Chapter 5 Reproductive Health

Birth Control vs. Contraception

Percentage of U.S. Women Ages 15–44 Using Major Contraceptive Methods

Legal Perspectives of Birth Control Griswold v. Connecticut (1965) Mandated coverage for contraception for federal employees via an act of Congress (1998) Private insurance companies: oral contraception coverage

Race and Religion Also Influence Contraception Use

Choosing a Contraceptive Kaiser Family Foundation Study Women found the following “very important”: Prevents pregnancy (90%) Protects against STIs (77%) No health risk (77%) Is easy to use (51%) Requires no advance planning (45%)

Failure Rates A failure rate is the chance that the average couple using a given birth control method will become pregnant in a given year. Failure rates can be either for “perfect use” (ideal conditions) or “actual use” (failure rate in the real world) Failure rates range from less than 1% to 30%. Condoms, sponges, and diaphragms have the largest difference between these rates.

Contraceptive Failure High rates of effectiveness—oral contraceptives, hormone injectables and implants, IUDs, condoms, vaginal hormonal ring, hormone patch, sterilization Lower rates of effectiveness—diaphragms, cervical caps, sponges, spermicidal agents, fertility awareness methods, rhythm method, withdrawal.

Birth Control Pills Most commonly used form of contraceptive 99% effective Suppresses a woman’s reproductive hormone cycle

ProsCons  Lighter and less painful periods  Lower PMS symptoms  Improved skin  Protect against breast, ovarian, and endometrial cancers and PID  Increased bone density with long-term use  Mood changes  Spotting  Weight changes  Drug interactions  Decreased libido  Headaches  Fluid retention  Health risks for some women Oral Contraceptives Used by 19% of women aged 15–44 years

Fertility Awareness Methods “Free, no equipment necessary, but not reliable” Calendar method Avoidance of intercourse during fertile time of month by calculating time of ovulation Basal body temperature Fertility cycle related to changes in basal body temperature Cervical mucus or ovulation method Fertility cycle related to variations in type of cervical mucus

ProsCons  No side effects  Used by anyone  Cost-effective  Limited effectiveness  Need to abstain from sexual intercourse certain days/month  No protection from STIs Pros vs. Cons of Fertility Awareness Methods

Hormone Delivery Methods Depo-Provera Injectable progestins every three to four months Ortho Evra Patch worn on skin for one-week intervals; fourth week is patch-free NuvaRing Vaginal ring worn for three weeks and removed during week of menstruation

Barrier Methods Spermicides

Barrier Methods Condoms

Barrier Methods Female condoms Polyurethane sheath lining entire vagina and external genitals

Barrier Methods Diaphragm, cervical cap Dome-shaped latex cup sealing cervix

Barrier Methods Pros: Condoms offer protection from STIs Can be used as backup for pill users (or with other methods) Can be used for the short or long term Cons: Small risk of bacterial infection or toxic shock syndrome for diaphragm, sponge, and cervical cap Must be used properly May have higher long-term costs

Permanent Methods Female sterilization Tubal ligation = fallopian tubes cut and tied –Laparoscopic sterilization –Minilaparotomy Male sterilization Vasectomy = vas deferens cut and tied

Other Forms of Contraception Abstinence No penis-in-vagina intercourse Withdrawal Coitus interruptus Breastfeeding Lactational amenorrhea method (LAM) Intrauterine device (IUD) Small plastic object placed in uterus for 1–10 years

Emergency Contraception NOT the same as RU-486, otherwise known as “the abortion pill” Use of high-dose birth control pills taken within 72 hours of unprotected sex Brands = Ovral, Alesse, Preven Plan B = progestin-only form of emergency contraception

Handling an Unplanned Pregnancy Adoption—can be “open” or “closed”; private or public Abortion

A controversial issue of debate or a very common medical procedure? …Both, actually

Perspectives on Abortion Why do women choose abortions? Pregnancy would reduce a woman’s ability to work, finish school, or care for others Can’t afford a(nother) baby Relationship issues or not wanting to be a single mother Completed childbearing Not ready for a(nother) child Didn’t want people to know she had gotten pregnant or had sex

Global Perspectives Motherhood continues to be a major risk to life and health in the developing world (most of Asia, Africa and Latin America)

Abortion Procedures Surgical abortion Vacuum curettage Dilation and curettage (D&C) Dilation and evacuation (D&E) Medical abortion (“abortion with pills”) Mifepristone, misoprostol Misoprostol alone

Informed Decision Making If you want to prevent pregnancy… Review your and your partner’s needs Personal medical history Review failure rates Risks and benefits of method Reevaluate periodically

Discussion Where can people respectfully agree/disagree about when and how women should be able to end their pregnancies? How should unsafe abortion be addressed as a public health issue? What are some ways to promote public health and reduce the number of abortions?