What do the elements of conception and abortion entail? - Chapter 7

Contraception is not as controversial as it used to be. Nowadays effective anticonception methods are available for a variety of reasons. For example, people who are not in a relationship typically want to prevent pregnancy. The fact that anticonception is becoming more ordinary has a positive impact on the number of teen pregnancies, especially in the United States. Another good reason is the reduction of healthcare costs by avoiding unnecessary abortions.

What hormonal methods for anticonception are available?

Hormonal methods are very effective. The methods include the pill, the patch, the vaginal ring and injections.

Combination pill

The combination birth control pill contains progestin, oestrogen and a synthetic progesterone in slightly higher levels than normal. The pill needs to be taken for twenty-one days with a placebo or no-pill seven days in between. There are variations on this number of placebos versus active pills. The pill prevents ovulation by heightening levels of oestrogen and progesterone, and thus inhibiting FSH and LH production. Progestin makes the tissue very thick so implantation if the eggs were fertilized is almost impossible. In the placebo days, when progestin and oestrogen are not taken, a withdrawal bleeding takes place.

The failure rate or pregnancy rate is the number of women who become pregnant during a year of contraception. There is the failure rate for perfect users and the failure rate for typical users. The failure rate for perfect users is about 0.3% and 9% for typical users. One side effect of the pill is disease in the circular system. Women on the pill have a higher risk on the development of blood clots and high blood pressure. Other side effects are nausea, weight gain, the increasement of vaginal discharge and heightened change of getting chlamydia.

Advantages of the pill are its effectiveness and it does not intervene with sex. It also reduces cramps and lowers the amount of menstrual flow. Besides the side effects, the correct intake of the pill can be a burden on women with a busy lifestyle. Also, when people do not engage in sex often, the pill can be a contraceptive overkill. Getting pregnant can take about three months after stopping the pill, but the rates are the same as women who never took the pill. Combinations with other drugs can decrease the effectiveness.

Other kinds of pills

There are pills available with lower levels of oestrogen and pills with high levels of progestin can lead to depression. Triphasic pills contain a steady level of oestrogen but differentiate in the level of progesterone. Progestin-only pills of minipills only have low levels of oestrogen and progestin to avoid side-effects. These inhibit ovulation and implantation. The failure rate is higher. They are effective for women who breastfeed as combination pills reduce milk production.

The patch

The patch or ortho evra contains the same hormones as the combination pill but is transdermally administered (through the skin). The patch lasts for seven days, so women do not have to remember to take the pill every day. Also, the pill does not have to be digested. Expectations are similar effectiveness of the combination pill, but extensive data is not yet available.

The vaginal ring

The NuvaRing is filled with the same hormones as the combination pill in lower dosage. She must insert the ring every twenty-one days with one stopping week. Also, this technique is quite recent, so there is no extensive research data available yet. Even though the expectation was that the typical user failure rate would be lower, this is about the same as the combination pill.

Depo-Provera injections

Depo-Provera (DMPA) is an injection of progestin, they must be repeated every three months. It inhibits ovulation and thickens the cervical mucus to prevent implantation. It is highly effective and has a low typical user failure rate. The advantage is that is does not interfere with sex and has no reliance on memory as taking pills does. Many people experience amenorrhea (no menstrual periods) which relieves endometriosis.

Emergency contraception

When a condom breaks, a woman can choose emergency contraception. The treatment should be started within twenty-four hours after intercourse and cannot be delayed any longer than five days. The pill may stop ovulation, inhibit the function of sperm and inhibit the development of a nourishing endometrium. It is used to prevent pregnancy, not to cause abortion. The failure rate is about one percent, when taken within five days of unprotected sex.

What are long-acting, reversible contraceptives (LARC)?

LARC methods, unlike sterilization can be reversed. One example is an implant, which are inserted under the skin of the arm. They only release progestin and suppress ovulation, thickening and inhibit the growth of the endometrium. The effectiveness is very high, and the typical and perfect user rates are the same. There are no lethal side effects. It requires no reliance on memory for the period of three years and there is no oestrogen causing the oestrogen-related side effects. One disadvantage is that unpredictable (or no) bleeding patterns can occur. After removal the menstrual cycle returns to normal within three months.

An intrauterine device (IUD) is inserted into the uterus. It has two plastic strings that hang from the cervix, this enables a woman to check whether the device is still in place. The IUD creates an environment that is toxic to eggs and sperm cells. Also, when fertilization would take place, it prevents implantation. The Mirena and Skyla IUD’s release progesterone into the endometrium which disrupts ovulation. The third IUD made of copper has an extra functionality. It alters the enzyme functioning to prevent implantation. The method is highly effective and lasts a long time. Side effects are irregular bleeding and for some women using the variant of copper it can increase menstrual cramps. The initial costs are high, but it pays off over the years of use. A woman can get pregnant immediately after removal.

