Contraception and Abortion. Chapter Thirteen. Agenda. Discuss History and Considerations Associated with Methods Discuss Contraception Methods Discuss Abortion. Class Exercise: Contraception Values Clarification. Complete the handout entitled “Contraception Values Clarification.
Une image / un lien ci-dessous est fourni (tel quel) pour télécharger la présentation
Politique de téléchargement : le contenu du site vous est fourni TEL QUEL pour votre information et votre usage personnel ; il ne peut être vendu, concédé sous licence ni partagé sur d’autres sites sans l’accord de son auteur.Le contenu vous est fourni TEL QUEL, pour votre information et votre usage personnel uniquement.Téléchargez la présentation en cliquant sur ce lien.Lors du téléchargement, si vous ne parvenez pas à télécharger une présentation, l’éditeur a peut-être supprimé le fichier de son serveur.Pendant le téléchargement, si vous ne parvenez pas à obtenir une présentation, le fichier a peut-être été supprimé par l’éditeur.
Introduction • Majority of U.S. pregnancies are not planned and most are a result of not using contraception • Factors increasing motivation to use contraception: • good communication with partner, • lower cost, • effectiveness rates, • frequency of intercourse, • motivation to avoid pregnancy, • side effects, • openness about sexuality
Contraception in Ancient Times Contraception in the U.S.: 1800s and Early 1900s Contraception Outside the U.S. Contraception: History
Contraception in Ancient Times • Ancient Greeks: magic, superstition, herbs • Egyptians: fumigating female genitalia, tampon soaked in herbal liquid & honey, inserting a mixture of crocodile feces, sour milk, & honey • South Africa: insert vegetable seed pods • Africa: insert a grassy cervical plug • Persia: insert alcohol soaked sponges • Greece: insert empty pomegranate halves
Contraception in the U.S.: 1800s and Early 1900s • Concern in early 1800s was to curb poverty by controlling fertility • 1873 Comstock laws prohibited dispersing information about contraceptives, including by doctors
Contraception use is affected by • Social issues – e.g. desired family size • Economic issues • Knowledge & misinformation • Religion • Gender roles & power – in some areas, men make the contraceptive decisions; for some it is the responsibility of both
FDA Approval Process • The U.S. Food and Drug Administration (FDA) must formally approve the method • 10-14 year process to develop a new contraceptive drug • Drug company submits a new drug application demonstrating safety in animal tests & a desire to conduct human trials
FDA Approval Process • 3 phases • Phase 1: 20-80 volunteers to test effectiveness • Phase 2: several hundred to test effectiveness, side effects, risks • Phase 3: hundreds to thousands are tested for generalization • Animal trials are conducted throughout the process
Class Discussion: Lifestyle Issues Associated with Contraceptive • The following factors seem to be associated with choosing a contraceptive method: • Own health & risks • Number of sexual partners • Frequency of intercourse • Risk of acquiring a STI • Responsibility level • Method cost • Advantages & disadvantages of the method • Discuss influence of each.
Barrier Methods: Condoms and Caps • Prevent sperm from entering the uterus • Barrier Methods: • Condoms • The Diaphragm • The Contraceptive Sponge • The Cervical Barriers
Condoms • 1850 – latex condoms available in the U.S. • $10-$15/dozen • Non-expired condom is rolled onto an erect penis (foreskin pulled back), ½-inch empty space at the tip • Water-based lubricants for latex condoms • Condom grasped at base when withdrawing • Latex condoms have lower rates of slippage & breakage, and offer better STI protection
Condoms • In 1994, female polyurethane/nonlatex condoms were available • $2 each • 7 inches long with 2 flexible rings • Inner ring squeezed and inserted close to the cervix • Outer ring lies outside the vagina • Adequate lubrication is necessary
Condoms • Effectiveness rates • Latex condoms: 85-98% • Female condoms: 79-95% • Latex & polyurethane protect against STI transmission • Lambskin condoms block sperm, but contain holes large enough for viruses to pass through • Heat can damage condoms
Condoms • Advantages: • STI protection • Encourages male participation • Inexpensive • No prescription necessary • Can reduce premature ejaculation • Can reduce postcoital drip • No medical side effects
Condoms • Disadvantages: • Reduces spontaneity • Can reduce sensation • Female condoms can be difficult to use, uncomfortable, noisy • Female & male condoms should never be used together • Popular in some countries, not used in others
The Diaphragm • Not widely used, almost 0% in 2002 • Made of latex or silicone • Many sizes and shapes; a fitting by a health care provider is necessary • $20-$35 diaphragm, $13 spermicidal jelly/cream, office visit charge • They can last for many years
The Diaphragm • Diaphragm rim is covered in spermicidal jelly & a tablespoon of jelly is placed in the dome; it is folded in half and inserted into the vagina with the front rim tucked under the pubic bone • It should not be felt & should cover the cervix • It can be inserted up to 6 hours prior to intercourse • Left in for at least 6-8 hours, no more than 24 • After use it is washed with soap & water
The Diaphragm • 84-94% effective, lower for those who have given birth • Advantages: • Increases spontaneity • Some STI & PID protection • Reduces risk of cervical dysplasia & cancer • Does not affect hormonal levels • Relatively inexpensive
The Diaphragm • Disadvantages: • Physician fitting and prescription • Insertion & removal involves touching the genitals • Increased risk of toxic shock syndrome and urinary tract infection • Postcoital drip • Low usage outside the U.S.
