1. Reproductive Choices

2. Objectives Differentiate between birth control effectiveness rates for perfect users and typical users. Know whether each type of birth control method protects against STIs as well as pregnancy. Understand the basics of each birth control method. Provide the advantages and disadvantages associated with the various birth control methods. Explain the different abortion procedures.

3. Reproductive Anatomy Males –Sperm production starts in the testes. –Sperm are ejaculated out of the penis. Females –A matured ovum is usually released once a month, during ovulation. –The menstrual cycle is about 28 days long on average. Conception happens when a sperm cell penetrates the ovum.

4. Choosing a Method of Contraception Cost Responsibility for the method Agreement between partners Convenience Ease of use Effectiveness Side effects Protection against STIs Permanence

5. Birth Control Categories There are two main categories of birth control: –Methods that protect against pregnancy and STIs –Methods that protect only against pregnancy Subcategories –Informational –Barrier –Short-term hormonal –Long-term hormonal –Other long-term

6. Informational Methods An informational method is all about knowledge. Users of an informational method must understand their body and how it works. Example: Abstinence (protects against both pregnancy and STIs).

7. Barrier Methods Block sperm from entering the female’s cervix, therefore creating a barrier. Examples (protect against both pregnancy and STIs): –Male condoms –Female condoms

8. Hormonal Methods Prescribed only to females. Change a female’s hormonal patterns in order to prevent pregnancy. Short-term hormonal methods include the pill, patch, ring, and shot. Long-term hormonal methods last for several years.

9. Other Long-Term Methods Methods that are permanent or last for several years and do not contain hormones.

10. Effectiveness Rates Perfect users are those who use a method correctly and consistently every time they have sex. They follow the proper instructions and get the highest percentage of pregnancy prevention. Typical users do not always use their birth control method correctly or consistently.

11. Methods That Protect Against Pregnancy and STIs Informational method: –Abstinence Barrier methods: –Male condoms –Female condoms

12. Abstinence Informational method where a person abstains from sexual activities. To avoid pregnancy and STIs, abstain from –vaginal sex, –oral sex, –anal sex, and –naked genital-to-genital rubbing. Abstinence is the only method that protects 100% against pregnancy and STIs. 100%

13. Male Condoms Barrier method Three types: latex, polyurethane (plastic), and natural membrane –Covers the shaft of the penis. –Use with water-based lubricant only. –Store in cool, dry places. –Condoms expire, so check the date. –Some people may be allergic to latex. –Natural membrane does not protect against STIs. Perfect: 98% Typical: 85%

14. Female Condoms Barrier method Made of polyurethane (plastic) material –Inserted into the female’s vagina. –Can be inserted up to 8 hours before intercourse. –Can only be used once. –Do not use with the male condom. –Store in cool, dry places. –More expensive than the male condom. Perfect: 95% Typical: 79%

15. Male and Female Condoms

16. Methods That Protect Only Against Pregnancy Informational methods –Withdrawal –Fertility awareness Barrier methods –Diaphragm –Cervical cap –Sponge –Spermicides (continued)

17. Methods That Protect Only Against Pregnancy (continued) Short-term hormonal methods –Pill –Patch –Ring –Shot Long-term hormonal methods –Implanon –Mirena (IUC) Other long-term methods –ParaGard (IUC) –Female sterilization –Male sterilization

18. Withdrawal Withdrawal, more commonly known as pulling out, is an informational method. The male must withdraw his penis from his partner’s vagina before he ejaculates, which may be just before, during, or after orgasm. Ejaculate must not come in contact with or be around the female’s genitals. A man must know his body well in order to use this method. Perfect: 96% Typical: 73%

19. Fertility Awareness There are four types of fertility awareness– based (FAB) methods. All are informational methods. –Calendar rhythm method –Standard days method –Ovulation method –Symptothermal method Users should take lessons on how to use FAB methods effectively. (continued) Perfect: 98-95% Typical: 88-78%

20. Fertility Awareness (continued) Calendar rhythm method calculates the days in which a female is fertile. Standard days method tracks the days of the menstrual cycle; cycle beads may be used. Ovulation method determines fertile time by checking the changes in a woman’s cervical mucus. Symptothermal method uses the ovulation method and also the female’s basal body temperature.

