Contraception and
Abortion
Chapter 6
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Contraceptives
 Definition:




Conception: the fusion of an ovum and sperm
that creates a fertilized egg, or zygote
Contraception: blocking conception through the
use of a device, substance, or method
Modern contraception methods are much more
predictable and effective than in the past
Many contraceptive products play a role in the
prevention against sexually transmitted diseases
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Principles of Contraception
 Types

of contraception:
Barrier, hormonal, natural, and surgical methods
 Factors

affecting choice
Advantages and disadvantages






Effectiveness
Convenience
Cost
Reversibility
Side effects and risks
Protection against STDs
 Effectiveness


Contraceptive failure rate
Continuation rate
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Oral Contraceptives: The Pill


Estrogen and progestins taken orally
Mimics the hormonal activity of the corpus luteum


Combination pill





Lybrel
“Minipill”


Most common
1-month packet containing estrogen and progestin
Extended-cycle pill


Corpus luteum secretes high levels of progesterone and
estrogen to suppress ovulation
1-month packet containing progesterone
Advantages
Disadvantages
Effectiveness: When taken as directed, the failure
rate is 0.3%
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Contraceptive Skin Patch
 Thin
1 ¾-inch square patch
 Releases estrogen and progestin slowly
into the bloodstream
 Prevents the same way as combination
OCs
 Worn for 1 week, replaced on the same
day for 3 consecutive weeks. Fourth week
no patch
 Advantages
 Disadvantages
 Effectiveness: When taken as directed,
failure rate is 0.3%
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Vaginal Contraceptive Ring
 The
NuvaRing
 Molded with progestin and estrogen
 2-inch ring slowly releases the hormones
 During fourth week, remove the ring and
use a new ring after the fourth week
 Advantages
 Disadvantages
 Effectiveness: When taken as directed,
the failure rate is 0.3%
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Contraceptive Implants
 Implanon







(2006)
Hormonal method - progestin
Single implant
Effective for 3 years
Inhibits ovulations and affects the
development of the uterine lining
Advantages
Disadvantages
Effectiveness: Failure rate is 0.1%, the most
effective method of contraception and the
most discrete
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Injectable Contraceptives
 Depo-Provera





Hormonal treatment
Injectable progestin every 12 weeks
Advantages
Disadvantages
Effectiveness: When taken as directed, the
failure rate is 0.3%
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Intrauterine Devices (IUDs)
 T-380A

(ParaGard) 10 years of protection
Copper
 Levonorgestral

(Mirena) 5 years of protection
Releases small amounts of progestin
 Not
exactly sure how it prevents pregnancy
 Advantages
 Disadvantages
 Effectiveness: 0.8% failure rate for ParaGard,
and 0.2% failure rate for Mirena
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Male Condoms
 Thin
latex, or polyurethane, sheaths
 Protection against STDs
 Advantages
 Disadvantages
 Effectiveness
During the first year of typical condom use
among 100 users, between 10 and
18 pregnancies occur
 2% failure rate with perfect use
 Use with spermicide

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Figure 6.1 Use of the male condom
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Female Condoms
A
clear, stretchy, disposable pouch with two
rings that can be inserted into a woman’s
vagina
 Advantages
 Disadvantage
 Effectiveness:

21% typical first-year failure
rate with first-year typical users
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The Diaphragm with Spermicide







Dome shaped cup of latex or silicone stretched
over a collapsible metal ring
Blocks sperm from entering the uterus
Custom fit
Must remain in place for 6 hours after sex
After intercourse, women should inspect
diaphragm for defects
Advantages
Disadvantages


Toxic shock syndrome (TSS)
Effectiveness


6% failure rate with perfect use
16% failure rate with typical use
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FemCap
 Small
silicone cap
 Must use spermicide
 Advantages
 Disadvantage
 Effectiveness


16% typical use failure rate for women who have
never had a child
32% typical use failure rate for women who have
had a child
 Uncommon
form of contraception in U.S.
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The Contraceptive Sponge
 Round,
absorbent device about 2 inches in
diameter
 Presaturated with the same spermicide that
is used in contraceptive creams and foams
 Advantages
 Disadvantages

