Unformatted text preview: Selecting Birth Control Methods Chapter 16
Karin Corriere Texas A&M University Chapter Objectives Prepare your own reproductive lifespan Identify factors that affect the menstrual cycle Describe the benefits and risks of the available contraceptive devices Properly explain the procedures for using a condom Differentiate between Right to Life and Pro Choice positions Access to Family Planning Family planning is not just a family issue, it has health, social and political implications Differences between countries Population control Right to information and services to prevent pregnancy In the US power lies in the hands of government officials Benefits of Family Planning Contributes to the decrease of women who live in poverty Provides women with more time to spend on education and employment Reduces the number of maternal and infant deaths Reduces the global population Reduces the number of teenagers who give birth, thus reducing overall premature and unintended pregnancies. Provides adolescents with opportunities for a better education, jobs and income and reduces the likelihood of divorce and separation Birth Control Methods June 1967--landmark decision by the U.S. Supreme Court Birth control methods are all the strategies used to keep from having a baby
All contraceptive methods IUDs Emergency contraception Abortion Contraceptive Choice Contraceptive Choices Methods available, health benefits and drawbacks, relative failure rates, cost estimate Method failure-the method itself fails User failure-the user makes a mistake ABSTINENCE
1. Delay of sexual intercourse--does not necessarily equate with nonsexual 2. 100% Effective 3. No cost FERTILITY AWARENESS METHODS Help women understand their menstrual cycle better Require high motivation by both partners Have high method and user failure rates Not suggested for couples who could not tolerate a pregnancy Offer no protection against SDIs/HIV Cycle Based Method Relies on abstinence during the period of time a women is ovulating Least user effective method Would be very effective method if a women could determine if the exact day of ovulation Couple should refrain from intercourse during the entire time that ovulation is possible, including 3-5 days after 25-30% failure rate Accepted by most religions Unpredictability of a women's cycle Basal Body Temperature Method Designed to determine when a women is ovulating A women's basal body temperature drops 1-2 days before ovulation then rises sharply to 1 degree during ovulation and remains elevated until the menstrual cycle begins Temperature should be taken every morning before rising from bed for reliability Sexual activity should not occur 3-4 days before ovulation and 3-4 days after temperature elevates Symptothermal Method Combination of basal body temperature and cervical mucus monitoring Consistency of the cervical mucus at ovulation becomes more watery failure rate of 20% no cost, no medical/hormonal side effects, accepted by most religions Withdrawal (coitus interruptus) Not a contraceptive method Leads to many unintended pregnancy Penis is withdrawn from the vagina before ejaculation The pre-ejaculate carries sperm that may be released into the vagina prior to withdrawal 15% effective Barrier Methods Have become increasingly popular because of the protection they provide against HIV and STIs Spermicides Male condom Female condom Diaphragm Cervical cap Spermicides Chemical method of contraceptive use Creams, gels, suppositories and foams Prevent contraception by killing sperm before it reaches the uterus Can be used alone or with another barrier methods, such as condoms, diaphragms, or cervical caps Must be reapplied before each ejaculation Recommendations for nonoxynol-9 have changed--not recommended as an effective means for HIV?AIDS or for pregnancy prevention in populations at high risk for HIV Male Condom Latex sheath designed to cover the erect penis and hold semen upon ejaculation Should contain the lubricant nonoxynol-9 86-90% effective when used alone 98% effective when used with a spermicide Drawbacks include: Loss of spontaneity and allergic reactions Cheap, readily available, no prescription needed How to Use a Condom Roll the condom down the penis as soon as it is erect Leave one-half inch of space at the tip of the condom-- extra space for the ejaculate If you use another lubricant, use something which is water based. Do not use an oil based lubricant. After ejaculation, hold the condom at the rim and withdraw the penis. Be careful that semen does not leak out the condom Remove the condom, wrap it in a tissue, and dispose of it safely in a waste container. Do not flush the condom down the toilet Female Condom, Reality Approved with restricted labeling by the FDA in 1993 One-size fits all barrier method First barrier method for women and offers protection against STIs Thin, polyurethane pouch with two flexible rings, one covers the cervix and the other partially covers the vagina Does not require fitting and is controlled by the women Lack of aesthetic appeal 12-22% failure rate Diaphragm Oval, dome-shaped device that covers the lower end of the uterus to prevent sperm from entering cervical canal Spermicide is applied into the dome and around the rim Not felt by either partner when fitted properly Should be left in place for 6-8 hours after intercourse, then removed Lowers probability of contracting several STIs Lowers the risk of cervical cancer, tubal infertility, and PID Increases risk of urinary tract, bladder and yeast infections Must be fitted by a health care provider Cervical Cap Small rubber cup fitted over narrow lower end of uterus to prevent sperm from entering cervical canal Designed to fit tightly over the cervix and should be filled with spermicide before intercourse Must be fitted by a health care provider Can remain in place for 48 hours 87-98% effective Higher failure rates among younger women Smaller size, lower cost, some protection against STIs More difficult to ensure it is in place Hormonal Methods Convenient, effective and reversible NO protection against STIs Intended solely to prevent pregnancy Oral contraceptives Norplant Depo Provera Several newly approved methods Oral Contraceptives 3rd most popular form of birth control in the world among married women Act by inhibiting ovulation through suppressing FSH and LH Two types: combination pills and progestin-only 94-97% effective Health Risks Associated with Oral Contraceptives
