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Risk and Responsibility
In the U.S., half of all pregnancies are intended
Half of unintended pregnancies are terminated by
abortion
Those who discuss preventing pregnancy are most
likely to use contraceptives
Over a period of a year, couples who do not use
contraception have a 90% chance of conception
Every year, 6.3 million of the 60 million women of
childbearing age become pregnant
Pregnancy Outcomes in the U.S.
% Distribution of U.S. Women Age 15-44, By
Current Contraceptive Status, 2002
Men, Women, and Birth Control:
Who Is Responsible?
Women may have a greater interest than
male partners in controlling fertility
Has traditionally been seen as the woman’s
job, but society no longer views birth control
responsibility as solely women’s
Male-controlled methods now account for
35% of reversible contraceptive use
Adolescents and Contraception
Adolescents are less likely than older
individuals to use contraception
55% of women 1st intercourse before age 16
used birth control compared with 70% at age
19 or older
Condoms are preferred method
Condom use may be stigmatized
Birth Control Methods
Regulate the number of children an
individual or couple may have
Also called contraception (prevent either
fertilization or implantation of embryo in the
uterine lining)
Abstinence – the most reliable method of
birth control
Not engaging in sexual behavior
Preventing transmission of STIs
-Refer to page 143 table 9.1
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Sexual Abstinence
Most reliable form of birth control
Involves refraining from sexual activity that
could cause pregnancy
Abstinence does not necessarily rule out
affection or non-coital sexual activities
Practitioners’ definitions of abstinence vary
From a contraceptive perspective, abstinence
from vaginal intercourse is required
Birth Control Methods
Most effective – 90% will not get pregnant
Sterilization and hormonal methods such as birth control
pill, injectable medicines, ring, patch, contraceptive
implants, and intrauterine devices (IUD)
Second most effective – 85-90% effective
Barrier methods such as diaphragm, cervical cap, vaginal
sponge, and condoms
Third most effective – less than 85% effective
Coitus interruptus and jellies, creams, and foams
Least effective
Natural family planning
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Sterilization
Permanent and Irreversible
Vasectomy
Tubal Ligation
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Vasectomy
Cutting the vasa deferens
Simple operation
Small incisions made on the scrotum to
expose the spermatic cords
Small section of the vasa deferens is
removed
Each end sealed so sperm are unable to
travel to the urethra
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Fig. 09-02
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Tubal Ligation
Uterine tubes are first cut and either tied or
sealed
Prevents sperm from reaching egg
Laparoscopy – two incisions are needed
Hysteroscopic sterilization – uterine tubes
are sealed with an electric current
25% failure rate
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Fig. 09-03
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Hormonal Methods
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Birth Control Pill
Usually a combination of estrogen and
progesterone
Usually taken for 21 days out of a 28-day cycle
No pill or inactive pill is taken for the remaining 7
days
Exceptions
Lybrel – hormones taken 365 days
Seasonale/Seasonique/Quasense – hormones taken for 12
weeks and inactive pills for 7 days
Yaz – hormones taken for 24 days and inactive pills for 4
days
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Fig. 09-01a
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Biological Activity of the Pill
Estrogen and progesterone shut down
pituitary production of FSH and LH
No follicle begins to develop in ovary
Ovulation does not occur
Pregnancy cannot occur
Pill provides female sex hormones for the
patient
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Secondary Biological Activities of the Pill
Prevents the cervical mucus from entering
midcycle phase of being thin and watery
Affects the transport of an embryo down the
uterine tubes so implantation does not occur
Prevents normal buildup of the lining of the
uterus so an embryo is unable to implant
Pill accounts for the menstrual cycle to last
fewer days and flow is lighter
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Side Effects of the Pill
Beneficial
Relief of discomforts with menstruation and
relief of acne
Adverse
Nausea, vomiting, irregular spotting, breast
swelling, weight gain, dizziness, blood clots
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% of Women Age 15-44 Who Have
Ever Used the Pill, 2002
Alternate Routes of Administration
Depo Provera (only progesterone)
Injectable form administered every 12 weeks (~three
months)
Causes changes in the endometrium that makes pregnancy
less likely to occur
Lunelle (both estrogen/progesterone)
Once-a-month injection
Vaginal Ring/Nuva Ring (both estrogen/progesterone)
Worn in the vagina for 21 days and removed for 7 days
Hormone Patch – Ortho Evra (both
estrogen/progesterone)
Changed every week for three weeks and not worn on the
fourth week
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Fig. 09-01f
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Morning After Pill
Also known as emergency contraception,
Preven, or Plan B
Medication that will prevent pregnancy after
unprotected intercourse
One, two, or four synthetic progesterone pills
Taken up to 72 hours after unprotected
intercourse and 12 hours later
Upsets the normal female reproductive cycle,
making it difficult for an embryo to implant itself
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Intrauterine Device (IUD)
Small piece of molded plastic that is inserted
into the uterus by a physician
Copper type – copper wire wrapped around
the stem
Progesterone-releasing type – progesterone
embedded in the plastic
Mirena – smaller and more flexible
Stays in place for 5 years
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Fig. 09-01b
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IUD
Biological Activity and Side Effects
of IUD
Biological activity
Prevents implantation of the embryo because
there is often an inflammatory reaction where the
device presses against the endometrium
Other theories
Side effects
Expulsion, pain, irregular bleeding, profuse
menstruation
Pelvic Inflammatory Disease (PID)
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Contraceptive Implant
Norplant
Long lasting contraceptive implanted under the
woman’s skin
Six, inch long, silicone rubber tubes containing
