1. Chapter 11 Contraception

2. Historical and Social Perspectives
Evidence of contraception since the beginning of recorded history
U.S. contraceptive efforts
1800s Comstock laws
1915: Margaret Sanger's
U.S. Supreme Court rulings
Griswold vs. Connecticut
Eisenstadt vs. Baird

3. Historical and Social Perspectives (cont.)
Contemporary issues
planning for wanted children
physical health of mother
insurance coverage of contraceptives
population growth
cultural gender-role expectations
wide diversity of views among cultures and religious leaders

4. Historical and Social Perspectives (cont.)
Fig Average number of children, by mother’s education level and race/ethnicity in the United States.

5. Sharing Responsibility and Choosing a Birth Control Method
How to share responsibility
ask about BC before intercourse
read & discuss options together
attend a class or clinic together
share expenses

6. Choosing a Birth Control Method
Choosing a BC method
consider effectiveness and cost
consider ease of use and side effects
characteristics of ineffective use
guilt
negative attitudes about sex
self-view

7. Contraceptive Effectiveness
Failure Rate
consistent use failure rate
typical use failure rate

8. Contraceptive Effectiveness
Fig Factors to consider when choosing a birth control method.

9. Choosing a Birth Control Method (cont.)
Hormone-Based Contraceptives
combination pill
Triphasic pill
Constant-dose
Progestin-only pill

10. Choosing a Birth Control Method (cont.)
Table 11.3 Possible side effects with the birth control pill.

11. Choosing a Birth Control Method (cont.)
Vaginal ring
Transdermal patch
Depo-Provera

12. Choosing a Birth Control Method (cont.)
Barrier Methods
Condom: sheath fits over erect penis

13. Choosing a Birth Control Method (cont.)
Fig. 11.5b A condom with a reservoir tip does not need to be twisted at the top as it is put on the penis.

14. Choosing a Birth Control Method (cont.)
Barrier Methods (cont.)
Female condom: sheath fits in vagina

15. Choosing a Birth Control Method (cont.)
Fig. 11.6b A female condom consists of two flexible polyurethane rings and a soft, loose-fitting polyurethane sheath

16. Choosing a Birth Control Method (cont.)
Vaginal spermicides:
foam
sponge
suppositories
creams
film

17. Choosing a Birth Control Method (cont.)
Barrier Methods (cont.)
Diaphragm: latex dome
Cervical cap
Fem Cap
Lea’s Shield

18. Choosing a Birth Control Method (cont.)
Barrier Methods (cont.)
Diaphragm: latex dome

19. Choosing a Birth Control Method (cont.)
Fig. 11.8e These figures illustrate the insertion and checking of a diaphragm.

20. Choosing a Birth Control Method (cont.)
Intrauterine Devices
affects sperm motility & viability
thicken cervical mucous
alter endometrial lining
impair tubal motility

21. Choosing a Birth Control Method (cont.)
Emergency contraception
Hormonal: birth control pills taken within 72 hours of unprotected intercourse
Copper-T IUD: inserted up to five days after unprotected intercourse
Access issues

22. Choosing a Birth Control Method (cont.)
Fertility Awareness Methods
Standard days method
Mucus method: based on cyclical changes
Calendar method: self- knowledge of fertility
Basal body-temperature

23. Choosing a Birth Control Method (cont.)
How to compute basal body temperature
Fig An example of a basal body temperature during a model menstrual cycle.

24. Choosing a Birth Control Method (cont.)
Sterilization (female)
tubal sterilization
Minilaparotomy
Laparoscopy
Culpotomy
Transcervical sterilization

25. Choosing a Birth Control Method (cont.)
Sterilization (female)
Fig Female sterilization by laparoscopic ligation. Front view shows tubes after ligation.

26. Choosing a Birth Control Method (cont.)
Sterilization (cont.)
Male vasectomy
Fig Male sterilization by vasectomy.

27. Less than Effective Methods
Nursing
amenorrhea is common for a brief period after birth while breastfeeding
80% ovulate before first period
unreliable

28. Less than Effective Methods (cont.)
Withdrawal before ejaculation
difficult to judge when to withdraw
anxiety may lower pleasure
Cowper's gland fluid may carry sperm
any sperm on vulva may travel into vagina/uterus; unreliable

29. Less than Effective Methods (cont.)
Douching
sperm reach uterus in 1-2 minutes
douching may speed sperm along
irritates vaginal tissue
very ineffective

30. New Directions in Contraception
For men
Testosterone & progestin may lower sperm count
GRH inhibitor (LHRH agonist) may lower number & motility of sperm
Medications used for other purposes

31. New Directions in Contraception (cont.)
For women
implants
new IUDs
new female condoms
spermicides with microbicides
immunocontraceptives

32. New Directions in Contraception (cont.)
For women (cont.)
one-sized & disposable diaphragms & cervical caps
spermicides containing microbicides, developed to prevent STD’s
IUDs with different shapes & hormones