Roe v. Wade

• In the 1973 Roe v. Wade decision, the U.S. Supreme Court ruled that a woman, in consultation with her physician, has a constitutional right to choose abortion in the early stages of pregnancy-that is, before viability. (24 weeks)

Abortion Control Act• In 1982, Pennsylvania passed the Abortion

Control Act. This Act required women to give:

1. Informed consent before abortions could be performed.

2. Imposed a 24-hour waiting period upon women seeking abortions, during which time the women would be provided with information regarding abortions.

Abortion Control Act

3. The act also provided that minors seeking abortions first obtain informed consent from their parents, except in cases of "hardship," in which a court could waive this requirement.

4. Except in "medical emergencies," a wife seeking an abortion must inform her husband of her plans prior to the procedure.

Abortion Control Act

5. Finally, the act required that all Pennsylvania abortion clinics report themselves to the state.

Planned Parenthood v. Casey

In 1992, Planned Parenthood of Southeastern Pennsylvania filed a lawsuit against the state, arguing that the Abortion Control Act violated the Supreme Court's ruling in Roe v. Wade.

The Court upheld Roe v. Wade and a woman’s basic right to abortion.

New Jersey Law

• No parental involvement/notification required for girls 12 years and older.

• No waiting period

Medical Abortion

• Abortion Pill

• 63 days or 9 weeks (Trimester #1)

• 97 % effective

• In the case that the medical abortion does not work a aspiration abortion / in-clinic abortion is required

• Medical Abortion Cost: $300.00-$800.00

Medical Abortion: Step 1

• RU-486 name under development – Mifepristone (1st pill) will be taken at a

clinic as well as other antibiotics

• Inhibits progesterone, which breaks down the uterine lining

Medical Abortion: Step 2

Misoprostol (2nd by mouth or vaginal suppository)

• Promotes uterine contractions

• Will cause you to have cramps and bleed heavy

• May see large blood clots or tissue at the time of the abortion

Step 2 - Continued

• Most women abort within 4-5 hours, but some take up to a few days.

• Bleeding or spotting may continue for up to four weeks after taking the Misoprostol.

Step 3

• You must have a follow up visit within two weeks. This is to make sure that the abortion is complete and you are well. An ultrasound will be completed at this time.

• If you are still pregnant you may require an aspiration abortion or in-clinic abortion .

In-Clinic Abortions

• Cost: $300-$950.00

• Most common: Vacuum aspiration and D&E (dilation and evacuation)

• Up to 16 weeks

Aspiration Abortion

• Uterine exam

• Pain medication

• Speculum inserted into the vagina

• Numbing medication for the cervix

• Cervix stretched with dilators – series of increasingly thick rods

• Tube inserted into uterus

• Suction device empties uterus

Aspiration Abortion

• At times a curette is used to remove any remaining tissue that lines the uterus

• Time required: 5-10 minutes

D&E Dilation and Evacuation

• Same as an aspiration abortion, however depending on trimester you may require a shot through your abdomen to be sure that there is fetal demise before the procedure begins.

• Time requirement: 10-20 minutes

Emergency Contraception

• Morning After Pills

1. Preven ($50.00 - $70.00)

2. Plan B ($49.99 or Sliding Scale Cost)

3. Levonorgestrel ($39.99)

Emergency Contraception

• Must be 17 years of age or older to purchase without a prescription

• 72 hours after accident

• Effectiveness: 75%-89%

Ancient Birth Control MethodsBeaver-Testicle Tea

Dances, Amulets, Rituals & Myths

• Squatting or kneeling to provoke sneezing

• Jumping backwards seven times

• Leather pouch containing a cat’s liver on the left foot

• Spitting in a frogs mouth three times

• Inserting a finger into the vagina and “swishing it around” after intercourse

Dances, Amulets, Rituals & Myths

• Soranus - Ancient Greek Doctor of Gynecology– Determined that women were fertile during

ovulation and promoted the rhythm method. Unfortunately, he assumed that ovulation occurred during menstruation.

