CONTRACEPTION

John B. Pryor, Ph.D.John B. Pryor, Ph.D.ILLINOIS STATE UNIVERSITYILLINOIS STATE UNIVERSITY

DEPARTMENT OF PSYCHOLOGYDEPARTMENT OF PSYCHOLOGY

Who needs contraception?

62 million U.S. women in childbearing years (15-44)

Of these 7 out of 10 are sexually active and do not want to become pregnant

Typical U.S. woman wants 2 children and therefore must use contraceptives for 3 decades of her life

Source: Alan Guttmacher Institute 2006

Who uses contraception? 98% of U.S. women who have had sex have

used at least one form of contraception 89% of women who do not want to become

pregnant are using some form of contraception

Method choice varies by age For women younger than 30, the pill is the

leading method By the time women reach 35, sterilization is

more common Source: Alan Guttmacher Institute 2006

Contraceptive method choice among U.S. women who practiced

contraception in 2002

30.6

27

18

9.2

5.3

42

1.2

1.2

0.4

0.3

0.9

Pill

Tubal sterilization

Male condom

Vasectomy

3-month injectable

Withdrawal

IUD

Calendar

Implant, 1-mon injectable, patch

Periodic abstinence

Diaphragm

Other

Source: Alan Guttmacher Institute 2006

Survey of 38,109 U.S. women

What do college What do college students use for students use for contraception?contraception?

8.3

7.3

19.1

7.6

1.4

26.8

29.5

Some other method

Withdrawal

Diaphram or sponge

Condoms

Birth control pills

Nothing or not sure

No sex

Form of ContraceptiveUsed by Illinois CollegeFemales the Last TimeThey Had SexualIntercourse

8.4

4.5

20.4

8.6

2.5

32.7

22.8

Some other method

Withdrawal

Diaphram or sponge

Condoms

Birth control pills

Nothing or not sure

No sex

Form of ContraceptiveUsed by Illinois CollegeMales the Last TimeThey Had SexualIntercourse

Some facts Some facts about common about common

forms of forms of contraception.....contraception.....

Methods of Birth Control - Methods of Birth Control - typical failure ratestypical failure rates

0.00% - Abstinence0.00% - Abstinence

0.15% - Sterilization - Males0.15% - Sterilization - Males

0.50% - Sterilization - Females0.50% - Sterilization - Females

27.0% - Withdrawal27.0% - Withdrawal

85.0% - No Method85.0% - No Method

Depo-Provera

Depo-Provera is a synthetic hormone that is injected into the buttock or arm every 12 weeks. The hormone keeps the ovaries from releasing eggs. It also thickens the cervical mucus. This keeps sperm from joining with an egg.

Typical failurerate = 3%

The Intrauterine Device (IUD)

IUDs are small devices made of plastic that contain copper or a natural hormone. IUDs usually work by preventing fertilization of the egg. They also may work by affecting the way sperm or eggs move or by affecting the lining of the uterus in ways that prevent implantation.

Typical failurerate = 0.1-0.8%

The PillCombined pills keep the ovaries from

releasing eggs (ovulation). Mini-pills can also prevent ovulation. But they work mainly by thickening the cervical mucus. This prevents the sperm from joining with the egg. Mini-pills may also prevent fertilized eggs from implanting in the uterus.

Typical failurerate = 8%

Birth Control PatchBirth Control Patch

Typical failurerate = 1.3%

The contraceptive patch contains hormones similar to those in birth control pills. You must change your patch once a week for three consecutive weeks. You do not need to apply a patch during the fourth week.

The RingThe vaginal contraceptive ring consists of a

flexible, transparent, colorless vaginal ring about 2.1 inches in diameter containing the hormones etonogestrel and ethinyl estradiol, which are similar to the active ingredients in some oral contraceptives. After the ring is inserted, it releases a continuous low dose of the hormones. A new ring is used each month for continuous contraception A woman inserts the ring herself, and it should remain in the vagina for three weeks. She then removes the ring for one week during which she will have her menstrual period.

.

.