The Contraceptive Sponge • The Today contraceptive sponge was taken off the market for a decade due to issues with the manufacturing plant; reintroduced in 2005 • Available over the counter in one size • The sponge covers the cervix & contains spermicide; it blocks, absorbs, & deactivates sperm • One box of 3 sponges is $13
The Diaphragm • Sponge is moistened with water to activate the spermicide, folded in half, & inserted to cover the cervix • Can be inserted up to 24 hours in advance, with intercourse occurring as many times as desirable in that time period • Must be left in at least 6 hours after intercourse • 75-89% effectiveness rates
The Diaphragm • Advantages: • No prescription necessary • Can have intercourse several times within 24 hours • Increase sexual spontaneity • Do not affect hormonal levels • Disposable
The Diaphragm • Disadvantages: • Increased risk of toxic shock syndrome & urinary tract infection • Cannot be used while menstruating • Requires touching of the genitals • High expense if frequently used • Some men can feel it • Low usage rates in other cultures
The Cervical Barriers • Thimble-shaped, silicone barriers that fit over the cervix • Block entrance to the uterus & deactivate sperm with the spermicide • Fitting by a health care provider is necessary • Two types: • FemCap • Lea’s Shield
The Cervical Barriers • $15-75 plus cost of spermicide • Left in place for 8 hours after intercourse • After use, it is washed with soap & water • Not to be used during menstruation • 86% effectiveness rate, lower for those who have had children
The Cervical Barriers • Advantages: • Left in place for up to 48 hours • Do not affect hormonal levels • Immediately effective • Not permanent • One-way release valve in Lea’s Shield reduces risk of toxic shock syndrome
The Cervical Barriers • Disadvantages: • Abnormal Pap smears • Increased risk of urinary tract infections • Increased vaginal odors • Cervical damage • Increased postcoital drip • Fitting is necessary • Some male partners feel it & may dislodge it
The Cervical Barriers • Widely used in England • Lea’s Shield is available over the counter in Germany, Austria, Switzerland, & Canada
Combined-Hormone Methods • Combination of estrogen & progesterone • Can repress ovulation and thicken cervical mucus
Birth Control Pills • Federally approved in 1960 • Most popular contraceptive in the U.S. and around the world • Most studied type of medication • Combination birth control pills are $12-25 per month • Designed to mimic a menstrual cycle, with 21 days of hormones and one off week • Bleeding is medically induced
Birth Control Pills • Some take 2 to 3 packs of active pills in a row to reduce the number of menstrual periods • Seasonale – 84-day active pill with 7-day placebo • Reducing periods can help those with heavy bleeding and cramping • 60% of women prefer to not have a period
Birth Control Pills • Increase in estrogen & progesterone prevent the pituitary from sending hormones to ripen the ovaries • Cervical mucus thickens & endometrium buildup is minimal • The body is tricked into thinking it is pregnant • May experience other signs of pregnancy that usually disappear within a few months
Birth Control Pills • Initially prescribed a low-dose estrogen pill; increased if breakthrough bleeding occurs • Monophasic pills contain the same dose of hormones in each pill • Multiphasic pills vary in hormone amount • Triphasil pills have 3 sets, each week the hormonal dosage increases • 92-99.7% effective • Need to take it each day at the same time
Birth Control Pills • Advantages: • High effectiveness rate • Doesn’t interfere with spontaneity • Reduced menstrual flow, cramps, & PMS • Increased menstrual regularity • Reduced risk of ovarian cysts, uterine & breast fibroids, facial acne, ovarian & endometrial cancers, PID, benign breast disease
Birth Control Pills • Disadvantages: • No STI protection • Female’s responsibility; taken daily • Can be expensive • Lower effectiveness if overweight • Not appropriate for smokers • Used throughout the world, although not popular everywhere; some places have it over the counter
Hormonal Ring • NuvaRing introduced in 2003 • Plastic ring inserted into the vagina once a month for 3 weeks, removed for 1 week • Affects the body as combination pills do • Body heat & moisture activate a constant dose of estrogen & progesterone; lower dose than pills • $30-35 per month • 99.7% effective
