5 CONTRACEPTION ABORTION 5 The oldest oracle in

5 CONTRACEPTION & ABORTION

5 “ The oldest oracle in Greece, sacred to the Great Mother of the earth, sea, and sky, was named Delphi, from delphos, meaning ‘womb’. ” - Barbara Walker -

5 PERSPECTIVES ON CONTRACEPTION HISTORICAL OVERVIEW BIRTH CONTROL v. Any procedure that prevents the birth of a baby CONTRACEPTION v. Any procedure used to prevent fertilization of the ovum

5 Ancient Methods: ØEgyptians ØConcoction of pastes inserted into vagina as diaphragms ØGreeks ØConcoction of pastes for diaphragm ØTeas and septic solution ingested as medicine ØStones/foreign objects used as early IUDs ØMixtures of acid, juice, honey, alcohol, opium as spermicides

5 Early Forms of Contraception: ØCondoms = linen sheaths ØDiaphragms ØCervical cap (early 1800 s) ØDiaphragm (late 1800 s) ØAbstinence Campaign: “Voluntary Motherhood” (mid 1800 s) ØAntifeminist Theory: “Race Suicide” (1905 -1910)

5 Legality of Birth Control: ØPresident Theodore Roosevelt (1905 -1910) ØGriswold v. Connecticut (1965) ØMandated coverage for contraception for federal employees via an act of Congress (1998) ØPrivate insurance companies: oral contraception coverage ØFederal restrictions on contraceptive development

5 ECONOMIC OVERVIEW METHOD COST OTHER COSTS Female Sterilization $1190 - $2467 Male Sterilization $353 - $756 Oral Contraceptives $18 - $21/cycle Annual GYN exam Male Condom $. 33 - $1. 04 Implant $365 $48 -$333 (insertion) $80 -$100 (removal) Injectable $30/per quarter Quarterly office visits Diaphragm $15 -$18 Office visit for fitting IUD $82 -$184 $62 -$207 (insertion) $11 -$70 (removal)

5 METHOD Female Condom Spermicides Sponge Cervical Cap COST $1. 25 -$3. 66 $8. 75 -$12. 00 $. 83 - $1. 50 $19 - $31 Evra Patch Similar to OCs OTHER COSTS Office visit fitting, spermicides

5 EPIDEMIOLOGY OF CONTRACEPTIVES CHOOSING A CONTACEPTIVE KAISER FAMILY FOUNDATION STUDY Women found the following “very important”: üPrevents pregnancy (90%) üProtects against STDs (77%) üNo health risk (77%) üIs easy to use (51%) üRequires no advance planning (45%)

5 CONTRACEPTIVE USE PERCENT OF WOMEN AGES 15 -44 YEARS USING THEIR CONTRACEPTIVE METHOD, USA

5 PERCENT OF WOMEN AGES 15 -44 YEARS USING THEIR CONTRACEPTIVE METHOD, DISTRIBUTED BY ETHNICITY/RACE, USA

5 CONTRACEPTIVE METHODS A/ FERTILITY AWARENESS METHODS CALENDAR METHOD: ØAvoidance of intercourse during fertile time of month by calculating time of ovulation BASAL BODY TEMPERATURE: ØFertility cycle related to changes in basal body temperature OVULATION METHOD: ØFertility cycle related to variations in type of cervical mucus

5 Pros vs. Cons of Fertility Awareness Methods: PROS q. No side effects q. Used by anyone q. Cost effective CONS q. Length of menstrual cycles vary q. Other factors can alter body temperature q. Sperm can survive 48 to 72 hours in female

5 B/ HORMONAL METHODS ORAL CONTRACEPTIVES: Ø 17% of women 15 -44 years of age PROS CONS q. Lighter & less painful q. Mood changes periods q. Spotting q PMS symptoms q. Weight changes q bone density q. Drug interactions q. Improved skin q. Protect against breast, ovarian & endometrial cancers, PID q. Improve skin conditions

5 Types of Birth Control Pills: Ø> 30 birth control pill brands available ØMonophasic: each cycle provides 21 identical hormone-containing pills ØBiphasic: Two-phase ØTriphasic: Thee-phase ØMinipills: Estrogen-free ØPros vs. Cons

5 Hormonal Implants: Norplant (late 1990 s) ØSubdermal contraceptive implant in arm ØNo estrogen PROS q. Lasts 5 years q. Very effective q. Protection begins within 24 hours CONS q. Menstrual irregularities q. Headache, acne, mood changes, weight changes q. Difficulty removing implants

5 Hormone Delivery Methods: Depo-Provera ØInjectable progestins every 3 -4 months Ortho Evra ØPatch worn on skin for 1 -week intervals and 4 th week is patch-free Nuva. Ring ØVaginal ring worn for 3 weeks and removed during week of menstruation

5 C/ BARRIER METHODS SPERMICIDES: ØForms = cream, foam, film, suppository, gel ØUsed in all barrier methods except condoms

5 DIAPHRAGM: ØDome-shaped latex cup sealing cervix

5 CERVICAL CAP: ØSimilar to a small, deep diaphragm sealing cervix

5 CONDOMS: ØWomen responsible for 40% condom sales

5 FEMALE CONDOMS: ØPolyurethane sheath lining entire vagina and external genitals

5 CONTRACEPTIVE SPONGE: ØModern version of history form (sea sponges) ØCervical barrier available without fitting or prescription PROS VS CONS OF BARRIER METHODS: üOverall safe üProtect from STDs üUsed as back-up for pill users § Diaphragm, sponge, and cervical cap = vaginal bacterial infections, toxic shock syndrome

5 D/ PERMANENT METHODS FEMALE STERLIZATION: ØTubal Ligation = fallopian tubes cut & tied ØLaparoscopic Sterilization ØMinilaparatomy MALE STERLIZATION: ØVasectomy = vas deferens cut & tied

5 E/ OTHER FORMS OF CONTRACEPTION ABSTINENCE ØNo penis-in-vagina intercourse WITHDRAWAL ØCoitus Interruptus BREAST FEEDING ØLactational Amenorrhea Method (LAM) IUD ØSmall plastic object placed in uterus for 1 -10 years MORNING-AFTER PILL ØProgestin-only pills prevent pregnancy after intercourse

5 PERSPECTIVES ON ABORTION HISTORICAL OVERVIEW ØAncient Practice: Common by Greek physicians ØUp to 1800 s: No legal prohibitions Ø 1973: Roe v. Wade Ø 1976: Hyde Amendment Ø 1980: Harris v. Mc. Rae Ø 1989: Webster v. Reproductive Health Services Ø 1991: Rust v. Sullivan

5 EPIDEMIOLOGY PERCENT OF TOTAL ABORTIONS IN THE U. S. , BY AGE, 1999

5 ABORTION PROCEDURES A/ SURGICAL ABORTION q Vacuum Curettage q Dilation and Curettage (D&C) q Dilation and Evacuation (D&E) B/ MEDICAL ABORTION q Methotrexate q Mifepristone (RU-486) C/ OTHER TECHNIQUES q Menstrual Induction/Menstrual Extraction

5 INFORMED DECISION-MAKING üReview Needs üMedical History üPros vs. Cons üRe-evaluate