1. Teens and Methods of Birth Control: An Overview
Lisa Wehr, Program Coordinator
Family Planning Plus of SUN & MJ Counties

2. Teen Sexual Trends and Birth Control Use
For the first time in 15 years, the teen birth rate increased.
Between 2005 and 2007, the percent-age of teens who have ever had sex increased while contraceptive use decreased.
(Source: 2007 Youth Risk Behavior Survey)
In December 2007, the federal government announced that the teen birth rate increased 3% between 2005 and 2006, the first increase in fifteen years. (from 40.5 live births per 1,000 girls to 41.9 births per 1,000)
Between 2005 and 2007:
The percentage of high school students who have ever had sex increased by 2%. (from 47% to 48%)
The percentage of high school students who reported having had sex before age 13 increased by 14.5%. (from 6% to 7%)
The percentage who reported having had sex during the last three month increased by 3%. (from 34% to 35%)
The percentage who used a condom at last sex decreased by 2%. (from 63% to 62%)
The percentage who used the birth control pill at last sex decreased by 9%. (from 18% to 16%)
Is the increase the beginning of a trend or is it a statistical anomaly? We cannot become complacent about teen pregnancy. We need to increase our efforts to help kids delay childbearing until they are more psychologically, emotionally, intellectually, and financially ready to raise a child.

3. Teens and Birth Control cont.
More than one-quarter of teen girls and almost one in five teen boys did not use a method of contraception the first time they had sex.
Teen girls have similar or better patterns of contraceptive use compared to older women.
Teen girls report that the primary reason why they stopped using contraception is because of “side effects.”
(Source: 2002 National Survey of Family Growth)
Source: This is a survey that is done every 7 years – so it will be interesting to see what they find in The National Survey of Family Growth was cited as the premier source of national information on teen sexual behavior by the National Campaign to Prevent Teen and Unplanned Pregnancy
Teen girls have similar patterns of contraceptive use compared to women in their 20s (slightly below those 20-24, and slightly above those 25-29) and better contraceptive practices than those 30 and older. Teens are more likely than any other age group to use condoms or to use both a condom and a hormonal method of birth control the last time they had sex.
Close to one third (28%) report that they have at some point in their lives stopped using a method of contraception. More than 2/3 of these girls said they stopped because of side effects, including worry about side effects, partner dissatisfaction, decreased sexual pleasure, and dissatisfaction with changes in their menstrual cycles.

4. It’s important for teens to know…
Except for abstinence, no birth control method is 100% effective.
If you do choose to have sex, correct and consistent use of some form of birth control is essential.
Expect side effects – report them to your medical care provider and learn how to manage them.
If 10 young couples have sexual intercourse regularly without using any method of birth control, 9 of them would experience a pregnancy by the end of one year.

5. It’s important for teens to know…
Partners should decide together which method to use.
Most birth control methods do not protect you against STDs – use additional protection.
Don’t try to make sexual decisions under the influence of drugs and alcohol.

6. Pregnancy Prevention Myths
What doesn’t work…
Drinking Mountain Dew before sex.
Having sex standing up or in other non-traditional positions.
Urinating after sex.
Douching after sex.
Having sex in water (pool, tub, river).
Jumping up and down after sex.

7. Pregnancy Prevention Myths
Don’t depend on…
Having sex during your period.
Having sex before she’s had her first menstrual period.
Withdrawal (pulling out).

8. Hormonal Methods

9. Hormonal methods in general…
Produce changes in hormone levels to trick the body into thinking it’s pregnant.
They work by…
Preventing ovulation.
Altering tubal transport of sperm and/or egg, thereby preventing fertilization.
Altering the endometrium which may inhibit implantation.
Are highly effective, but must be used correctly and consistently for maximum protection.

