. All Rights Reserved.  Thin latex, or polyurethane, sheaths  Protection against STDs  Advantages  Disadvantages  Effectiveness  During the first year of typical condom use among 100 users, between 10 and 18 pregnancies occur  2% failure rate with perfect use  Use with spermicide 10

11. 11 ©2012 McGraw-Hill Companies. All Rights Reserved. 11

12. 12 ©2012 McGraw-Hill Companies. All Rights Reserved.  A clear, stretchy, disposable pouch with two rings that can be inserted into a woman’s vagina  Advantages  Disadvantage  Effectiveness:  21% typical first-year failure rate with first-year typical users 12

13. 13 ©2012 McGraw-Hill Companies. All Rights Reserved.  Dome shaped cup of latex or silicone stretched over a collapsible metal ring  Blocks sperm from entering the uterus  Custom fit  Must remain in place for 6 hours after sex  After intercourse, women should inspect diaphragm for defects  Advantages  Disadvantages Toxic shock syndrome (TSS)  Effectiveness 6% failure rate with perfect use 16% failure rate with typical use 13

14. 14 ©2012 McGraw-Hill Companies. All Rights Reserved.  Small silicone cap  Must use spermicide  Advantages  Disadvantage  Effectiveness  16% typical use failure rate for women who have never had a child  32% typical use failure rate for women who have had a child  Uncommon form of contraception in U.S. 14

15. 15 ©2012 McGraw-Hill Companies. All Rights Reserved.  Round, absorbent device about 2 inches in diameter  Presaturated with the same spermicide that is used in contraceptive creams and foams  Advantages  Disadvantages  Toxic shock syndrome (TSS)  Effectiveness  16% typical use failure rate for women who have never had a child 15

16. 16 ©2012 McGraw-Hill Companies. All Rights Reserved.  Foams, creams, jellies  Spermicidal suppository  Vaginal Contraceptive Film (VCF)  After 60 minutes, their effectiveness is drastically reduced  Must wait 6 hours post-intercourse if the women wants to douche  Advantages  Disadvantages  Effectiveness: 29% failure rate with typical first-year use 16

17. 17 ©2012 McGraw-Hill Companies. All Rights Reserved.  Abstinence  Decision to go without intercourse or sexual activities  Benefits Religious, moral, cultural, personal beliefs Emotional needs Time for relationship to grow 17

18. 18 ©2012 McGraw-Hill Companies. All Rights Reserved.  Methods  Calendar methods  Temperature methods  Mucus method  Withdrawal  Coitus interruptus 18

19. 19 ©2012 McGraw-Hill Companies. All Rights Reserved.  Postcoital Pill, Morning After Pill, Plan B, Plan B One-Step, Next Choice  Newer products now more common and effective, with fewer side effects, than old methods  Prevents fertilization, does not affect an already fertilized egg  Best used within 24 hours  Plan B, Plan B One-Step, and Next Choice available as OTCs for those 17 and older  Intrauterine devices 19

20. 20 ©2012 McGraw-Hill Companies. All Rights Reserved.  Severing of the vasa deferentia  Can have sex again in about a week  About one-half of reversals are successful  Effectiveness  Failure rate is 0.2% 20

21. 21 ©2012 McGraw-Hill Companies. All Rights Reserved.  Tubal sterilization (laparoscopy) is most commonly known as tubal ligation  Essure system  Tiny spring-like metallic implants cause scarring, thus blocking the Fallopian tubes, no incision needed  Adiana  Tiny inserts block Fallopian tubes, no incision needed  Hysterectomy  More costly, complicated, and permanent than male sterilization 21

22. 22 ©2012 McGraw-Hill Companies. All Rights Reserved.  Key considerations include: 1. Health risks 2. Implications of unplanned pregnancy 3. STD risk 4. Convenience and comfort level 5. Type of relationship 6. Ease and cost of obtaining and maintaining each method 7. Religious or philosophical beliefs 8. Potential non-contraceptive benefits 22

23. 23 ©2012 McGraw-Hill Companies. All Rights Reserved.  Abortion  The expulsion of an embryo or fetus from the uterus before it is sufficiently developed to survive  Miscarriage  Spontaneous abortion that occurs naturally

24. 24 ©2012 McGraw-Hill Companies. All Rights Reserved.  1973: Roe versus Wade  Supreme Court ruled : Pregnancy divided into 3 trimesters 1st trimester - up to women & doctor 2nd trimester - state may regulate once the fetus becomes viable 3rd trimester - state may regulate and bar all abortions that are not life-threatening to mother  States have a variety of laws on abortion  Between 1995 and 2006, the number of state laws restricting abortion more than quadrupled

25. 25 ©2012 McGraw-Hill Companies. All Rights Reserved.  Pro-life  Pro-choice  Many people have moral beliefs that combine the two viewpoints  Many people believe the fetus gains increasing human value as pregnancy advances  Most Americans see the issue as complex  Views vary depending on situation  Most support legal right to abortion in certain situations

26. 26 ©2012 McGraw-Hill Companies. All Rights Reserved.

27. 27  Legal arguments  Moral arguments  Short- and long-term ramifications  Adoption option

28. 28 ©2012 McGraw-Hill Companies. All Rights Reserved.  The majority of women who get abortions share the following characteristics:  Are under age 25  Have previously given birth  Have never been married  Are poor  Live in a metropolitan area

29. 29 ©2012 McGraw-Hill Companies. All Rights Reserved.  Two categories  Surgical Suction curettage Manual vacuum aspiration Multi-fetal pregnancy reduction Dilation and evacuation Intact dilation and extraction  Medical – Use of medication Generally used in very early pregnancy Emergency contraception pills or IUD

30. 30 ©2012 McGraw-Hill Companies. All Rights Reserved.  Physical effects  Post-abortion physical warning signs  Fever above 100º F  Abdominal pain, tenderness, or swelling  Cramping or backache  Prolonged or heavy bleeding  Foul-smelling vaginal discharge  Vomiting  Fainting  Delay of 6 or more weeks in resuming menstruation

31. 31 ©2012 McGraw-Hill Companies. All Rights Reserved.  Possible feelings after having an abortion  Guilt  New strength in having made and carried out an important decision  Depression  Sense of loss  Negative feelings about sex  Relationship may end  Anger  Bitterness

32. Chapter 6 Contraception and Abortion ©2012 McGraw-Hill Companies. All Rights Reserved.