Contraception and Birth Control Chapter Eleven Contraception and Birth Control

Risk and Responsibility In the United States, half of all pregnancies are unintended Half of unintended pregnancies occur in couples who do not use contraception Those who discuss preventing pregnancy are most likely to use contraceptives 2

Men, Women, and Birth Control: Who Is Responsible? Women may have a greater interest than male partners in controlling fertility Traditionally been seen as the woman’s job Male-controlled methods now account for 35% of reversible contraceptive use

Adolescents and Contraception Adolescents are less likely than older individuals to use contraction Condoms are preferred method Condom use may be stigmatized

Birth Control and Contraception: What’s the Difference? Birth control: any means of preventing a birth from taking place; includes contraception and abortion Contraception: birth control that works specifically to prevent conception 3

Choosing a Method Best method is the one you will use correctly and consistently Theoretical effectiveness assumes consistent and correct usage User effectiveness: Actual statistical effectiveness incorporating those who use method but do not do so consistently and correctly

Sexual Abstinence Most reliable form of birth control Involves refraining from sexual activity that could cause pregnancy Abstinence doesn’t necessarily rule out affection or non-coital sexual activities Practitioners’ definitions of abstinence vary From a contraceptive perspective, abstinence from vaginal intercourse is required

Hormonal Methods Oral contraceptives “the pill”; the most widely used form of reversible contraceptive in the U.S. Highly effective in preventing pregnancy Contains progestin and (usually) estrogen How they work: Suppress ovulation Thicken cervical mucous Thin the lining of the uterus Slow the rate of ovum transport 4

Hormonal Methods Oral contraceptives Effectiveness rates Suppresses ovulation Multiple types Advantages Disadvantages Possible problems

Other Hormonal Methods Injectable contraceptives: Depo - Provera The Patch: Ortho Evra Effectiveness rates Advantages Disadvantages The vaginal ring: Nuva Ring

Other Hormonal Methods The vaginal ring: Nuva Ring Effectiveness rates Advantages Disadvantages Implants: Jadelle

Barrier Methods of Contraception Condom Spermicide: nonoxynol – 9 Latex vs. polyurethane Women and condom use Effectiveness and advantages Possible problems The female condom 5

Barrier Methods of Contraception Diaphragm and Cervical Cap Both cover the cervical opening to prevent entry of semen Both are filled with spermicidal jelly and cream Different shapes and style of fit Effectiveness Advantages Possible problems

Barrier Methods of Contraception Contraceptive sponge The FemCap Spermicide Foam Film Creams, jellies, and vaginal suppositories

Intrauterine Device (IUD) Tiny plastic or copper device inserted into uterus Multiple types currently available 10-12 years Not an abortifacient Projections for increased popularity 7

Fertility Awareness Based Methods Calendar (rhythm) method Basal body temperature (BBT) method Ovulation method Symptothermal method 8

Sterilization Men: Women: Vasectomy Tubal ligation Laparoscopy Essure 9

Emergency Contraception Taken within 120 hours of unprotected sex Plan B Concentrated doses of progestin and/or estrogen Stops ovulation, fertilization, and implantation Will not abort an established pregnancy Different from “abortion pill” Copper IUD Less common method; interferes with implantation 10

Abortion Medical definition: expulsion of the conceptus Can happen naturally (miscarriages) Can be medically or surgically induced Abortions are not all the same Circumstances of pregnancy vary Differences by stage of pregnancy 11

Abortion Under safe, clean, legal conditions abortion is a safe medical procedure Self-administered or illegal abortions can be very dangerous, sometimes fatal

Methods of Abortion Medical Abortion A two-drug regimen (mifepristone with misoprostol) that can terminate early pregnancy. Most effective up to 49 days after the beginning of the pregnant woman’s last period

Mifepristone/Misoprostol

Methods of Abortion Surgical Abortion Vacuum Aspiration Used in first trimester Dilation and Evacuation (D&E) Used in second trimester Only 1.5% of US abortions Hysterotomy Used in later stages of pregnancy Like a cesarean section; extremely rare

Prevalence of Abortion About half of unintended pregnancies end in abortion Highest rates: Ages 18-29, unmarried, Black or Hispanic, and/or economically disadvantaged women Number of abortions decreased between 1994 and 2000 Emergency contraception accounts for as much as 43% of decrease

Three Factors Leading to Abortion Failure to practice contraception Incorrect or inconsistent use of contraception Failure of contraceptive method Emotional issues for women Reevaluation of relationships Examination of childbearing plans A search to understand role of sexuality An attempt to clarify life goals

Women, Men, and Abortion Emotional issues for men Experience of guilt and anxiety Ambivalence about parenthood Powerlessness May experience erectile or ejaculatory difficulties Effect on relationships Stress, conflict, and guilt sometimes lead to break-up Clinics now provide counseling for both men and women

The Abortion Debate Pro-life Argument Pro-choice Argument Human life begins at fertilization Same rights in utero as after birth Abortion is moral equivalent of murder Pro-choice Argument Women should be able to choose whether or not they will have children Abortion should be available as a back-up birth control method Women will get illegal and unsafe abortions if the procedure is made illegal

The Abortion Debate Abortion and Religion The Bible is silent on abortion Scriptural basis for or against is a matter of interpretation The debate about when human life begins is theological American religious organizations take both pro-choice and pro-life stances

The Abortion Debate Constitutional Issues U.S. Supreme Court Roe v. Wade (1973) Webster v. Reproductive Rights (1989) Planned Parenthood v. Casey (1992)