Lecture Notes
Chapter 8 Contraception and Abortion
Modified:
2007-05-18
Contraception and abortion are two of the most controversial topics
in America today. Where both have become routine and legal, that has
not prevented the creation and growth of two diametrically opposed
camps of followers. Their debate will continue for many years.
- Population Problem
- Erotophobia, Erotophilia and Contraception
- Five steps of contraceptive use
- acquire accurate knowledge
- acknowledge likelihood of engaging in intercourse
- obtain the contraceptive
- communicate with partner about contraception
- use method of contraception
- Erotophobics
- do not discuss sex
- high levels of guilt
- fear of sex disapproval
- infrequent intercourse
- few partners
- not likely to use contraception
- Erotophilics
- discuss sex
- little guilt about sex
- more frequent intercourse
- more partners
- aroused by erotic films
- likely to use contraception
- Success Rates of Contraception
- Lowest observed failure rate (theoretical rate)
- this the rate typically reported in controlled studies
of the method
- Failure rate for typical users (actual rate)
- this is the rate reported 'in the field' (i.e.,
forgetting to take pill)
- Methods
- Birth control pills
- prevent ovulation by causing high levels of
estrogen
- progestin also used to make thicker cervical mucus,
discourage implantation
- failure rates from .1 to 3%
- side effects similar to pregnancy
- several types of pill
- combination pill (estrogen and progestin)
- biphasic (estrogen and two levels of progestin)
- progestin only (mini pills)
- side effects
- blood clotting
- higher blood pressure
- vaginitis, gonorrhea
- nausea
- weight gain
- water retention
- no evidence of cancer causation
- Norplant
- implanted in skin
- lasts up to six years
- most effective method of all (0.09% actual)
- Depo-Provera
- progestin injections
- last up to 90 days
- amenorrhea
- 6-12 months for full reversibility
- IUD
- device inserted into uterus
- unknown method of contraceptive action
- T-shaped IUDs are only type still available in US
- Dalkon shield case
- effective method (1.5 -5% failure rate)
- side effects
- PIDs
- increased menstrual cramps
- pain on insertion
-
- Diaphragm
- individually fitted rubber dome
- used with spermicide
- mechanical action
- effectiveness depends of user (2-18% failure rate)
- few side effects
- loss of spontaneity
- moderate cost
- reversible method
- Cervical Cap
- similar to diaphragm in action
- used with spermicide
- higher failure rate for multiparous women (36%)
- Contraceptive Sponge
- similar to diaphragm and cervical cap
- includes spermicide
- worn for up to 12 hours
- toxic shock syndrome possible if not removed
-
- Condom
- Male
- only reversible male method
- method that reduces chances of AIDS
infection
- failure rate 2-10%, better with spermicide
- Female
- newer device
- reduces chances if AIDS infection
- relatively high failure rate (21%)
- Spermicides
- not for use as primary method (25% failure rate)
- Douching
- not a contraceptive method
- Withdrawal
- also not an effective contraceptive method (19%)
- only last minute (second?) method
- Rhythm (fertility awareness)
- Catholics...
- kits available but used also for fertility
enhancement
-
- Sterilization
- Male
- Female
- Minilaparotomy
- Laparoscopy
- Abortion
- Methods
- Vacuum aspiration
- Dilation and evacuation
- Induced labor
- Hysterotomy
- Psychological Aspects
- most women have positive outcomes
- Czechoslovakia data
- problems for children of mothers denied
abortions
- New Methods of Contraception
- RU-486
- 'morning after' pill
- not really contraception
- controversy over use in US
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