I. Abortion - Every child a wanted child?
A. Rates
- relatively stable since 1970- 1.6 million annually (about 29% of all pregnancies)
- 91% occur in 1st trimester; 9% 2nd trimester; .001 after 24 weeks
- about half of women seeking an abortion used contraception
- only 9% of women having abortions never used birth control
B. Risks of Illegal Abortion
- In 1965, illegal abortion accounted for 17% of all deaths due to pregnancy and childbirth
- when abortions were illegal, number of deaths was 8 times greater than death rate from legal abortions
- illegal abortions today-still exist, mostly African American and Hispanic women
C. Risks of Legal Abortion
- 11 times safer than carrying pregnancy to term
- vacuum aspiration method-no increased risk of infertility, ectopic pregnancy, miscarriage, stillbirth, infant mortality or complications
- NO increased risk for breast cancer
- Reactions-most common -relief & happiness
V. Legal Aspects of Abortion
A. Parental consent-often required for abortion
In contrast, in majority of states, a minor can consent to:
- placing a child for adoption (46 states + DC)
- prenatal care and delivery services (27 states +DC)
- medical care for a child (28 states + DC)
- treatment for STD's (49 states + DC)
- services for substance abuse (46 states + DC)
B. Abortion and Waiting Periods
- 8/10 women said they had already thought carefully about the decision and didn't need more time to think
- 93% said there was NO benefit from 24 hr. waiting period
- more 2nd trimester abortions occurred due to waiting period
C. Abortion Access now
- 85 % of all counties have no abortion services
- In 1988, 27% of women seeking abortion had to travel at least 50 miles; 9% had to travel more than 100 miles
- 19 states have 24 hr or more waiting periods
- 29 states have parental notification or consent
VI. Consequences of compulsory pregnancy and forced motherhood - Unwanted children
- more emotional handicaps
- do less well scholastically, low achievers
- twice as likely to have record of juvenile delinquency
- 4x as likely to have adult criminal record
- more likely to abuse alcohol and drugs
- 6x more likely to receive welfare between 16-21
- poorer relationships with parents
- higher risk to be abused or neglected by parents
- less happy with their lives
The Issue of Choice:
Every child a wanted child.
A. "Low tech" methods
1. Abstinence
2. Cyclical charting (Natural family planning)
b. Cervical mucus method - mucus that is clear, slippery, and stretchable peaks at ovulation
Advantages - health; religious or ethical ; low cost
Disadvantages
- high failure rate
- constant vigilance
- long avoidance of sexual intercourse
- impractical
3. Withdrawal
1. Typical failure rate is 19%
2. Advantage - man assumes responsibility
3. Disadvantages
- difficult for men to predict ejaculation
- pre-ejaculatory fluid can carry sperm
- requires discipline, motivation, and self-control
III. Barrier methods (prevent sperm and egg from meeting) - examples
A. Terms used: Effectiveness of contraception
1. Perfect use failure rate
2. Typical use failure rate
B. male condom
1. contraceptive sheath worn over erect penis
- Typical failure rate=16%, PUFR=3%
2. advantages:
- availability
- protection of STD's
- usually, no side effects
- male responsibility
3. disadvantages
- requires motivation and consistency
- condom can slip off
- penis must be withdrawn immediately after ejaculation
C. Female condom (pouch worn inside vagina)
1. can be inserted 8 hrs before intercourse
2. can't be used with male condom
3. advantages
- no side effects
- available
- moderate protection from STDs
4 disadvantages
- some loss of sensitivity
- requires motivation
- not as affect in preventing STDs as male condom
5. Typical failure rate=21%, PUFR=5%
D. Diaphragm
1. dome-shaped rubber device worn over cervix; proper use includes spermicide
2. Typical failure rate=18%, PUFR=6%
3. advantages:
- 6 hrs before intercourse to 24 hrs after
- used with spermicide, it reduces risk of STDs
- no hormones involved
- reduces risk of pelvic inflammatory disease (PID)
4. disadvantages:
- must be fitted by health professional
- must remain in place at least 6 hrs
- requires motivation and skill
E. Cervical cap
small, thimble-shaped soft rubber device that fits over cervix; used with spermicide
1. sperm=killing agents placed in vagina
2. various forms: foam, gel, suppositories
3. Most effective when used with another barrier method
G. Intrauterine device (IUD)
1. contraceptive device placed within uterine
2. prevents passage of sperm to fallopian tube
3. used to be thought that IUD's prevent implantation of fertilized egg in uterus
4. Typical failure rate=0.8-2%, PUFR=.1-1.5%, depending on brand
5. advantages
- requires little attention
- low cost after initial purchase
- progestin- or progesterone-releasing IUD decrease menstrual flow
6. disadvantages
- high initial cost
- no protection against STDs
- many possible problems: spontaneously expelled; ecotopic pregnancy, uterine wall perforation, infertility (less of a problem now?); spontaneous abortion
- some risk of PID
A. Combination oral contraceptives (birth control pills)
1. contraceptive hormones taken daily by mouth
2. combination of low estrogen to inhibit ovulation and progesterone to thicken mucus, inhibit ovulation, and hamper implantation.
3. pills vary in whether hormone levels are constant or change during cycle
4. Typical failure rate=3%, PUFR=1%
5. advantages:
- effective
- easy
- generally safe
- decreases menstrual cramps, shortens period
6. disadvantages
- must be taken daily
- cost
- effects from hormones
- can decrease milk production
- health problems for some women
- no protection from STDs
B. Progestin-only contraceptives - examples
use a synthetic progesterone that prevents ovulation
Norplant: placed beneath skin of are; effective up to five years - surgery can cause pain or problems
Depo-Provera: injected once every three months
Interrupts fallopian tubes by sealing tubes
B. Vasectomy (Part a and Part b)
1. cut and tie the vas deferens
2. Sperm still present up to 8 weeks after surgery
3. Typical failure rate= 0.15%; PUFR=0.1%
VI. Post-coital contraception - examples
A. "Morning after pill"
1. Two high dosages of hormones taken as soon as possible after intercourse
2. Not a good contraceptive solution
B. RU-486
1. Antiprogestorne drug that inhibits action of progesterone
2. Prevents implantation
3. Taken within 72 hrs of intercourse
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