10. Hormonal methods in general…
Have more minor side effects during the first few months of use.
May have serious side effects, including…
Blood clots - Heart Disease
Stroke - Liver problems
Smoking increases these risks.
Do not provide protection against STDs.
Are available by prescription only, with the exception of…
Some of the most common side effects usually clear up after two or three months. They include
A change in menstrual bleeding (bleeding between periods, a missed period, spotting)
breast tenderness
Change in complexion (acne or an improvement in complexion)
Mood swings
headaches
Decrease or increase in sexual drive
nausea and vomiting
problems, that may be fatal in very rare cases, include heart attack, stroke, having a blood clot in the legs, lungs, heart, or brain, or developing high blood pressure, liver tumors, gallstones, or yellowing of the skin or eyes (jaundice).  The risk for these problems increases if you
are age 35 or older
are very overweight
have certain inherited blood-clotting disorders
have diabetes
have high blood pressure
have high cholesterol
need prolonged bed rest
smoke
Serious problems usually have warning signs. Report any of these signs to your health care provider as soon as possible:
a new lump in your breast
aura — seeing arching, bright, flashing zigzag lines that develop slowly and don't last long
headaches that are different, worse, or happen more often than usual
no period after having a period every month
pain in your abdomen or chest
severe depression
severe headaches
shortness of breath or coughing up blood
unusual swelling or pain in your leg or arm
unusually heavy bleeding from your vagina
yellowing of the skin or eyes
In fact, hormones can make the lining of the vagina thinner making it easier to get an STD.

11. Emergency Contraceptive Pills
Can be used up to 120 hours after unprotected sex, contraceptive failure, or sexual assault to prevent pregnancy.
Prevents pregnancy, does not terminate pregnancy.
Works mainly by delaying ovulation – the same way as the pill.
Extremely safe to use.
Better known as “the morning after pill” to young people, and packaged as Plan B.
Works best if used within 24 hours. Instructions state “use within 72 hours.” New research has shown that it can be effective up to 5 days after unprotected sex. The sooner, the better.
Explain how pregnancy can occur up to 5 days after sex.
Plan B is like a big dose of progestin-only birth control pills. The difference is that Plan B® contains two pills with a larger dose of levonorgestrel than the amount found in a single birth control pill. Plan B® is believed to work by:
Preventing ovulation
Possibly preventing fertilization by altering tubal transport of sperm and/or egg
Altering the endometrium, which may inhibit implantation
Since it contains no estrogen, it’s considered very safe to use.

12. Emergency Contraceptive Pills
Reduces the risk of pregnancy by 75-89%.
Should be considered emergency contraception.
Consists of 2 pills taken in one or two doses.
Available over the counter to women 18 and older - around $45.
Most common side effects are nausea and menstrual changes
Risk of pregnancy is dependent on stage of menstrual cycle and interval between unprotected sex and use.
Plan B® isn't regular birth control and should not be used that way. Plan B® is not as effective as other methods of birth control used consistently and correctly. It's important to have another reliable source of birth control that's right for you.

13. Oral Contraceptives
AKA, the “pill,” OCs come in many variations, brands, and types.
Must be taken at same time everyday.
>99% effective when used perfectly, but are typically 92% effective.
Certain medicines and supplements make the pill less effective
Have other medical benefits.
Pills come in many formulations: 21 hormone, 7 placebo; 24 hormone, 4 iron (Loestrin 24 Fe); 12 week hormone, 1 week placebo (seasonale); continuous hormone (lybrel).
Combined hormone pill vs. progestin-only pill.
Monophasic vs. triphasic.
All have various levels of hormones.
Not to mention all the different brands and manufacturers.
There is no one pill that would suit everyone. Trial and error.
Need to take at least a week’s worth of pills to rely on pills for effectiveness.
Especially progestin-only pills must be taken at same time. If miss a pill by over 24 hours, need to use a back-up method for the next seven days.
Due to missing pills and taking other medications with pills, the pill typically only 92% effective
Certain medicines and supplements may make the pill less effective. These include
the antibiotic rifampin — other antibiotics do not make the pill less effective
certain medicines that are taken by mouth for yeast infections
certain HIV medicines
certain anti-seizure medicines
St. John's wort
Women who do not need birth control often choose to take the pill for the other benefits it offers. Combination and progestin-only pills
reduce menstrual cramps
make periods lighter 
offer some protection against pelvic inflammatory disease, which often leads to infertility when left untreated
The combination pill offers many other benefits, including some protection against
acne
breast growths that are not cancer
ectopic pregnancy
endometrial and ovarian cancers. Protection increases with each year of use.
iron deficiency anemia
ovarian cysts
premenstrual symptoms, including headaches and depression
vaginal dryness and painful intercourse related to menopause
Combination pills can be used to control when and how often you have your period. Some pills are specially packaged for women to have only a few periods a year. Other pills can also be used continuously to prevent having periods.
A one-month supply costs about $15–$50.

