Chapter Six Contraception and Abortion

Contraception Contraception procedures are used to decrease chances of fertilization of an ovumContraception procedures are used to decrease chances of fertilization of an ovum Modern contraceptive methods are much more predictable and effective than in past yearsModern contraceptive methods are much more predictable and effective than in past years Many types of contraceptives play an important role in protecting against sexually transmitted diseases (STDs)Many types of contraceptives play an important role in protecting against sexually transmitted diseases (STDs)

Principles of Contraception Barrier methodsBarrier methods Block sperm from reaching the ovumBlock sperm from reaching the ovum Hormonal methodsHormonal methods Altering body chemistry, preventing ovulationAltering body chemistry, preventing ovulation Natural methodsNatural methods Based on understanding how sperm and ova functionBased on understanding how sperm and ova function Surgical methodsSurgical methods Sterilization proceduresSterilization procedures

Contraceptive Effectiveness vs. User Effectiveness Contraceptive effectiveness: measure of a contraceptive method’s ability to prevent a pregnancy as directed during intercourse Contraceptive effectiveness: measure of a contraceptive method’s ability to prevent a pregnancy as directed during intercourse User Effectiveness: effectiveness of the method in preventing conception when used by the general publicUser Effectiveness: effectiveness of the method in preventing conception when used by the general public Continuation rate: percentage of people who continue to use a method after a period of timeContinuation rate: percentage of people who continue to use a method after a period of time

Oral Contraceptives: The Pill Oral Contraceptives: The Pill Oral Contraceptive Pills Daily ingestion; estrogen works by reducing the ovum development; progesterone reduces ovulation by mimicking hormonal activity of the corpus luteum, and can thicken cervical mucus Side effects Tenderness in breastsTenderness in breasts NauseaNausea HeadachesHeadaches SpottingSpotting Weight gainWeight gain Sex drive fluctuationSex drive fluctuation Frequent vaginal infectionsFrequent vaginal infections Mild depressionMild depression Advantages Reduction of certain types of cancers, reversibility, and decreased incidences of PID and iron-deficiency anemia

Other Hormonal Methods Minipills Low dosage progesterone Injectable Contraceptive “Depo Provera” (99% effective for 3 months) Progestin-only contraceptive Lunelle (injectable progestin/estrogen) are injected every month, discontinued in Subdermal Implants “Norplant” progesterone rods inserted in the upper arm release hormone over 5 year period…discontinued in 2002 Others include Implanon (single capsule device) and Norplant 2 (two capsule device) Contraceptive Patch Estrogen/Progestin on skin/replaced every 3 weeks

Hormonal Methods (cont.) Lea’s Shield One-size fits all diaphragm device available by prescription. Silicone rubber allowing flow of air/fluids from cervix, must be used with spermicide and left in place for 8 hours after intercourse. User/failure rates are similar to diaphragm user rate effectiveness is unknown as this time. Contraceptive Ring Polymer device containing estrogen and progestin; placed deep in the vagina for a 3 week period Typical user failure rate is 8% Emergency Contraception Hormonal or IUD insertion known as “morning after” pill Numbers not available at this time

Emergency Contraception In 1998, the FDA approved the first combination pill (Preven)In 1998, the FDA approved the first combination pill (Preven) A year later, a progestin pill was developed (Plan B)A year later, a progestin pill was developed (Plan B) ECP’s reduce the risk of pregnancies by delaying or inhibiting ovulation when taken within 120 hours of unprotected intercourseECP’s reduce the risk of pregnancies by delaying or inhibiting ovulation when taken within 120 hours of unprotected intercourse Effective rates improve when taken earlier vs. laterEffective rates improve when taken earlier vs. later ECP’s do not induce a medical abortion or affect the developing pre-embryos or embyrosECP’s do not induce a medical abortion or affect the developing pre-embryos or embyros Side effects are expected when taking these hormones

Current Birth Control Methods, cont’d Condom Latex or polyurethane 85% user rate effective during the first year Condom with Spermicide Nonoxynol-9 has been associated with UTI’s in women which could increase HIV risk user rate effectiveness varies with contributing factors Female condom Latex or polyurethane 78% user rate effective during the first year Contraceptive Sponge OTC product that fits over cervix and used with spermicide and acts as a barrier Removed from the market in 1995, planning on a 2005 return

Prescription Birth Control Methods Diaphragm Soft rubber cap, must be fitted by health care professional, used with spermicide Typical failure rate is 16% Cervical Cap Thimble shaped device fits over the cervix Failure rate is 16% IUD T-shaped item is inserted into the uterus, is the world’s popular reversible contraceptive method; many experts still don’t know exactly how this works but somehow interferes with implantation of the ovum The Copper T-380A (Paragard) and Levonorgestral (Mirena) are available today Failure rate is 0.8% during the first year

Natural Birth Control Methods Abstinence no sexual activity 100% effective Chance no method used 15% user rate effective Withdrawal removal of penis from vagina before ejaculation 73% user rate effective during the first year

