Contraception and Abortion
Agenda
Discuss History and Considerations
Associated with Methods
Discuss Contraception Methods
Discuss Abortion
Class Exercise: Contraception Values
Clarification
Complete the handout entitled “Contraception
Values Clarification.
After you have completed the handout, discuss your response in small groups.
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
Contraception in Ancient Times
Contraception in the U.S.: 1800s and
Early 1900s
Contraception Outside the U.S.
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
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
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
FDA Approval Process
Lifestyle Issues
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
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
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.
Barrier Methods: Condoms and Caps
Prevent sperm from entering the uterus
Barrier Methods:
Condoms
The Diaphragm
The Contraceptive Sponge
The Cervical Barriers
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
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
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
Condoms
Advantages:
STI protection
Encourages male participation
Inexpensive
No prescription necessary
Can reduce premature ejaculation
Can reduce postcoital drip
No medical side effects
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
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
Diaphragms come in a variety of different shapes and sizes and must be fitted by a health-care provider.
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
Instructions for proper insertion of a diaphragm.
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
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.
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
The Today contraceptive sponge was back on the market in late 2005 in the United States.
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
Instructions for proper insertion of a contraceptive sponge.
The Diaphragm
Advantages:
No prescription necessary
Can have intercourse several times within
24 hours
Increase sexual spontaneity
Do not affect hormonal levels
Disposable
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
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
The FemCap is a silicone cup shaped like a sailor’s hat that fits securely over the cervix.
Lea’s Shield is a silicone cup with a one-way valve and a loop for easier removal.
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
The Cervical Barriers
Advantages:
Left in place for up to 48 hours
Do not affect hormonal levels
Immediately effective
Not permanent
Oneway release valve in Lea’s Shield reduces risk of toxic shock syndrome
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
The Cervical Barriers
Widely used in England
Lea’s Shield is available over the counter in
Germany, Austria, Switzerland, & Canada
Hormonal Methods for Women: The
Pill, the Patch, and More
Changing hormonal levels can deter production of ova, fertilization, and implantation
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
Combined-Hormone Methods
Combination of estrogen & progesterone
Can repress ovulation and thicken cervical mucus
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
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
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
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
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
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
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
The NuvaRing is inserted deep into the vagina; moisture and heat cause it to time-release hormones that inhibit ovulation.
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
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
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
The Ortho Evra patch is worn on the buttock, abdomen, or upper torso for three weeks each month.
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Insertion of an IUD.
Intrauterine Methods for Women: IUDs and IUSs
Advantages:
Least expensive method over time
Allows for spontaneity
Decreases menstrual flow (Mirena)
Long lasting effects
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
Natural Methods for Women and Men
Natural Family Planning and Fertility
Awareness
Withdrawal
Abstinence
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
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
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
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
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
Withdrawal
Advantages:
Useful if other methods are not acceptable for religious reasons
No costs
Good if couples aren’t concerned about prevention
Withdrawal
Disadvantages:
No STI protection
Low effectiveness
May lead to premature ejaculation
May be stressful
Requires trust & restraint
Widely used in many countries
Abstinence
Refraining from sexual intercourse
100% effective
Protects against STIs
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
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
Essure is a permanent method of contraception.
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
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
In a vasectomy, each vas deferens is clipped, cut, or cauterized. A vasclip uses a flexible plastic clip to block the vas deferens.
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
Permanent (Surgical) Methods
Advantages:
High effectiveness
Permanent
Allows for spontaneity
Disadvantages:
Expensive, irreversible surgery
No STI protection
Widely used throughout the world
The Abortion Debate
Why Do Women Have Abortions?
Abortion Procedures
Reactions to Abortion
Teens and Abortion
Cross-Cultural Aspects of Abortion
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.
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.”
Pro-Life versus Pro-Choice
Historical Perspectives
Legal versus Illegal Abortions
Pro-Life versus Pro-Choice
Pro-life supporters: an embryo at any stage of development is a person and aborting a fetus is murder
Prochoice supporters: it is a woman’s choice and the government should not control her body
No gender differences in abortion attitudes
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
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
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
Legal versus Illegal Abortions
Since legalization in 1973, deaths from abortion decreased significantly
Video: “If these Walls Could Talk”
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
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
Abortion Procedures
First-trimester Surgical Abortion
Second-trimester Surgical Abortion
Medical Abortion
Mifepristone (RU-486)
Methotrexate
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
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
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
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
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
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
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
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
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
Reactions to Abortion
Women’s Reactions
Physiological Symptoms
Psychological Symptoms
Men’s Reactions
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
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
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
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
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
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.
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.