14. OrthoEvra® Contraceptive Patch
A thin, beige, plastic patch containing time-released hormones absorbed through the skin.
Placed on the skin once a week for 3 weeks in a row, followed by a patch-free week.
Same effectiveness and medical benefits as the pill.
Less effective for women weighing > 198 lbs.
Like the pill, some medicines and supplements make the patch less effective.
Slightly greater risk for blot clots.
If you put the patch on at 9:00 on Thursday, next Thursday at 9:00 you will need to remove it and put a new patch on. You do this again the following Thursday. The fourth Thursday, you remove the patch and leave it off for a week. (this is when you get your period)
It is a good idea to vary where you’re placing the patch because of skin irritation. It can be worn on the lower abdomen, the arm, the upper back, the lower back or the buttocks.
Patch-users should check to make sure their patch is in place. It can sometimes fall off, especially for those who have oily skin.
Should not use powders, make-up, oils, or lotions anywhere near the patch.

15. NuvaRing® Contraceptive Ring
A small, flexible ring inserted into the vagina containing time-released hormones.
The ring is left in place for 3 weeks, followed by a ring-free week.
Same effectiveness and medical benefits as the pill.
Like the pill, some medicines and supplements make the patch less effective.
Greater risk of vaginal irritation and infection.
May be removed prior to sex.
It may cause increased vaginal discharge, vaginal irritation, or infection.
Regularly using oil-based medicines in the vagina for yeast infections while the ring is in place may increase the level of hormones released into the blood. This will not reduce the effectiveness of the ring. The effect of using these types of yeast infection medications with the vaginal ring long-term is unknown. Talk with your health care provider if you need long-term treatment for yeast infections while you are using the ring.
Use a backup method of birth control for seven days if the ring is out of your vagina for more than three hours.

16. Depo-Provera® Injections
AKA “the shot.”
Given every weeks.
Progestin-only method.
Less risk of serious side effects.
>99% effective when used perfectly, but typically 97% effective.
Most common side effect is irregular bleeding.
Breastfeeding women can use it.
Decrease in bone density.
Slower return to fertility.
Available in two formulations Depo IM and Depo SQ (intramuscularly 150 mg and subcutaneously 105 mg.) SQ version may create fatty deposits or indentations at the injection site.
Irregular bleeding is the most common side effect, especially in the first 6 to 12 months of use.
Given every 12 weeks but can be given up to 2 weeks early and one week late.
Contains no estrogen, so less risk of serious side effects.
Typically 3 out of 100 women will become pregnant (mainly due to women forgetting that it’s time for their shot).
For most women, periods become fewer and lighter. After one year, half of the women who use the birth control shot will stop having periods completely. 
Some women have longer, heavier periods.
Some women have increased spotting and light bleeding between periods.
There are also some less common side effects:
change in sex drive
change in appetite or weight gain
depression
hair loss or increased hair on the face or body
headache
nausea
nervousness, dizziness
a rash or darkening of the skin
sore breasts

