Contraception and Abortion Chapter 6 ©2012 McGraw-Hill Companies. All Rights Reserved. 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 2 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 3 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% ©2012 McGraw-Hill Companies. All Rights Reserved. 4 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% ©2012 McGraw-Hill Companies. All Rights Reserved. 5 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% ©2012 McGraw-Hill Companies. All Rights Reserved. 6 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 7 Injectable Contraceptives Depo-Provera Hormonal treatment Injectable progestin every 12 weeks Advantages Disadvantages Effectiveness: When taken as directed, the failure rate is 0.3% ©2012 McGraw-Hill Companies. All Rights Reserved. 8 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 9 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 10 Figure 6.1 Use of the male condom ©2012 McGraw-Hill Companies. All Rights Reserved. 11 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 12 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 13 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. ©2012 McGraw-Hill Companies. All Rights Reserved. 14 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 15 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 16 Abstinence Abstinence Decision to go without intercourse or sexual activities Benefits Religious, moral, cultural, personal beliefs Emotional needs Time for relationship to grow ©2012 McGraw-Hill Companies. All Rights Reserved. 17 The Fertility Awareness Method Methods Calendar methods Temperature methods Mucus method Withdrawal Coitus interruptus ©2012 McGraw-Hill Companies. All Rights Reserved. 18 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 19 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% ©2012 McGraw-Hill Companies. All Rights Reserved. 20 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 21 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 22 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 23 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 24 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 25 Figure 6.3 Public opinion about abortion ©2012 McGraw-Hill Companies. All Rights Reserved. 26 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 28 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 29 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 30 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 ©2012 McGraw-Hill Companies. All Rights Reserved. 31 Contraception and Abortion Chapter 6 ©2012 McGraw-Hill Companies. All Rights Reserved.