Health benefits: protection against certain forms of cancer, lowered risk for ectopic pregnancies and PID, lighter and less painful menstrual flow, decreases in iron deficiency anemia Side Effects (estrogen): nausea, breast tenderness, fluid retention Side Effects (progestin): increased irregular menstrual cycles, vaginal bleeding Risk for cardiovascular disease Yasmin Low-dose birth control approved in 2001 99% effective Prevents pregnancy by suppressing ovulation and thickening the cervical mucus Contain synthetic progestin for women who experience adverse side effects from other progestins Transdermal (Skin) Patch Ortho Evra Approved in 2001 Thin, plastic patch placed on the skin of the buttocks, stomach, upper outer arm or torso once a week for three out of four weeks. Releases hormones through the skin into the blood stream that prevent pregnancy for one month 99% effective Side effects similar to birth control pills Less effective in women weighing more than 198 pounds The Nuvaring Clear, small, flexible ring that is inserted into the vagina that releases hormones that protect against pregnancy for one month Remains in place for 3 weeks 98-99% effective Suppresses ovulation and causes the cervical mucus to thicken Side effects similar to birth control pills Lunelle Monthly Contraceptive Injection Hormonal injection given in the arm, thigh or buttocks monthly to prevent pregnancy Effective as oral contraceptives Side effects similar to those associated with oral contraceptives Cigarette smoking increases the risk of serious cardiovascular side effects Norplant Progestin-only implant that is inserted under the skin of the upper arm Gives continuous long-lasting birth control without sterilization (5 years) Number of side effects (irregular bleeding, headache, nausea, acne, hair loss) Lack of estrogen side effects, 99.95% effective, high reversibility Depo Provera Trademark name for contraceptive method utilizing progestin injection into the gluteal or deltoid muscle once every three months Most widely used progestin injection Prevents the egg from ripening, thus suppressing ovulation Thickens cervical mucus Last approximately 12 weeks 99.7% effective High reversibility Vaginal bleeding, amenorrhea, weight gain, headache, nervousness, dizziness, stomach cramps, decreased sex drive Emergency Contraception
FDA approved the first emergency contraceptive pill in 1998 Work by delaying ovulation or preventing fertilization or implantation Reduces the risk of pregnancy by 75 to 89%involves the administration of high doses of oral contraception Do not induce a medical abortion Contraindications for Hormonal Methods Should be asked if she is pregnant, has active liver disease, heart problems, breast cancer, diabetes, hypertension, migraine headaches, epilepsy, or a history of blood clotting Sexual history Intrauterine Devices Safest, most effective, least expensive reversible methods Less than 1% of contraception users in the US choose this method Most popular method worldwide An IUD is inserted into the uterus during menstruation by a health care provider Prevents pregnancy by: reducing the number of sperm that reach the fallopian tubes, decreases viability of sperm, prevents the implantation of a fertilized egg within the uterus (99.2-99.9% effective) Sterilization: Tubal Ligation Most prevalent form of birth control used in the US Involves closing the fallopian tubes, either by cautery, tying, cutting or clamping, thus preventing the egg from becoming fertilized Low user/method failure rates and low reversibility 99.5-99.9% effective Sterilization: Vasectomy Third most popular method Vas deferens is cauterized, tied or sutured to prevent sperm from being ejaculated Safer, cheaper and has a better reversibility rate than a tubal ligation 99.5-99.9% effective CHOOSING A BIRTH CONTROL METHOD 1. 2. 3. 4. 5. 6. 7. What is your ideal birth control method? Things to consider: Personal considerations Effectiveness Safety Cost Benefits Reversibility Convenience QUESTIONS TO ASK YOURSELF Have I had problem with this method before? Will I have trouble remembering to use this method? Am I opposed to using this method due to my religious/moral beliefs? What will my partner think? Am I at risk for HIV/STIs Will this method embarrass me? How many partners do I have? How would I feel about having children now? Abortion 210 million pregnancies each year 15% spontaneously miscarriage or have a stillbirth 22% will terminate the pregnancy by abortion (20 million legally) Reasons for abortion are personal Social influences Financial concerns Religious beliefs Defining Abortion The spontaneous or deliberate termination of a pregnancy Therapeutic Infected abortion Septic abortion Threatened abortion Spontaneous Voluntary Surgical Abortions Vacuum aspiration Dilation and curettage (D&C) Dilation and evacuation Late term procedures (D&E) Hysterotomy Extraction Medical Abortion 2000 FDA approved Mifeprex (RU-486) Used by 100 million women worldwide 2 medications-3 physician visits Effective in 95% of women when used within 49 days Post-abortion Issues
Studies show that the majority of women who choose abortion experience relief after the abortion and the immediate feelings of guilt, loss and/or depression are usually transient A woman needs to handle the event in her own way Post-abortion Syndrome-mainstream positions have never supported this assertion Political Debate Politicians elected based on their view of the issue Right to Life, Pro-Life, Anti-Choice Pro-Choice, Pro-Abortion Chapter Summary Family planning Fertility awareness methods Withdrawal Barrier methods Hormonal methods Emergency contraception Intrauterine devices Sterilization Choosing a birth control method Abortion categories Surgical procedures Medical abortion Choosing abortion For more information Planned Parenthood: http://www.plannedparenthood.org The National Women's Health Information Center: 4woman.gov American College of Obstetricians and Gynecologists Resource Center: http://www.acog.org ...
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This note was uploaded on 03/26/2008 for the course HLTH 700 taught by Professor Chaney during the Fall '05 term at Texas A&M.
- Fall '05