• Review 2.16.15 In-Class Assignment
• Quiz
• Group Project Review & Preparation
• Contraception Lecture
• No In-Class Assignment

• Project and presentation due on 3/2/15
• Assign order of presentation
• Q &A

CONTRACEPTION

 Birth control
 any means of preventing a birth from taking place; includes contraception and abortion
 Contraception
 The prevention of conception
 Technique designed to either prevent the release of an ovum, prevent the fertilization of an ovum, or prevent a fertilized ovum from implanting in the uterine wall

 Abstinence-refraining from sexual intercourse
(vaginal, oral, & anal)
 Celibacy-not engaging in any kind of sexual activity
 Outercourse-a method of birth control using all avenues of sexual intimacy except sexual intercourse

 Best method is the one you will use consistently
 Theoretical effectiveness
 User/Typical effectiveness

• Typical use failure rate
– Percentage of typical users of a contraceptive method who will get pregnant within one year
• Theoretical use failure rate
– Percentage of users of a contraceptive method who will get pregnant within one year while using the method perfectly each time

• Not a “method” at all
• Withdrawal (aka: Coitus interruptus)
• Douching
• Assumption: cleanses the vaginal canal by squirting a liquid into the vagina
• Actuality: Not recommended for any use; no good purpose and can promote infections
• Urination after intercourse

BARRIER HORMONAL
Cervical Cap
Diaphragm
Depo-Provera
Lunelle
Emergency
Contraception
Female Condom Implants
Male Condom Patch
The Sponge Pill
Ring
LONG-TERM NATURAL FAMILY
PLANNING
Female
Sterilization
Basal Body
Temperature
IUD
Male
Sterilization
Cervical Mucus/
Ovulation Method
Rhythm Method

• Preventing the release of an ovum
• Can also cause the cervical mucus to thicken which prevents sperm from entering the uterus
• The ingestion or injection of estrogen or progestin or a combination of the two.


 Also known as Plan B
 Estrogen and progesterone or just progestin.
 For use within 72 hours of unprotected sex. No later than 5 days.
 “morning after pill” is not an appropriate name
 Must be taken well BEFORE implantation.

 Two forms of pills
 Estrogen & Progestin (the combination pill)
 Most women choose this method
 Side effects from estrogen include severe headaches and high blood pressure
 Progestin (the mini pill)
 Mostly selected due to side effects experienced from estrogen in the combo pill

• Any woman (including those over 35) with no risk factors that preclude OCs.
• Women with mild headaches or migraines
• Women who have diabetes without any blood vessel related complications
• Women with a history of abnormal, precancerous Papsmears (displasia).

Works by inserting progestin rods under the skin and continuously release tiny amounts of progestin into the bloodstream
– Norplant (used five rods and lasted five years)
• is no longer available in the United States
– Replaced by implanon
• Uses one rod
• Provides protection against pregnancy for up to three years
– Can be removed at anytime
– After removal, can resume menstruation in one month

• Depo-Provera
– Progestin
– Administered four times a year
• Lunelle
– Estrogen + Progestin
– Administered every 4 weeks

• Estrogen and Progestin
• A once-a-week birth control option that's as effective as the Pill.
• It is the first weekly, non-invasive form of reversible contraception
• How does it work?
• What are advantages and disadvantages?

• NuvaRing® delivers steady low-dose contraceptive hormones around the clock.
– Progestin and Estrogen
• One ring is used each month. The ring stays in for 3 weeks and then is removed for one week. Then you insert a new NuvaRing®.

