Unit 5: Contraception

WOMEN’S HEALTH: A PUBLIC HEALTH PERSPECTIVE

Lecture Objectives

 Define contraception

 Describe different contraceptive methods

 Understand the difference between perfect use and typical use

 Understand a variety of issues important in choosing a contraception option

1 Contraception

Definitions

 Contraception  Any procedure used to prevent fertilization of an ovum  Family Planning  Timing and spacing of children   Procedures that prevent the birth of a baby (could include a number of contraceptive measures)

2 Four Ways Birth Control Happens

1. Preventing from entering the reproductive tract 2. Preventing sperm from fertilizing ovum once it has entered the reproductive tract 3. Preventing ovulation/ preventing the ovum from reaching the sperm 4. Preventing progression or implantation of a fertilized ovum

3 Contraception and Public Health

The Importance of Contraception

 CDC recognizes contraception as one of the 10 great public health achievements of the last century.  Fewer children  Spaced births  Healthier infants, women, and children  Enabled women’s advancement in society

4 Alan F. Guttmacher (1898-1974)

“No woman is completely free unless she is wholly capable of controlling her fertility and…no baby receives its full birthright unless it is born gleefully wanted by its parents.”

Who Uses Contraceptives?

 Virtually all women  99% of women aged 15-44 who have ever had intercourse have used at least one method.

 Contraceptive use has grown.  56% of women in 1985  76% of women in 2000- 2004  84% of women in 2005- 2008

5 Who Uses Contraceptives?

 Overall, 62% of 62 million women aged 15- 44 are currently using a contraceptive method.

 Among the 43 million fertile, sexually active women who do not want to become pregnant, 89% are practicing contraception.

Which Methods Are Used?

Other, 2.8 , Injectable, 3.8 2.2 Withdrawal, 5.2

IUD, 5.6 Pill, 27.5

Male Ster., 10

Condom, 16.3 Female Ster., 26.6

6 Non Contraceptive Purposes

 14% of oral contraception (OC) users do so exclusively for non contraceptive reasons.  33% of teens use OC for non- contraceptive reasons.

Efficacy

7 Contraceptive Efficacy

 Consistency and correct use are the MOST IMPORTANT factors for efficacy

 Perfect Use  The highest efficacy ever reached in a reputable clinical trial

 Typical Use  Rate based on an analysis from reputable studies for typical users

First Year Contraceptive Failure Rates

Method Perfect Use% Typical Use% Pill (Combined) 0.3% 8.7% Tubal 0.5% 0.7% 0.1% 0.2% Male 2.0% 17.4% 3-Month Injectable 0.3% 6.7% Withdrawal 4.0% 18.4% IUD Copper-T 0.6% 1.0% IUD Mirena 0.1% 0.1% 1- Month Injectable .05% 3.0% Diaphragm 6.0% 16.0% 5.0% 27.0%

8 First Year Contraceptive Failure Rates

Method Perfect Use% Typical Use% Sponge - Had child 20.0% 32.0% Sponge – Never Child 9.0% 16.0% Cervical Cap- Had Child 26.0% 32.0% Cervical Cap -Never Child 9.0% 16.0% 18.0% 29.0% Abstinence 0% 0.1% Calendar 9.0% 25.0% Ovulation Method 3.0% 25.0% Thermal 2.0% 25.0% No Method 85.0% 85.0%

The Need for Contraceptives

 62 million women are of reproductive age

 7 in 10 are sexually active and DO NOT want to become pregnant

 The “typical” woman only wants 2 children  To achieve this goal, she must use contraceptives for roughly 3 decades of her life.

9 How to Choose a BC Method Best for You

1. Evaluate Needs 2. Review Medical History 3. Review Reproductive History 4. Weigh Risks and Benefits 5. Reevaluate Decision Periodically

Economic Perspectives

 Important economic consequences  Contraceptive costs for a couple

 Contraceptive issues with healthcare plans

 Cost/benefits to society compared to unintended outcomes

10 Contraceptive Costs Low Reliability OptionsEconomic Perspectives Abstinence Free Free Better Reliability Options Cervical Cap $30-$60/year $150/year Diaphragm $60/year, plus doctor visit Vaginal Sponge $500/year Best Reliability Options Birth Control Pills or Patch $160-$600/year Injectables $220-$460/year Sterilization $1500-$6000, but effective for years Vaginal Ring $160-$600, plus doctor visit IUD $500-$1,000 initial cost, but can last up to 12 years

Economic Perspective

 19.1 million women in need

 Gov’t funding provide family planning services to women in need

 Good Return on Investment (ROI)

11 Test Your Knowledge

Which is not a fertility awareness method of contraception?: A. Calendar Method B. Method C. Method D. Cervical Mucus Method

Test Your Knowledge

The diaphragm is an example of what time of broad category of contraceptive method: A. Fertility Awareness B. Hormonal C. Barrier D. Permanent

12 Test Your Knowledge

True or False. More than one method of contraception can be used at once.

Lecture Wrap Up

 Key Terms:  Contraception, Fertility Awareness Methods, Hormonal Methods, Barrier Methods, Perfect Use, Typical Use.  Individual Health Importance:  Choosing an appropriate methods of contraception includes many considerations.  Public Health Importance:  Many women who do not wish to become pregnant have little access to appropriate contraceptive methods  Social/Political Importance:  Contraceptives have recently been a controversial issue for many political and social reasons

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