Chapter 11 and 14.pdf

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Family Relations and Human Development
FRHD 2100
Cynthia Clark

Unit 10: Contraception and Abortion and STI’s, HIV & AIDS Chapters 11, 14 1. Gain knowledge of the historical and legal developments around contraception Abortion - Attitudes have varied across cultures and eras - Right-to-life Pro-life movement assert that human life begins at conception and views abortion as murder of an unborn child (Some in the movement would permit abortion to save the mother’s life, or when a pregnancy results from rape or incest) - Pro-choice movement contends that abortion Is a matter of personal choice - Abortion was illegal in Canada until 1969 - The struggle between pro-life and pro-choice groups has sometimes been violent. - Dr.Henry Morgentaler, the leader of the pro-choice movement in Canada has been challenging the law since 1969 by establishing private abortion clinics - Morgentaler was awarded the Order of Canada in 2008 for his commitment to increased health-care opportunities for women and his efforts to influence public policy - The Supreme Court of Canada overturned the abortion law in 1988, stating it violated the Charter of Rights and Freedoms, after this, no federal law restricting abortion - In 1989, the Supreme Court ruled against a man trying to stop his former girlfriend from having an abortion, stating that the law doesn’t recognize a fathers right to do so - Despite these legal decisions, access to abortions are limited, often available only in urban centres - Some provinces restrict women’s access to abortions at public hospitals and refuse to pay for abortions performed at private clinics 2. Describe the various methods of contraception and their effectiveness including birth control pills, IUDs, diaphragms, spermicides, condoms, withdrawal, rhythm methods, sterilization, hormone- delivery systems, and barrier/spermicide methods Oral Contraceptives Oral Contraceptive: A contraceptive that consists of sex hormones and is swallowed Combination Pill: A birth control pill that contains synthetic estrogen and progesterone Minipill: A birth control pill that contains synthetic progesterone but no estrogen How it Works - Combination pill fools the brain into thinking the woman is already pregnant - Cervical mucus thickens and becomes more acidic, becoming a barrier to sperm (in response to progesterone) - Progesterone also inhibits the development of the endometrium, making implantation difficult - Minipill works through the last two ways Effectiveness - Used consistently and correctly, failure rate is 0.5% or less - typical use -3% - Reversibility: Ovulation begins regularly within 3 months Advantages Disadvantages Nearly 100% effective when used properly Confers no protection against STIs Doesn’t interfere with spontaneity or May reduce the effectiveness of antibiotics sensation Reduce the risk of PID, benign ovarian Must plan to use it several weeks before cysts and breast growths becoming sexually active Regularizes menstrual cycles Not advised for women with various health concerns (e.g., hypertension, diabetes, migraine headaches, blood clots, etc.) or smokers Reduces premenstrual cramping and May have side effects (e.g., nausea, weight discomfort gain, depression) May be helpful in treating iron-deficiency anemia and facial acne Reduces some forms of cancer Emergency Contraception - The “morning after pill” taken after unprotected intercourse or when contraception fails - In Canada – Plan B and Yuzpe regimen - Plan B has fewer side effects and is more effective (It is not an abortion pill because won’t end an established pregnancy. Available without a prescription on customer accessible shelves) How it Works - Prevents the joining of the sperm and egg - Prevents a fertilized egg from attaching to the uterine wall - Most effective when taken within 72 hours (should be taken as soon as possible) - Side effect is nausea, lasts a day or two Effectiveness - Pregnancy rate 1-3% The Contraceptive Patch - Delivers estrogen and progestin to prevent ovulation and implantation - Ortho Evra has been available in Canada since 2004 - Patch is thin and measures about 5 cm - Worn on the abdomen, buttocks, upper arm, or upper torso (not breasts) - Effectiveness: When used correctly, more than 99% - Advantages: Women who use it don’t need to think about contraception daily - Disadvantages: Side effects and potential hazards are similar to those of the pill The Vaginal Ring - Relatively new method in Canada called the Nuva Ring - Delivers estrogen and progestin through the skin - Inserted in the vagina and worn for 3 consecutive weeks, followed by one-ring free week - At the end of this week, the woman inserts another ring - Ring is left in place during sex, can be reinserted if it slips out - Usually unnoticed during sex - As effective as the bc pill - Advantages: May be helpful if the women has a hard time remembering to take a pill every day - Disadvantages: Research needed to determine long-term side-effects Injectable Contraception - Depo-Provera is an injectable hormone solution available by prescription - 99.7% effective - Administered by a needle in the arm or buttocks every 12 weeks, preventing pregnancy for 12 weeks. Advantages Disadvantages Highly effective Similar side effects to other hormonal contraceptives (e.g., vaginal bleeding, headaches, weight gain, irregular menstrual