1. Contraception

3. Figure 1: Birth rates per 1,000 females ages 15-19, by race/ethnicity, 1990-2012

4. Most female teens report that they would be very upset (58%) or a little upset (29%) if they got pregnant, while the remaining 13% report that they would be a little or very pleased Most teen males report that they would be very upset (47%) or a little upset (34%) if they got someone pregnant, while the remaining 18% report that they would be pleased or a little pleased

6. Skills-how to set and maintain boundaries, knowing when to ask for help, accessing services, self-love, communicating with partner(s) openly and honestly, using method(s) correctly, obtaining and carrying condoms, listening to your gut Knowledge-STD and pregnancy prevention methods, Reproductive Anatomy, Right to Access Services, Family Pact, Clinic Locations, STD’s(symptoms, testing, rates, consequences), Partner(s) Info Motivation/Self Awareness-Why does this all matter? Intentions, strengths and weaknesses, What are my values? What motivates me?

8. Shared Responsibility- Preventing a pregnancy/STD’s is the responsibility of both partners Respect-both partners deserved to be treated with dignity and respect

9. STD/HIV prevention skills involve possessing the actual ability, and the confidence to abstain from sexual intercourse, or to obtain and carry condoms, negotiate condom use with a partner, and to protect oneself through consistent condom usage.

10. Hormone-basedMethod How it works % effectiveness STD protection  Pill  Patch  Injection  Implant  Vaginal Ring Contain either 1) progesterone alone or 2) progesterone and estrogen to prevent ovulation by shutting down LH & FSH. ( Pill taken daily; Patch applied weekly; Injection every 12 weeks; Implant under skin[3yrs]; Ring into vagina monthly ) 92-98 % Except implant which is 99% NO! NO! Pill: Taken daily Patch: Applied weekly Injection: Shot every 12 weeks Implant: surgically every 3 years Vaginal Ring: Inserted to vagina monthly

11. Hormone-basedMethodAdvantagesDisadvantages  Pill  Patch  Injection  Implant  Vaginal Ring ALL TYPES: no interruption to sexual activity. 1. More regular periods, decreased acne, decreased cancer risk 2. Can be worn while bathing, no pills to remember to take 3. Same as 1 & 2, more effective than other methods. 4. Same as 1 & 2, can be used while breastfeeding, no affect on bone density. 5. No pills to remember to take. ALL TYPES: No STD protection. Medications can interfere with effectiveness. Can take a few days to take effect – not immediate!! 1. Must remember to take. Higher risk of blood clots, heart attack & stroke (smokers/>35) 2. Skin reaction; same as 1. 3. Dr. visit; can cause headaches, tender breasts, mood swings, weight change, loss in bone density, spotting. 4. Dr. must implant, effects similar to #3. 5. Same as #1

12. SterilizationMethod How it works % effectiveness STD protection  Tubal Ligation  Vasectomy ♀ : Fallopian tubes cut surgically and tied, preventing sperm from reaching egg and egg from getting to uterus. ♂ : Vas deferens cut surgically and tied to prevent sperm from leaving body. 99% 99% NO! NO! Vasectomy Tubal Ligation

13. SterilizationMethodAdvantagesDisadvantages  Tubal Ligation  Vasectomy  Does not affect or interrupt sexual activity or pleasure.  Does not require anything to be put in or on the body.  No lasting side effects.  No STD protection!  Requires surgery.  Permanent, so successful reversals are very RARE if you change your mind.  Tubal (ectopic) pregnancies may occur [very rare!]  Vasectomy may take up to 3 months to take effect...sperm can still be in the Vas deferens!

14. BarriersMethod How it works % effectiveness STD protection  Male Condom  Female Condom  Diaphragm  Cervical Cap  Sponge ALL TYPES: Provides barrier to prevent egg and sperm from meeting. Many with spermicide! 1. Latex, polyurethane, or animal skin condom placed over the penis to prevent semen from entering the female’s body. 2. Latex covering inserted inside vagina/small portion outside. 3. Large latex cup inserted into vagina/covers cervix. 4. Small rubber cap inserted into vagina/covers cervix. 5. Sponge inserted into vagina. 75- 85% YES CONDOM only! (must be latex or polyurethane ) NO for everything else. Male Condom: placed over penis Female Condom: Inserted inside vagina Diaphragm: Inserted into vagina over cervix Cervical cap: Inserted into vagina over cervix Sponge: Inserted into vagina over cervix

15. BarriersMethodAdvantagesDisadvantages  Male Condom  Female Condom  Diaphragm  Cervical Cap  Sponge ALL TYPES: No side effects from taking hormones. Used only as needed. 1 & 2: sold in stores. Offers some STD protection. 3 & 4: can be put in place up to 24 hours ahead of sexual activity. 5: sold in stores. ALL TYPES: most are latex. Allergies – can’t use it! 1 & 2: can interrupt sexual activity. Some lubricants may be added that can cause breakage. Some people say it reduces pleasure. 3,4, & 5. Must be left in place for up to 6 hours after sex. No STD protection. Can be difficult o insert. 3 & 4 must be fitted by a doctor. Spermicide

16. Uterine Implant Method How it works % effectiveness STD protection IUD/IUC 1. Paragard 2. Mirena ALL TYPES: Device implanted in the uterus by doctor. Prevents implantation of fertilized egg. Also blocks tubes to prevent sperm from reaching egg. 1. See above. 2. Mirena also releases hormones to prevent ovulation. 99% NO! MirenaIUD

17. Uterine Implant MethodAdvantagesDisadvantagesIUD/IUC 1. Paragard 2. Mirena ALL TYPES: Does not disrupt sexual activity, no pills, shots, etc. to take regularly. 1. Can last up to 12 years. 2. Can last 3-5 years. Can reduce bleeding and pain during menstruation. Some women have little to no menses. ALL TYPES: no STD protection, spotting between periods can occur. 1. Can increase bleeding and pain during menstruation. String is used to check placement, but may harbor bacteria.

18. Other Methods Method How it works % effectiveness STD protection Spermicide Gel, foam, cream, film, or tablet that contains chemicals to kill sperm. Placed inside the vagina. 70 % NO! Withdrawal Male removes penis from vagina prior to ejaculation. 70% NO! NO! Fertility Awareness Female monitors her body temperature to determine when she ovulates and avoids sex during most fertile times. 75-85% NO! NO! “Morning after” Pill aka Plan B ( emergency contraceptive) Pill taken within 3 days after sex that prevent ovulation. Does not work if taken after egg is fertilized. Thickens cervical mucus and thins uterine lining. Available over-the-counter to age 15 and older. 89% (If used within 3 days) NO! Abstinence Do not engage in sexual activity (vaginal, oral, or anal sex) 100%YES!

19. Other Methods MethodAdvantagesDisadvantagesSpermicide Sold in stores  May cause skin irritation  Can increase chance of STDS  Do NOT use oil based lubricants! Can break condoms!  Can change pH balance in vagina. Withdrawal Nothing to buy! No side effects  Sperm can release prior to ejaculation  No STD protection  Requires self control! Fertility Awareness No side effects.  Females’ bodies can vary greatly so fertile periods are hard to predict.  Expert training is required! “Morning after” Pill aka Plan B (emergencycontraceptive) People who cannot take hormone based drugs can usually take ECPs  Can cause nausea, dizziness, headaches, spotting, tender breasts.  No STD protection  Must be prescribed by doctor Abstinence No STDs! No Pregnancy! Some people find it difficult to abstain from sexual activity!

20. What is the overall effectiveness of various forms of contraception? NY Times Effectiveness Interactive Page