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Contraceptives . Historical Background. A wide variety of effective contraceptive devices is a modern phenomena The US formerly prohibited both their use and the dissemination of relevant information – The Comstock Laws of 1870

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historical background
Historical Background
  • A wide variety of effective contraceptive devices is a modern phenomena
  • The US formerly prohibited both their use and the dissemination of relevant information – The Comstock Laws of 1870
  • Margaret Sanger led the charge to give women some control their own fertility
  • in 1960 the birth control pill debuted
more background
More Background
  • In 1965 the Supreme Court ruled in Griswold vs. Connecticut that married couples can use contraceptives
  • In 1968 use was extended to singles
  • Thus began the controversial Right to Privacy
  • Now the debate has shifted to parental notification
contemporary issues
Contemporary Issues
  • Contraceptives have contributed to women’s financial stability, health, and career advancement
  • Should health insurance plans cover?
  • Should we halt population growth?
  • Cultural gender-role expectations?
  • Religious objections? But 70% of US Catholics use banned methods.
ideally a mutual decision
Ideally, a Mutual Decision
  • Today, contraception is much more effective if both partners participate
  • Also,
  • Discussion can enhance a relationship
  • Together women can learn how to obtain; men can learn how to request their use
  • Now both sexes are more likely to use, even the first time
choosing a method
Choosing a Method
  • Many forms are available
  • None are perfect
  • Each has its advantages and disadvantages
  • They vary as to price, effectiveness, convenience and safety
effectiveness
Effectiveness
  • The biggest peril? Errors by the user.
  • About half of unintended pregnancies occur among women using contraceptives.
  • Poor, unmarried women under 30 have the highest failure rate.
characteristics of those who try but fail
Characteristics of those who try, but fail
  • They feel guilty about using it
  • They have a negative view of sex itself.
  • Some women feel that being prepared makes them appear too “eager”.
  • Taking this into account, each contraceptive has a failure rate – the number out of a 100 who become pregnant by the end of the first year of use
back up
Back-up
  • With so much human error in play, many couples use two methods to be sure.
  • When backups are necessary:

during the pill’s first cycle

if you missed a few pills

if you are taking antibiotics with the pill

during the first 3 months of IUD use

while using a new method

the pill
The Pill
  • Work by altering hormone levels
  • Used by 100 million worldwide
  • Top choice among American women
  • Four basic types

Constant-dose Combination

Triphasic

Seasonale

Progestin-only

the constant dose combination
The Constant-dose Combination
  • Number 1 in US
  • Available since the early 60’s
  • Two hormones, synthetic estrogen & progestin are taken at a level daily dose
  • Very effective, if used properly, only .3 fail
  • Reduces cramps and flow
  • Some possible side-effects
the triphasic pill
The Triphasic Pill
  • Varies proportions of estrogen and progesterone during the menstrual cycle
  • Reduces overall hormone dosage
  • Fewer side-effects
  • Also very effective
seasonale
Seasonale
  • The latest
  • Lower yet hormone doses
  • Reduces periods to just 4 per year
  • Progestin-only - just a constant dose of a very small level of progestin
how they do it
How they do it
  • The combination and triphasic pills and Seasonale primarily inhibit ovulation.
  • Their estrogen dose stops the hypothalamus from releasing hormones essential to ovulation.
  • Their progestin hampers the sperm’s passage into the uterus.
  • The progestin-only stops sperm in cervix.
taking the pill
Taking the Pill
  • Must be taken every day
  • Should be taken at the same time each day
  • Many forget to take the pill each day
  • Objective measures showed that 50% missed up to 3 pills per cycle
  • If so, a backup is necessary
advantages
Advantages
  • No effect on sexual spontaneity
  • Easily reversible
  • If taken as prescribed, very effective
  • Lessen menstrual discomfort
  • Also reduces risk of some cancers
disadvantages
Disadvantages
  • Does not protect against Aids or other STDs
  • Some side effects from steady presence of hormones in blood stream
  • For women over 35 who smoke, the risks outweigh the benefits
  • Some medications weaken the pill’s effectiveness and vice versa
aches
ACHES
  • An acronym for serious problems possibly associated with the pill
  • Abdominal pain (severe)
  • Chest pain (severe) or shortness of breath
  • Headaches (severe)
  • Severe leg pain, calf or thigh
  • Many deal with blood clots/cardiovascular concerns
condoms
Condoms
  • The most basic of the barrier methods
  • Work by preventing sperm from entering the vagina
  • Men’s only temporary form of birth control
  • Made of surgical latex or sheep membrane
  • Wide variety, long history
  • Mass production followed the vulcanization of rubber in the 1840s
  • 6 to 9 billion sold each year worldwide
how to use
How to use
  • Must be used effectively
  • Must be put on before penetration
  • Cowper’s gland secretions can contain sperm
  • The end of a plain-end condom must be twisted
  • Lubrication helps prevent breakage
  • Avoid oil based lubricants
advantages of condoms
Advantages of Condoms
  • The best protection against contracting and spreading STDs and preventing vaginal infections
  • Easily available
  • No harmful side effects
  • Can decrease sensitivity for greater endurance
disadvantages1
Disadvantages
  • Can interrupt spontaneity
  • Decreases penile sensitivity
  • Tiny leaks can ruin effectiveness
  • Should be put on properly
the iud
The IUD
  • Intrauterine devices – small plastic objects inserted into the uterus
  • Various types halt conception in differing ways
  • Some prevent fertilization
  • Others disrupt normal ovulatory patterns
using the iud
Using the IUD
  • Inserted by a health care professional using sterile instruments
  • Careful screening is necessary
  • Woman should be over 25, in a monogamous relationship, with no history of STDs or PID
  • String should be checked each month after menstruation
advantages of the iud
Advantages of the IUD
  • Tremendous effectiveness
  • Very little inconvenience
  • Can work for 10 years
  • Very inexpensive
  • Possible discomfort usually diminishes within a month or so
disadvantages2
Disadvantages
  • Insertion can be painful
  • Some expel the device
  • Serious problems – PAINS
  • Period disappears or is late
  • Abdominal pain
  • Increased temperature, fever, chills
  • Nasty discharge, foul smell
  • Spotting, bleeding, heavy periods
emergency contraception ec
Emergency Contraception (EC)
  • Taking hormone pills or inserting a Copper-T IUD (99% effective) can serve in an emergency
  • Could possibly eliminate over 2 million unintended pregnancies a year in the US alone
  • But only 49% are aware of this
  • Hormone pills can be taken up to 5 days after intercourse but the sooner the better
slide28
ECII
  • Side effects such as nausea and vomiting are possible
  • Approved in 1996, but available only through prescription?
  • Unwise
  • Some states have changed this
  • Also access can be difficult
  • Catholic hospitals often refuse to provide
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