cycles etc.) Permits spontaneous sex Prolonged use associated with bone loss Remains effective without taking it daily Ovulation may take a few months to return Not recommended for women with health concerns (e.g., breast or uterine cancers, elevated blood pressure, etc.) Intrauterine Devices (IUDs) - Small object inserted into the uterus by a doctor or nurse practitioner and left in place - Used by less than 5% of sexually active women of reproductive age in Canada - Two main devices and systems available in Canada (Copper IUDs – Flexi T and Nova T & Legonorgesteral-releasing IUD system – Mirena) How It Works - Prevents sperm from fertilizing egg - Prevents fertilized egg from implanting in the uterus - Effectiveness: About 99% for up to 5 years - Reversibility: About 9/10 former IUD users who wish to become pregnant do so within a year Advantages Disadvantages Highly effective Side effects – most common are excessive menstrual cramping, irregular bleeding (spotting) between periods, and heavier than usual flow Relatively maintenance-free Risk of pelvic inflammatory disease (PID) Greater risk for ectopic pregnancy Women with pelvic infections, or risk factors for PID, should not use The Diaphragm - Shallow cup or dome made of think latex rubber - Rim in a flexible metal ring covered with rubber - Come in different sizes for a precise fit - Available by prescription and must be fitted by a health-care practitioner How it Works - Forms a barrier against sperm when placed over the cervical opening - Unreliable when used alone – must be used with spermicidal cream of jelly - Woman must insert and leave in place for at least 6 hours after intercourse - Effectiveness: If used correctly and consistently, failure rate is 6%. In typical use, failure rate the first year is 18%. - Advantages: Fairly effective when used correctly. Use as needed, as opposed to taking every day. - Disadvantages: High pregnancy rate associated with typical use. Need to insert before intercourse – may be disruptive. The Cervical Cap - Dome-shaped rubber cap which comes in different sizes - Must be fitted by a health-care professional - Smaller than a diaphragm (the size of a thimble) - Inserted by the woman before sex, left in for at least 8 hours - Effectiveness: Failure rate in typical use is high – 18% in women who haven’t borne children and 36% in women who have - Disadvantages: Some women find the cap uncomfortable. Side effects include UTI and allergic reactions or sensitivities to the rubber or the spermicide. Spermicides - Coat the cervical opening, blocking the passage of sperm and killing sperm by chemical action - Come in different forms: jellies, creams, suppositories, and aerosol foams - Should be left in the vagina for several hours after intercourse - Suppositories must be inserted 15 minutes before sex to allow time to dissolve - Effectiveness: Typical use, first-year failure rate for spermicides used alone is 21% - When used correctly and consistently, 6% - All are more effective when combined with other methods (ie.condom) - Disadvantages: May cause vaginal or penile irritation. Some find the taste unpleasant. The Contraceptive Sponge - Soft, disposable device - Provides a barrier with built in spermicide - doesn’t need to be fitted - can be inserted in the vagina several hours before intercourse - absorbs sperm - 1/20 is mildly irritated by the spermicide - currently unavailable in Canadian pharmacies The Male Condom - Sheaths made of latex, polyurethane, and intestinal membranes of lambs (which do not provide protection against some STIs) - Many have nipples or reservoirs to catch semen and prevent bursting during ejaculation - Though they protect against STIs, many use for protection from pregnancy How it works - serves as a barrier, preventing the passage of sperm and disease-carrying micro-organisms from the man to his partner - helps to prevent infected vaginal fluids (and micro-organisms) from entering the man’s urethral opening or penetrating through small cracks in the skin of the penis - Effectiveness: Typical use – 12% failure rate - Drops dramatically if used correctly and consistently and with a spermicide Advantages Disadvantages Unparalleled protection against STIs Some people have allergic reactions to the spermicide Both partners can share in putting it on, Some people are allergic to latex making it an erotic part of lovemaking rather than an intrusion Use of textured or ultra-thin condoms can Condoms can also sometimes slip off, increase sensitivity break, or tear May make sex less spontaneous Some men experience erectile difficulties using condoms The Female Condom - a polyurethane sheath that’s used to line the vagina during intercourse - held in place by a flexible plastic ring - provides a secure but flexible shield that barricades against sperm but allows the penis to move freely within the vagina during intercourse - Can be inserted up to 8 hours before sex, but should be removed immediately following - A new one must be used for each act of intercourse - During testing trials, pregnancy rate was estimate to be range between 21-26%, though it is estimated to be as low as 5% among cautious users - Many women complain it is bulky and difficult to insert - Costs several times more than the male condom Douching - Many couples believe that if a woman douches (rinse of washes the vagina by inserting a liquid and allowing it to drain out) after