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Chapter 6: Birth Control. For use with Human Sexuality Today (4 th Ed.) Bruce King Slides prepared by: Traci Craig. Chapter Overview. Teen Pregnancy in the US Worldwide need for contraception Myths and Ineffective Methods Fertility Awareness Methods Barrier Methods IUD Hormonal Methods

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chapter 6 birth control

Chapter 6: Birth Control

For use with Human Sexuality Today (4th Ed.)

Bruce King

Slides prepared by: Traci Craig

chapter overview
Chapter Overview
  • Teen Pregnancy in the US
  • Worldwide need for contraception
  • Myths and Ineffective Methods
  • Fertility Awareness Methods
  • Barrier Methods
  • IUD
  • Hormonal Methods
  • Sterilization
teen pregnancy
Teen Pregnancy
  • Rate peaked in 1991, but US rate is twice as high as England and Canada and 8 times as high as Japan.
fathers
Fathers?
  • Half of the fathers are 20 years old or older, when mothers are 14 to 17.
  • Getting a woman pregnant a sign of masculinity.
  • No responsibility for ‘acquaintances’
  • ½ spend time with the child 1/5th contribute money
  • Do poorly in school, lack long-term goals, impoverished backgrounds, socially deviant behavior.
babies
Babies
  • High-risk babies with health problems—lack of prenatal care
  • Children of teen parents more likely to be victims of child abuse and neglect
  • Girls born to teen mothers are likely to experience economic dependence and an inability to escape poverty
  • Often become teen parents themselves.
  • Seek emotional closeness younger due to emotional deprivation from their own teen mother.
birth control
Birth Control
  • Procreation only attitudes lack of contraception
  • Margaret Sanger watched a woman die from trying to self-induce abortion, founded Planned Parenthood.
  • 2/3rds of Americans in 1936 believed contraception should be made available to those who wanted it.
  • Last law prohibiting the sale of contraceptives to married couples was repealed in 1965, to unmarried couples in 1972.
world wide contraception
World Wide Contraception
  • Overpopulation: limited natural resources
  • World population: 6 billion 1999
overpopulation
Overpopulation
  • UN estimates 9-10 billion people by 2050
  • Half of children born today are at poverty levels
  • To support this population, ALL cropland would have to produce 2.8 tons of grain per acre, per year.
  • Mass starvation: Ethiopia, Somalia, Asia, and in Brazil alone 2,000,000 children are abandoned
  • Indiainfanticide
overpopulation9
Overpopulation
  • China1982 forced birth control, no more than 1 child, pressure to abort second children
  • US Birth rates fell in the 60s. US population has stabilized.
  • In 20 developed countries, now below the replacement level.
birth control methods
Birth Control Methods
  • 85-90% of couples would conceive within 1 year if they did not use any contraception
  • Perfect-use and Typical-use—1st year of use
contraceptive myths these aren t true
Contraceptive Myths—These aren’t true.
  • Males drinking Mountain Dew/Splurge before sex reduce sperm count to zero.
  • Females douching with coca-cola or ice water prevents pregnancy.
  • You can’t get pregnant the first time, or if you don’t kiss, or if the female is on top, or standing up.
  • If the woman doesn’t have an orgasm, she can’t get pregnant.
ineffective methods
Ineffective Methods
  • Coitus Interuptus (withdrawal)—the man withdraws the penis from the vagina just before ejaculation.
  • 13% of high school students rely on this method.
  • First year of use: 20% pregnancy rate
  • Also possible to get pregnant if the man ejaculates near a woman’s vagina—heavy petting.
  • Not very physically or emotionally satisfying, but perhaps better than nothing.
ineffective methods13
Ineffective Methods
  • Douching after intercourse.
  • Sperm can make it to the cervix quickly and in fact the pressure caused by douching can force sperm further into the cervical opening.
  • Pregnancy rate: 40%
  • Increases risk of PID.
ineffective methods14
Ineffective Methods
  • Breast feedingcauses the release of FSH and LH and prevents normal menstrual cycles.
