Reproductive Choices

1. Reproductive Choices

2. Objectives • Differentiate between birth control effectiveness rates for perfect users and typical users. • Know whether each type of birth control method protects against STIs as well as pregnancy. • Understand the basics of each birth control method. • Provide the advantages and disadvantages associated with the various birth control methods. • Explain the different abortion procedures.

3. Reproductive Anatomy • Males • Sperm production starts in the testes. • Sperm are ejaculated out of the penis. • Females • A matured ovum is usually released once a month, during ovulation. • The menstrual cycle is about 28 days long on average. • Conception happens when a sperm cell penetrates the ovum.

4. Choosing a Method of Contraception • Cost • Responsibility for the method • Agreement between partners • Convenience • Ease of use • Effectiveness • Side effects • Protection against STIs • Permanence

5. Birth Control Categories • There are two main categories of birth control: • Methods that protect against pregnancy and STIs • Methods that protect only against pregnancy • Subcategories • Informational • Barrier • Short-term hormonal • Long-term hormonal • Other long-term

6. Informational Methods • An informational method is all about knowledge. • Users of an informational method must understand their body and how it works. • Example: Abstinence (protects against both pregnancy and STIs).

7. Barrier Methods • Block sperm from entering the female’s cervix, therefore creating a barrier. • Examples (protect against both pregnancy and STIs): • Male condoms • Female condoms

8. Hormonal Methods • Prescribed only to females. • Change a female’s hormonal patterns in order to prevent pregnancy. • Short-term hormonal methods include the pill, patch, ring, and shot. • Long-term hormonal methods last for several years.

9. Other Long-Term Methods Methods that are permanent or last for several years and do not contain hormones.

10. Effectiveness Rates • Perfect users are those who use a method correctly and consistently every time they have sex. They follow the proper instructions and get the highest percentage of pregnancy prevention. • Typical users do not always use their birth control method correctly or consistently.

11. Methods That Protect Against Pregnancy and STIs • Informational method: • Abstinence • Barrier methods: • Male condoms • Female condoms

12. Abstinence 100% • Informational method where a person abstains from sexual activities. • To avoid pregnancy and STIs, abstain from • vaginal sex, • oral sex, • anal sex, and • naked genital-to-genital rubbing. • Abstinence is the only method that protects 100% against pregnancy and STIs.

13. Male Condoms Perfect: 98% Typical: 85% • Barrier method • Three types: latex, polyurethane (plastic), and natural membrane • Covers the shaft of the penis. • Use with water-based lubricant only. • Store in cool, dry places. • Condoms expire, so check the date. • Some people may be allergic to latex. • Natural membrane does not protect against STIs.

14. Female Condoms Perfect: 95% Typical: 79% • Barrier method • Made of polyurethane (plastic) material • Inserted into the female’s vagina. • Can be inserted up to 8 hours before intercourse. • Can only be used once. • Do not use with the male condom. • Store in cool, dry places. • More expensive than the male condom.

15. Male and Female Condoms

16. Methods That Protect Only Against Pregnancy • Informational methods • Withdrawal • Fertility awareness • Barrier methods • Diaphragm • Cervical cap • Sponge • Spermicides (continued)

17. Methods That Protect Only Against Pregnancy (continued) • Short-term hormonal methods • Pill • Patch • Ring • Shot • Long-term hormonal methods • Implanon • Mirena (IUC) • Other long-term methods • ParaGard (IUC) • Female sterilization • Male sterilization

18. Withdrawal Perfect: 96% Typical: 73% • Withdrawal, more commonly known as pulling out, is an informational method. • The male must withdraw his penis from his partner’s vagina before he ejaculates, which may be just before, during, or after orgasm. • Ejaculate must not come in contact with or be around the female’s genitals. • A man must know his body well in order to use this method.

19. FertilityAwareness Perfect: 98-95% Typical: 88-78% • There are four types of fertility awareness–based (FAB) methods. All are informational methods. • Calendar rhythm method • Standard days method • Ovulation method • Symptothermal method • Users should take lessons on how to use FAB methods effectively. (continued)

20. Fertility Awareness (continued) • Calendar rhythm method calculates the days in which a female is fertile. • Standard days method tracks the days of the menstrual cycle; cycle beads may be used. • Ovulation method determines fertile time by checking the changes in a woman’s cervical mucus. • Symptothermal method uses the ovulation method and also the female’s basal body temperature.

21. Cycle Beads

22. Diaphragm Perfect: 94% Typical: 84% • Dome-shaped latex barrier that comes in different sizes. • Must be fitted by a health care provider. • Placed in the vagina, covering the cervix. • Must be used with spermicide. • Must be left in for at least 6 hours but no more than 24 hours.

23. Have not borne children Previously borne children Cervical Cap Perfect: 74% Typical: 71% Perfect: 96% Typical: 86% • Silicone barrier shaped like a sailor’s cap. • Must be fitted by a health care provider. • Snuggly fits around the cervix, blocking sperm from entering the uterus. • Must be used with spermicide. • Must be left in for at least 6 hours but no more than 48 hours.

