Chapter 6 Birth Control

Unwanted and unplanned pregnancies • Birth control – methods of preventing unwanted births; this term includes “contraception.” • Contraception – birth control by means of preventing conception. • Margaret Sanger – champion of women’s rights to safe and legal birth control since 1912; later founded Planned Parenthood. • Nearly half of U.S. pregnancies are unplanned. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Teen pregnancy in the United States • In 1960 15% of births to teens were out of wedlock compared to 75% today. • Nearly 80% of pregnancies to teens today are unintended; half of those end in abortion. • Although rates are dropping, U.S. teen pregnancy rate is still much higher than other first-world nations (Japan, Canada, Europe). • Ignorance about contraception is common among U.S. teens. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Teen parenting in the U.S. • Birthrates are highest among low-income (and low education) groups, in which Latinos and African-Americans are over-represented. • Poor prenatal care, high infant mortality rates. • Higher rates of child neglect and abuse. • Children born to teens more likely to become teen parents themselves. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

World Population • 5 billion in 1987, 6 billion in 1999, projected to 9.3 billion in 2050. • Mass starvation is already a reality in some parts of the world. • China ordered mandatory birth control in 1982. • Fertility rates are dropping in developed nations where birth control is widely available. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

WorldPopulation China, where farmland per person ratios are low, has managed to decrease the number of children per woman from 6 (1970) to about 2 (1997). Will other nations follow their lead? King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Effectiveness of birth control methods • Rates are calculated over a year’s time. • 85 – 90% fertility rate in unprotected couples. • Perfect-use pregnancy rate – if all users use a method consistently and properly. • Typical-use pregnancy rate – includes method failures due to inconsistent/improper use. • Forget about these myths – douching with Coca Cola, first-sex infertility, certain sexual positions, etc. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Relatively ineffective methods • Withdrawal (coitus interruptus) – 13% of high school students rely on it even though the failure (pregnancy) rate is 25%. • Douching to wash sperm out of the vagina fails for 40% of couples using it to prevent pregnancy. • Any method used less often than every time or used improperly will fail to prevent pregnancy. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Abstaining from sex • Abstinence-only programs show no long-term effects on teen sexual decisions or behavior. • The U.S. government only funds abstinence-only sex education programs in schools. • Only the “Abstinence-plus” programs have proven effective in reducing teen pregnancies. • Teaching abstinence and contraception King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Lactational amenorrhea method • Women who fully breast-feed their babies and who are not menstruating experience only a 2% risk of pregnancy during the first 6 months following the birth of their child. • The 2% rate is only in women who never use a pacifier or bottled formula or water to satisfy the baby’s need to suck. • Typical-use failure rates are much higher. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Fertility Awareness: Abstaining from sex during ovulation • Calendar method – 25% typical-use failure rate • Basal body temperature method – 25% typical-use failure rate • Billings method (cervical mucus or ovulation method) – 20% typical-use failure rate • Sympto-thermal method (combine Billings, basal body temperature and other symptoms of ovulation) – much lower failure rates King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Spermicides – Kill sperm prior to conception • Foam, cream, suppositories, gel, or film (that melts into gel) – 26% typical-use failure rate. • 1 in 20 people experience burning irritation to the vagina or penis; more so with nonoxynol-9 than with other chemical spermicides. • Chemical irritation of the vaginal lining may increase risk of HIV transmission. • A good back-up to the barrier methods. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Condoms • Male condoms (latex or skins) – 12% typical-use failure rate; 1-3% for perfect-use. • Latex condoms also provide significant STD risk reduction (“skin” condoms do not). • Polyurethane condoms are believed to offer pregnancy and STD protection similar to latex and are viewed as more comfortable by many. • Female condoms – 21% typical-use failure rate, 5% perfect-use. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Become “condom friendly” • Learn to put it on correctly, before intercourse. • Use each condom only once. • Check expiration date, package seal, store in a safe place, find a brand/size that fits you best. • Always use water-based lubricant to increase comfort and decrease risk of breakage. • Oil-based lubricants may be used with polyurethane condoms (baby oil, lotions, vegetable oils, petroleum jellies). King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Diaphragms • Rubber cup, always used with spermicidal gel – 15% typical-use failure • Must be fitted by your health care provider. • May be inserted up to 2 hours prior to intercourse. • Leave in for at least 6 hours after intercourse but no longer than 12 hours. • Problems for women with urinary infections. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Cervical Cap and Lea’s Shield • Cervical cap, used with spermicidal gel – 18% typical-use failure rate (better for women who have not yet given birth), fitted by your health care provider, may be left in place for up to 24 hours, not for women with abnormal Pap tests. • Lea’s shield, used with spermicidal gel – 15% typical-use failure rate, non-prescription (one-size fits most), may leave in for 48 hours. • This is relatively new; approved for use in 2002 King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

