Chapter 6: Birth Control

1. Chapter 6: Birth Control For use with Human Sexuality Today (4th Ed.) Bruce King Slides prepared by: Traci Craig

2. Chapter Overview • Teen Pregnancy in the US • Worldwide need for contraception • Myths and Ineffective Methods • Fertility Awareness Methods • Barrier Methods • IUD • Hormonal Methods • Sterilization

3. Teen Pregnancy • Rate peaked in 1991, but US rate is twice as high as England and Canada and 8 times as high as Japan.

4. Fathers? • Half of the fathers are 20 years old or older, when mothers are 14 to 17. • Getting a woman pregnant a sign of masculinity. • No responsibility for ‘acquaintances’ • ½ spend time with the child 1/5th contribute money • Do poorly in school, lack long-term goals, impoverished backgrounds, socially deviant behavior.

5. Babies • High-risk babies with health problems—lack of prenatal care • Children of teen parents more likely to be victims of child abuse and neglect • Girls born to teen mothers are likely to experience economic dependence and an inability to escape poverty • Often become teen parents themselves. • Seek emotional closeness younger due to emotional deprivation from their own teen mother.

6. Birth Control • Procreation only attitudes lack of contraception • Margaret Sanger watched a woman die from trying to self-induce abortion, founded Planned Parenthood. • 2/3rds of Americans in 1936 believed contraception should be made available to those who wanted it. • Last law prohibiting the sale of contraceptives to married couples was repealed in 1965, to unmarried couples in 1972.

7. World Wide Contraception • Overpopulation: limited natural resources • World population: 6 billion 1999

8. Overpopulation • UN estimates 9-10 billion people by 2050 • Half of children born today are at poverty levels • To support this population, ALL cropland would have to produce 2.8 tons of grain per acre, per year. • Mass starvation: Ethiopia, Somalia, Asia, and in Brazil alone 2,000,000 children are abandoned • Indiainfanticide

9. Overpopulation • China1982 forced birth control, no more than 1 child, pressure to abort second children • US Birth rates fell in the 60s. US population has stabilized. • In 20 developed countries, now below the replacement level.

10. Birth Control Methods • 85-90% of couples would conceive within 1 year if they did not use any contraception • Perfect-use and Typical-use—1st year of use

11. Contraceptive Myths—These aren’t true. • Males drinking Mountain Dew/Splurge before sex reduce sperm count to zero. • Females douching with coca-cola or ice water prevents pregnancy. • You can’t get pregnant the first time, or if you don’t kiss, or if the female is on top, or standing up. • If the woman doesn’t have an orgasm, she can’t get pregnant.

12. Ineffective Methods • Coitus Interuptus (withdrawal)—the man withdraws the penis from the vagina just before ejaculation. • 13% of high school students rely on this method. • First year of use: 20% pregnancy rate • Also possible to get pregnant if the man ejaculates near a woman’s vagina—heavy petting. • Not very physically or emotionally satisfying, but perhaps better than nothing.

13. Ineffective Methods • Douching after intercourse. • Sperm can make it to the cervix quickly and in fact the pressure caused by douching can force sperm further into the cervical opening. • Pregnancy rate: 40% • Increases risk of PID.

14. Ineffective Methods • Breast feedingcauses the release of FSH and LH and prevents normal menstrual cycles. • In the first 6 months of breast feedingless than 2% pregnancy rate. • After 6 months the pregnancy rate rises. • Only works if the baby is fed on demand. • Less effective in America where women are not likely to be able to nurse the infant on demand.

15. Abstinence • 100 percent effective and a recent decline in teens having sex. • Teaching abstinence • “Education Now Babies Later”: no effect on teen’s sexual decisions. • “Abstinence-plus”: also teaches contraception and is very effective in reducing teen pregnancy • Denmarkcomprehensive sex ed in it’s schools • Denmark teens just as sexually active as American teens, but the Denmark teen pregnancy rate is lowest in the world.

