Contraception: Self, Society, and Culture

Contraception is any process or method used to prevent conception or pregnancy. Abortion is not considered contraception.

The Comstock Act (1873) made it illegal to distribute information about contraception and devices.
Margaret Sanger (1879-1966) advocated for free love and sexual rights and is credited with coining the term "birth control."
- She campaigned to decriminalize contraception.
In 1965, the U.S. Supreme Court ruled Comstock laws unconstitutional.
The first oral contraceptive was approved in 1960.
Birth control was legalized for all citizens in 1972.
Emergency contraception became widely available in 1992.
Available methods continue to expand; however, access is not universal.

Contraceptive knowledge helps individuals understand:
- The reliability of different methods.
- The importance of consistent contraception use in preventing unintended pregnancies and STIs.
- How contraception can enhance sexual pleasure.
Withdrawal method: An unreliable method involving removing the penis from the vagina before ejaculation.

Desire for future children:
- Tubal ligation: A permanent surgical method in which a woman’s fallopian tubes are tied, cut, or blocked.
- Vasectomy: A permanent surgical method preventing sperm from mixing with semen by cutting or tying off the vas deferens.
Effectiveness of different methods:
- Failure rate: The number of women out of 100 who become pregnant within the first year of using a method.
- Typical failure rate: Reflects how people typically use a method.
- Perfect-use failure rate: Reflects the failure rate when a method is used consistently and correctly.
- Human error is a critical factor in evaluating effectiveness.
Other issues:
- Condom use is vital for STI protection, irrespective of the primary contraception method.
- Health problems or risk factors may limit method choices.
- Personal comfort level is a factor.
- Understanding sexual behavior is important because most contraceptives do not protect against STIs or HIV.

The effectiveness of different contraception methods varies from most effective to least effective:

Most Effective:
- Implants, IUDs, female sterilization: Little to do or remember after the procedure.
- Vasectomy: Use another method for the first 3 months.
Moderately Effective:
- Injectables: Get repeat injections on time.
- Pills: Take a pill each day.
- Patch, ring: Keep in place, change on time.
Least Effective:
- Condoms, diaphragm: Use correctly every time you have sex.
- Fertility awareness methods: Abstain or use condoms on fertile days. Newest methods (Standard Days Method and TwoDay Method) may be easier to use.
- Withdrawal, spermicides: Use correctly every time you have sex.

Abstinence or fluid-free sexual behaviors require a strong commitment.
- Continuous abstinence: Refraining from sexual intercourse completely.
- Selective abstinence: Avoiding specific sexual behaviors that could lead to pregnancy or STI transmission.
- Fluid-free sexual behavior: Avoiding the sharing or mixing of bodily fluids.
Barrier methods prevent sperm from reaching an egg.
- Male condom: A sheath made of latex, natural membrane, polyurethane, silicone, or other synthetic material.
  - Latex and polyurethane condoms are the only barrier methods that protect against STIs, including HIV.
- Female condom: A sheath made of latex or polyurethane worn internally by a woman.

Cervical barrier contraception methods use an object in combination with vaginal spermicide to cover the cervix.
- Four types available in the U.S.: diaphragm, cervical cap, Lea’s Shield, and FemCap.
Spermicides: Creams, foams, gels, suppositories, and films that kill sperm cells.
- They can be used alone or with a barrier method.

METHOD	HOURS BEFORE INTERCOURSE	HOURS AFTER INTERCOURSE
Diaphragm	up to 6	at least 6; no more than 24
Cervical cap	up to 6	at least 8; no more than 24
FemCap	up to 8	at least 8; no more than 48
Lea’s Shield	up to 8	at least 8; no more than 48

Female hormonal methods alter a woman’s ovulation cycle or reproductive tract.
- Prevent ovulation, thicken cervical mucus, or alter the uterine lining to prevent implantation.
Oral contraceptives: Pills containing female hormones taken daily to prevent pregnancy (birth control pills).
- Combination pills: Combine estrogen and progestin (monophasic, biphasic, and triphasic).
- The minipill: Contains progestin only, for breastfeeding women or those with certain health conditions.
Hormonal implants: Small tubes of progestin inserted under the skin of a woman’s upper arm.
Injectable contraceptives (Depo-Provera): Provide protection for up to 14 weeks.
A patch (Ortho Evra): Releases hormones through the skin.
The vaginal ring (Nuva-Ring): Delivers hormones over a 3-week period.
Emergency contraception (EC): Concentrated hormonal pills to prevent unplanned pregnancy after unprotected intercourse.
- Plan B is the most common form.

Intrauterine device (IUD): A T-shaped plastic device containing hormones or copper placed in the uterus.
- Hormonal (progestin): Mirena, Kyleena, Liletta, and Skyla.
- Copper: ParaGard T-380A.

Sterilization, or voluntary surgical contraception (VSC): Surgically blocks sperm cells from fertilizing an ovum.
- Laparoscopy: Small incisions for inserting a viewing scope and surgical instruments.
- Vasectomy: Cutting and blocking the vas deferens.

Research shows two factors associated with a reduction in abortion:
- Better sexual literacy.
- Access to preventive health care for family planning.
Removing choice may increase unintended pregnancy and abortion.
Advocates for contraception have two goals:
- Greater access.
- More choice.
New forms of contraception are being developed, including hormonal methods for men.
Contraceptive decisions protect sexual health and maximize pleasure.