1. Chapter 6 Contraception and Abortion

2. ©2010 McGraw-Hill Companies. All Rights Reserved.  Definition:  Conception: the fusion of an ovum and sperm that creates a fertilized egg.  Contraception: Preventing conception by blocking the female’s egg from uniting with the male’s sperm, thereby preventing pregnancy.  Modern contraception are much more predictable and effective than in the past.  Many play a role in the prevention against sexually transmitted diseases 2

3. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 3  Based on the physiology of reproduction  Types: Barrier, Hormonal, Natural Methods, and Surgical  Factors affecting choice  Advantages and disadvantages  Effectiveness

4. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 4  Estrogen and progesterone taken orally  Mimics the hormonal activity of the corpus luteum  Most common is the combination pill, both estrogen and progestin  “Minipill” (only progestins)  Advantages  Disadvantages  Effectiveness (~99.7%)

5. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 5  Thin 1 3/4 inch square patch Ex: Ortho Evra  Releases estrogen and progestin slowly into the bloodstream.  Prevention the same way as oral contraceptives  Worn for one week, replaced on the same day for 3 consecutive weeks. Fourth week no patch  Placements: Upper arm, abdomen, buttocks, or upper torso (not breast)  Advantages  Disadvantages  Effectiveness (~99.7% in the first year of use; less effective in women weighing more than 198 lbs.)

6. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 6  The NuvaRing  Resembles the rim of a diaphragm and is 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 (~99.7%; 8% failure rate )

7. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 7  Norplant; Jadelle (Norplant II); Implanon (2006)  Hormonal method  6 flexible matchstick capsules  Protection for 5 years  Progestin inhibits ovulation  Advantages  Disadvantages (e.g., menstrual irregularities)  Effectiveness (~99.95%)

8. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 8  Depo-Provera, Lunelle (2002 voluntary recall)  Hormonal treatment  Injectable progestin every 12 weeks  Injectable locations: arm or buttocks  Advantages  Disadvantage  Side effects period will subside - ovaries will not release egg It may take 12 months before cycle will return  Effectiveness (~99.5%)

9. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 9  Postcoital Pill, Morning After Pill, Plan B (OTC)  Use a EPT (emergency pregnancy test) kit  Most common is the two dose regimen  Prevents uterine implantation  Needs to be taken within 72 hours. Best used within 24 hours

10. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 10  T-380A (ParaGard) 10 years of protection  Copper  Levonorgestral (Mirena) 5 years of protection  Release small amounts of progestin  Not exactly sure how it prevents pregnancy— perhaps it works to prevent fertilization  Advantages  Disadvantages (e.g., heavy menstrual flow and bleeding occurs)  Effectiveness (99.2%)

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12. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 12  Thin latex sheaths  Protection against STD’s  Advantages  Disadvantages  Effectiveness  Use with spermicide

13. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 13  Reality Brand  Polyurethane sheath with two flexible rings  Advantages  Disadvantage  Effectiveness

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15. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 15  Dome shaped cup of thin rubber stretched over a collapsible metal ring.  Available only by prescription  Custom fit  Removed following intercourse  Advantages (e.g., sensation increases, protection against STI’s)  Disadvantages Toxic shock syndrome (TSS) – occasionally fatal bacterial infection  Effectiveness (approximately 84%)  Lea’s Shield (silicon rubber)

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17. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 17  Small rubber or plastic cap  Must use foam kit  Advantages (similar to the diaphragm)  Disadvantage

18. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 18  How it works  Advantages  Disadvantages  Effectiveness (~71%)

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20. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 20  Abstinence  Without intercourse or sexual activities  Benefits: more self respect and respect for others. Security that you are being pursued for sexual reasons. Less worry about STDs and Pregnancy.

21. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 21  FAM  Calendar method  Temperature method  Mucus method  Withdrawal  Combining methods

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23. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 23  Severing of the vasa deferentia  May return to work in 2 days  Reversal varies between 80% to 50%, depending on the report.  Complication rate (low)  Effectiveness (~99.85%)

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25. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 25  Tubal sterilization (laparoscopy) is most common  Hysterectomy (removal of the uterus)  Complication rate (low)  Reversibility

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27. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 27  Appropriate method of birth control  Individual health risks  Implications of unplanned pregnancy  Risks of STDs  Convenience and comfort level  Type of relationship  Ease and Cost  Religious or other philosophical beliefs

28. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 28  The history of abortion in the U.S.  Mid-1800’s: Prior to 20 weeks was legal  1900’s: Physicians joined with other groups - stating untrained people were performing them. All states made abortion illegal

29. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 29  1973: Roe versus Wade  Supreme Court ruled : Pregnancy divided into 3 trimesters 1st trimester - up to women & doctor 2nd trimester - state may regulate 3rd trimester - state may regulate and bar all abortions that are not life threatening to mother  U.S. Congress and federal Medicaid funds  17 states provide nonfederal public money  Current issues  2000 Nebraska ban on partial birth (Stenberg v. Carhart ); a surgical abortion that is typically performed during the third trimester or later part of the second trimester of pregnancy and in which the uterine cervix is dilated and death of the fetus is induced after it has passed partway through the birth canal -- called also D&X, partial-birth abortion  President Bush signed the Partial-Birth Abortion Ban Act (S. 3) into law on November 5, 2003  2004 The Partial Birth Abortion Ban Act is declared unconstitutional by federal judges in San Francisco, New York, and Lincoln, Nebraska.  2007 Gonzales v. Carhart: The Supreme Court upholds the Partial Birth Abortion Ban Act.

30. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 30  Pro-life  Pro-life: The fertilized egg is a human being from the moment of conception and therefore an abortion is murder.  Any women having sex knows pregnancy is possible - she has a moral obligation  Women unable or unwilling to raise the children should consider placing him/her up for adoption  Abortion has destructive effects on our traditional morals and values

31. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 31  Pro-Choice :  Pro-Choice :There are distinct stages of fetal development and that preserving the fetus early in pregnancy is not the ultimate moral concern.  Women should have the right to make their own decisions  If not legal then unsafe and unregulated practices would occur  Women would be divided into those who could afford and those who could not.  Some physicians would be forced to break the law

32. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 32  Two categories  Surgical - 98% of all abortions  Medical  Ends a pregnancy before birth takes place  Miscarriage/Spontaneous abortion - embryo or fetus dies in the uterus and is expelled by the body  Ending a pregnancy voluntarily - induced abortion  Approx. 88 % of all abortions are performed during the first trimester  Typically performed at a clinic, health center, or in a doctors office.  Women are usually able to return home an hour or so later

33. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 33  Vacuum aspiration  Early abortion; about 6 th to 12 th week  Used about 90% of all abortions  Vagina is washes with antiseptic, Anesthetic is injected into or near the cervix.  Cervix is gently and gradually stretched over a 24 hour period.  After dilation a tube connected to a suction machine gently empties the uterus  After suction a Curette (narrow metal loop) gently scrapes the walls of the uterus  After a few hours in recovery the woman can return home

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35. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 35  MVA  Done within 4 or 5 weeks of last menstrual cycle  More effective and safer if performed at least 6 or 7 weeks  Gentle suction of a syringe  Cervix is dilated with meds.  Uterus is emptied with a handheld syringe  If a definitive gestational sac is not identified then women is tested for possible ectopic pregnancy

36. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 36  Possible physical effects  Fever above 100º F.  Abdominal pain or tenderness  Swelling  Backache  Prolonged or Heavy bleeding  Foul smelling vaginal discharge  Vomiting  Fainting  Delay of 6 or more weeks in resuming menstruation

37. chapter 6 ©2008 McGraw-Hill Companies. All Rights Reserved. 37  Possible feels 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

38.  Chapter 6 Connect Assignment Due Tuesday, February 9 th  Study guide for Exam I will be posted on instructor’s website: www.cerritos.edu/lnguyen  Exam I next Wednesday, February 10 th  No late and/or make-up exams will be given. Chapter 6 ©2010 McGraw-Hill Companies. All Rights Reserved. 38