16. Fertility Awareness: Abstaining during ovulation. • Rhythm Method/Natural Family Planning • Not opposed by the Catholic Church and EVANGLICAL Protestant denominations. • 3 variations of this method. • Pregnancy can only occur when an egg is present in the first 24 hours or so after ovulation. • Identification of ‘safe days’ and ‘unsafe periods’

17. Fertility Awareness • Only works for women with regular cycles. • Sperm can live for 3-5 days. • Day of ovulation pregnancy rate is 12% • Calendar method • Subtract 18 from the length of the shortest cycle • Subtract 11 from the length of the longest cycle • The results are the days you should abstain • Tests Human Willpower & 40-45% failure rate

18. Basal Body Temperature • A woman’s resting temperature rises by a few tenths of one degree 24 to 72 hours after ovulation. • Abstain from end of menstruation until 4 days after rise in temperature. • Temperature should be taken first thing in the morning before doing ANYTHING. • Some women have irregular basal body temp • Test of willpower and 25% pregnancy rate.

19. Billings Method • Changes in the cervical mucus: changes from white to clear a day or two before ovulation. • Douching makes this ineffective • Abstain from end of menstruation until 4 days post change in consistency (wait until discharge is white again) • 16-20% pregnancy rate for typical use • 17 days per month of abstinence could be trying • Combining Billings and Basal Body Temp is called sympto-thermal method and is better than either method alone.

20. Spermicides • Nonoxynol-9 or octoxinol-9: foams, jellies, creams, and film (VCF) • Put into the vagina shortly before intercourse. • Typical use rate is 26%, as low as 6% with proper use. • Reduce gonorrhea, chlamydia and cervical cancer. • Increase risk of HIV, and urinary tract infection. • 1 in 20 people experience that spermicides burn or irritate the vagina or penis.

21. Barrier Methods: Male Condoms • Latex, lamb intestine, polyurethane or synthetic elastomers condoms prevent sperm from meeting egg. • Highly effective against STDs • American men are often reluctant to use them. • Condoms come rolled up, dry or lubricated, and in different sizes.

22. Barrier Methods: Male Condoms • Put the condom on prior to intercourse. • Unroll over penis (pull back foreskin if uncircumcised). • Hold on to base of condom at withdrawal. • Use only once, do not store in warm places, check expiration date. • Do not use with oils, lotions or petroleum jelly.

23. Barrier Methods: Male Condoms • With spermicide the theoretical failure rate is less than 1%. • Breakage rate is 1-3% with human vaginal intercourse, higher for anal intercourse. • Two condoms reduces breakage rate to 0. • Breakage more likely in men who do not use condoms regularly.

24. Male Condoms and Reluctance • Men believe it reduces sensitivity (only slightly and a pro) • Polyurethane condoms are only half as thick as rubber and transmit heat better. • Allergy—1-3% of people are allergic to rubber. • Loss of spontaneity • Minor annoyance compared to diaphragm, cervical cap, etc. • Women buy 40-50% of condoms

25. Barrier Methods: Female Condoms • Intravaginal, 7” long polyurethane bag held in place by two flexible rings. Insert the close ended ring against the cervix, outside ring partially covers the labia.

26. Barrier Methods: Female Condoms • Thinner than male condoms • No health concerns or adverse effects • Women can protect themselves even when partner refuses to use male condoms. • Pregnancy rate in first year is 5% or less.

27. Barrier Methods: Diaphragm • Dome shaped rubber cup with a flexible rim that fits over the cervix. • Only about 1.7% of American women use this method. • Fitted by a health care worker, prescription given for a diaphragm that fits her. • Requires instructions and coaching on proper use.

28. Barrier Methods: Diaphragm • Use with spermicidal jelly on inside of diaphragm and rim. • Insert no more than 2 hours prior to sex. • Leave in for 6-8 hours to ensure there are no more live sperm. Do not leave in more than 12 hours.

29. Barrier Methods: Diaphragm • Pregnancy rate is 6%, typical use is 15%. • Not for women with a history of urinary tract infection. Should not use during menstruation or if there is abnormal vaginal discharge. • Detract from oral-genital relations.

30. Barrier Methods: Cervical Cap • Made of latex rubber or plastic and smaller and more compact than a diaphragm. • Used with a small amount of spermicide. • Fits over cervix via suction. • Insertion and removal more difficult than for diaphragm. • After intercourse, make sure it is in place and hasn’t been dislodged.

31. Barrier Methods: Cervical Cap • 1st year failure rate is 18%. • May have adverse effects on cervical tissue. • More effective for women who have not given birth.

32. Barrier Methods: Contraceptive Sponge • Most popular over the counter method prior to the production stop in 1995. • New sponge by new company. • Polyurethane contraceptive sponge, 2” in diameter and 1” thick, containing spermicide. Blocks cervical opening and kills sperm.