17. Implanon®
A thin, flexible, plastic, match-stick-sized rod inserted under the skin of the upper arm.
Provides continuous pregnancy protection for up to three years.
Progestin-only method, so less risk of serious side effects.
Breastfeeding women can use it.
Most common side effect is irregular bleeding.
Must be inserted by health care professional – insertion site will be sore and/or look bruised for a few days afterward.
Implanon can be removed at any time. Your health care provider will numb the area with a painkiller and will usually make one small cut to remove the implant. Removal usually takes just a few minutes, but it generally takes longer than insertion. A new implant may be inserted at this time. Pregnancy can happen anytime after the implant is removed.
Irregular bleeding is the most common side effect, especially in the first 6–12 months of use.
For most women, periods become fewer and lighter. After one year, 1 out of 3 women who use Implanon will stop having periods completely.
Some women have longer, heavier periods.
Some women have increased spotting and light bleeding between periods.
These side effects are completely normal. Some woman may worry that they are pregnant if they do not have a regular period. But when Implanon is used correctly, it is very effective. If you are concerned about a possible pregnancy, you can always take a pregnancy test.
Less common side effects of Implanon include
acne
change in appetite
change in sex drive
cysts on the ovaries
depression
discoloring or scarring of the skin over the implant
dizziness
hair loss
headache
nausea
nervousness
pain at the insertion site
sore breasts
Serious problems usually have warning signs. Tell your health care provider immediately if
You have arm pain.
You have bleeding, pus, and increasing redness or pain at insertion site.
You have a migraine or other severe headache.
You have a new lump in your breast.
You have severe pain in the stomach or abdomen.
You have unusually heavy or prolonged bleeding from your vagina.
The implant comes out.
The cost of the exam, Implanon, and insertion ranges from $400–$800. Removal costs between $75 and $150.
Some medications and supplements may make it less effective.
Requires minor surgery for removal.
Initial high cost but relatively cost effective.

18. Hormonal Intrauterine Systems
Mirena® is an intrauterine system that contains time-released progestin.
Provides continuous protection up to five years.
Over 99% effective.
Is a progestin-only method, so less risk of serious side effects
Breastfeeding women can use it.
Reduces menstrual flow.
IUDs must be inserted by a medical professional – mirena lasts for 5 years but can be removed at any time.
Most healthy women can use an IUD, including younger women who have not had children. You should not use an IUD if your uterus is too small or you
have had a pelvic infection following either childbirth or an abortion in the past three months
have or may have a sexually transmitted infection or other pelvic infection
have an abnormally-shaped uterus that prevents correct placement of IUD
have very large fibroids in the uterus
have cervical cancer that hasn't been treated
have cancer of the uterus
have pelvic tuberculosis
have a uterine perforation during IUD insertion
You should not use the Mirena IUD if you
have severe liver disease
have, or may have, breast cancer
The Mirena IUD may reduce period cramps and make your period lighter. On average, menstrual flow is reduced by 90 percent! For some women, periods stop altogether.
Spotting between periods is common.
You may experience menstrual cramps or backaches.
The IUD can sometimes slip out of the uterus. Sometimes it comes all the way out. Sometimes it only comes out a little. This is more likely to happen to women who are younger and who have never had a baby. If the IUD slips out of place, pregnancy can happen. If it comes out only part of the way, it has to be removed.
In rare situations, a woman could develop an infection when using the IUD. This happens if bacteria get into the uterus when the IUD is inserted. Most infections develop within three weeks of having the IUD inserted. If the infection is not treated, it can affect a woman's ability to become pregnant in the future.
In very rare situations, when the IUD is inserted, it can push through the wall of the uterus. This might sound painful, but it usually isn't. Usually, when this happens, the health care provider will notice it and it can be fixed right away. But if not, the IUD can move around and harm other parts of the body. When this happens, surgery may be needed to remove the IUD.
Tell your health care provider immediately if you
find the length of the string ends to be shorter or longer than they were at first, when you feel for them with your fingers
are not able to feel the string ends when you check
feel the hard plastic bottom of the "T" part of the IUD against the cervix, when you check
think you might be pregnant
have periods that are much heavier than normal or last much longer than normal
have severe abdominal cramping, pain, or tenderness in the abdomen
have pain or bleeding during sex
have unexplained fever and/or chills
have flu-like symptoms, such as muscle aches or tiredness
have unusual vaginal discharge
have unexplained vaginal bleeding
The cost for the medical exam, the ParaGard or Mirena IUD, the insertion of the IUD, and follow-up visits to your health care provider can range from $175 to $500.
If pregnancy does occur, there is a higher risk of ectopic pregnancy.
Initial high cost, but cost effective.