intercourse, she won’t become pregnant - Douching is ineffective because sperm move beyond the range of the douche seconds after ejaculation - Regular douching can alter the natural chemistry of the vagina Withdrawal - Man removes his penis before ejaculating - First-year failure rates among typical users 20% - Several reason to failure: Man may not withdraw in time, some ejaculate may still fall on the vaginal lips, a man may not be aware he has begun to ejaculate, active sperm may be present in pre- ejaculatory secretions. Fertility-Awareness Methods - Also called “rhythm methods” – rely on awareness of a woman’s menstrual cycle - Intercourse is avoided on days when conception is most likely - Methods: The calendar method, the basal-body-temperature method, the cervical-music (ovulation) method, ovulation prediction kits . - Effectiveness: Estimated first year failure rate 20% - Advantages: Appeal to people who want to avoid artificial means. No side effects and inexpensive. - Disadvantages: Low reliability and abstaining from sexual intercourse Sterilization - Surgical procedures that render people incapable of reproduction, without affecting sexual activity - Most effective form of contraception with the exception of abstinence - Prospect change in self-concept Vasectomy (Male Sterilization) - surgically cutting each vas deferens and tying it back or cauterizing it to prevent sperm from reaching the urethra - Carried out in doctor’s office, under local anaesthesia in about 15-20 minutes - Does not diminish sex drive, sensations, or function - Few serious complications have been reported - Minor complications (e.g., inflammation, swelling) are not uncommon - Reversibility is a complicated practice (vasovasotomy) with success rates ranging from 16% to 79%. Tubual sterilization/ tubal ligation (Female sterilization) - Fallopian tubes are surgically blocked to prevent meeting of sperm and ovum - the most common method of female sterilization - Doesn’t disrupt sex drive, sexual response or menstrual cycle - Unfertilized egg is reabsorbed by the body - Highly effective in preventing pregnancy (0.4% failure rate) - Should be considered irreversible (43% to 88% reversals are successful) 3. Consider ethical and moral concerns about abortion, specifically in terms of defining when human life begins, while considering societal and cultural attitudes about abortion Induced Abortion - Purposeful termination of a pregnancy before the embryo or fetus is capable of sustaining independent life - Perhaps more divisive than any other social issue - Rarely used as a primary means of birth control - Reasons for abortion include psychological factors and external circumstances - Moral question of when life begins Psychological Consequences of Abortion - Women may experience a range of negative emotions, including rear, anger, guilt, and ambivalence - Reactions depend on various factors including the strength of social support and their relationship with their partners - The sooner the abortion occurs, the less stressful it is - More distress post-abortion is associated with: having a difficult time reaching a decision, blaming the pregnancy on their own character, having a lower coping ability, having less social support. - In one survey of 882 women, the majority: Were satisfied with their decision to have an abortion, would make the same decision again, experienced more benefits than harm. 4. Explain the various methods of abortion such as vacuum aspiration and dilation and evacuation Vacuum Aspiration: Removal of the uterine contents via an aspirator (suction machine) • Painless and inexpensive, it can be done with little or no anaesthesia in a medical office or clinic • Cervix is dilated wither via insertion of progessively larger curved metal rods or dilators or by insertion hours earlier of a stick of seaweed called Laminaria digitata, which expands as it absorbs mosture, providing a gentler means of opening the os • Used during the first trimester Dilation and Evacuation (D&E): Removal of the uterine contents via a suction tube and forceps. The uterine wall may be scraped, to ensure that the lining has been fully removed • Performed under general anesthesia in a hosptial • Cervix must be dilated more fully than the vaccum aspiration, to allow for passage of the larger fetus • Suction tube is then inserted and used to remove some of the uterine contents Abortion Drugs • RU-486 or mifepristone, was developed and approved in France • It hasn't yet been approved for use in Canada • Mifepristone induces early abortion by blocking the effects of progesterone, the hormone that stimulates proliferation of the endometrium and allows implantation of the fertilized ovum • Supporters argue that it offers a safe, non-invasive substittue for more costly and unpleasent abortion procedures 5. Learn about bacterial (chlamydia, gonorrhea, and syphilis) and viral (human papillomavirus [HPV] and herpes simplex virus type 2 [HSV-2] Sexually Transmitted Infections (STIs) as well as HIV and AIDS, vaginitis, and hepatitis Bacterial Infections Chlamydia - Most common bacterial STI in Canada - Caused by Chlamydia trachomatis bacterium - Causes several types of infection (Non-gonoccocal urethritis [NGU] in women and men. Epididymitis in men. Cervictis in women. Endometritis in women. Pelvic inflammatory disease in women.) - Transmission: Sexual in
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