33. Contraceptive Sponge • Does not require pelvic exam. • Easy to insert • Moisten with tap water and insert deep into the vagina. • Can be left in 24 hours—no need to add more spermicide • Small loop enables removal for disposal. • Some women report mild irritation (6%) • Actual use rate is 17-20%. • More effective in women who have not given birth.

34. IUD • Intrauterine Device • Numerous health problems with early IUDs and taken off the market. • Prevent implantation of a fertilized egg • However, studies show primarily prevents fertilization by their effect on sperm transit. • Copper or progesterone coating which impair sperm passage.

35. IUD • Body tries to expel the device from the uterus. • Added thread so women could check to for dislodging transmission of bacteria and viruses • Heavier and longer menstrual flow.

36. The IUD Today • Progestasert T and Copper T have a single filament polyethylene stringdo not increase PID risk. • Less than .8 percent of contraceptive users chose the IUD in 1995.

37. Hormonal Methods • One of the most popular reversible method of contraception. Failure rate is 3%. • Not immediately effective—it takes one full cycle to be effective. • Various types: • Combination pills • Minipill

38. Hormonal Methods • Contain synthetic progesterone and estrogen. • Prevents ovulation by stopping release of FSH and LH from pituitary • Keeps uterine lining thin and cervical mucus thick.

39. Hormonal Methods • Minipill contains only progestins. • Inhibits development of endometrium • Keeps cervical mucus thick • Women who are breastfeeding or cannot tolerate other side effects. • Today’s combination pills have 50 micrograms of estrogen (compared to 150 micrograms in 70s and 80s).

40. Hormonal Methods • Side Effects: nausea, constipation, breast tenderness, bloating, emotional depression • Most diminish within a few months. • Increased susceptibility to yeast infection. • Smoking and taking the pill increase risk for cardiovascular problems. • For nonsmokers, the risks associated with the pill are less than those associated with pregnancy and childbirth.

41. Hormonal Methods • Lowers risk for ovarian cancer • Decrease in number of benign breast tumors. • Reduces ratse of ovarian cysts, rheumatoid arthritis, and PID. • Reduces PMS, pain and bleeding and improves acne.

42. Depo-Provera • Progestin shot lasts for 3 months and prevents ovulation by blocking FSH and LH from being released. • Pregnancy rate of less than 1% • Side effects: menstrual irregularity, weight gain (15 lb), tiredness, weakness, nervousness, dizziness, headache. • Lunelle—new shot with estrogen & progesterone.

43. Norplant • Hormonal method of protection for 5 year period. • Six flexible silicon tubes are inserted under the skin of the upper arm in a fan like pattern. • Tubes release synthetic progesterone inhibits LH surge and ovulation. • 15-30 minute procedure

44. Norplant • Failure rate is 2 in 1000. • In the first year, side effects include irregular bleeding, spotting, weight gain, headache, nervousness, dizziness, nausea, breast tenderness, and acne. • Should not be used by women with liver disease or tumors, breast cancer, or a history of blood clots.

45. Emergency Contraception • 3 methods • Yuzpe method: synthetic estrogen and then levonorgestrel within 72 hours and again 12 hours later—75% effective. Not abortion. • Progestin only pill as well—90% effective. • Implantation of IUD—hard to find doctor willing to take the time to do this.

46. Voluntary Sterilization • More Americans rely on sterilization than any other method (28% female, 11% male). • Married couples use this method after last planned child. • Unmarried women who are also not planning on future children.

47. Vasectomy • Men—Vasectomy • Small incision in the scrotum under local anesthetic. Tying off and cutting the vas deferens. Takes 20 minutes. • China—no scalpel method, skin of scrotum is pierced with a sharp instrument. 10 minutes. Less bleeding and infection.

48. Vasectomy • Does not interfere with production of hormones or sperm. • Sperm that are already past the vas deferens must be eliminated before vasectomy is effective (12-16 ejaculations). • Men who have been sterilized still ejaculated, the semen does not contain sperm.

49. Tubal Ligation • Tying off and/or cutting the fallopian tubes. Prevent passage of egg and sperm. Eggs absorbed by woman’s body. • All require general anesthesia, but no need for prolonged hospital stay.

50. Tubal Ligation • Minilaparotomy: 1 inch incision in abdomen fallopian tubes tied up and cut. • Laparoscopy is done via video transmitted via inserting a tube-like camera and surgical instruments into the belly button to cut the fallopian tubes. • Culpotomy: cutting of fallopian tubes is done through small incisions in the vagina.