Teen Pregnancy & Pregnancy Prevention

1. Teen Pregnancy & Pregnancy Prevention Senior Health - Bauberger

2. Teen Pregnancy Stats • The U.S. has the highest rates of teen pregnancy and births in the western industrialized world. • Teen pregnancy costs the U.S. at least $7 billion annually. • About 1/3 of girls in the U.S. will get pregnant in their teens • Every year around 750,000 teenagers will get pregnant.  • Depending on the state, teen birth rates differ. • Nevada has the highest rate: 113 per 1000 • North Dakota has the lowest 42 per 1000.  • Unmarried teens having children account for 24% of all unmarried expectant mothers.  • More than 2/3 of all teenagers who have a baby will not graduate from high school. 

3. Teen Pregnancy Stats • In 2002 the abortion rate among teenager moms was 50% lower than its high point in 1988.  • Among African American teens, the pregnancy rate dropped around 40% since 1990.  • Among Hispanic teens, the pregnancy rate dropped around 19% since 1990.  • Among Caucasian teens, the pregnancy rate dropped around 34% since 1990.

4. Teen Pregnancy Stats • 82% of teen pregnancies are unplanned; they account for about 1 in 5 of all unintended pregnancies annually. • 2/3 of all teen pregnancies occur among 18-19 year olds. • Teen pregnancy rates in the U.S. are 2x as high as in England or Canada, and 8x as high as in Japan. • 11 % of all U.S. births are to teens. • Babies born to teens are more likely to be low birth weight. • Teen moms are more likely than in the past to complete high school/GED, but are less likely than women who delay pregnancy to go to college.

5. Early Signs of Pregnancy • Abdominal bloating • Breast sensitivity (tenderness, swelling) • Fatigue • Food cravings or aversions • Frequent urination • Light bleeding or spotting • Missed menstrual period • Nausea or queasiness

6. Sexually Transmitted Infections • Of the 18.9 million new cases of STIs each year, 9.1 million (48%) occur among 15-24 yr olds. • Although 15-24 yr olds represent only 1/4 of the sexually active population, they account for nearly 1/2 of all new STIs each year. • HPV infections account for about 1/2 of STIs diagnosed among 15-24 yr olds each year. It is extremely common and often asymptomatic. If left undetected it can lead to cervical cancer. • In 2006, the FDA approved the vaccine Gardasil as safe and effective for use among girls and women aged 9-26. The vaccine prevents the types of HPV most likely to lead to cervical cancer.

7. Pregnancy/STI Prevention Methods: • Oral Contraceptives • Implants • Injectables • Emergency Contraception • Male Condom • Female Barriers • Spermicides • IUD • Withdrawal • Sterilization • Family Planning • Abstinence

8. Oral Contraceptives • Made from very low doses of synthetic estrogen and progestin. They are very effective in preventing pregnancy when taken consistently and correctly. They are safe for most women. • Characteristics: • Effectiveness: 0.1% to 8% failure rate during the first year of typical use; 0.01% failure rate with perfect use in the 1st year. • Age limitations No restrictions on use from menarche to age 40. • Mode of action: Primarily by inhibiting ovulation; secondary mechanisms include thickening of the cervical mucus, changing endometrium, and reducing sperm transport. • Effect on STI risk: Not protective. • Duration of use: Most women can use them safely throughout their lives. • Return to fertility: Immediately or after slight delay (average 2–3 months).

9. Implants • Consist of hormone-filled capsules that are inserted under the skin in a woman's upper arm. • The first contraceptive implant system developed was the Norplant system, which consists of thin, flexible capsules made of silicone. It’s a safe & effective method of reversible, long-term contraception. • They are effective within 24 hours after insertion. • Characteristics: • Effectiveness: 0.1%-1.0% failure rate for implants during 1st year of use • Age limitations: No restrictions on use for women age 16 and over. • Mode of action: Primarily by thickening cervical mucus, thereby preventing sperm penetration, and also by inhibiting ovulation. • Effect on STI risk: Not protective. • Duration of use: Norplant implants are effective for 5 years • Return to fertility: Immediately upon removal.