• Preventing fertilization of an ovum
• Providing a physical barrier between the semen and the cervix in order to prevent sperm from reaching the egg cell

• Male
• Female
• Use either one or the other at one time
– Never both at the same time

• Back on the US market
• blocks sperm from entering the uterus and absorbs and kills off the sperm.
• Intended to be used with spermicide

• Work to prevent sperm from entering the uterus
– Intended to be used with spermicide
• Diaphragm
– a flexible ring around the top, the diaphragm is inserted into the vagina prior to sexual intercourse.
• Cervical Cap
– smaller and fits more tightly around the cervix when in place
– must be fitted by your doctor and then purchased from a local pharmacy
– can leave the cervical cap in place for up to 48 hours

Spermicide - substance toxic to sperm
 Contraceptive foam
 Contraceptive film
 Creams, jellies & Vaginal suppositories
 Non-oxynol 9??

•
IUD
•
Female Sterilization
•
Male Sterilization

 Tiny T-shape plastic or copper device inserted into uterus
 Multiple theories on how it works
 Insertion can be painful, heavy cramping and menstrual flow
 Two currently available in the United States:
– Progestasert (~ 10 years)
– ParaGard (~ 1 year)

WOMEN
Laparoscopy- closing the tubes by electrocauterization
–
–
–
–
Minilaparotomy-tubes are tied off or sealed
Culpotomy-tubes tied and cut
Culdoscopy- Same as Culpotomy; however, leaves less visible scars
Hysterectomy-surgical removal of the uterus
MEN
Vasectomy
 cut or tie off the
Vas deferens

• Spontaneous abortion
– aka miscarriage
– Loss of baby before 20 weeks of pregnancy
• Induced abortion
– Surgical
– Drug-based

• Vacuum Aspiration
– First trimester method
• Dilation and Extraction (D & X)
– Late surgical method

• Mifepristone (RU 486) –Injection, 0rally
– An anti-progesterone
• prevents progesterone from making uterine lining hospitable for implantation
• If fetus is already implanted, causes the uterus to shed its lining and, along with it, the fertilized fetus
– Approved by FDA in September 2000 for abortion
• As an alternative to surgical procedure
– Effectiveness is increased if used with another drug,
Misoprostol (95-98%)
– Most effective within 7 weeks of fertilization

• Methotrexate –Injection; orally (rarely)
– Prevents cell division and multiplication
– Can be used to induce an abortion
• Effectiveness is increased if used with another drug, Misoprostol (95%)
– Approved by FDA for treatment of cancer, arthritis and psoriasis
– Most effective within 7 weeks of fertilization
• Misoprostol – orally or vaginally
– Legal Drug used in conjunction with above drugs
– The second drug used to complete the abortion procedure
• Taken a day or two after administration of the first drug
– Causes the uterus to contract and expel its contents
– Approved in the US for coating the stomach of people who take stomachirritating anti-inflammatory drugs.

• A method or substance that causes a fertilized egg that has implanted in the uterine wall or fetus to be expelled.
• Which of the drug-based methods is an abortifacient?

• Nearly half of pregnancies among American women are unintended, and four in 10 of these are terminated by abortion.
• Twenty-two percent of all pregnancies (excluding miscarriages) end in abortion.
• In 2005, 1.21 million abortions were performed, down from 1.31 million in 2000. From 1973 through 2005, more than 45 million legal abortions occurred.
• Each year, about two percent of women aged 15-44 have an abortion; 47% of them have had at least one previous abortion.
Source: Perspectives on Sexual and
Reproductive Health

Source: Guttmacher Institute

• Surgical
– In 2005, the cost of a non-hospital abortion with local anesthesia at 10 weeks’ gestation ranged from
$90 to $1,800; the average amount paid was $413
(Source: Perspectives on Sexual and Reproductive Health)
• Drug-based
– most providers do charge more for this method

• Roe v. Wade
– 1973 Supreme Court decision stating
• 1st trimester abortions cannot be regulated by states and the decision to abort is between woman and physician
• 2nd trimester abortions permitted when mental or physical health of mother at risk
• 3rd trimester abortions allowed when life of mother at risk

• California does not have any of the major types of abortion restrictions – such as waiting period, mandated parental involvement or limitations on publicly funded abortions – often found in other states.
Source: Alan Guttmacher Institute

• Anti-abortion (Pro-life) position
• Pro-choice position