19. Barrier Methods

20. Barrier methods in general…
Prevent pregnancy by forming a barrier between the sperm and egg.
Are generally less effective than hormonal methods.
Have fewer side effects.
Can be used safely by women who are breastfeeding.
Are less expensive than hormonal methods.
Must be inserted prior to intercourse which could affect sexual spontaneity.

21. Spermicides The Today® Sponge
Chemicals that cover the cervix and prevent sperm from moving.
Available in foams, creams, gels, films, suppositories.
Must be reapplied with each sex act.
Available without a prescription.
The Today® Sponge
A plastic foam device that contains spermicide; it covers the cervix to trap and immobilize sperm.
Can be used continuously for 24 hours.
Less effective for women who have had children.
Available without a prescription
They
block the cervix, so sperm cannot reach an egg
keep sperm from moving, so they cannot join with an egg
Nonoxynol-9 is the most common type of spermicide. It
has certain risks. If it is used many times a day, or by people at risk for HIV, it may irritate tissue and increase the risk of HIV and other sexually transmitted infections.
If women always use spermicide as directed, 15 out of 100 will become pregnant each year.
If women don't always use spermicide as directed, 29 out of 100 will become pregnant each year.
The sponge is made of plastic foam and contains spermicide. It is soft, round, and about two inches in diameter. It has a nylon loop attached to the bottom for removal. It is inserted deep into the vagina before intercourse.
The Today Sponge is the only brand of contraceptive sponge available in the United States today.
The sponge can be inserted up to 24 hours before intercourse. It must be left in place for at least six hours after the last time you have intercourse. It should not be worn for more than 30 hours in a row.
The sponge is more effective for women who have never given birth.
If women who have never given birth always use the sponge as directed, 9 out of 100 will become pregnant each year.
If women who have never given birth don't always use the sponge as directed, 16 out of 100 will become pregnant each year.
Women who have previously given birth have a higher risk of pregnancy.
If women who have given birth always use the sponge as directed, 20 out of 100 women will become pregnant each year.
If women who have given birth don't always use the sponge as directed, 32 out of 100 will become pregnant each year.
The sponge may not be right for you if you
are allergic to sulfa drugs or the things that make up the sponge — polyurethane and spermicide
are not comfortable touching your vagina or vulva
have certain physical problems with your vagina
have difficulty inserting the sponge
have had a recent abortion, childbirth, or miscarriage
have a history of toxic shock syndrome
have a reproductive tract infection
You should not use the sponge when you have any kind of vaginal bleeding — including during your period. It could increase your risk of toxic shock syndrome.
A package of three sponges costs $9–$15. The costs may be slightly lower or higher depending on where you live.

