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Chapter 6 Contraception and Abortion ©2012 McGraw-Hill Companies. All Rights Reserved.
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2 Definition: Conception: the fusion of an ovum and sperm that creates a fertilized egg, or zygote Contraception: blocking conception through the use of a device, substance, or method Modern contraception methods are much more predictable and effective than in the past Many contraceptive products play a role in the prevention against sexually transmitted diseases 2
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3 ©2012 McGraw-Hill Companies. All Rights Reserved. Types of contraception: Barrier, hormonal, natural, and surgical methods Factors affecting choice Advantages and disadvantages Effectiveness Convenience Cost Reversibility Side effects and risks Protection against STDs Effectiveness Contraceptive failure rate Continuation rate 3
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4 ©2012 McGraw-Hill Companies. All Rights Reserved. Estrogen and progestins taken orally Mimics the hormonal activity of the corpus luteum Corpus luteum secretes high levels of progesterone and estrogen to suppress ovulation Combination pill Most common 1-month packet containing estrogen and progestin Extended-cycle pill Lybrel “Minipill” 1-month packet containing progesterone Advantages Disadvantages Effectiveness: When taken as directed, the failure rate is 0.3% 4
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5 ©2012 McGraw-Hill Companies. All Rights Reserved. Thin 1 ¾- inch square patch Releases estrogen and progestin slowly into the bloodstream Prevents the same way as combination OCs Worn for 1 week, replaced on the same day for 3 consecutive weeks. Fourth week no patch Advantages Disadvantages Effectiveness: When taken as directed, failure rate is 0.3% 5
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6 ©2012 McGraw-Hill Companies. All Rights Reserved. The NuvaRing Molded with progestin and estrogen 2-inch ring slowly releases the hormones During fourth week, remove the ring and use a new ring after the fourth week Advantages Disadvantages Effectiveness: When taken as directed, the failure rate is 0.3% 6
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7 ©2012 McGraw-Hill Companies. All Rights Reserved. Implanon (2006) Hormonal method - progestin Single implant Effective for 3 years Inhibits ovulations and affects the development of the uterine lining Advantages Disadvantages Effectiveness: Failure rate is 0.1%, the most effective method of contraception and the most discrete 7
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8 ©2012 McGraw-Hill Companies. All Rights Reserved. Depo-Provera Hormonal treatment Injectable progestin every 12 weeks Advantages Disadvantages Effectiveness: When taken as directed, the failure rate is 0.3% 8
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9 ©2012 McGraw-Hill Companies. All Rights Reserved. T-380A (ParaGard) 10 years of protection Copper Levonorgestral (Mirena) 5 years of protection Releases small amounts of progestin Not exactly sure how it prevents pregnancy Advantages Disadvantages Effectiveness: 0.8% failure rate for ParaGard, and 0.2% failure rate for Mirena 9
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10 ©2012 McGraw-Hill Companies. All Rights Reserved. Thin latex, or polyurethane, sheaths Protection against STDs Advantages Disadvantages Effectiveness During the first year of typical condom use among 100 users, between 10 and 18 pregnancies occur 2% failure rate with perfect use Use with spermicide 10
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11 ©2012 McGraw-Hill Companies. All Rights Reserved. 11
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12 ©2012 McGraw-Hill Companies. All Rights Reserved. A clear, stretchy, disposable pouch with two rings that can be inserted into a woman’s vagina Advantages Disadvantage Effectiveness: 21% typical first-year failure rate with first-year typical users 12
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13 ©2012 McGraw-Hill Companies. All Rights Reserved. Dome shaped cup of latex or silicone stretched over a collapsible metal ring Blocks sperm from entering the uterus Custom fit Must remain in place for 6 hours after sex After intercourse, women should inspect diaphragm for defects Advantages Disadvantages Toxic shock syndrome (TSS) Effectiveness 6% failure rate with perfect use 16% failure rate with typical use 13
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14 ©2012 McGraw-Hill Companies. All Rights Reserved. Small silicone cap Must use spermicide Advantages Disadvantage Effectiveness 16% typical use failure rate for women who have never had a child 32% typical use failure rate for women who have had a child Uncommon form of contraception in U.S. 14
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15 ©2012 McGraw-Hill Companies. All Rights Reserved. Round, absorbent device about 2 inches in diameter Presaturated with the same spermicide that is used in contraceptive creams and foams Advantages Disadvantages Toxic shock syndrome (TSS) Effectiveness 16% typical use failure rate for women who have never had a child 15