Spermicides, IUDs, Pessaries, & Douches

• Dried cow, elephant, & crocodile dung mixed with honey

• Ground dates, acacia tree bark, & honey blended into a paste

• Dried fish or cotton soaked with lemon

• Half lemons with the juice squeezed out

• Glass or metal diaphragms

Spermicides, IUDs, Pessaries, & Douches

• IUDs invented by Arabs would placed pebbles in the uteruses of their camels

• 1920 – German gynecologist Ernest Grafenberg developed the first IUD for humans, which was made from silkworm gut and coiled wire.

• Seaweed, leaves, wooden blocks, and apricot pits were also used to block the cervix

• Vinegar injected into the vagina

Douche French term for soak or wash

Douche Bag Douche Can

Coitus Interruptus

• “Pull out” or withdrawal method

• When a man withdraws his penis from a woman prior to ejaculation

• 80% Effective

• Couples in monogamous relationships who do not have to worry about STIs or caring for a child.

Breastfeeding

• Suppresses fertility

• Breastfeeding can provide up to 98% effective contraception if three criteria are met:

- The mother has not experienced the return of her menstrual periods

- The mother is fully or nearly fully breastfeeding

- The baby is less than six months old.

Evolution of the Condom

• Latin word "condus" which means "vessel”

• Oiled silk paper, linen sheaths, sheep intestine, snake skin leather, or very thin hollow horn

Condoms Today

• Condoms can be found in a variety of shapes, sizes, colors, flavors and textures. Many condoms also contain lubricants, spermacides and a reservoir tip.

• Condoms that play music when they break– “Dixie,” “The Anniversary Waltz,” “Happy

Birthday to You,” & the “1812 Overture”

Steps to Success1. Sexual Arousal

2. Erection

3. Leave room at the tip & squeeze out any air

4. Roll on condom

5. Intercourse

6. Hold onto the base/rim of the condom

7. Withdrawal the penis

8. Orgasm

9. Loss of erection

10. Relaxation

Barrier Methods

Male Condom

• Made of latex or polyurethane• Single use barrier method that blocks sperm

from entering the female• Approximately 86%-97% effective• Some protection against STIs • Over the counter

• Inexpensive• May leak, break, or interfere with spontaneity

Female condom

• Rubber sheath with a flexible ring that is inserted in to the female

• Single use barrier method that blocks sperm from entering the female

• 79%-95% effective• Some protection against STIs • Over the counter

• May leak, break, or interfere with spontaneity• More difficult to use

What You Need to Know About Nonoxynol-9

• N-9 is the active ingredient in all of the over-the-counter (OTC) spermicidal products available in the U.S. and has been used for pregnancy prevention since the 1950s. An Advisory Review Panel of the Food and Drug Administration (FDA) has deemed N-9 a safe and effective contraceptive.

N-9• Mechanism of Action• N-9 is the active ingredient in all OTC spermicidal

products in the U.S. N-9 is a chemical detergent that damages sperm cell membranes, killing the cells.

• N-9 is marketed and sold as a spermicidal contraceptive product in several different formulations, including:

• - Suppositories - Foam - Film - Gel - Cream

N-9 USE

• Diaphragms and cervical caps are FDA approved for use in conjunction with spermicidal gels and creams. Also, some condoms include a spermicidal lubricant.

N-9 USE RECOMMENDATIONS FROM WHO & CDC

• N-9 can be used as a contraceptive, alone or in combination with a cervical barrier method, and among women at low risk of HIV/STI infection (Use the product no more than once daily.)

• N-9 should not be used for the purpose of HIV/STI prevention.

• N-9 should not be used for contraception by women at high risk of HIV infection.

N-9 USE RECOMMENDATIONS FROM WHO & CDC

• Condoms with N-9 should not be promoted for disease prevention. (However, it is better to use N-9-lubricated condoms than no condoms at all.)

• N-9 should not be used rectally.