21. Cycle Beads

22. Diaphragm Dome-shaped latex barrier that comes in different sizes. Must be fitted by a health care provider. Placed in the vagina, covering the cervix. Must be used with spermicide. Must be left in for at least 6 hours but no more than 24 hours. Perfect: 94% Typical: 84%

23. Cervical Cap Silicone barrier shaped like a sailor’s cap. Must be fitted by a health care provider. Snuggly fits around the cervix, blocking sperm from entering the uterus. Must be used with spermicide. Must be left in for at least 6 hours but no more than 48 hours. Perfect: 74% Typical: 71% Perfect: 96% Typical: 86% Previously borne children Have not borne children

24. Cervical Cap and Diaphragm

25. Sponge Pillow-shaped barrier method made of polyurethane foam that contains spermicide. Placed in the vagina, covering the cervix. Available over-the-counter; one size fits all. Must be left in for at least 6 hours but no more than 30 hours. Cannot be used during a menstrual period. Have not borne children Previously borne children Perfect: 91% Typical: 84% Perfect: 80% Typical: 68%

26. Spermicides Spermicides are chemical barriers that kill sperm. Inserted in the vagina back by the cervix, creating a barrier. Four types: jelly, foam, film, and suppositories. Jelly and foam are effective right after insertion. Film and suppositories must be allowed to melt for 10 to 15 minutes. Must be left in the vagina for at least 6 hours. Perfect: 82% Typical: 71%

27. Birth Control Pill Daily combination hormonal method. One pill is taken orally at the same time every day. Most pill brands come in either a 21-pill or 28-pill pack. The 28-pill pack usually has 7 placebo pills at the end. Use a backup method for the first 7 days. Perfect: 99.7% Typical: 92%

28. Birth Control Patch Weekly combination hormonal method. A transdermal contraceptive patch is worn on the skin. The patch is changed weekly for 3 weeks; fourth week is patch free. Don’t wear the patch in the same spot twice. Use a backup method for the first 7 days. Perfect: 99.7% Typical: 92%

29. Birth Control Ring Monthly combination hormonal method. Sold under the brand name NuvaRing. Insert the ring into the vagina using the fingers. The ring is worn for 3 weeks; the fourth week is ring free. Use a backup method for the first 7 days. Perfect: 99.7% Typical: 92%

30. Birth Control Shot Hormonal method. The shot is a 3-month progestin-only method. The shot (brand name Depo-Provera) is an intramuscular injection given in the arm or buttocks of the female. The shot lasts for 3 months. A woman should receive her next shot in 11 to 13 weeks. Perfect: 99.7% Typical: 97%

31. Implanon Long-term hormonal method in the form of a small, thin implant. Inserted into the skin of the inner side of the female’s upper arm. Inserted by a health care professional. Releases progestin and lasts up to 3 years. Works similar to other progestin-only methods, with the same possible side effects. >99%

32. Mirena (IUC) Long-term hormonal method—a small, plastic, T- shaped device that contains the hormone levonorgestrel. Works in three ways: –Thickens the cervical mucus. –Thins the lining of the uterus. –Inhibits sperm movement and survival. Lasts up to 5 years. Inserted into the uterus and removed by a health care provider. Perfect: 99.9% Typical: 99.9%

33. ParaGard (IUC) Long-term method—a small, plastic, T- shaped device covered in copper. Prevents sperm from reaching the egg. Prevents the egg from attaching in the lining of the uterus. Lasts up to 10 years. Inserted into the uterus and removed by a health care provider. Perfect: 99.4% Typical: 99.2%

34. Female Sterilization Long-term method performed as an outpatient procedure. In each procedure the fallopian tubes are cut, cauterized, or blocked. Recovery time ranges from 2 days to a week. Permanent sterilization. Three types of procedures: minilaparotomy, laparoscopy, and culpotomy. 99.5%

35. Laparoscopy

36. Male Sterilization Long-term method that is a safe, fast outpatient procedure, usually taking approximately 20 minutes. A physician cuts, cauterizes, or blocks the vas deferens. Recovery time ranges from a day to less than a week. Permanent sterilization. Method is not effective immediately; residual sperm may be present. 99.9%

37. Emergency Contraception Also called the morning-after pill. Only contraceptive that can be taken after intercourse. Effective up to 120 hours (5 days) after intercourse. More effective the sooner it is taken and can be up to 89% effective. Available over the counter for people aged 18 and older. Available by prescription for aged 17 and younger.

38. Medical Abortion Done within the first 9 weeks (63 days) of the first trimester. Three regimens can be used. –Regimens may consist of different types of medication: mifepristone, misoprostol, or methotrexate. –Depending on the regimen, medication may be taken orally, vaginally, or intramuscularly.

39. Surgical Abortion Aspiration –Performed in the first trimester. –The cervix is dilated, and then manual or electric vacuum aspiration is used to empty the contents of the uterus. Dilation and evacuation (D&E) –Performed in the second trimester, usually between 13 and 16 weeks. –Dilation may take several hours, even overnight. Then the contents of the uterus are evacuated.

40. History of Abortion Roe v. Wade –Legalized abortions in the United States. –Based on a person’s right to privacy. Parental consent or notification Partial-Birth Abortion Ban Act of 2003 –Banned the intact D&E, where the physician aborts the fetus after part of it has passed through the vagina and has been partially delivered intact. –Gonzales v. Carhart tried to overturn it but failed.

41. Psychological Effects of Abortion Psychological problems are rare following abortions. Incidence of psychiatric illness has been found in less than 1% of abortion patients compared with 10% of women who give birth.