10. Injectables • Contain synthetic hormones given by intramuscular injection. • Safe & effective method of reversible contraception for women • 2 types of injectable contraceptives: progestin-only and combined injectables that contain both a progestin and an estrogen hormone. • Characteristics: • Effectiveness: Progestin-only injectables: 0.1%-0.6% failure rate during 1st year of use. Combined injectables: 0.2% to 0.4% failure rate during first year of use. • Age limitations: Progestin-only injectables not recommended for girls <16 because of theoretical concern about the effect on bone density. • Mode of action: Primarily by thickening cervical mucus, thereby preventing sperm penetration, and by inhibiting ovulation. • Effect on STI risk: Not protective. • Duration of use: Most women can use it safely throughout their lives • Return to fertility: After a delay of about 3-6 months

11. Emergency Contraception • A contraceptive that can be used to prevent pregnancy after unprotected sex. • 2 types are available: pills (ECPs) or emergency IUD insertion. ECPs can be used up to 72 hours after intercourse; IUDs can be used up to 5 days after. • Characteristics: • Effectiveness: ~ 74%-85%, depending on type used & when treatment is initiated. • Age limitations: No restrictions on use • Mode of action: Inhibits ovulation; may also cause changes in the endometrium • Effect on STI risk: Not protective • Duration of use: Intended for occasional "emergency" use; other methods used correctly and consistently provide more effective ongoing contraceptive protection • Return to fertility Immediate; so it is critical that women begin another form of contraception immediately after use • ***The most effective method of emergency contraception is the insertion of an IUD. If inserted within 5 days of unprotected intercourse, the copper IUD prevents pregnancy in 99% of cases.

12. Male Condom • A sheath designed to fit over a man's erect penis and prevent passage of sperm into the female reproductive tract. • Most are made of thin latex rubber. • Very effective in preventing pregnancy when used correctly and consistently with every act of intercourse • Condoms are effective in protection against STIs, but are less effective against those STIs that are transmitted by skin contact, since the infected areas may not be covered. • Characteristics: • Effectiveness: 3%-12% failure rate during first year of typical use; 3% failure rate during first year of perfect use. • Age limitations: No restrictions. • Mode of action: Prevents sperm from reaching female reproductive tract. • Effect on STI risk: Protective against most STIs, including HIV. • Duration of use: Most can use condoms safely throughout their lives • Return to fertility: Immediately upon discontinuation.

13. Female Barrier Method • Contraceptive that a woman places in her vagina before sex to prevent pregnancy. • Mechanical barrier methods include devices such as the diaphragm, the cervical cap, & the female condom. The sponge is both a mechanical & chemical barrier. • The diaphragm is a latex device that covers the cervix and part of the vaginal wall, and is held in place by a flexible rim. • The cervical cap is a small rubber device that fits around the cervix. • The female condom is made of thin, soft plastic that a woman inserts in her vagina before sex. It has 2 rings: a flexible ring at the closed end & a larger ring that stays outside the vagina at the open end to help protect the external genitalia. • Characteristics • Effectiveness: 1st year failure rates for typical use ~20% • Age limitations: No restrictions on age. • Mode of action: Creates a physical barrier to block passage of sperm into the uterus & fallopian tubes; diaphragm & cervical cap is more effective by use of spermicide. • Effect on STI risk: Diaphragm and cervical cap are somewhat protective against agents that attack the cervix; the female condom offers significant protection for all STIs • Duration of use: Used near or at the time of intercourse. The diaphragm and cap must be left in place for at least 6 hours after intercourse. • Return to fertility: Immediately upon discontinuation.

14. Spermicides • Chemical products inserted in a woman's vagina before sex that inactivate or kill sperm. Spermicides often are used as a temporary method while waiting for a long-term method or by couples who have intercourse infrequently. • Spermicides come in several different forms—cream, jelly (gels), foaming tablet, aerosol foam, and C-film. Some condoms also come lubricated with spermicide. • Characteristics • Effectiveness: 20 to 25% failure rate (typical use) in the first year of use. Efficacy is improved if spermicides are used in conjunction with mechanical barrier methods. • Age limitations: No restrictions on age. • Mode of action: Spermicides destroy or immobilize sperm. • Effect on STI risk: Somewhat protective; using them alone is not recommended. • Duration of use: Used at or near the time of intercourse; appropriate for both short-term and long-term use; women can use spermicides throughout their reproductive years. • Return to fertility: Immediately upon discontinuation.

