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.