24. Cervical Cap and Diaphragm

25. Previously borne children Have not borne children Sponge Perfect: 80% Typical: 68% Perfect: 91% Typical: 84% • Pillow-shaped barrier method made of polyurethane foam that contains spermicide. • Placed in the vagina, covering the cervix. • Available over-the-counter; one size fits all. • Must be left in for at least 6 hours but no more than 30 hours. • Cannot be used during a menstrual period.

26. Spermicides Perfect: 82% Typical: 71% • Spermicides are chemical barriers that kill sperm. • Inserted in the vagina back by the cervix, creating a barrier. • Four types: jelly, foam, film, and suppositories. • Jelly and foam are effective right after insertion. • Film and suppositories must be allowed to melt for 10 to 15 minutes. • Must be left in the vagina for at least 6 hours.

27. Birth Control Pill Perfect: 99.7% Typical: 92% • Daily combination hormonal method. • One pill is taken orally at the same time every day. • Most pill brands come in either a 21-pill or 28-pill pack. The 28-pill pack usually has 7 placebo pills at the end. • Use a backup method for the first 7 days.

28. Birth Control Patch Perfect: 99.7% Typical: 92% • Weekly combination hormonal method. • A transdermal contraceptive patch is worn on the skin. • The patch is changed weekly for 3 weeks; fourth week is patch free. • Don’t wear the patch in the same spot twice. • Use a backup method for the first 7 days.

29. Birth Control Ring Perfect: 99.7% Typical: 92% • Monthly combination hormonal method. • Sold under the brand name NuvaRing. • Insert the ring into the vagina using the fingers. • The ring is worn for 3 weeks; the fourth week is ring free. • Use a backup method for the first 7 days.

30. Birth Control Shot Perfect: 99.7% Typical: 97% • Hormonal method. • The shot is a 3-month progestin-only method. • The shot (brand name Depo-Provera) is an intramuscular injection given in the arm or buttocks of the female. • The shot lasts for 3 months. A woman should receive her next shot in 11 to 13 weeks.

31. Implanon >99% • Long-term hormonal method in the form of a small, thin implant. • Inserted into the skin of the inner side of the female’s upper arm. • Inserted by a health care professional. • Releases progestin and lasts up to 3 years. • Works similar to other progestin-only methods, with the same possible side effects.

32. Mirena (IUC) Perfect: 99.9% Typical: 99.9% • Long-term hormonal method—a small, plastic, T-shaped device that contains the hormone levonorgestrel. • Works in three ways: • Thickens the cervical mucus. • Thins the lining of the uterus. • Inhibits sperm movement and survival. • Lasts up to 5 years. • Inserted into the uterus and removed by a health care provider.

33. ParaGard (IUC) Perfect: 99.4% Typical: 99.2% • Long-term method—a small, plastic, T-shaped device covered in copper. • Prevents sperm from reaching the egg. • Prevents the egg from attaching in the lining of the uterus. • Lasts up to 10 years. • Inserted into the uterus and removed by a health care provider.

34. Female Sterilization 99.5% • Long-term method performed as an outpatient procedure. • In each procedure the fallopian tubes are cut, cauterized, or blocked. • Recovery time ranges from 2 days to a week. • Permanent sterilization. • Three types of procedures: minilaparotomy, laparoscopy, and culpotomy.

35. Laparoscopy

36. Male Sterilization 99.9% • Long-term method that is a safe, fast outpatient procedure, usually taking approximately 20 minutes. • A physician cuts, cauterizes, or blocks the vas deferens. • Recovery time ranges from a day to less than a week. • Permanent sterilization. • Method is not effective immediately; residual sperm may be present.

37. Emergency Contraception • Also called the morning-after pill. • Only contraceptive that can be taken after intercourse. • Effective up to 120 hours (5 days) after intercourse. • More effective the sooner it is taken and can be up to 89% effective. • Available over the counter for people aged 18 and older. • Available by prescription for aged 17 and younger.

38. Medical Abortion • Done within the first 9 weeks (63 days) of the first trimester. • Three regimens can be used. • Regimens may consist of different types of medication: mifepristone, misoprostol, or methotrexate. • Depending on the regimen, medication may be taken orally, vaginally, or intramuscularly.

39. Surgical Abortion • Aspiration • Performed in the first trimester. • The cervix is dilated, and then manual or electric vacuum aspiration is used to empty the contents of the uterus. • Dilation and evacuation (D&E) • Performed in the second trimester, usually between 13 and 16 weeks. • Dilation may take several hours, even overnight. Then the contents of the uterus are evacuated.

40. History of Abortion • Roe v. Wade • Legalized abortions in the United States. • Based on a person’s right to privacy. • Parental consent or notification • Partial-Birth Abortion Ban Act of 2003 • Banned the intact D&E, where the physician aborts the fetus after part of it has passed through the vagina and has been partially delivered intact. • Gonzales v. Carhart tried to overturn it but failed.

41. Psychological Effects of Abortion • Psychological problems are rare following abortions. • Incidence of psychiatric illness has been found in less than 1% of abortion patients compared with 10% of women who give birth.