Chapter 13: Contraception and Abortion

Contraception

The deliberate use of artificial methods or other techniques to prevent pregnancy

Birth Control

Another term for contraception

Abortion

Induced termination of a pregnancy before fetal viability

U.S. Food and Drug Administration (FDA)

The agency in the U.S. federal government that has the power to approve and disapprove new drugs

Intrauterine devices (IUDs)

A small device made of flexible plastic that is placed in the uterus to prevent pregnancy

Lactational Amenorrhea Method (LAM)

A method of avoiding pregnancies based on the postpartum infertility that many women experience when they are breastfeeding

Effectiveness Rates

Estimated rates of the number of women who do not become pregnant each year using each method of contraception

Typical Use

Refers to the probability of contraceptive failure for less than perfect use of the method

Perfect Use

Refers to the probability of contraceptive failure for use of the method without error

Condom

A latex or polyurethane sheath that fits over the penis and is used for protection against pregnancy and sexually transmitted infections; female condoms made of either polyurethane or polymer, which protect the vaginal walls, are also available

nonoxynol-9

A spermicide that has been used to prevent pregnancy and protect against sexually transmitted infections

Spermicide

Chemical method of contraception, including creams, gels, foams, suppositories, and films, that works to reduce the survival of sperm in the vagina

Postcoital Drip

A vaginal discharge (dripping) that occurs after sexual intercourse

Microbicide

Chemical that works by inhibiting sperm function; effective against HIV and other STIs, and not harmful to the vaginal or cervical cells

Cervical Barrier

A plastic or rubber cover for the cervix that provides a contraceptive barrier to sperm

Diaphragm

A contraceptive device consisting of a latex dome on a flexible spring rim; used with spermicidal cream or jelly

Cervical Cap

A birth control device similar to a diaphragm, but smaller

FemCap

Reusable silicone barrier vaginal contraceptive that comes in three sizes

Contraceptive Sponge

Polyurethane sponge impregnated with spermicide, inserted into the vagina for contraception

Oral Contraceptive

The "pill"; a preparation of synthetic female hormones that blocks ovulation

Combination Birth Control Pill

A contraceptive pill that contains synthetic estrogen and progesterone

Monophasic Pill

A type of oral contraceptive that contains one level of hormones in all the active pills

Biphasic Pill

A type of oral contraceptive that contains two different doses of hormones in the active pills

Triphasic Pill

A type of oral contraceptive that contains three different doses of hormones in the active pills

Breakthrough Bleeding

Slight blood loss from the uterus that may occur when a woman is taking oral contraceptives

Start Day

The actual day that the first pill is taken in a pack of oral contraceptives

Placebo Pills

In a pack of 28-day oral contraceptives, the seven pills at the end; these pills are sugar pills and do not contain any hormones; they are used to help a woman remember to take a pill everyday

Pelvic Inflammatory Disease

Widespread infection of the female pelvic organs

NuvaRing

A small plastic contraceptive ring that is inserted into the vagina once a month and releases a constant dose of estrogen and progestin

Ortho Evra Patch

A thin, peach-colored patch that sticks to the skin and time-releases synthetic estrogen and progestin into the bloodstream to inhibit ovulation, increase cervical mucus, and render the uterus inhospitable; also referred to as the “patch”

Progestin only Birth Control Method

Contraceptive hormonal method that does not contain estrogen and works by changing a woman's menstrual cycle

Minipills

A type of birth control pill that contains only synthetic progesterone and no estrogen

Subdermal Contraceptive Implant

Contraceptive implant that time-releases a constant dose of progestin to inhibit ovulation

Norplant

A contraceptive implant that consisted of six progestin capsules, which were implanted into the upper arm. Norplant is not currently available in the United States.

Depo-Provera

Depo-medroxyprogesterone, an injectable contraceptive that prevents ovulation and thickens cervical mucus

Vaginal Contraceptive Film

Spermicidal contraceptive film that is placed in the vagina

Fertility Awareness

Basal body temperature charting used in conjunction with another method of contraception

Fertility Awareness-based Methods

Contraceptive or family planning method that involves identifying a fertile period in a woman's cycle

Rhythm Method

A contraceptive method that involves calculating the period of ovulation and avoiding sexual intercourse around this time

Basal Body Temperature (BBT)

The body's resting temperature used to calculate ovulation in the symptothermal method of contraception

Natural Family Planning

A contraceptive method that involves calculating ovulation and avoiding sexual intercourse during ovulation and at other unsafe times

Symptothermal Method

A contraceptive method that involves monitoring both cervical mucus and basal body temperature to determine ovulation

Coitus Interruptus

A contraceptive method that involves withdrawal of the penis from the vagina before ejaculation

Sterilization

Surgical contraceptive method that causes permanent infertility

Tubal Sterilization

A surgical procedure in which the Fallopian tubes are cut, tied, or cauterized for permanent contraception

Cauterization

A sterilization procedure that involves the burning or searing of Fallopian tubes or vas deferens for permanent sterilization

Ligation

A sterilization procedure that involves the tying or binding of the Fallopian tubes or vas deferens

Vasectomy

A surgical procedure in which each vas deferens is cut, tied, or cauterized for permanent contraception

Outpatient Surgery

Surgery performed in the hospital or doctor's office, after which a patient is allowed to return home

