Decision Making about Pregnancy and Parenthood Chapter Ten Decision Making about Pregnancy and Parenthood This chapter is more than a litany of birth control methods. It offers a sound basis for understanding the issues to be weighed in personal decision making about contraception, placing them in the broader context of world overpopulation. It also surveys some issues, such as abortion and use of fetal tissue for research purposes, that continue to generate debate and controversy.

Historical Perspectives Throughout history, people have found it necessary to limit family size for various reasons Folk methods and avoidance of intercourse Victorian influence restricted contraceptive info Comstock Laws (1870s) in U.S. Margaret Sanger instrumental in causing changes in the availability of birth control and contraceptive devices to women Zero population growth People’s sense of well-being contributes to their choices about having children. Human beings have sought to minimize the connections between sex and childbirth. In ancient times, botanical preparations may have provided contraceptive protection. Distribution of information about birth control was limited in the United States by the Comstock Laws, which were passed in the 1870s. Activist Margaret Sanger was influential in broadening the rights of women to learn about and use contraception in the early part of this century, although laws prohibiting the sale of contraceptives existed until the 1960s. Because of the earth’s burgeoning populations, some people believe that increased efforts to develop and promote contraception are necessary; others look toward redistribution of global wealth. Many children live in substandard conditions. It is believed that many global pregnancies are unwanted. Political and social factors may determine what kinds of birth control are accessible.

Deciding About Contraceptives Ethics Religion Politics Health Personal Feelings and Behaviors Culture Risks In making a decision about contraceptive use, people are influenced by several factors, including ethical/moral and religious beliefs; possible effects on the woman’s health; and psychological and social factors. Guilt, fear, or anxiety may not always inhibit sexual behavior, but these feelings may inhibit preparing for it. Each person must sort through his or her personal values and concerns about birth control, understand his or her personal reactions to sexual feelings and activities, and learn how to communicate with a partner effectively in order to prepare fully for contraceptive decision making. There is no “best” method of birth control for all individuals. Each couple must consider several factors in making a choice: age and amount of time required, how long the method will be used, what might hinder the method’s use, and cost.

Methods of Birth Control Abstinence Sex without intercourse Coitus interruptus Oral contraceptives Contraceptive implants Injectables Intrauterine devices (IUD) Female sterilization or tubal ligation Laparotomy Laparoscopy Postcoital - emergency contraception The theoretical or perfect use failure rate assumes that the birth control method is being used correctly and without technical failure. The typical use failure rate is the more realistic rating of the method, taking into account human error, carelessness, and technical failure. Even though most methods of contraception are designed for women, there are many ways for the responsibility to be shared by both partners, including cooperating in applying the method, communicating openly about birth control, and sharing the cost. Cultural imperatives sometimes interfere with the sharing of this responsibility. Hormones that prevent ovulation and change the consistency of cervical mucus can be administered in the form of combined oral contraceptive pills or progestin-only minipills. The pill provides protection against ovarian and endometrial cancers, but it may also have some side effects. Hormonal implants consist of six capsules that are implanted under the skin, releasing a synthetic hormone that prevents ovulation for up to 5 years. The intrauterine device (IUD) is inserted into the uterus and may work by preventing fertilization or implantation by the embryo. It was once implicated in a high risk of pelvic inflammatory disease (PID), and its use has since declined. The most accessible means of emergency contraception at present is to take extra doses of certain birth control pills. IUD insertion is also effective, and the drug mifepristone may become a form of postcoital birth control.

Barrier Methods Diaphragm Cervical Cap Male Condom Female Condom Spermicide Barrier methods prevent sperm from entering the uterus and are most effective when used with a spermicide. These include the diaphragm, cervical cap, and condom. Condoms protect against disease as well as pregnancy. Female condoms do not have as high a rate of effectiveness as male condoms.

Natural Family Planning Also called fertility awareness or rhythm method High failure rate Helpful when desiring pregnancy Over-the-counter ovulation tests Natural family planning/fertility awareness allows the woman to become more aware of her fertile period during the menstrual cycle by charting the length of her cycle, basal body temperature, and consistency of cervical mucus.

Vasectomy (Male Sterilization) Vasectomy involves cutting and tying the male vas deferens.

The Options for Unintended Pregnancy When an unintended pregnancy occurs, one of several options must be chosen: keeping the baby, placing it up for adoption, or abortion.

Some pregnancies terminate naturally, which is called miscarriage or spontaneous abortion. First-trimester abortions are usually done by vacuum curettage. Mifepristone in combination with prostaglandins offers a nonsurgical alternative. Later abortions may be done by dilation and evacuation or dilation and curettage or induced by injection of prostaglandins, saline, or urea. Induced abortion has been legal in the United States since 1973, but Supreme Court decisions have gradually allowed states to restrict its availability. There are conflicts between right-to-life and pro-choice groups about whether abortion should be continued as a legal option. The use of fetal tissue transplants in medical research has become part of the abortion controversy. The U.S. federal government currently allows fetal tissue to be used for research. Some women experience a degree of guilt, loss, or other psychological reactions. The availability of counseling before and after an abortion is important.