Contraceptive foam, film, suppositories

• Available over the counter

• Must be inserted close to time of intercourse

• Limited or no STI protection

• 74%-94% effective

Diaphragm • Dome-shaped rubber disk that covers the cervix so

sperm cant reach the uterus• Best if used with a spermicide• 80%-94% effective • Inserted before intercourse, left in for at least 6 hours • Can be used multiple times• Uncomfortable to use• Has to be fitted• Limited protection against STDs

Cervical Cap

• Soft rubber cup with a round rim which fits around the cervix

• 80%-94% effective

• Hard to insert

• Can remain in place for up to 48 hours without being removed

Hormonal Contraception

IUD (Intrauterine device)

• A T-shaped device inserted into the uterus by a doctor

• Can last from 1 to 10 years

• About 2 in 100 pregnancies a year

• May result in ectopic pregnancies in the fallopian tubes

Combination Pill

• Effectiveness

• Adult Users 99.7%

• Actual effectiveness: 92 %– Forget to take a pill daily– Eating disorders

Combination Pill

• Benefits – regular cycle every 28 days, reduces cramps and flow, reduces risks of uterine and ovarian cancer and other diseases

• Side Effects – nausea, headaches, weight gain, fluid retention, bleeding between periods, depression, mood changes, changes in vision, dizziness, yeast infections, and smokers increase chances of stroke and heart attack

• Who should not use it – heavy smokers, suffer from severe depression, get migraines, have had blood clots, cancer or blood diseases

• Cost – Depends on insurance coverage

Extended Cycle Pill

• Prevents ovulation, changes lining, difficult for fertilized ovum to implant, thickens the cervical mucous

• Only four period per year• 99% effective• Advantage for women who suffer from severe cramping or

PMS• Side Effects – irregular bleeding, fluid retention (hands

and feet), raise blood pressure, nausea, vomiting, headache, vision, appetite, depression infections and allergic reactions

• Who should not use it – same as mini and combo pill users• Cost - $100 to $120 for three months

Nuva Ring

• It is a small, flexible ring that is inserted into the vagina once a month

• It is left in place for three weeks and taken out for the remaining week

• The Ring releases synthetic estrogen and progestin to protect against pregnancy for one month.

Vaginal Ring

• Small, flexible, plastic ring that is about 2 inches wide• Placed in the vagina each month and releases

hormones similar to those in birth control pills• Prevents ovulation, removed after three weeks, after

having a menstrual period insert a new one• Effectiveness – 98-99%• Benefits – regular menstrual period, shorter and

lighter flow• Side effects – bleeding between period, nausea,

headaches, weight gain or loss, mood changes

Vaginal Ring

• Who should not use it– Smokers, High Blood Pressure, CVD, liver

disease, cancer

– Cost - $30-35 a month

Ortho Evra (patch)

• Patch worn on the lower abdomen or on the upper body

• Releases progestin and estrogen into the bloodstream

• Less effective for women weighing more than 198 pounds

• New patch applied once a week for 3 weeks, 4th week no patch is worn so female can have her menstrual period

Skin Patch

• Hormones are released to prevent ovulation from occurring, mucus thickens, ovulation returns three months after the patch is last used

• Effectiveness – 99% in women who weigh 198 pounds or less

• Other benefits – menstrual cycle regular, shorter and lighter flow

• Side effects – bleeding between periods, nausea, headaches, weight gain or loss, mood changes

• Who should not use them – Same as others, include history of blood clots

• Cost - $30-$35 a months

Norplant (Implant)

• 6 matchstick sized rubber rods implanted under skin of the upper arm

• Steadily releases a contraceptive steroid levonorgestrel

• Very effective. About 1 in 100 pregnancies• Lasts for 5 years • Reversible• Expensive• No STD protection

Depo-Provera (injection)

• Injectable progestin that prevents ovulation• Prevents sperm from reaching egg and

keeps egg from implanting in the uterus• Less than 1 out of 100 pregnancies• 1 injection every 3 months• Not safe against STDs• Fertility may take a few months to get back

to normal

MISCELLANEOUS

WITHDRAWAL

• pregnancy is possible if sperm are ejaculated on or into the vagina

• not effective against sexually transmitted infections

WITHDRAWAL

• ADVANTAGES• can be used when no other method is available • POSSIBLE DISADVANTAGES• requires great self-control, experience, and trust • not for men who ejaculate prematurely • not for men who don’t know when to pull out • not recommended for teens