Fertility Awareness Methods (FAM) Periodic Abstinence (Rhythm Method) Calendar (calculating the unsafe days of ovulation)Calendar (calculating the unsafe days of ovulation) Basal temperature (raise in body temperature could result in ovulation)Basal temperature (raise in body temperature could result in ovulation) Billings Cervical Mucus Method (evaluate consistency of vaginal discharge to predict ovulation)Billings Cervical Mucus Method (evaluate consistency of vaginal discharge to predict ovulation) Sympothermal (combines basal type and mucus together)Sympothermal (combines basal type and mucus together) 75% user rate effective See Table 6-4 for available contraceptive methods

Sterilization VasectomyVasectomy – separation of the vas deferens TubalTubal ligation – separation of the fallopian tubes HysterectomyHysterectomy – removal of the uterus

Which Contraceptive Methods is Right For You? Health RisksHealth Risks Implications of unplanned pregnancyImplications of unplanned pregnancy STD riskSTD risk Relationship typeRelationship type Affordability Affordability Ease of use Ease of use Interference with religious or philosophical expression Interference with religious or philosophical expression Considerations to evaluate when choosing contraception

What is Abortion? Expulsion of an embryo or fetus from the uterus before it sufficiently developsExpulsion of an embryo or fetus from the uterus before it sufficiently develops Can also be referred to as those expulsions that are artificially induced by mechanical means or drugsCan also be referred to as those expulsions that are artificially induced by mechanical means or drugs Miscarriage is generally used as a natural form of expulsion without any causal interventionMiscarriage is generally used as a natural form of expulsion without any causal intervention

Current Legal Status In 1973, the U.S. Supreme Court made abortion legal in the landmark case, Roe vs. WadeIn 1973, the U.S. Supreme Court made abortion legal in the landmark case, Roe vs. Wade First Trimester: decision left to pregnant woman and physicianFirst Trimester: decision left to pregnant woman and physician Second Trimester: similar rights but state may dictate regulatory factorsSecond Trimester: similar rights but state may dictate regulatory factors Third Trimester: State regulates and can bar abortions, unless it is to preserve the life of the womanThird Trimester: State regulates and can bar abortions, unless it is to preserve the life of the woman U.S. Congress has barred the use of federal Medicaid funds to pay for abortions, except in cases of incest, rape, or immediate life- threatening dangerU.S. Congress has barred the use of federal Medicaid funds to pay for abortions, except in cases of incest, rape, or immediate life- threatening danger

Current Trends 43% of a decline of abortions was due to the use of emergency contraception43% of a decline of abortions was due to the use of emergency contraception Many states are imposing additional restrictions on abortion i.e. waiting period, counseling, age of consent, and type of procedureMany states are imposing additional restrictions on abortion i.e. waiting period, counseling, age of consent, and type of procedure The typical woman having an abortion is:The typical woman having an abortion is: Age 20Age 20 Has a previous birth historyHas a previous birth history Has never marriedHas never married From a lower socio-economic backgroundFrom a lower socio-economic background Lives in a metropolitan areaLives in a metropolitan area Is considered “Christian”Is considered “Christian”

Methods of Abortion Manual Vacuum AspirationManual Vacuum Aspiration MVA is considered a new option not available at all clinicsMVA is considered a new option not available at all clinics Cervix is dilated and a plastic tube attached to a syringe is insertedCervix is dilated and a plastic tube attached to a syringe is inserted Gestational sac is removed by suction forceGestational sac is removed by suction force

Abortions after the First Trimester Dilation and Evacuation (D&E)Dilation and Evacuation (D&E) Method most commonly used after the 12 th week of pregnancyMethod most commonly used after the 12 th week of pregnancy Cervix is opened using dilators and surgical instruments are used to remove the uterine contents, along with an aspiratorCervix is opened using dilators and surgical instruments are used to remove the uterine contents, along with an aspirator Induction of LaborInduction of Labor Prostaglandins are used to induce laborProstaglandins are used to induce labor Delivery of fetus usually occurs in 6-24 hours laterDelivery of fetus usually occurs in 6-24 hours later Fewer than 1% use this methodFewer than 1% use this method

Complications of Abortion Fever >100 degree FFever >100 degree F Abdominal pain or swelling, cramping, or backacheAbdominal pain or swelling, cramping, or backache Prolonged or heavy bleedingProlonged or heavy bleeding Foul-smelling vaginal dischargeFoul-smelling vaginal discharge Vomiting or fainting Abdominal tenderness (to pressure) Delay in resuming menstrual periods (6 weeks or more) These are possible physical effects due to an abortion

Psychological After-effects of Abortion These aftereffects vary with the individualThese aftereffects vary with the individual Many women go through a period of ambivalenceMany women go through a period of ambivalence Stronger feelings are felt immediately after the abortionStronger feelings are felt immediately after the abortion Support from a partner, friend, and/or family member can be helpfulSupport from a partner, friend, and/or family member can be helpful

Chapter Six Contraception and Abortion