15. Intrauterine Devices (IUD) • Small flexible devices made of metal or plastic that prevent pregnancy when inserted into a woman's uterus through her vagina. • The most widely used IUDs are copper-bearing IUDs. • It’s a safe and effective method of reversible, long-term contraception for most women. • Characteristics: • Effectiveness: 0.4% to 2.5% failure rate for copper IUDs and 0.1% failure rate for the progestin releasing-IUD during the first year of use. • Age limitations: No restrictions on use for women age 20 and over. • Mode of action: Through a combination of mechanisms: inhibiting sperm migration in the upper female genital tract, inhibiting ovum transport, and stimulating endometrial changes. • Effect on STI risk: Not protective. • Duration of use: Some remain effective for up to 10 years; some remain effective for up to 5 yrs. Women can use IUDs safely throughout their life. • Return to fertility: Immediately upon removal.

16. Male Withdrawal • Male withdrawal, also called coitus interruptus, requires a man to withdraw from his partner's vagina prior to ejaculation • Withdrawal can be effective in preventing pregnancy when the male is motivated and able to practice it correctly with every act of intercourse. • Characteristics: • Effectiveness: up to 19% failure rate during first year of typical use; 4% failure rate with perfect use in the first year. • Age limitations: No restrictions. • Mode of action: Prevents sperm from entering the vagina. • Effect on STI risk: Not protective • Duration of use: Withdrawal can be used safely throughout their life • Return to fertility: Immediately upon discontinuation.

17. Female Sterilization • Female sterilization, also called tubal occlusion or ligation, is a permanent method for women who don’t want more children. The method requires a surgical procedure. • Characteristics: • Effectiveness: 0.2% to 0.5% failure rate during first year of use. • Age limitations: No restrictions. • Mode of action: By blocking the fallopian tubes to prevent the ovum and sperm from uniting. • Effect on STI risk: Not protective. • Duration of use: Female sterilization is a permanent method. • Return to fertility: A woman is sterile from the time the procedure is completed.

18. Male Sterilization • Male sterilization, also called vasectomy, is a permanent contraceptive method for men who don’t want more children. The method requires a simple surgical procedure and is performed under local anesthesia. • Male sterilization is not castration; it does not affect the testes. It does not interfere with intercourse or affect a man's sexual ability. • Characteristics: • Effectiveness: .1%-.15% failure rate in the 1st year after the procedure. • Age limitations: No restrictions. • Mode of action: By blocking the vas deferens (ejaculatory duct) to prevent sperm from being released into the ejaculate. • Effect on STI risk: Not protective. • Duration of use: Male sterilization is a permanent contraceptive method. • Return to fertility: It’s not effective immediately; a man’s ejaculate is sperm-free about 3 months (20 ejaculations) after the procedure is completed.

19. Natural Family Planning • Natural family planning (“periodic abstinence”) requires practicing abstinence during the fertile period of a woman's menstrual cycle. Must identify the start & end of a woman's fertile period. • Can be very effective when properly trained and motivated to avoid unprotected intercourse for a week or more each month. • Characteristics: • Effectiveness: 2% to 30% failure rate during first year of use • Age limitations: No restrictions. • Mode of action: Helps a client prevent pregnancy by avoiding unprotected sex during the fertile period of a woman's menstrual cycle. • Effect on STI risk: Not protective. • Duration of use: Can use safely throughout reproductive years • Return to fertility: Immediately upon discontinuation.

20. Abstinence • The practice of voluntarily refraining from some or all aspects of sexual activity. • Characteristics: • Effectiveness: 100% • Age limitations: No restrictions. • Mode of action: Prevents pregnancy by not taking part in sexual intercourse. • Effect on STI risk: Protective if abstaining from all sexual acts. • Duration of use: Can use safely for any period of time. • Return to fertility: Remain fertile throughout.