Emergency Contraception

Contraception that is designed to prevent pregnancy after unprotected vaginal intercourse

Immunocontraceptives

Vaccines designed to suppress testicular function and eliminate sperm and testosterone production

Back-alley abortion

Illegal abortion, which was all that was available before the legalization of abortion in the 1970s

Parental Notification

Abortion legislation that requires the notification of the parents of a minor before an abortion procedure

Parental Consent

Abortion legislation that requires the consent of the parents of a minor before an abortion procedure

First-trimester surgical abortion

Termination of pregnancy within the first 16 weeks of pregnancy

Vacuum Aspiration

The termination of pregnancy by using suction to empty the contents of the uterus

Dilation Rods

A series of graduated metal rods that are used to dilate the cervical opening during an abortion procedure

Cannula

A tube, used in an abortion procedure, through which the uterine contents are emptied

Vacuum Aspirator

A vacuum pump that is used during abortion procedures

Second-trimester surgical abortion

Termination of pregnancy between the 16th and 21st weeks of pregnancy

Dilation and Evacuation (D&E)

A second-trimester abortion procedure that involves cervical dilation and vacuum aspiration of the uterus

Laminaria

Seaweed used in second-trimester abortion procedures to dilate the cervix. Used when dried, it can swell three to five times its original diameter

Mifepristone

Drug used in medication abortion procedures; it blocks the development of progesterone, which causes a breakdown in the uterine lining. Previously referred to at RU-486 in development

Misoprostol

A synthetic prostaglandin drug used for early abortion

Prostaglandin

Compounds that can cause changes in the smooth muscle cells, leading to strong cramps

Cervical Laceration

Cuts or tears on the cervix

Uterine Perforation

Tearing a hole in the uterus

Judicial Bypass Option

Abortion legislation that allows for a judge to bypass parental consent or notification for a minor to acquire an abortion

Pro-life Supporter

Individual who believes that abortion should be illegal or strictly regulated by the government

Pro-Choice Supporter

Individual who believes that the abortion decision should be left up to the woman and not regulated by the government

Several Factors Increasing Risk for Unintended Pregnancy

Being young, unmarried, or poor increases the risk for unintended pregnancy.

Factors Increasing Motivation to Use Contraception

Ability to communicate with a partner, cost, effectiveness rates, frequency of vaginal intercourse, motivation to avoid pregnancy, side effects, and openness about sexuality influence use.

Margaret Sanger

One of the first people in the United States to publicly advocate contraception.

Planned Parenthood

Organization founded by Margaret Sanger.

Global Factors Affecting Contraceptive Use

Social/economic issues, knowledge, gender roles, and religious views affect contraceptive use worldwide.

FDA Role

Approves all prescription medications and medical devices in the United States.

New Drug Application

Must show animal-test safety and enough safety to begin human trials.

Phase 1 Trials

About 20–80 healthy volunteers test safety/effects.

Phase 2 Trials

Several hundred people test the effectiveness, risks, and adverse effects.

Phase 3 Trials

Hundreds to thousands participate in expanded testing.

Medical Device Regulation

Devices such as IUDs are strictly evaluated and regulated.

Time to Develop New Contraceptive Method

Estimated 10–14 years.

Choosing a Contraceptive Method

Consider health, risks, number of partners, intercourse frequency, STI risk, responsibility, cost, and pros/cons.

Barrier Methods

Prevent sperm from entering the uterus. Includes condoms, cervical barriers, and contraceptive sponges.

Spermicidal Condoms

Lubricated with nonoxynol-9; use carries risks.

Leading Cause of Condom Breakage

Using expired condoms.

Advantages of Male Condoms

Discreet, STI protection, no prescription, inexpensive, minimal side effects, may reduce premature ejaculation, reduce postcoital drip, combine with other methods, usable during oral/anal sex.

Polyurethane Condoms

Longer shelf life and usable with oil- or water-based lubricants.

Disadvantages of Male Condoms

Reduced spontaneity, sizing/erection issues, reduced sensation, discomfort, slipping/bunching, embarrassment, and interruption of foreplay.

Original Female Condom

Reality Vaginal Pouch (“F”), made of polyurethane.

FC2 Female Condom

Newer softer, more flexible female condom.

Female Condom Structure

About 7 inches long with an inner insertion ring and an outer external ring.

Reddy / VA w.o.w. Condom

Latex female condom with sponge; available outside U.S., not FDA approved.

Female Condom Cost

About $3.50 each; may be free in clinics.

Advantages of Female Condoms

Discreet, STI protection, no prescription, reduces drip, latex-allergy friendly, oil lubricants allowed, breastfeeding-safe, no erection needed, stays in place if erection lost, usable for anal sex, may increase clitoral stimulation.

Disadvantages of Female Condoms

Difficult insertion, discomfort, expensive, reduced sensation, slipping, excess lubrication, noise, and may interrupt foreplay.

Types of Cervical Barriers

Include diaphragms and cervical caps.

Diaphragm History

One of the oldest contraceptives; most prescribed in U.S. in 1930.

Cervical Barrier Cost

Device $60–$75; exam $50–$200; spermicide $8–$10.

How Cervical Barriers Work

Block uterus's entrance and deactivate sperm with spermicide.