Comparing Different Methods of Contraception

Important Considerations

•effectiveness

–measured by failure rate

•perfect users

•typical users

•side effects

•advantages

•disadvantages

•reversibility

Hormonal or Pharmaceutical Methods

•birth control pills

–combination pill contains estrogen & progestin

•most effective type of pill

–triphasic pill

–progestin-only pill

oemergency contraception (pills)

available over the counter w/o prescription

most effective if begun within 12 to 24 hours, cannot be delayed longer than 120 hours

acts to prevent pregnancy, not cause abortion

making Plan B available to teenagers has no effect on whether they had unprotected intercourse or on their number of sexual partners

•patch (Ortho Evra)

- same hormones as combination pill

- more effective than the pill

–vaginal ring (NuvaRing)

- same hormones as combination pill, at slightly lower doses

- more effective than the pill

•implants (Implanon)

othin rods or tubes containing progestin inserted under skin, effective for 3 years

olowest failure rate of all contraceptive methods

typical user rate is same as perfect user rate

•Depo-Provera

- progestin injection repeated every 3 months

oin comparison to other hormonal methods, dmpa has the second lowest failure rate among typical users

Barrier Methods

•intrauterine device (iud)

–most effective barrier method

–prevents fertilization +/or implantation

–Mirena also contain progesterone (sometimes called intrauterine system, or IUS, because it combines barrier & hormonal methods)

- more effective than copper-T

•vaginal barrier devices prevent sperm from entering uterus, all should be combined with spermicide to increase effectiveness

diaphragm

should be fitted by physician

must be left in place for at least 6 hours

cervical cap

failure rate depends upon previous pregnancies

sponge not very effective

male condom and female condom

prevent sperm from entering vagina

provide some protection against STIs

female condom less effective

spermicides

not very effective unless used with a diaphragm or condom

foams more effective than creams or jellies

Behavioral Methods

douching not effective as contraceptive

withdrawal not very effective

highest failure rate for typical users

fertility awareness or rhythm methods

–very high failure rate for typical users

–depends upon accurate determination of ovulation

•calendar method

•standard days method

•basal body temperature method

•cervical mucous method

•sympto-thermal method most accurate

•home ovulation tests

periods of abstinence of at least 8 days and possibly as long as 2-3 weeks necessary

Sterilization

–most common method of birth control in the U.S. today

–vasectomy

osimpler than female sterilization procedures

otraditional vs. “no scalpel” procedures

onewer techniques may be reversible in some cases, but one should decide to have a vasectomy based on the assumption that it is irreversible

–tubal ligation

ominilaparotomy

olaparoscopy

otranscervical approach

microsurgery techniques make reversibility possible in some cases, but a woman should assume that sterilization surgery is irreversible

Contraception Among Teenage Women

Each year 750,000 American teenagers become pregnant

approximately 30% of these unwanted pregnancies end in abortion

57% result in live births

the rest end in miscarriage

17% of sexually active teenage girls did not use contraception the last time they had intercourse

Factors associated with consistent use of contraceptives

access to contraceptives and a belief that one has access

knowledge about sexual and reproductive health and contraception

strong motivation to use contraception

Factors associated with failure or inconsistent use of contraceptives

unrealistic expectations regarding the risk and consequences of pregnancy

belief in “fantasy” sexual scripts based on media images

Most direct solution would be better sexuality education programs in schools.

Comparing Different Methods of Abortion

Abortion Procedures

vacuum aspiration or suction curettage

•performed in first trimester and accounts for 88% of abortions in U.S.

dilation and evacuation (d & e)

•performed from 14 to 24 weeks gestation

medically induced abortion procedures in physician’s office

RU-486

mifepristone used to induce a very early abortion

administered as tablet followed two days later by small dose of prostaglandin

methotrexate

used in combination with misoprostol to induce early abortion

both drugs are readily available

Psychological Aspects of Abortion for Women

best scientific evidence indicates that most women do not experience severe negative psychological responses to abortion