  • In the first 6 months of breast feedingless than 2% pregnancy rate.
  • After 6 months the pregnancy rate rises.
  • Only works if the baby is fed on demand.
  • Less effective in America where women are not likely to be able to nurse the infant on demand.
abstinence
Abstinence
  • 100 percent effective and a recent decline in teens having sex.
  • Teaching abstinence
    • “Education Now Babies Later”: no effect on teen’s sexual decisions.
    • “Abstinence-plus”: also teaches contraception and is very effective in reducing teen pregnancy
  • Denmarkcomprehensive sex ed in it’s schools
  • Denmark teens just as sexually active as American teens, but the Denmark teen pregnancy rate is lowest in the world.
fertility awareness abstaining during ovulation
Fertility Awareness: Abstaining during ovulation.
  • Rhythm Method/Natural Family Planning
  • Not opposed by the Catholic Church and EVANGLICAL Protestant denominations.
  • 3 variations of this method.
  • Pregnancy can only occur when an egg is present in the first 24 hours or so after ovulation.
  • Identification of ‘safe days’ and ‘unsafe periods’
fertility awareness
Fertility Awareness
  • Only works for women with regular cycles.
  • Sperm can live for 3-5 days.
  • Day of ovulation pregnancy rate is 12%
  • Calendar method
    • Subtract 18 from the length of the shortest cycle
    • Subtract 11 from the length of the longest cycle
    • The results are the days you should abstain
  • Tests Human Willpower & 40-45% failure rate
basal body temperature
Basal Body Temperature
  • A woman’s resting temperature rises by a few tenths of one degree 24 to 72 hours after ovulation.
  • Abstain from end of menstruation until 4 days after rise in temperature.
  • Temperature should be taken first thing in the morning before doing ANYTHING.
  • Some women have irregular basal body temp
  • Test of willpower and 25% pregnancy rate.
billings method
Billings Method
  • Changes in the cervical mucus: changes from white to clear a day or two before ovulation.
  • Douching makes this ineffective
  • Abstain from end of menstruation until 4 days post change in consistency (wait until discharge is white again)
  • 16-20% pregnancy rate for typical use
  • 17 days per month of abstinence could be trying
  • Combining Billings and Basal Body Temp is called sympto-thermal method and is better than either method alone.
spermicides
Spermicides
  • Nonoxynol-9 or octoxinol-9: foams, jellies, creams, and film (VCF)
  • Put into the vagina shortly before intercourse.
  • Typical use rate is 26%, as low as 6% with proper use.
  • Reduce gonorrhea, chlamydia and cervical cancer.
  • Increase risk of HIV, and urinary tract infection.
  • 1 in 20 people experience that spermicides burn or irritate the vagina or penis.
barrier methods male condoms
Barrier Methods: Male Condoms
  • Latex, lamb intestine, polyurethane or synthetic elastomers condoms prevent sperm from meeting egg.
  • Highly effective against STDs
  • American men are often reluctant to use them.
  • Condoms come rolled up, dry or lubricated, and in different sizes.
barrier methods male condoms22
Barrier Methods: Male Condoms
  • Put the condom on prior to intercourse.
  • Unroll over penis (pull back foreskin if uncircumcised).
  • Hold on to base of condom at withdrawal.
  • Use only once, do not store in warm places, check expiration date.
  • Do not use with oils, lotions or petroleum jelly.
barrier methods male condoms23
Barrier Methods: Male Condoms
  • With spermicide the theoretical failure rate is less than 1%.
  • Breakage rate is 1-3% with human vaginal intercourse, higher for anal intercourse.
  • Two condoms reduces breakage rate to 0.
  • Breakage more likely in men who do not use condoms regularly.
male condoms and reluctance
Male Condoms and Reluctance
  • Men believe it reduces sensitivity (only slightly and a pro)
  • Polyurethane condoms are only half as thick as rubber and transmit heat better.
  • Allergy—1-3% of people are allergic to rubber.
  • Loss of spontaneity
  • Minor annoyance compared to diaphragm, cervical cap, etc.