What are condoms?

The male condom can be described as a contraceptive cover that is placed over the penis. These are typically made of latex, but other condoms, such as the polyurethane condom are available for people with allergies. The popularity increased due to the protection against STDs, including HIV. The condom must be unrolled prior to intercourse, not to ejaculation. The condom catches the semen and prevents it from entering the vagina. The condom is very effective and there is no side effect. However, the spontaneity of intercourse is disrupted, and some men complain about the reduction in sensation. The female condom exists from a ring that is placed over the cervix while another goes outside the body and covers the vulva.

What is the Diaphragm, the Sponge and the FemCap?

The diaphragm consists of thin rubber and is inserted into the vagina. It fits over the cervix and is used with a contraceptive cream. The diaphragm must be inserted six hours before intercourse and stay until six hours after. It should not be worn longer than twenty-four hours. This was the mainstream contraception until the 1960s. The FemCap is like the diaphragm but is made of silicone. The sponge is another vaginal barrier method and is a pillow-shaped sponge containing spermicide. It is effective for twenty-four hours. However, the sponge is not very effective.

What is the withdrawal -and rhythm method of birth control?

Withdrawal is a contraceptive method where the penis is withdrawn from the vagina before ejaculation. It is not a very effective method and the failure rate lies around twenty-two percent. However, it remains the only last-minute method and can be used when nothing else is available. The fertility awareness (rhythm) method is based on abstaining from intercourse around the time of ovulation. The calendar method is similar, but the woman keeps a calendar to record when she is ovulating. The basal body temperature method (BBT) is another rhythm method where a woman keeps track of her temperature to determine when she is ovulating. The cervical mucus method includes a woman checking her cervical mucus and the symptom-thermal method means that both the body temperature and cervical mucus are combined to see whether a woman is ovulating.

What is the process of sterilization?

Sterilization or voluntary surgical contraception (VSC) is the sterilization by surgical methods. Currently the word sterilization has emotional overtones because it threatens our manhood or femininity. A physician is very careful in performing this surgery and the principle of informed consent must be followed. They are gaining in popularity though.

• Male sterilization or vasectomy is the cutting of the vas deferens. Another option is a no-scalpel vasectomy where only a small incision in the scrotum is made. The vasectomy prevents the sperm from being in the ejaculate. Even though there are methods of reversing a vasectomy (vasovasostomy), the man should assume it cannot be undone.

• Female sterilization or laparoscopy includes the blocking of the fallopian tubes. Another procedure is called inilaparotomy which is done immediately after giving birth. The transcervical approach is a procedure that does not require an incision, devices block the fallopian tubes and scar tissue forms around it. It does not interfere with the ovaries and does not bring on menopause. They are also performed as a treatment of cancer.

What are the attitudes towards contraception?

Even though there are many ways of anticonception, teen pregnancies still happen every year. This can be because teenagers think they do not have access to birth control, they have a weak self-effectiveness and therefore are not motivated to avoid pregnancy. Another issue is the embarrassing and humiliating presentation of anti-conception methods in the mass-media. Solutions include better sex education and legitimizing the purchase of anti-conception methods.

What is the procedure of abortion?

Abortion is the termination of a pregnancy and is a highly controversial subject. Advocates speak of women’s rights over their own bodies and the opposition argues for the right of the foetus. Therefore, policies of abortions vary widely. There are several procedures available for abortion.

• Surgical abortion or vacuum aspiration method can be done in the first trimester and is the suctioning out of the contents of the uterus. It is also referred to as suction curettage.

• Medication abortions or mifepristone is the abortion pill and can be used for a very early abortion. The endometrium of the uterus is then sloughed off.

What are the psychological aspects of abortion?

The decision-making process for abortion is very difficult, many people experience anxiety and anger. The foetus has a right to live, but also to be born in a stable family. It is argued that women can be psychologically traumatized after abortion. After a few years they show good adjustment though. Men are often supportive of abortion if they are included in the decision.

What are the new developments in contraception?

According to some, the perfect method of anticonception is not yet found. Besides the condom, there is no protection from sexually transmitted diseases. Therefore, research to contraception continues.

• New male methods are new condoms to provide more sensation and are not made of latex. Other new methods are male hormonal methods to suppress production of LH and FSH so that sperm won’t be produced. RISUG or reversible inhibition of sperm under guidance makes the sperm unviable. Another option is to target pituitary FSH to block sperm production without stopping testosterone.

• New female methods include microbicides to kill sperm and protect against STD’s are now researched. Also, a better pill could lower a woman’s testosterone levels so she feels more sexual desire while she uses it. One way to add androgens to the combination pill. Vaginal rings are also being further developed and there has been research on reversible and nonsurgical sterilization.