CONTRACEPTION John B. Pryor, Ph.D. ILLINOIS STATE UNIVERSITY DEPARTMENT OF PSYCHOLOGY

Who needs contraception?  62 million U.S. women in childbearing years (15-44)  Of these 7 out of 10 are sexually active and do not want to become pregnant  Typical U.S. woman wants 2 children and therefore must use contraceptives for 3 decades of her life Source: Alan Guttmacher Institute 2006

Who uses contraception?  98% of U.S. women who have had sex have used at least one form of contraception  89% of women who do not want to become pregnant are using some form of contraception Method choice varies by age  For women younger than 30, the pill is the leading method  By the time women reach 35, sterilization is more common Source: Alan Guttmacher Institute 2006

Survey of 38,109 U.S. women

What do college students use for contraception?

Form of Contraceptive Used by Illinois College Females the Last Time They Had Sexual Intercourse

Form of Contraceptive Used by Illinois College Males the Last Time They Had Sexual Intercourse

Some facts about common forms of contraception.....

Methods of Birth Control - typical failure rates 0.00% - Abstinence 0.15% - Sterilization - Males 0.40% - Sterilization - Females 18.0% - Withdrawal 85.0% - No Method

Norplant A small amount of the hormone is released constantly. The hormone keeps the ovaries from releasing eggs. It also thickens the cervical mucus. This keeps sperm from joining with an egg. Some researchers believe that Norplant also may work by preventing a fertilized egg from attaching to the lining of the uterus. Typical failure rate =.04%

Depo-Provera Depo-Provera is a synthetic hormone that is injected into the buttock or arm every 12 weeks. The hormone keeps the ovaries from releasing eggs. It also thickens the cervical mucus. This keeps sperm from joining with an egg. Typical failure rate =.03%

The Intrauterine Device (IUD) IUDs are small devices made of plastic that contain copper or a natural hormone. IUDs usually work by preventing fertilization of the egg. They also may work by affecting the way sperm or eggs move or by affecting the lining of the uterus in ways that prevent implantation. Typical failure rate =.08%

The Pill Combined pills keep the ovaries from releasing eggs (ovulation). Mini- pills can also prevent ovulation. But they work mainly by thickening the cervical mucus. This prevents the sperm from joining with the egg. Mini-pills may also prevent fertilized eggs from implanting in the uterus. Typical failure rate = %

Birth Control Patch (brand name: ORTHO EVRA ) Typical failure rate = 1.0% The contraceptive patch contains hormones similar to those in birth control pills. You must change your patch once a week for three consecutive weeks. You do not need to apply a patch during the fourth week.

The Ring The vaginal contraceptive ring consists of a flexible, transparent, colorless vaginal ring about 2.1 inches in diameter containing the hormones etonogestrel and ethinyl estradiol, which are similar to the active ingredients in some oral contraceptives. After the ring is inserted, it releases a continuous low dose of the hormones. A new ring is used each month for continuous contraception A woman inserts the ring herself, and it should remain in the vagina for three weeks. She then removes the ring for one week during which she will have her menstrual period.. Typical failure rate = 1.0%

The Condom  barrier method  added protection if used with spermicide  reccomended model - latex with reservoir tip  use water-based lubricants only Typical failure rate = 12.0%

Putting on a condom Put a drop or two of lubricant inside the condom. Place the rolled condom over the tip of the hard penis. Leave a half-inch space at the tip to collect semen. If not circumcised, pull back the foreskin before rolling on the condom.

Putting on a condom (continued) Pinch the air out of the tip with one hand. (Friction against air bubbles causes most condom breaks.) Unroll the condom over the penis with the other hand. Roll it all the way down to the base of the penis. Smooth out any air bubbles. Lubricate the outside of the condom.

Diaphram Diaphragms and cervical caps are soft rubber barriers that are intended to fit securely over the cervix. Both are used with a spermicide cream or jelly. Each blocks the entrance to the uterus, and the jelly or cream immobilizes sperm, preventing it from joining the egg. Cervical Cap The Diaphragm & Cervical Cap Typical failure rate =17.0%

Female Condom Typical failure rate = 24.8%

Foam, Jelly, Film, Suppository  contain spermicide  barrier method  must be reapplied for each subsequent intercourse Typical failure rate = 20.0%- 50%

Fertility Awareness Methods  trying to predict peak fertility times & avoiding intercourse during those times  three methods of prediction  basal body temperature method  cervical mucus method  calendar or "rhythm" method Typical failure rate = 20.0%

Emergency Contraception  Post-Coital Contraceptives –morning after pill (e.g., Preven & Plan B) - Emergency contraception (EC) consists of the same hormones found in ordinary birth control pills. –within 72 hours of unprotected intercourse –Side-effects: nausea, vomiting, and cramping –20-25% become pregnant  Like regular contraceptive pills, Plan B generally acts by preventing ovulation or fertilization, according to the F.D.A. Plan B may in rare circumstances prevent a fertilized egg from becoming implanted, something abortion opponents decry. But regular oral contraceptives do that, too.

Emergency Contraception  The U.S. Food and Drug Administration (FDA) announced on August 24, 2006 the approval of Plan B as an over-the- counter (OTC) option for women aged 18 and older. Plan B will remain available as a prescription-only product for women age 17 and under.  As much as 43% of the decline in abortion between 1994 and 2000 can be attributed to the use of emergency contraception.

Reasons for Emergency Contraception  His condom broke or slipped off, and he ejaculated inside your vagina.  He forced you to have unprotected vaginal intercourse.  Your diaphragm or cervical cap slipped out of place, and he ejaculated inside your vagina.  You miscalculated your "safe" days for periodic abstinence or fertility awareness methods.

Reasons for Emergency Contraception (continued)  You forgot to take your birth control pill more than two days in a row.  You weren't using any birth control.  He didn't pull out in time.

RU 486  antiprogesterone that blocks uterine receptors of progesterone, a hormone critical for the maintenance of pregnancy  induces abortion when administered in early pregnancy  success rate is 96 percent for women who are less than 63 days from their last menstrual period

life-time failure rate LTF = 1 - (1 - AFR) years LTF (pill) = 1 - (1 -.02) 30 pill (2%) 50% condom (5%) 100% 30 years of reproduction ( age 17-47) ALL COUPLES WILL HAVE A PREGNANCY

Other new methods of contraception have also been approved recently  Barrier methods –Lea’s Shield ® (2002) –FemCap ® (2003)  Intrauterine contraceptive –Mirena ® (2000)  Sterilization –Vas occlusion: VasClip ® (2002) –Tubal occlusion: Essure ® (2002)

Some methods are awaiting FDA review or approval  Single-rod hormonal implant: Implanon ®  Sponge: Today ® Sponge  “Frameless” intrauterine device (IUD): GyneFix ®

The world’s population has increased dramatically in the past century Population (in billions) Year (Projected)