Toxic shock syndrome (TSS)
 Effectiveness

16% typical use failure rate for women who have
never had a child
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Vaginal Spermicides
 Foams,


creams, jellies
Spermicidal suppository
Vaginal Contraceptive Film (VCF)
 After
60 minutes, their effectiveness is
drastically reduced
 Must wait 6 hours post-intercourse if the
women wants to douche
 Advantages
 Disadvantages
 Effectiveness: 29% failure rate with typical
first-year use
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Abstinence
 Abstinence


Decision to go without intercourse or sexual
activities
Benefits



Religious, moral, cultural, personal beliefs
Emotional needs
Time for relationship to grow
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The Fertility Awareness Method
Methods
 Calendar
methods
 Temperature methods
 Mucus method
Withdrawal
 Coitus
interruptus
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Emergency Contraception (EC)
 Postcoital
Pill, Morning After Pill, Plan B, Plan
B One-Step, Next Choice





Newer products now more common and
effective, with fewer side effects, than old
methods
Prevents fertilization, does not affect an already
fertilized egg
Best used within 24 hours
Plan B, Plan B One-Step,
and Next Choice available
as OTCs for those 17 and
older
Intrauterine devices
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Male Sterilization: Vasectomy
 Severing
of the vasa deferentia
 Can have sex again in about a week
 About one-half of reversals are successful
 Effectiveness

Failure rate is 0.2%
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Female Sterilization
 Tubal
sterilization (laparoscopy) is most
commonly known as tubal ligation
 Essure system

Tiny spring-like metallic implants cause scarring, thus
blocking the Fallopian tubes, no incision needed
 Adiana

Tiny inserts block Fallopian tubes, no incision needed
 Hysterectomy
 More
costly, complicated,
and permanent than male
sterilization
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Which Contraceptive Method is
Right for You?
 Key
1.
2.
3.
4.
5.
6.
7.
8.
considerations include:
Health risks
Implications of unplanned pregnancy
STD risk
Convenience and comfort level
Type of relationship
Ease and cost of obtaining and
maintaining each method
Religious or philosophical beliefs
Potential non-contraceptive benefits
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The Abortion Issue
 Abortion

The expulsion of an embryo or fetus from the
uterus before it is sufficiently developed to
survive
 Miscarriage

Spontaneous abortion that occurs naturally
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Legal Status of Abortion
 1973:

Roe versus Wade
Supreme Court ruled :
 Pregnancy divided into 3 trimesters
 1st trimester - up to women & doctor
 2nd trimester - state may regulate once the
fetus becomes viable
 3rd trimester - state may regulate and bar
all abortions that are not life-threatening
to mother
 States
have a variety of laws on abortion
 Between 1995 and 2006, the number of
state laws restricting abortion more than
quadrupled
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Public Opinion
 Pro-life
 Pro-choice
 Many
people have moral beliefs that combine
the two viewpoints
 Many people believe the fetus gains increasing
human value as pregnancy advances
 Most Americans see the issue as complex
 Views vary depending on situation
 Most support legal right to
abortion in certain situations
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Figure 6.3 Public opinion about
abortion
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Personal Considerations
Legal
arguments
Moral arguments
Short- and long-term ramifications
Adoption option
27
Abortion Statistics
 The
majority of women who get abortions
share the following characteristics:





Are under age 25
Have previously given birth
Have never been married
Are poor
Live in a metropolitan area
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Methods of Abortion
Two
categories
 Surgical
Suction curettage
 Manual vacuum aspiration
 Multi-fetal pregnancy reduction
 Dilation and evacuation
 Intact dilation and extraction

 Medical
– Use of medication
Generally used in very early pregnancy
 Emergency contraception pills or IUD

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Complications of Abortion
 Physical
effects
 Post-abortion physical warning signs
 Fever above 100º F
 Abdominal pain, tenderness, or swelling
 Cramping or backache
 Prolonged or heavy bleeding
 Foul-smelling vaginal discharge
 Vomiting
 Fainting
 Delay of 6 or more weeks in resuming
menstruation
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Possible Psychological Effects
 Possible








feelings after having an abortion
Guilt
New strength in having made and carried out an
important decision
Depression
Sense of loss
Negative feelings about sex
Relationship may end
Anger
Bitterness
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31
Contraception and
Abortion
Chapter 6
©2012 McGraw-Hill Companies. All Rights Reserved.