  • Women buy 40-50% of condoms
barrier methods female condoms
Barrier Methods: Female Condoms
  • Intravaginal, 7” long polyurethane bag held in place by two flexible rings. Insert the close ended ring against the cervix, outside ring partially covers the labia.
barrier methods female condoms26
Barrier Methods: Female Condoms
  • Thinner than male condoms
  • No health concerns or adverse effects
  • Women can protect themselves even when partner refuses to use male condoms.
  • Pregnancy rate in first year is 5% or less.
barrier methods diaphragm
Barrier Methods: Diaphragm
  • Dome shaped rubber cup with a flexible rim that fits over the cervix.
  • Only about 1.7% of American women use this method.
  • Fitted by a health care worker, prescription given for a diaphragm that fits her.
  • Requires instructions and coaching on proper use.
barrier methods diaphragm28
Barrier Methods: Diaphragm
  • Use with spermicidal jelly on inside of diaphragm and rim.
  • Insert no more than 2 hours prior to sex.
  • Leave in for 6-8 hours to ensure there are no more live sperm. Do not leave in more than 12 hours.
barrier methods diaphragm29
Barrier Methods: Diaphragm
  • Pregnancy rate is 6%, typical use is 15%.
  • Not for women with a history of urinary tract infection. Should not use during menstruation or if there is abnormal vaginal discharge.
  • Detract from oral-genital relations.
barrier methods cervical cap
Barrier Methods: Cervical Cap
  • Made of latex rubber or plastic and smaller and more compact than a diaphragm.
  • Used with a small amount of spermicide.
  • Fits over cervix via suction.
  • Insertion and removal more difficult than for diaphragm.
  • After intercourse, make sure it is in place and hasn’t been dislodged.
barrier methods cervical cap31
Barrier Methods: Cervical Cap
  • 1st year failure rate is 18%.
  • May have adverse effects on cervical tissue.
  • More effective for women who have not given birth.
barrier methods contraceptive sponge
Barrier Methods: Contraceptive Sponge
  • Most popular over the counter method prior to the production stop in 1995.
  • New sponge by new company.
  • Polyurethane contraceptive sponge, 2” in diameter and 1” thick, containing spermicide. Blocks cervical opening and kills sperm.
contraceptive sponge
Contraceptive Sponge
  • Does not require pelvic exam.
  • Easy to insert
  • Moisten with tap water and insert deep into the vagina.
  • Can be left in 24 hours—no need to add more spermicide
  • Small loop enables removal for disposal.
  • Some women report mild irritation (6%)
  • Actual use rate is 17-20%.
  • More effective in women who have not given birth.
slide34
IUD
  • Intrauterine Device
  • Numerous health problems with early IUDs and taken off the market.
  • Prevent implantation of a fertilized egg
  • However, studies show primarily prevents fertilization by their effect on sperm transit.
  • Copper or progesterone coating which impair sperm passage.
slide35
IUD
  • Body tries to expel the device from the uterus.
  • Added thread so women could check to for dislodging transmission of bacteria and viruses
  • Heavier and longer menstrual flow.
the iud today
The IUD Today
  • Progestasert T and Copper T have a single filament polyethylene stringdo not increase PID risk.
  • Less than .8 percent of contraceptive users chose the IUD in 1995.
hormonal methods
Hormonal Methods
  • One of the most popular reversible method of contraception. Failure rate is 3%.
  • Not immediately effective—it takes one full cycle to be effective.
  • Various types:
    • Combination pills
    • Minipill
hormonal methods38
Hormonal Methods
  • Contain synthetic progesterone and estrogen.
  • Prevents ovulation by stopping release of FSH and LH from pituitary
  • Keeps uterine lining thin and cervical mucus thick.
hormonal methods39
Hormonal Methods
  • Minipill contains only progestins.
    • Inhibits development of endometrium
    • Keeps cervical mucus thick
    • Women who are breastfeeding or cannot tolerate other side effects.
