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