Typical failurerate = 5%

The Condom

barrier method added protection if used with

spermicide reccomended model - latex with

reservoir tip use water-based lubricants only

Typical failurerate = 15%

Putting on a condomPutting on a condomPut a drop or two of Put a drop or two of lubricant inside thelubricant inside the condom. condom. Place the rolled condomPlace the rolled condom over the tip of the over the tip of the hard penis. hard penis. Leave a half-inch space Leave a half-inch space at the tip to collect semen. at the tip to collect semen. If not circumcised,If not circumcised, pull back the foreskin pull back the foreskin before rolling on the before rolling on the condom. condom.

Putting on a condom (continued) Putting on a condom (continued) Pinch the air out of the tip Pinch the air out of the tip with one hand. (Friction againstwith one hand. (Friction against air bubbles causes air bubbles causes most condom breaks.) most condom breaks.) Unroll the condom over Unroll the condom over the penis with the other hand. the penis with the other hand. Roll it all the way down toRoll it all the way down to the base of the penis. the base of the penis. Smooth out any air bubbles. Smooth out any air bubbles. Lubricate the outside of Lubricate the outside of the condom. the condom.

DiaphramDiaphragms and cervical caps are soft rubber barriers

that are intended to fit securely over the cervix. Both are used with a spermicide cream or jelly. Each blocks the entrance to the uterus, and the jelly or cream immobilizes sperm, preventing it from joining the egg.

CervicalCap

The Diaphragm & Cervical Cap

Typical failurerate =16-32%

FemaleCondom Typical

failurerate = 21%

Foam, Jelly, Film, Suppository

contain spermicide barrier method must be reapplied for each

subsequent intercourseTypical failurerate = 29%

Fertility Awareness Methods

trying to predict peak fertility times & avoiding intercourse during those times

three methods of prediction basal body temperature method cervical mucus method calendar or "rhythm" method

Typical failurerate = 25%

Emergency Contraception Post-Coital ContraceptivesPost-Coital Contraceptives

– morning after pill (e.g., Preven & Plan B)- Emergency contraception (EC) consists of the same hormones

found in ordinary birth control pills.

– within 72 hours of unprotected intercourse– Side-effects: nausea, vomiting, and cramping– 20-25% become pregnant

Like regular contraceptive pills, Plan B generally acts by preventing ovulation or fertilization, according to the F.D.A. Plan B may in rare circumstances prevent a fertilized egg from becoming implanted, something abortion opponents decry. But regular oral contraceptives do that, too.

Emergency Contraception The U.S. Food and Drug Administration

(FDA) announced on August 24, 2006 the approval of Plan B as an over-the-counter (OTC) option for women aged 18 and older. Plan B will remain available as a prescription-only product for women age 17 and under.

As much as 43% of the decline in abortion between 1994 and 2000 can be attributed to the use of emergency contraception.

Reasons for Emergency ContraceptionReasons for Emergency Contraception His condom broke or slipped off, and he ejaculated

inside your vagina. He forced you to have unprotected vaginal

intercourse. Your diaphragm or cervical cap slipped out of

place, and he ejaculated inside your vagina. You miscalculated your "safe" days for periodic

abstinence or fertility awareness methods.

Reasons for Emergency Reasons for Emergency Contraception (continued)Contraception (continued)

You forgot to take your birth control pill more than two days in a row.

You weren't using any birth control. He didn't pull out in time.

RU 486 (RU 486 (Mifepristone)Mifepristone)

Mifepristone is an anti-progesterone that blocks uterine receptors of progesterone, a hormone critical for the maintenance of pregnancy.

In early pregnancy, a 600 mg dose of mifepristone is administered by a clinician. Two days later, a clinician administers 400 mg of another drug, misoprostol, to induce contractions. This method terminates pregnancy in about 92% of cases.

life-time failure ratelife-time failure rate

LTF = 1 - (1 - AFR)years

pill (8%) LTF (pill) = 1 - (1 - .08)30 = 92%condom (15%) LTF (condom) = 1 - (1 - .15)30 > 99%

30 years of reproduction ( age 17-47)

ALMOST ALL COUPLES WILL ULTIMATELY ALMOST ALL COUPLES WILL ULTIMATELY HAVE A PREGNANCY EVEN IF THEY USE HAVE A PREGNANCY EVEN IF THEY USE BIRTH CONTROL BIRTH CONTROL