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16 ©2012 McGraw-Hill Companies. All Rights Reserved. Foams, creams, jellies Spermicidal suppository Vaginal Contraceptive Film (VCF) After 60 minutes, their effectiveness is drastically reduced Must wait 6 hours post-intercourse if the women wants to douche Advantages Disadvantages Effectiveness: 29% failure rate with typical first-year use 16
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17 ©2012 McGraw-Hill Companies. All Rights Reserved. Abstinence Decision to go without intercourse or sexual activities Benefits Religious, moral, cultural, personal beliefs Emotional needs Time for relationship to grow 17
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18 ©2012 McGraw-Hill Companies. All Rights Reserved. Methods Calendar methods Temperature methods Mucus method Withdrawal Coitus interruptus 18
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19 ©2012 McGraw-Hill Companies. All Rights Reserved. Postcoital Pill, Morning After Pill, Plan B, Plan B One-Step, Next Choice Newer products now more common and effective, with fewer side effects, than old methods Prevents fertilization, does not affect an already fertilized egg Best used within 24 hours Plan B, Plan B One-Step, and Next Choice available as OTCs for those 17 and older Intrauterine devices 19
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20 ©2012 McGraw-Hill Companies. All Rights Reserved. Severing of the vasa deferentia Can have sex again in about a week About one-half of reversals are successful Effectiveness Failure rate is 0.2% 20
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21 ©2012 McGraw-Hill Companies. All Rights Reserved. Tubal sterilization (laparoscopy) is most commonly known as tubal ligation Essure system Tiny spring-like metallic implants cause scarring, thus blocking the Fallopian tubes, no incision needed Adiana Tiny inserts block Fallopian tubes, no incision needed Hysterectomy More costly, complicated, and permanent than male sterilization 21
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22 ©2012 McGraw-Hill Companies. All Rights Reserved. Key considerations include: 1. Health risks 2. Implications of unplanned pregnancy 3. STD risk 4. Convenience and comfort level 5. Type of relationship 6. Ease and cost of obtaining and maintaining each method 7. Religious or philosophical beliefs 8. Potential non-contraceptive benefits 22
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23 ©2012 McGraw-Hill Companies. All Rights Reserved. Abortion The expulsion of an embryo or fetus from the uterus before it is sufficiently developed to survive Miscarriage Spontaneous abortion that occurs naturally
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24 ©2012 McGraw-Hill Companies. All Rights Reserved. 1973: Roe versus Wade Supreme Court ruled : Pregnancy divided into 3 trimesters 1st trimester - up to women & doctor 2nd trimester - state may regulate once the fetus becomes viable 3rd trimester - state may regulate and bar all abortions that are not life-threatening to mother States have a variety of laws on abortion Between 1995 and 2006, the number of state laws restricting abortion more than quadrupled
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25 ©2012 McGraw-Hill Companies. All Rights Reserved. Pro-life Pro-choice Many people have moral beliefs that combine the two viewpoints Many people believe the fetus gains increasing human value as pregnancy advances Most Americans see the issue as complex Views vary depending on situation Most support legal right to abortion in certain situations
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26 ©2012 McGraw-Hill Companies. All Rights Reserved.
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27 Legal arguments Moral arguments Short- and long-term ramifications Adoption option
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28 ©2012 McGraw-Hill Companies. All Rights Reserved. The majority of women who get abortions share the following characteristics: Are under age 25 Have previously given birth Have never been married Are poor Live in a metropolitan area
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29 ©2012 McGraw-Hill Companies. All Rights Reserved. Two categories Surgical Suction curettage Manual vacuum aspiration Multi-fetal pregnancy reduction Dilation and evacuation Intact dilation and extraction Medical – Use of medication Generally used in very early pregnancy Emergency contraception pills or IUD
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30 ©2012 McGraw-Hill Companies. All Rights Reserved. Physical effects Post-abortion physical warning signs Fever above 100º F Abdominal pain, tenderness, or swelling Cramping or backache Prolonged or heavy bleeding Foul-smelling vaginal discharge Vomiting Fainting Delay of 6 or more weeks in resuming menstruation
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31 ©2012 McGraw-Hill Companies. All Rights Reserved. Possible feelings after having an abortion Guilt New strength in having made and carried out an important decision Depression Sense of loss Negative feelings about sex Relationship may end Anger Bitterness
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Chapter 6 Contraception and Abortion ©2012 McGraw-Hill Companies. All Rights Reserved.
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