  • Today’s combination pills have 50 micrograms of estrogen (compared to 150 micrograms in 70s and 80s).
hormonal methods40
Hormonal Methods
  • Side Effects: nausea, constipation, breast tenderness, bloating, emotional depression
  • Most diminish within a few months.
  • Increased susceptibility to yeast infection.
  • Smoking and taking the pill increase risk for cardiovascular problems.
  • For nonsmokers, the risks associated with the pill are less than those associated with pregnancy and childbirth.
hormonal methods41
Hormonal Methods
  • Lowers risk for ovarian cancer
  • Decrease in number of benign breast tumors.
  • Reduces ratse of ovarian cysts, rheumatoid arthritis, and PID.
  • Reduces PMS, pain and bleeding and improves acne.
depo provera
Depo-Provera
  • Progestin shot lasts for 3 months and prevents ovulation by blocking FSH and LH from being released.
  • Pregnancy rate of less than 1%
  • Side effects: menstrual irregularity, weight gain (15 lb), tiredness, weakness, nervousness, dizziness, headache.
  • Lunelle—new shot with estrogen & progesterone.
norplant
Norplant
  • Hormonal method of protection for 5 year period.
  • Six flexible silicon tubes are inserted under the skin of the upper arm in a fan like pattern.
  • Tubes release synthetic progesterone inhibits LH surge and ovulation.
  • 15-30 minute procedure
norplant44
Norplant
  • Failure rate is 2 in 1000.
  • In the first year, side effects include irregular bleeding, spotting, weight gain, headache, nervousness, dizziness, nausea, breast tenderness, and acne.
  • Should not be used by women with liver disease or tumors, breast cancer, or a history of blood clots.
emergency contraception
Emergency Contraception
  • 3 methods
  • Yuzpe method: synthetic estrogen and then levonorgestrel within 72 hours and again 12 hours later—75% effective. Not abortion.
  • Progestin only pill as well—90% effective.
  • Implantation of IUD—hard to find doctor willing to take the time to do this.
voluntary sterilization
Voluntary Sterilization
  • More Americans rely on sterilization than any other method (28% female, 11% male).
  • Married couples use this method after last planned child.
  • Unmarried women who are also not planning on future children.
vasectomy
Vasectomy
  • Men—Vasectomy
    • Small incision in the scrotum under local anesthetic. Tying off and cutting the vas deferens. Takes 20 minutes.
    • China—no scalpel method, skin of scrotum is pierced with a sharp instrument. 10 minutes. Less bleeding and infection.
vasectomy48
Vasectomy
  • Does not interfere with production of hormones or sperm.
  • Sperm that are already past the vas deferens must be eliminated before vasectomy is effective (12-16 ejaculations).
  • Men who have been sterilized still ejaculated, the semen does not contain sperm.
tubal ligation
Tubal Ligation
  • Tying off and/or cutting the fallopian tubes. Prevent passage of egg and sperm. Eggs absorbed by woman’s body.
  • All require general anesthesia, but no need for prolonged hospital stay.
tubal ligation50
Tubal Ligation
  • Minilaparotomy: 1 inch incision in abdomen fallopian tubes tied up and cut.
  • Laparoscopy is done via video transmitted via inserting a tube-like camera and surgical instruments into the belly button to cut the fallopian tubes.
  • Culpotomy: cutting of fallopian tubes is done through small incisions in the vagina.
sterilization reversal
Sterilization Reversal
  • Not a guarantee
  • Microsurgery required to tie the vas deferens or fallopian tubes back together
  • Success rates are better for reversing vasectomy.
  • Studies show male sterilization is a better option for a couple in terms of expense, complication rates, and regret.
unwanted pregnancy final options
Unwanted Pregnancy:Final Options
  • Keeping and raising a baby—higher than normal levels of frustration for women who may stop education to raise the child.
  • Adoption—long-lasting adjustment problems for the biological mother/father.
  • Abortion—lots of controversy regarding the issue.
future technology
Future Technology
  • More female condom options
  • Unisex condom garment
  • Lea’s shield
  • Disposable cervical cap
  • Male pill
  • Vaccination
  • US is behind other countries in developing contraceptives.
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