22. Condoms
Latex or plastic sheaths worn on the penis or inside the vagina to catch semen.
Reduce the risk of STDs.
Male condoms come in many varieties.
Must be used correctly for maximum effectiveness.
Inexpensive and easy to get.
Can be used in addition to other methods to increase effectiveness of pregnancy prevention.
Male & female condoms should never be worn together.
Condoms are available in different styles and colors, and are available dry, lubricated, and with spermicide.
Like all birth control methods, condoms are more effective when you use them correctly.
Each year, 2 out of 100 women whose partners use condoms will become pregnant if they always use condoms correctly.
Each year, 15 out of 100 women whose partners use condoms will become pregnant if they don't always use condoms correctly.
You can make condoms more effective if you
use spermicide with them
pull out before ejaculation.
Using condoms is safe, simple, and convenient. Women and men like condoms because they
let men help prevent pregnancy and sexually transmitted infections
are inexpensive and easy to get
are lightweight and disposable
do not require a prescription
can help relieve premature ejaculation
may help a man stay erect longer
can be put on as part of sex play
can be used with all other birth control methods except the female condom to provide very effective pregnancy prevention and to reduce risk of sexually transmitted diseases
Most women and men can use condoms with no problem. Condoms have no side effects except for people who are allergic to latex. About 1 or 2 in 100 people have such allergies. If you are allergic to latex, you can use condoms or female condoms made of plastic instead.
Be sure to handle condoms properly. Keep in mind that certain types of lubricants can damage a latex condom. Use only water-based lubricants, such as K-Y jelly or AstroGlide, with latex condoms. Oil-based lubricants like petroleum jelly, cold cream, butter, or mineral and vegetable oils damage latex and will make the condom ineffective at preventing pregnancy and infection.
Putting on a Condom
Each package of condoms includes detailed instructions. Be sure to read and understand the instructions and check the expiration date before you use a condom.
Put the condom on before the penis touches the vulva. Men leak fluids from their penises before and after ejaculation. This fluid can carry enough germs to pass sexually transmitted infections and possibly cause pregnancy.
Use a condom only once. Use a fresh one for each erection ("hard-on"). Have a good supply on hand.
Condoms usually come rolled into a ring shape. They are individually sealed in aluminum foil or plastic. Be careful — don't tear the condom while unwrapping it. If it is torn, brittle, stiff, or sticky, throw it away and use another.
Put a drop or two of lubricant inside the condom.
Pull back the foreskin, unless circumcised, before rolling on the condom.
Place the rolled condom over the tip of the hard penis.
Leave a half-inch space at the tip to collect semen.
Pinch the air out of the tip with one hand while placing it on the penis.
Unroll the condom over the penis with the other hand.
Roll it all the way down to the base of the penis.
Smooth out any air bubbles. (Friction against air bubbles can cause condom breaks.)
Lubricate the outside of the condom.
Like all birth control methods, the female condom is more effective when you use it correctly.
If women always use the female condom correctly, 5 out of 100 will become pregnant each year.
If women don't always use the female condom correctly, 21 out of 100 will become pregnant each year.
Female condoms can also be used for anal sex.
Female condoms
can be used with oil-based as well as water-based lubricants
may enhance sex play — the external ring may stimulate the clitoris during vaginal intercourse
stay in place whether or not a man maintains his erection
However, the female condom may
be noisy — adding extra lubricant can help if the female condom is noisy
To insert the female condom
Put spermicide or lubricant on the outside of the closed end.
Find a comfortable position. You can stand with one foot on a chair, sit on the edge of a chair, lie down, or squat.
Squeeze together the sides of the inner ring at the closed end of the condom and insert it into the vagina like a tampon.
Push the inner ring into the vagina as far as it can go — until it reaches the cervix.
Pull out your finger and let the outer ring hang about an inch outside the vagina.
During vaginal intercourse, it is normal for the female condom to move side to side. Stop intercourse if the penis slips between the condom and the walls of the vagina or if the outer ring is pushed into the vagina. As long as your partner has not yet ejaculated, you can gently remove the condom from the vagina, add extra spermicide or lubricant, and insert it once again.
To remove the female condom
Squeeze and twist the outer ring to keep semen inside the pouch.
Gently pull it out of the vagina or anus.
Throw it away. Do not flush it down the toilet.
Do not reuse the female condom.
Nationwide and online, a female condom costs about $3.60. But costs vary from community to community.