The sponge is back! • Polyurethane sponge covers the cervix – 10 – 20% typical-use failure rate (best for women who have not yet given birth). • “Today” and “Protectaid” brands both contain the spermicide nonoxynol-9 (activated with tap water before insertion), trapping and killing sperm that move toward the cervix. • Available online without prescription, may be left in place for 24 hours. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

IUD – Intrauterine Device • Very popular worldwide, works primarily by preventing fertilization by impairing passage of sperm through the uterus, but in some cases may prevent implantation of a fertilized egg. • Copper or progesterone coated plastic, T-shaped device – less than 1% failure rate. • Inserted by a physician, copper IUD can be left in for 10 years; progesterone for 5 years. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

The new IUDs The new IUDs are not associated with PID, ectopic pregnancy, endometrial cancer, infertility, increased bleeding and have no fatalities; they also have a lower expulsion rate. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Hormonal methods – Birth control pills • Combination pill – 3% typical-use failure rate • Must be taken for one month prior to depending upon its actions to prevent ovulation • Mini pill – 4% typical-use failure rate • Works primarily by inhibiting development of endometrium and thickening the cervical mucus. • Perfect-use failure rate is near zero • Remember to take it every day and don’t use other medications that may interfere with its effectiveness King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

How the pill works Synthetic hormones in the pill interrupt the normal bio-chemistry of the menstrual cycle by acting on the pituitary gland as well as the uterus itself. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Birth control pills – Health risks and side effects • Temporary side effects in some women are similar to those of early pregnancy. • Newer formulations result in fewer side effects. • A few women report negative mood changes. • Smokers and women at risk for high blood pressure, diabetes, cervical or breast cancer should generally not take birth control pills. • For non-smokers, health risks are much less than risks caused by pregnancy and childbirth. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Birth control pills – Health benefits • Lighter periods and ability to schedule periods. • Decreased risk of endometrial, ovarian cancer. • Decrease in benign breast tumors, ovarian cysts, rheumatoid arthritis, and PID. • Reduction of PMS and menstrual pain. • Improvement of acne. • Peace of mind regarding unwanted pregnancy. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Other hormonal methods • Norplant implants – not currently available but new versions will be available in the future; 5 yr. protection. • OrthoEvra (the patch) – worn on the body, changed weekly, effectiveness and side effects same as low-dose combination pills plus possible skin reactions. • NuvaRing – inserted into the vagina, worn for 3 weeks, effectiveness and side effects same as the pill. • Depo-Provera (the shot) - <1% failure rate, requires doctor visit every 3 months. • Side effects may include: menstrual irregularities, weight gain, dizziness, headaches, nervousness. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Emergency contraception – Preventing abortions • Yuzpe – oral synthetic hormones taken within 72 hours of intercourse are 75% effective. • May prevent ovulation, fertilization or implantation. • Plan B – oral synthetic hormones; 99.5% effective if taken within 24 hours or 85% if taken within 3 days of intercourse. • Copper IUD – emergency implantation within 7 days of intercourse. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Voluntary sterilization • Used by more than half of married couples after the birth of their last child. • Tubal ligation – cutting and tying off the fallopian tubes to keep eggs from sperm. • Essure – nonsurgical implantation of a micro-insert into the fallopian tubes; blocks the tubes. • Vasectomy – cutting and tying off the vas deferens to keep sperm from leaving the man. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Unwanted pregnancies – The adoption option • Only 2 – 3% will choose adoption; it is emotionally difficult and not well supported by society (How could you give up your baby?) • Open adoptions have become common – birth parents are active participants in choosing the adoptive couple who will parent their child. • All involved (birth parents, adoptive parents and eventually, the child) will benefit from counseling. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Unwanted pregnancies - Abortion • Rates are highest for unmarried and economically disadvantaged women. • 90% obtain the abortion within 12 weeks. • Modern, legal abortions do not increase a woman’s risk of infertility, miscarriage, ectopic pregnancy or low-birthweight babies in future. • Women who suffer emotionally generally had emotional problems before the abortion. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Medical abortion • Medical (RU 486) – this and other drug combinations are useful up to 8 weeks after a woman’s last menstrual period; 95 – 96% effective (no need of a surgical procedure). • 1/3 of abortions in France are by this method; only recently available in the U.S. • First dose taken at doctor’s office, 2nd at home, followed by endometrial shedding. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Surgical abortion procedures (1) • Dilation and Evacuation (D&E) – 98% of U.S. abortions are done by this method. • A tube inserted through the cervix suctions out the fetal material. • Dilation and curettage (D&C) – for pregnancies of 15 weeks or less. • General anesthesia; more bleeding and discomfort than the D&E. Cervix is dilated and lining of uterus is scraped away. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Surgical abortion procedures (2) • Induced labor – used exclusively for pregnancies of 16 weeks or more. • Saline solution injected into amniotic sac, inducing labor within 12 – 36 hours; fetus is born dead. • Intact dilation and evacuation (intact D&E or D&X) – performed in very late-term pregnancies when the mother’s health is in danger. • Fetus is partially delivered then brain is removed. • Highly controversial; banned by Congress in 2002 King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Abortion beliefs • Pro-Life (right-to-life) – protect fetal rights • a vocal minority; always or usually against abortion • Pro-Choice – protect women’s rights • 90% support abortion rights in at least some cases • 59% support choice in most cases • Historically, beliefs have changed many times • 1588, Pope Sixtus V declares abortion is murder • 1591, Pope Gregory XIV says it isn’t murder because the soul is not present early in pregnancy • 1869, Pope Pius IX again declares abortion murder; the soul is present from the moment of fertilization King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Abortion laws in the U.S. (1) • 1973 Roe v. Wade • Supreme Court prohibits states from interfering during 1st trimester and only allowing limited regulation of 2nd trimester. • 1977 Hyde Amendment • Supreme Court supports decision to withhold Medicaid funding for abortions • Without federal funding, many poor women are unable to secure safe and legal abortions. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Abortion laws in the U.S. (2) • 1989 Webster v. Reproductive Health Services • Further restrictions of public funds; tests for viability • 1992 Planned Parenthood v. Casey • Law upheld requiring 24-hour waiting period and parental notification for minors • 1990s – 86% of U.S. counties are without providers • 2003 – Congress passes “partial-birth” ban • The Intact D&E method is banned regardless of medical reasons such as the mother’s health. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Future Technology • In addition to “Lea’s Shield” other silicone intra-vaginal barrier methods are being tested. • FemCap, resembling the cervical cap. • A new generation of female condoms. • Research on a male birth control pill continues. • Vaccines to prevent implantation. King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Choosing a method • Comfort understanding and using the method • Health risks and side effects • Financial considerations and doctor visits • Effectiveness in preventing pregnancy • Effectiveness in preventing STDs • Partner’s attitudes • Reversibility King, Human Sexuality Today, 5/e (c) 2005 by Prentice Hall

Chapter 6 Birth Control