progestin (synthetic progesterone)
Implanon
Only used today
Only one tube, easier to insert and remove than
norplant
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Fig. 09-01e
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Barrier Methods
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Diaphragm, Cervical Cap, and
Vaginal Sponge
Diaphragm – soft rubber or plastic cup with a
flexible rim that fits over the cervix
Inserted at most two hours before sexual relations
Used with spermicide and left in place for at least 6 hours after
intercourse
Cervical Cap – thicker and smaller than the
diaphragm
Is effective even if left in place for several days
Vaginal Sponge
Does not need to be fitted by a physician
One size fits all
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Fig. 09-01c
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Fig. 09-04
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Condoms
Male Condom – thin skin or sheath that fits
over the erect penis
Ejaculate is trapped inside the sheath and does
not enter vagina
Protection against STIs
Female Condom – large polyurethane tube
with a flexible ring that fits onto the cervix
Also protects against STIs
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Fig. 09-05
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Fig. 09-01d
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Fig. 09-06
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Coitus Interruptus
Withdrawal
Discharge the semen outside of the vagina
Advantage
Always available
Disadvantage
First drop of semen is released before orgasm
and contains numerous sperm
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Spermicidal Jellies, Creams, and
Foams
Contains sperm killing ingredients such as
nonoxynol-9
Inserted into the vagina with an applicator up
to 30 minutes before intercourse
Disadvantage
Women may have an allergy
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Natural Family Planning
Rhythm method of birth control
Based on the fact a woman ovulates only
once per month and egg and sperm are
viable for a limited number of hours or days
Subtract 18 from the shortest cycle
Unsafe period begins
Subtract 11 from longest cycle
Unsafe period ends
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Natural Family Planning Calendar
Shortest cycle: 25 days
Longest cycle: 29 days
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Natural Family Planning Calendar
Natural Family Planning
More reliable method is to await the day of
ovulation and wait three more days before
engaging in intercourse
Body temperature is lower before ovulation
Preceding ovulation temperature drops 0.2°F and
following ovulation the temperature rises 0.6°F
Level of sugar in the vagina increases near
ovulation (Tes-Tap: yellow turns blue)
pH can be tested (acid to alkaline, ovulation is near)
Weight of cervical mucous decreases at ovulation
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Oral Body Temperature
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Abortion
Medical definition: expulsion of the conceptus
Can happen naturally (miscarriages)
Can be medically or surgically induced
Abortions are not all the same
Circumstances of pregnancy vary
Differences by stage of pregnancy
Abortion
Conditions matter
Under safe, clean, legal conditions abortion is a
safe medical procedure
Self-administered or illegal clandestine abortions
can be very dangerous, sometimes fatal
Weeks of Pregnancy When Women
Have Abortions
Abortion
Termination of pregnancy before the fetus is
capable of surviving, fetal weight of less than
1 pound
Surgical Abortion – legally available in most states
Abortion Pill – mifepristone (anti-progesterone)
and misoprostol (induces contractions)
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Methods of Abortion
Surgical Abortion
Vacuum Aspiration
Used in first trimester and performed under local anesthesia
Most widely used abortion procedure in the U.S.
Dilation and Evacuation (D&E)
Used in second trimester
Only 1.5% of U.S. abortions
Hysterotomy
Used in later stages of pregnancy
Like a cesarean section, extremely rare
Vacuum Aspiration
Methods of Abortion
Abortion Pill
A two-drug regimen (mifepristone with
misoprostol) that can terminate early pregnancy
Mifepristone prevents the cells of the uterine
lining from getting the progesterone they need to
support the fertilized ovum
Misoprostol causes uterine contractions
Most effective when used during the 1st 9 weeks
(63 days) after the beginning of the pregnant
woman’s last period
Mifepristone and Misoprostol
Prevalence of Abortion
A common experience among U.S. women
Approximately half of unintended pregnancies end
in abortion
Highest rates among
Ages 18-29, unmarried, Black or Hispanic, and/or
economically disadvantaged women
Number of abortions decreased between 1994 and
2000
Emergency contraception accounts for as much as 43%
of decrease
Rate of Abortions in Women Aged
15-44 By Year
The Abortion Debate
A pro-life argument
Human life begins at fertilization
Same rights in utero as after birth
Abortion is moral equivalent of murder
A pro-choice argument
Women should be able to choose whether or not they
will have children
Abortion should be available as a back-up birth control
method
Women will get illegal and unsafe abortions if the
procedure is made illegal
Infertility
Failure of a couple to achieve pregnancy after
one year of regular, unprotected intercourse
AMA estimates that 15% of couples are
infertile
Attributed to males (40%), female (40%), or both
(20%)
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Causes of Infertility
Males
Low sperm count and/or abnormal sperm
Environmental influences
Females
Extreme underweight
Pelvic inflammatory disease (PID)
Endometriosis – presence of uterine tissue
outside the uterus
Stress
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Assisted Reproductive Technologies (ART)
Techniques used to increase the chances of
pregnancy
Artificial insemination – sperm placed in vagina
Drugs are given to stimulate the ovaries
In vitro fertilization (IVF) – conception occurs in
laboratory glassware, embryo is transferred to
uterus
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Assisted Reproductive Technologies (ART)
Techniques used to increase the chances of
pregnancy
Intracytoplasmic sperm injection – single sperm
injected into an egg
Gamete intrafallopian transfer (GIFT) – egg and
sperm placed in uterine (fallopian) tubes
immediately after they have been brought
together in laboratory glassware
Surrogate mothers
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Fig. 09-09
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