Chapter 6

Contraception and Abortion

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Definition:Conception: the fusion of an ovum and

sperm that creates a fertilized egg.Contraception: Preventing conception by

blocking the female’s egg from uniting with the male’s sperm, thereby preventing pregnancy.

Modern contraception are much more predictable and effective than in the past.

Many play a role in the prevention against sexually transmitted diseases

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Based on the physiology of reproduction Types: Barrier, Hormonal, Natural

Methods, and Surgical Factors affecting choice

Advantages and disadvantages Effectiveness

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Estrogen and progesterone taken orally Mimics the hormonal activity of the

corpus luteum Most common is the combination pill, both

estrogen and progestin “Minipill” (only progestins) Advantages Disadvantages Effectiveness (~99.7%)

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Thin 1 3/4 inch square patchEx: Ortho Evra

Releases estrogen and progestin slowly into the bloodstream.

Prevention the same way as oral contraceptives Worn for one week, replaced on the same day for 3

consecutive weeks. Fourth week no patch Placements: Upper arm, abdomen, buttocks, or

upper torso (not breast) Advantages Disadvantages Effectiveness (~99.7% in the first year of use; less

effective in women weighing more than 198 lbs.)

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The NuvaRing Resembles the rim of a diaphragm and is

molded with progestin and estrogen 2-inch ring slowly releases the hormones During fourth week, remove the ring and use a

new ring after the fourth week. Advantages Disadvantages Effectiveness (~99.7%; 8% failure rate)

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Norplant; Jadelle (Norplant II); Implanon (2006)Hormonal method6 flexible matchstick capsulesProtection for 5 yearsProgestin inhibits ovulationAdvantagesDisadvantages

(e.g., menstrual irregularities)Effectiveness (~99.95%)

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Depo-Provera, Lunelle (2002 voluntary recall) Hormonal treatment Injectable progestin every 12 weeks Injectable locations: arm or buttocks Advantages Disadvantage Side effects

period will subside - ovaries will not release egg

It may take 12 months before cycle will return

Effectiveness (~99.5%)

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Postcoital Pill, Morning After Pill, Plan B (OTC)Use a EPT (emergency pregnancy test) kitMost common is the two dose regimenPrevents uterine implantationNeeds to be taken within 72 hours. Best

used within 24 hours

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T-380A (ParaGard) 10 years of protection Copper

Levonorgestral (Mirena) 5 years of protection Release small amounts of progestin

Not exactly sure how it prevents pregnancy—perhaps it works to prevent fertilization

Advantages Disadvantages (e.g., heavy menstrual flow

and bleeding occurs) Effectiveness (99.2%)

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Thin latex sheaths Protection against STD’s Advantages Disadvantages Effectiveness

Use with spermicide

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Reality Brand Polyurethane sheath with two

flexible rings Advantages Disadvantage Effectiveness

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Dome shaped cup of thin rubber stretched over a collapsible metal ring.

Available only by prescription Custom fit Removed following intercourse Advantages (e.g., sensation increases, protection

against STI’s) Disadvantages

Toxic shock syndrome (TSS) – occasionally fatal bacterial infection

Effectiveness (approximately 84%) Lea’s Shield (silicon rubber)

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Small rubber or plastic cap Must use foam kit Advantages (similar to the

diaphragm) Disadvantage

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How it works Advantages Disadvantages Effectiveness (~71%)

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AbstinenceWithout intercourse or sexual activitiesBenefits: more self respect and respect for

others. Security that you are being pursued for sexual reasons. Less worry about STDs and Pregnancy.

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FAMCalendar methodTemperature methodMucus method

Withdrawal Combining methods

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Severing of the vasa deferentia May return to work in 2 days Reversal varies between 80% to 50%,

depending on the report. Complication rate (low) Effectiveness (~99.85%)

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Tubal sterilization (laparoscopy) is most common

Hysterectomy (removal of the uterus) Complication rate (low) Reversibility

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Appropriate method of birth control Individual health risks Implications of unplanned pregnancyRisks of STDsConvenience and comfort levelType of relationshipEase and CostReligious or other philosophical beliefs

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The history of abortion in the U.S.Mid-1800’s: Prior to 20 weeks was legal1900’s: Physicians joined with other groups -

stating untrained people were performing them. All states made abortion illegal

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1973: Roe versus Wade Supreme Court ruled :

Pregnancy divided into 3 trimesters 1st trimester - up to women & doctor 2nd trimester - state may regulate 3rd trimester - state may regulate and bar all abortions that are not

life threatening to mother

U.S. Congress and federal Medicaid funds 17 states provide nonfederal public money Current issues

2000 Nebraska ban on partial birth (Stenberg v. Carhart ); a surgical abortion that is typically performed during the third trimester or later part of the second trimester of pregnancy and in which the uterine cervix is dilated and death of the fetus is induced after it has passed partway through the birth canal -- called also D&X, partial-birth abortion

President Bush signed the Partial-Birth Abortion Ban Act (S. 3) into law on November 5, 2003

2004 The Partial Birth Abortion Ban Act is declared unconstitutional by federal judges in San Francisco, New York, and Lincoln, Nebraska.

2007 Gonzales v. Carhart: The Supreme Court upholds the Partial Birth Abortion Ban Act.

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Pro-lifePro-life: The fertilized egg is a human being from the moment of conception and therefore an abortion is murder. Any women having sex knows pregnancy is possible

- she has a moral obligation Women unable or unwilling to raise the children

should consider placing him/her up for adoption Abortion has destructive effects on our traditional

morals and values

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Pro-Choice :Pro-Choice :There are distinct stages of fetal development and that preserving the fetus early in pregnancy is not the ultimate moral concern. Women should have the right to make their own

decisions If not legal then unsafe and unregulated practices

would occur Women would be divided into those who could afford

and those who could not. Some physicians would be forced to break the law

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Two categories Surgical - 98% of all abortions Medical

Ends a pregnancy before birth takes place Miscarriage/Spontaneous abortion - embryo or fetus

dies in the uterus and is expelled by the body Ending a pregnancy voluntarily - induced abortion Approx. 88 % of all abortions are performed during

the first trimester Typically performed at a clinic, health center, or in a

doctors office. Women are usually able to return home an hour or

so later

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Vacuum aspiration Early abortion; about 6th to 12th week Used about 90% of all abortions Vagina is washes with antiseptic, Anesthetic is

injected into or near the cervix. Cervix is gently and gradually stretched over a 24

hour period. After dilation a tube connected to a suction machine

gently empties the uterus After suction a Curette (narrow metal loop) gently

scrapes the walls of the uterus After a few hours in recovery the woman can return

home

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MVA Done within 4 or 5 weeks of last menstrual cycle More effective and safer if performed at least 6 or 7

weeks Gentle suction of a syringe Cervix is dilated with meds. Uterus is emptied with a handheld syringe If a definitive gestational sac is not identified then

women is tested for possible ectopic pregnancy

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Possible physical effects Fever above 100º F. Abdominal pain or tenderness Swelling Backache Prolonged or Heavy bleeding Foul smelling vaginal discharge Vomiting Fainting Delay of 6 or more weeks in resuming menstruation

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Possible feels after having an abortion Guilt New strength in having made and carried out an

important decision Depression Sense of loss Negative feelings about sex Relationship may end Anger Bitterness

Chapter 6 Connect Assignment Due Tuesday, February 9th

Study guide for Exam I will be posted on instructor’s website: www.cerritos.edu/lnguyen

Exam I next Wednesday, February 10th

No late and/or make-up exams will be given.

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