No Method No Protection

• Free

• No protection against pregnancy

• No protection against STDs

ABSTINENCE • 100% EFFECTIVE• ADVANTAGES • No medical or hormonal side effects • Easy to use • Prevents sexually transmitted infections• 100%FREE• POSSIBLE DISADVANTAGES• many people find it difficult to abstain from sex • many people fail to use protection when abstinence ends • A commitment required by both people• Peer pressure

STERILIZATION• ADVANTAGES• permanent protection against pregnancy • no lasting side effects • no effect on sexual pleasure • protects women whose health would be seriously

threatened by pregnancy • POSSIBLE DISADVANTAGES• risks of minor surgery if incision is made • some people later regret not being able to have

children • not usually reversible if you change your mind • rarely, tubes reopen, allowing pregnancy to occur

STERILIZATION

• Tubal sterilization — intended to permanently block woman's tubes where sperm join egg

• Vasectomy — intended to permanently block man's tubes that carry sperm

• 99.5-99.9% EFFECTIVENot effective against sexually transmitted infections — use latex or female condoms to reduce the risk.

STERILIZATION• Tubal sterilization o bruising if incision is made o very rare injury to blood vessels or bowel o pregnancies that rarely occur are more likely to be

ectopic (in a fallopian tube) • Vasectomy o infection or blood clot in or near the testicles o temporary bruises, swelling, or tenderness of the scrotum • sperm leakage may form temporary small lumps near

testicles

STERILIZATION

• COST$2,000-$6,000/ tubal sterilization240-$520/ vasectomy(Vasectomy costs less because it is a simpler procedure that can be done in the clinician’s office.)

OUTERCOURSE

• NEARLY 100% EFFECTIVE• pregnancy is possible if sperm are ejaculated

on or inside the vagina• reduces the risk of many sexually transmitted

infections — unless body fluids are exchanged through unprotected oral or anal intercourse.

Outercourse

• ADVANTAGES

• no medical or hormonal side effects

• may prolong sex play and enhance orgasm

• can be used when no other methods are available

Outercourse

• POSSIBLE DISADVANTAGES

• many people find it difficult to abstain from vaginal intercourse

• many people fail to use protection from pregnancy or infections if intercourse takes place

Fertility Awareness Methods

• Nothing to purchase

• Permitted by some religious groups that don’t allow other methods

• Requires commitment to other person

• No intercourse during menstrual cycle

• 80%-99% effective if done correctly

Facts to Know About Birth Control Methods

• How it works: the way the birth control methods works to prevent pregnancy

• Instructions for correct use: directions for using the birth control method the right way

• Effectiveness: – Theoretical Effectiveness: % that tells how well birth control

works if adult users use it the correct way every time and have no preexisting conditions that reduce how well it works

– Actual user Effectiveness: % that tells how well birth control works if adult users do not use it in the correct way and have no conditions that reduce how well it works

Facts To Know

• Other Benefits from correct use: benefits from the birth control method that are in addition to its use to prevent pregnancy

• Side Effects: unwanted changes, including health risks, that might occur when the birth control method is used

• Who should not use: a list of cautions that identify users who should not use the birth control method because it might cause health risks or might be inappropriate

• Cost: an estimate of how much money the birth control method will cost

Kinds of Birth Control methods

• Abstinence from Sex• Oral Contraceptives - Combination Pill, Progestin Only

Pill, Extended-Cycle Pill• Vaginal Ring• Injectable Contraceptives – injectable Progestin• Skin Patch• Barrier Methods – Spermicides, Diaphragm, Cervical cap,

Male and Female Condom• Fertility Awareness Methods – basal Body Temperature

Method, The Calendar Method, The Mucous Method• Sterilization – Tubal Ligation (Female), Vasectomy (Male)• Unreliable Methods – The Douche and Withdrawal