The document provides information about various methods of birth control, including their effectiveness and typical failure rates. It discusses that most forms of female birth control place responsibility on women, though men can help share responsibility. Methods described include diaphragms, cervical caps, spermicides, female and male condoms, fertility awareness methods, pills, implants, shots, IUDs, tubal ligation, vasectomy, and abstinence. It concludes by asking if birth control pills should be available over-the-counter and how they should be regulated.

1. Chapter 18:birth control Sarah Wall 6/13/11

2. “Reproductive choice is every woman’s right” .

3. Men, Women, and Birth Control Most women and men believe that the responsibility for birth control should fall on women, but this is inappropriate and unfair. This can cause pressure on women because we usually have to do everything involving it including doctor’s visits, prescriptions, drug store visits, and even the physical effects. But a man can share the responsibility as well. He can use condoms if no other method is available at the moment, help pay for doctors visits and prescriptions, remind us to take the Pill each day, help to put in certain methods, and check supply availability. When a man is willing to help with these things, it often makes the women feel better about herself and more respected.

4. Choosing a birth control method .

5. Diaphragm with Spermicidal Jelly/Cream The diaphragm is made of soft rubber in the shape of a shallow cup. It must always be used with a spermicidal cream or jelly. When properly fitted and inserted, it fits snugly over your cervix. The diaphragm is completely safe, but there is still about a 20% failure rate.

6. Cervical Cap A small thimble-shaped rubber cap that fits snugly over the cervix. It blocks sperm from entering the cervical opening. A spermicide is usually used on the cap. The typical failure rate is 20% for women who have never given birth. But if you have given birth, this method is less effective.

7. Vaginal Spermicides Designed for use with diaphragm, cervical cap, and extra protection with condoms. The active ingredient is nonoxynol-9, a detergent that kills sperm. There are jellies, foams, creams, and suppositories. Creams and jellies are deposited just outside the entrance to your cervix at the top of the vagina.

8. Female Condom Consists of a soft, loose fitting polyurethane sheath, which is closed at one end (covering the opening of the cervix). The opened end remains outside the vagina creating a passageway for the penis and also a barrier between the labia and the base of the penis. It has a failure rate of about 21%, but gives more protection against STD’s, including HIV.

9. Male Condom Is a sheath made of thin, strong latex rubber, designed to fit over an erect penis to keep semen from getting into a women’s vagina. Can also be combined with spermicidal jellies for a more protection. Typical failure rate is about 14% but can also greatly prevent STD’s including HIV infection.

10. Natural Fertility Observation A simple, accurate way to understand when you can and cannot become pregnant as your cycle unfolds. Based on changes in your own fertility signs. 1. Cervical fluid – tells when fertility begins and ends in each cycle. Fertility begins when cervical fluid appears, and lasts through the evening of the fourth day past the cervical fluid peak. Ovulation occurs anywhere from two days before to two days after this peak day. 2. Basal body temperature (BBT) – indicates ovulation after it has occurred, identifies postovulatory infertile days, and confirms pregnancy. Temps are lower before ovulation, 97o to 97.5oF, and higher afterward, 97.6o to 98.6oF. A sustained rise (up to 3 days) of at least 4/10 of a degree confirms that ovulation has occurred. If the BBT remains elevated for more than 17 days, pregnancy is confirmed. 3. Cephalad shift (cervix changes) – represents a change in position and feel of the cervix. When you are fertile, the cervix becomes softer and higher, and the opening widens. When the cervical fluid changes from wet to dry, the cervix becomes lower, and less open.

11. The Pill Combination pills prevent pregnancy by inhibiting the development of the egg in the ovary. There are three different types of pills. There is the monophasic, which has constant doses of estrogen and progestin during the whole cycle. There is the biphasic, which has 2 phases during the cycle. They provide less progestin during the first 10 days, and more in the next 10 days. The estrogen dose remains the same during the whole cycle. There is also the triphasic, which has 3 phases. In each third of the menstrual cycle, the amount of progestin varies, or the amount of progestin and estrogen varies. In all triphasic pills, the amount of progestin slowly increases throughout the cycle. There is a typical failure rate of about 5%. Pregnancy is more likely if you forget to take a pill. Can be combined with other methods like condoms.

12. Norplant Consists of 6 match-size flexible rubber capsules, each containing the synthetic progestin levonorgestrel. They are inserted in the fleshy part of the upper arm, just under the skin, by a qualified specially trained practitioner. The hormone is slowly released through the walls of the capsules until they are removed. It is designed to last for up to 5 years. Norplant is extremely effective, with a failure rate of 0.05% in the first year, 0.5% in the second, 1.2% in the third, 1.6% in the fourth, and 0.4% for the fifth year. The overall failure rate for five years of continuous use is 3.7%.

13. Depo-Provera A progestin only hormonal contraceptive. It is administered as a deep intramuscular injection of 150mg every 3 months, but actually provides up to 14 weeks of protection. Depo-Provera works by preventing ovulation, and thickening cervical fluid, making a barrier to sperm. In the first year of use, there is a 0.3% failure rate. This method can lead to delays in the return on fertility when discontinued.

15. Vasectomy Male sterilization is a simple process. It also takes about 30 minutes, but can be done in a doctor’s office or clinic. The practitioner applies a local anesthetic and makes one or two small incisions in the scrotum, locates the two vasa deferentia, or the tubes that carry the sperm from the testes to the penis, removes a piece of each, and ties off the ends. Men are not sterile immediately because sperm are already in the vasa deferentia. Another use of birth control is highly recommended for 2 months after the procedure.

16. Abstinence Abstinence means making love without having intercourse. It is the most effective form of birth control. It has been used for centuries and is still very common.

17. Something to think about… Do you think that birth control pills should be offered as an over the counter medication? If yes, how do we regulate guidelines as to who can and cannot purchase? (ex. Should there be an age limit?)