23. Diaphragms and Cervical Caps
Silicone or latex cups that cover the cervix to prevent pregnancy.
Must be used with spermicide.
Can be re-used for up to 2 years.
Must be fitted by a practitioner.
Must be left in place at least 6 hours after intercourse, but no longer than hours.
Cervical caps are less effective in women who have had children.
For women who have never been pregnant or given birth vaginally, 14 out of 100 who use the cervical cap will become pregnant each year.
For women who have given birth vaginally, 29 out of 100 who use the cervical cap will become pregnant each year.
The cervical cap may not be right for you if you
are allergic to silicone or spermicide
are not comfortable touching your vagina or vulva
gave birth in the last 10 weeks
have breaks or cuts in your vaginal or cervical tissue
have cancer of the uterus, vagina, or vulva
have certain physical problems with your uterus or vagina
have difficulty inserting the cervical cap
have a history of toxic shock syndrome
have poor vaginal muscle tone
have a reproductive tract infection
recently had an abortion
recently had surgery on your cervix
INSERTING A CERVICAL CAP
Put one-quarter teaspoon of spermicide in the dome of the cervical cap and spread a thin layer on the brim.
Put one-half teaspoon in the folded area between the brim and the dome.
 Find a comfortable position — stand with one foot on a chair, sit on the edge of a chair, lie down, or squat. Put your index and middle fingers in your vagina to locate your cervix. That way, you will know where to place the cap.
 Separate the labia with one hand and squeeze the rim of the cap together with the other hand. Slide the cervical cap dome-side down into the vagina, with the long brim entering first.
 Push down toward the anus and then up and onto the cervix. Make sure the cervix is completely covered. (It is easier to insert before you are sexually aroused.)
After you remove the cervical cap, wash it with mild soap and warm water.
Allow it to air dry.
Do not use any powder on the cervical cap — it can cause infections.
You should not use the cervical cap when you have any kind of vaginal bleeding — including during your period. It could increase your risk of toxic shock syndrome.
FemCap is available in three sizes:
small, for women who have never been pregnant
medium, for women who have had an abortion or a cesarean delivery
large, for women who have given birth vaginally
Cervical caps may be purchased at a drugstore or clinic with a prescription. An examination costs from $50 to $200. Cervical caps average from $60 to $75. Spermicide jelly or cream costs about $8 to $17 a kit.
If women always use the diaphragm as directed, 6 out of 100 will become pregnant each year.
If women don't always use the diaphragm as directed, 16 out of 100 will become pregnant each year.
The diaphragm may not be right for you if you
are allergic to latex or spermicide
are not comfortable touching your vagina and vulva
gave birth in the last six weeks
have difficulty inserting the diaphragm
have frequent urinary tract infections
have poor muscle tone in your vagina
recently had an abortion after the first trimester of pregnancy
INSERTING A DIAPHRAGM
 Put about a tablespoon of spermicide in the cup. Spread some around the rim.
  Find a comfortable position. You can stand with one foot on a chair, sit on the edge of a chair, lie down, or squat. Separate the lips of your vulva with one hand. Pinch the rim of the diaphragm to fold it in half with the other hand.
  Place your index finger in the center of the fold for a firmer grip. The spermicide must be inside the fold.
 Push the diaphragm as far up and back in your vagina as possible. Tuck the edge of the diaphragm behind your pubic bone. Make sure your cervix is covered.
  Diaphragms are available in many sizes and designs. A new size may be needed after any of the following:
a full-term pregnancy
abdominal or pelvic surgery
a miscarriage, or abortion after 14 weeks of pregnancy
a 20-percent change in weight
Diaphragms may be purchased at a drugstore or clinic with a prescription. An examination costs from $50 to $200. Diaphragms average from $15 to $75. Spermicide jelly or cream costs from about $8 to $17 a kit.
More spermicide is needed for repeated acts of intercourse.
May cause more vaginal or urinary tract infections.

24. Paragard® IUD
A small T-shaped device containing copper that is placed inside the uterus.
Effective for 12 years.
Must be inserted and removed through the cervix by a medical professional.
Extremely low failure rate.
Increases menstrual flow and cramping.
High initial cost, but extremely cost-effective.
ParaGard may cause a 50–75 percent increase in menstrual flow. In some cases, this can lead to a low red blood cell count.
You may experience menstrual cramps or backaches.

25. Natural Methods Sexual Abstinence Breastfeeding or LAM
Natural Family Planning
- CM/BBT
- Calendar

26. Permanent Methods
Vasectomy – pieces of the vas deferens are removed and the ends sealed shut.
Tubal Ligation – pieces of the fallopian tubes are removed and the ends sealed shut.

27. Remember to Emphasize
Only abstinence provides 100% protection against pregnancy.
Be sure to talk with your partner about how you will prevent pregnancy. If you choose a method other than abstinence, be sure to make a plan if pregnancy should occur.
There are many different methods of birth control. Be sure to choose one that suits your personality and lifestyle. Consider advantages and disadvantages of each method.
Contraception works best when used correctly and consistently.
Don’t mix alcohol/drugs and sex.
If STDs are a concern, remember that most contraceptives will not provide any protection against STDs. Either abstain or use a condom in addition to your regular birth control method.