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CONTRACEPTION
&
ABORTION
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“ The oldest oracle in Greece,
sacred to the Great Mother of
the earth, sea, and sky, was
named Delphi, from delphos,
meaning ‘womb’.”
- Barbara Walker -
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PERSPECTIVES ON
CONTRACEPTION
HISTORICAL OVERVIEW
BIRTH CONTROL
Any procedure that prevents the birth of a
baby
CONTRACEPTION
Any procedure used to prevent fertilization of
the ovum
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Ancient Methods:
Egyptians
Concoction of pastes inserted into vagina as
diaphragms
Greeks
Concoction of pastes for diaphragm
Teas and septic solution ingested as medicine
Stones/foreign objects used as early IUDs
Mixtures of acid, juice, honey, alcohol, opium as
spermicides
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Early Forms of Contraception:
Condoms = linen sheaths
Diaphragms
Cervical cap (early 1800s)
Diaphragm (late 1800s)
Abstinence Campaign: “Voluntary Motherhood”
(mid 1800s)
Antifeminist Theory: “Race Suicide” (1905-1910)
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Legality of Birth Control:
President Theodore Roosevelt (1905-1910)
Griswold v. Connecticut (1965)
Mandated coverage for contraception for federal
employees via an act of Congress (1998)
Private insurance companies: oral contraception
coverage
Federal restrictions on contraceptive development
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ECONOMIC OVERVIEW
METHOD
COST
OTHER COSTS
Female Sterilization $1190 - $2467
Male Sterilization
$353 - $756
Oral Contraceptives $18 - $21/cycle Annual GYN exam
Male Condom
Implant
$ .33 - $1.04
$365
Injectable
Diaphragm
IUD
$15-$18
$82-$184
$48-$333 (insertion)
$80-$100 (removal)
$30/per quarter Quarterly office visits
Office visit for fitting
$62-$207 (insertion)
$11-$70 (removal)
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METHOD
COST
Female Condom
Spermicides
Sponge
Cervical Cap
$1.25-$3.66
$8.75-$12.00
$.83 - $1.50
$19 - $31
Evra Patch
Similar to OCs
OTHER COSTS
Office visit fitting,
spermicides
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EPIDEMIOLOGY OF
CONTRACEPTIVES
CHOOSING A CONTACEPTIVE
KAISER FAMILY FOUNDATION STUDY
Women found the following “very important”:
Prevents pregnancy (90%)
Protects against STDs (77%)
No health risk (77%)
Is easy to use (51%)
Requires no advance planning (45%)
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CONTRACEPTIVE USE
PERCENT OF WOMEN AGES 15-44 YEARS USING
THEIR CONTRACEPTIVE METHOD, USA
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PERCENT OF WOMEN AGES 15-44 YEARS USING
THEIR CONTRACEPTIVE METHOD, DISTRIBUTED
BY ETHNICITY/RACE, USA
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CONTRACEPTIVE
METHODS
A/ FERTILITY AWARENESS METHODS
CALENDAR METHOD:
Avoidance of intercourse during fertile time of month by
calculating time of ovulation
BASAL BODY TEMPERATURE:
Fertility cycle related to changes in basal body temperature
OVULATION METHOD:
Fertility cycle related to variations in type of cervical mucus
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Pros vs. Cons of Fertility
Awareness Methods:
PROS
No side effects
Used by anyone
Cost effective
CONS
Length of menstrual
cycles vary
Other factors can
alter body temperature
Sperm can survive
48 to 72 hours in
female
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B/ HORMONAL METHODS
ORAL CONTRACEPTIVES:
17% of women 15-44 years of age
PROS
CONS
Lighter & less painful
Mood changes
periods
Spotting
 PMS symptoms
Weight changes
 bone density
Drug interactions
Improved skin
Protect against breast,
ovarian & endometrial
cancers, PID
Improve skin conditions
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Types of Birth Control Pills:
>
30 birth control pill brands available
Monophasic: each cycle provides 21
identical hormone-containing pills
Biphasic: Two-phase
Triphasic: Thee-phase
Minipills: Estrogen-free
Pros vs. Cons
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Hormonal Implants:
Norplant (late 1990s)
Subdermal contraceptive implant in arm
No estrogen
PROS
Lasts 5 years
Very effective
Protection begins within
24 hours
CONS
Menstrual irregularities
Headache, acne, mood
changes, weight changes
Difficulty removing
implants
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Hormone Delivery Methods:
Depo-Provera
Injectable progestins every 3-4 months
Ortho Evra
Patch worn on skin for 1-week intervals and 4th week
is patch-free
NuvaRing
Vaginal ring worn for 3 weeks and removed during
week of menstruation
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C/ BARRIER METHODS
SPERMICIDES:
Forms = cream, foam, film, suppository, gel
Used in all barrier methods except condoms
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DIAPHRAGM:
Dome-shaped latex cup sealing cervix
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CERVICAL CAP:
Similar to a small, deep diaphragm sealing
cervix
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CONDOMS:
Women responsible for 40% condom sales
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FEMALE CONDOMS:
Polyurethane sheath lining entire vagina and
external genitals
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CONTRACEPTIVE SPONGE:
Modern version of history form (sea sponges)
Cervical barrier available without fitting or prescription
PROS VS CONS OF BARRIER METHODS:
Overall safe
Protect from STDs
Used as back-up for pill users
 Diaphragm, sponge, and cervical cap = vaginal
bacterial infections, toxic shock syndrome
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D/ PERMANENT METHODS
FEMALE STERLIZATION:
Tubal Ligation = fallopian tubes cut &
tied
Laparoscopic Sterilization
Minilaparatomy
MALE STERLIZATION:
Vasectomy = vas deferens cut & tied
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E/ OTHER FORMS OF CONTRACEPTION
ABSTINENCE
No penis-in-vagina intercourse
WITHDRAWAL
Coitus Interruptus
BREAST FEEDING
Lactational Amenorrhea Method (LAM)
IUD
Small plastic object placed in uterus for 1-10 years
MORNING-AFTER PILL
Progestin-only pills prevent pregnancy after intercourse
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PERSPECTIVES ON
ABORTION
HISTORICAL OVERVIEW
Ancient Practice: Common by Greek physicians
Up to 1800s: No legal prohibitions
1973: Roe v. Wade
1976: Hyde Amendment
1980: Harris v. McRae
1989: Webster v. Reproductive Health Services
1991: Rust v. Sullivan
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EPIDEMIOLOGY
PERCENT OF TOTAL ABORTIONS IN THE U.S.,
BY AGE, 1999
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ABORTION PROCEDURES
A/ SURGICAL ABORTION
 Vacuum Curettage
 Dilation and Curettage (D&C)
 Dilation and Evacuation (D&E)
B/ MEDICAL ABORTION
 Methotrexate
 Mifepristone (RU-486)
C/ OTHER TECHNIQUES
 Menstrual Induction/Menstrual Extraction
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INFORMED
DECISION-MAKING
Review Needs
Medical History
Pros vs. Cons
Re-evaluate