Knocked Up

Reproduction, Contraception, Unplanned Pregnancy, Pregnancy

& Birth

• Decisions around parenting

• Deciding to use contraception

• Contraception versus safer sex

• Effectiveness (the only 100% effective method)

• Reversibility (complete and immediate)• Advantages (free, no side effects, nothing

to remember)• Disadvantages (must be used every time,

requires strong self control and commitment)

Abstinence

Withdrawal

• Effectiveness (81-96%)

• Reversibility (complete and immediate)

• Advantages (free, available, ease of use, no side effects some protection against STD’s)

• Disadvantages (possibility of failing to recognizing impending ejaculation, interrupts sexual pleasure, great self control required on the part of the male)

Male condom1.      Consistent use

2.      Correct use

3.      Effectiveness (86-97%)

4.      Advantages (relatively inexpensive, no prescription needed, easy to obtain, may help a man control ejaculation, protection from STD’s, allow male to participate in birth control

5.      Disadvantages

6.      Communication

7.      Multicultural dimensions

latex

polyurethane

polyisoprene

Female condom

1.      Effectiveness (79-95%)

2.      Advantages (easy to use, provide more sensation than male condoms, provide a woman-controlled alternative to male condoms

3.      Disadvantages (awkward to use, messy, hard to find)

Female condom

Latex FC (not in US yet)

Nitrile FC (not in US yet)

Spermicides• Effectiveness (76-94%)

• Reversibility (complete and immediate)

• Advantages (easy to use, readily available without a prescription, no serious side effects, good back up method, no partner participation required)

• Disadvantages (lower effectiveness rating than other methods, some women may suffer lesions and ulcers along vaginal walls)

• Nonoxynol-9

The Sponge (is back)

Natural family planning – fertility awareness methods

A.    Calendar method

B.     Ovulation method

C.    Sympto-thermal method1.      Effectiveness (91-99% if practiced perfectly)

2.      Reversibility (complete and immediate)

3.      Advantages (excellent way to learn about fertility, require equal involvement of both partners, free, may alert women to the need for medical attention)

4.      Disadvantages (no protection from STD’s, requires vigorous commitment by both partners)

PRESCRIPTION METHODS

Oral contraceptives

1.      Combination pill

2.      Minipill

3.      Effectiveness (95-99.9%)

4.      Reversibility (complete, but may take longer in some women)

5.      Advantages

6.      Disadvantages

Emergency Contraception

a)     Effectiveness (75 to 89 percent)

b)     Advantages (may be the only method available)

c)     Disadvantages

-provides no protection against STI’s

-less effective than other forms of

hormonal birth control

-frequent use of ECPs may cause periods to become irregular.

1-888-NOT-2-LATE

1-888-NOT-2-LATE

The Ring

• 95-99 %

Advantages: protects against pregnancy for one month, doesn't require a "fitting" by a clinician, doesn't require the use of spermicide

Disadvantages: increased vaginal discharge, possible vaginal irritation or infection,can't use a diaphragm or cervical cap for a backup method of birth control

• 95-99 % effective

Advantages: protects against pregnancy for one month

Disadvantages: can’t use if you are over 198lbs, skin reaction at the site of application,menstrual cramps

The Patch

Intrauterine Devices (IUD’s)

1.      Effectiveness (97-99%)

2.      Reversibility (complete and immediate once the device is

removed)

3.      Advantages (highly effective, no systemic side effects, no planning necessary)

4.   Disadvantages (still a small chance of conception taking place, no protection from STI’s)

  Diaphragm

1.      Effectiveness (80-94%)

2.      Reversibility (complete and immediate)

3.      Advantages (highly effective if used correctly and consistently, easy to use, no systemic side effects)

4.      Disadvantages (must be inserted prior to intercourse, consistent and correct use is vital, limited protection from STD’s, increased risk of UTI’s, may cause TSS)

Cervical cap

1.      Effectiveness (80-91%)

2.      Reversibility (complete and immediate)

3.      Advantages (easy to use, no systemic side effects, can be kept in place for up to 48 hours)

4. Disadvantages (elevated rates of precancerous cervical abnormalities for cervical cap users, may irritate cervix, may cause unpleasant odor or vaginal dryness, may cause TSS, may become dislodged during intercourse)

PERMANENT METHODS   Sterilization

1.      Effectiveness (nearly 100%)

2.      Reversibility (reversals are expensive and not guaranteed)

3.      Advantages (permanent, highly effective, cost effective, lack side effects, safe, don’t interfere with love making)

4.      Disadvantages (no protection from STD’s, permanent)

Male sterilization

1.      Vasectomy

2. Reversibility through vasovasectomy (approx. half will result in a pregnancy

Female sterilization

1.      Minilamparotomy

2.      Laparoscopy

3.      Open laparoscopy

4.      Vaginal approaches

5.      Transcervical methods

6. Reversibility (0-60% success, depending upon method)

THE FUTURE OF CONTRACEPTIVES

 A.    Ovulation predictors

B.     Spermicidal agent

C.    Other chemical agents

D.    Ovulation promoters and inhibitors

E.     Male contraceptives

F.     Improving existing methods

G. Microbicides

Some Pregnancy Stats• 6 million US women become pregnant

every year. 2/3 live births, 20% abortion, remaining are miscarriages

• In US, about 50% of pregnancies are unintended; 42% of these end in abortion

• 9/10 US women use contraception at least some of the time

Unplanned Pregnancy

• Parenting

• Abortion

• Adoption

Abortion

• ~46 million abortions worldwide. 20 million are clandestine/unsafe abortions. >75% of all abortions occur in developing countries.

• In US, rate of abortion has been declining since 1980

• 1 of 3 US women will have an abortion by age 28

• 6/10  U.S. women having abortions are already mothers. More than half intend to have (more) children in the future. 

• Nearly eight in 10 U.S. women obtaining an abortion report a religious affiliation (43% are Protestant, 27% Catholic and 8% another religion). Among all women aged 15–44, 51% are Protestant, 28% are Catholic and 5% belong to other religions. 

• 9/10 abortions in US occur in the first 12 weeks of pregnancy and 56% occur in the first 8 weeks. only 1.4% are 21 wks or more

• 87% of US counties have no abortion provider; 1/3 of women aged 15–44 live in those counties. Almost 1/4 travel more than 50 miles to reach a provider, and 8% travel more than 100 miles.

Abortion procedures

• Medical: misoprostol + mifepristone . Up to 49 days/7 weeks

• Manual vacuum aspiration (MVA): up to 12 weeks LMP

• Dilation and Evacuation (D&E): used in 2nd trimester, 1% of abortions; 3rd trimester = .04%

Adoption

• Closed: birth mom/dad and adopting family are anon

• Open: identifying info is exchanged

• Agency: public (foster care, etc), private both follow state regs

• Independent: birth and adoptive parents find each other, mediated through lawyers

• Relatives: slightly informal