CONTRACEPTION

1. CONTRACEPTION John B. Pryor, Ph.D. ILLINOIS STATE UNIVERSITY DEPARTMENT OF PSYCHOLOGY

2. Who needs contraception? • 62 million U.S. women in childbearing years (15-44) • Of these 7 out of 10 are sexually active and do not want to become pregnant • Typical U.S. woman wants 2 children and therefore must use contraceptives for 3 decades of her life Source: Alan Guttmacher Institute 2006

3. Who uses contraception? • 98% of U.S. women who have had sex have used at least one form of contraception • 89% of women who do not want to become pregnant are using some form of contraception Method choice varies by age • For women younger than 30, the pill is the leading method • By the time women reach 35, sterilization is more common Source: Alan Guttmacher Institute 2006

4. Cross-sectional survey of 38,109 U.S. women Source: Alan Guttmacher Institute 2006

5. Some facts about common forms of contraception.....

6. Methods of Birth Control - typical failure rates 0.00% - Abstinence 0.15% - Sterilization - Males 0.40% - Sterilization - Females 18.0% - Withdrawal 85.0% - No Method Failure rates calculated from samples of married couples: What percent have a pregnancy in a year using this method?

7. Depo-Provera Typical failure rate = .03% Depo-Provera is a synthetic hormone (progestin) that is injected into the buttock or arm every 12 weeks. The hormone keeps the ovaries from releasing eggs. It also thickens the cervical mucus. This keeps sperm from joining with an egg. For some women, their menstrual periods are suppressed.

8. Nexplanon/Implanon/Implanon NXT Typical failure rate = .05% Small plastic rod inserted just under the skin of a woman's upper arm that contains etonorgestrel (progestin-like hormone). Lasts up to 3 years. Inhibition of ovulation in almost all cycles as the primary mechanism of action.

9. The Pill Typical failure rate = 1.0- 2.0% Combined pills keep the ovaries from releasing eggs (ovulation). Mini-pills can also prevent ovulation. But they work mainly by thickening the cervical mucus. This prevents the sperm from joining with the egg. Mini-pills may also prevent fertilized eggs from implanting in the uterus.

10. Birth Control Patch (brand name: ORTHO EVRA) The contraceptive patch contains hormones similar to those in birth control pills. You must change your patch once a week for three consecutive weeks. You do not need to apply a patch during the fourth week. Typical failure rate = 1.0% • Possible • side effects? • More estrogen • exposure than • the pill • Blood clots

11. The Ring The vaginal contraceptive ring consists of a flexible, transparent, colorless vaginal ring about 2.1 inches in diameter containing the hormones etonogestrel and ethinyl estradiol, which are similar to the active ingredients in some oral contraceptives. After the ring is inserted, it releases a continuous low dose of the hormones. A new ring is used each month for continuous contraception A woman inserts the ring herself, and it should remain in the vagina for three weeks. She then removes the ring for one week during which she will have her menstrual period. . . Typical failure rate = 1.0%

12. The Intrauterine Device (IUD) Typical failure rate = .08% IUDs are small devices made of plastic that contain copper or a natural hormone. IUDs usually work by preventing fertilization of the egg. They also may work by affecting the way sperm or eggs move or by affecting the lining of the uterus in ways that prevent implantation.

13. The Condom Typical failure rate = 12.0% barrier method added protection if used with spermicide reccomended model - latex with reservoir tip polyurethane condoms available if you are allergic to latex use water-based lubricants only

14. Putting on a condomPut a drop or two of lubricant inside the condom. Place the rolled condom over the tip of the hard penis. Leave a half-inch space at the tip to collect semen. If not circumcised, pull back the foreskin before rolling on the condom.

15. Putting on a condom (continued) Pinch the air out of the tip with one hand. (Friction against air bubbles causes most condom breaks.) Unroll the condom over the penis with the other hand. Roll it all the way down to the base of the penis. Smooth out any air bubbles. Lubricate the outside of the condom.

16. Cervical Cap The Diaphragm & Cervical Cap Diaphram Diaphragms and cervical caps are soft rubber barriers that are intended to fit securely over the cervix. Both are used with a spermicide cream or jelly. Each blocks the entrance to the uterus, and the jelly or cream immobilizes sperm, preventing it from joining the egg. Typical failure rate =17.0%

17. Sponge • Soft polyurethane sponge containing nonoxynol 9 spermicide • Blocks path of sperm • Sponge abosorbs sperm • Spermicide kills sperm on contact Typical failure rate =32.0%

18. FemaleCondom Typical failure rate = 24.8%

19. Foam, Jelly, Film, Suppository Typical failure rate = 20.0%-50% contain spermicide barrier method must be reapplied for each subsequent intercourse very frequent use could make women more susceptible to some STIs (studies of prostitutes)

20. Fertility Awareness Methods • trying to predict peak fertility times & avoiding intercourse during those times • three methods of prediction • basal body temperature method • cervical mucus method • calendar or "rhythm" method Typical failure rate = 20.0%

21. Breastfeeding Breastfeeding can be used as birth control when, after giving birth, a woman breastfeeds her baby exclusively. That means the baby does not drink anything besides breast milk. The act of breastfeeding naturally changes a woman's hormones so that she does not ovulate. Effective upr to 6 mons. after a birth. Typical failure rate = 1-2%

22. Emergency Contraception • Post-Coital Contraceptives • morning after pill (e.g., Preven & Plan B) - Emergency contraception (EC) consists of the same hormones found in ordinary birth control pills. • within 72 hours of unprotected intercourse • Side-effects: nausea, vomiting, and cramping • 20-25% become pregnant • Like regular contraceptive pills, Plan B generally acts by preventing ovulation or fertilization, according to the F.D.A. Plan B may in rare circumstances prevent a fertilized egg from becoming implanted, something abortion opponents decry. But regular oral contraceptives do that, too.

23. Emergency Contraception • The U.S. Food and Drug Administration (FDA) announced on August 24, 2006 the approval of Plan B as an over-the-counter (OTC) option for women aged 18 and older. Plan B will remain available as a prescription-only product for women age 17 and under. • As much as 43% of the decline in abortion between 1994 and 2000 can be attributed to the use of emergency contraception.

24. Reasons for Emergency Contraception • His condom broke or slipped off, and he ejaculated inside your vagina. • He forced you to have unprotected vaginal intercourse. • Your diaphragm or cervical cap slipped out of place, and he ejaculated inside your vagina. • You miscalculated your "safe" days for periodic abstinence or fertility awareness methods.

25. Reasons for Emergency Contraception (continued) • You forgot to take your birth control pill more than two days in a row. • You weren't using any birth control. • He didn't pull out in time.

26. RU 486 • antiprogesterone that blocks uterine receptors of progesterone, a hormone critical for the maintenance of pregnancy • induces abortion when administered in early pregnancy • success rate is 96 percent for women who are less than 63 days from their last menstrual period

27. life-time failure rate 30 years of reproduction ( age 17-47) LTF = 1 - (1 - AFR)years LTF (pill) = 1 - (1 - .02)30 pill (2%) 50% HALF OF ALL COUPLES WILL HAVE A PREGNANCY ANYWAY ATF=annual failure rate