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Chapter 7

Contraception and Abortion - Chapter 7

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Western University
Psychology 2075
William Fisher

Human Sexuality Midterm 2 Contraception andAbortion - Chapter 7 (Pat) Sex Leads to Babies ­ Disturb FSH production, cut off ties with seminal vesicles etc ­ Stop sperm production? Not yet ­ Stop ovum production ­ Stop sperm transport: e.g. vasectomy ­ Condoms used to be made form pig intestines ­ Cover up cervix, diaphragm etc ­ Female condoms ­ Hormonal Contraception ­ Stop ova transport: ‘tubes tied’ Does Sex Lead to Babies Having Babies? Adolescent Pregnancy in Canada ­ 26% single young women and partners, aged 15-17 did not always use birth control past 6 months o Rates of teenage pregnancy, childbirth, abortion declining in recent years o Outlook for mother and baby better than previously thought  Contribution of baseline economic status > contribution of adolescent childbearing o Social and economic support available o Day care centers in high schools ­ Fear of adolescent pregnancy ­ Two threats of sexual activity o Threat of pregnancy  declining o Population explosion ­ In the past teen mom and baby were often isolated ­ Poor or middle class SES is more of a risk factor: limited education, lifetime of poverty ­ Social Isolation in the past: today social integration is more supportive with positive outcomes ­ Two biggest predictive factors for a low pregnancy rate: o Health units with after school hour birth control clinics had lower pregnancy rates o Presence of a rural satellite clinic that people could actually get to ­ Social support a tremendous difference in health of moms and babies ­ From 1994 to 2003 o Birth rate and abortion rate have all been in decline o Pregnancy still a concern but not an epidemic Contraception: Taking the Worry Out of Being Close ­ Contraception in Canada ­ Contraceptive behaviour o What choices are people making o Age, marital status ­ Contraceptive methods Human Sexuality Midterm 2 o What is available Contraception in Canada ­ Criminal Code of Canada (1892-1969) ­ Advertising and distributing illegal ­ Turn marriage into prostitution ­ Birth control obscene o “tending to corrupt morals” ­ Liable to imprisonment, unless accused could prove provision o “for the public good” “For the Public Good” ­ Albert Kaufman: Kitchener 1926 o Rubber manufacturer ­ Dr Elizabeth Bagshaw: Hamilton 1931 o Attempted to provide services in form of birth control clinic o No one would rent to her o Opened her own o Hamilton BirthControl Society ­ Dorthea Palmer: Ottawa 1936 o Social worker o Provided birth control consultation to workers at Kaufman o Arrested ­ Contraception legit if married—but not legal in Canada 1950s-1960s ­ Barbra and George Cadbury protest arrest of Toronto druggest for selling condom 1961 ­ Canadian Crim Code changed in 1969: Under Trudeau: legalization of contraception but not abortion Trials of Morgentaler in QU, MA, ON ­ Quebec jury refused to convict Morgentaler (Public Good) ­ Morgentalers acquittal was reversed on appeal and he was sentenced to jail o 10 months in jail, without a second trial ­ ON and MAtrials and acquittals followed ­ Canadian abortion law declared unconstitutional in 1988 ­ Few hospitals had abortion committees ­ Common for women to go to Buffalo to get an abortion and then come back with no follow up care ­ Morgantaler an abortion activist ­ Wasn’t allowed into med school (Jewish) ­ Performed abortions on women even though its illegal ­ Opened a clinic in Winnipeg and Quebec (cheeky) ­ Jury refused to convict him because he was serving the public good ­ Violated womens right to deny them abortions ­ Presently no law respecting abortion o A women deserves control over her body o Appropriate that it is not legislated Abortion Remains Controversial Human Sexuality Midterm 2 ­ Still remains super controversial ­ Some call it terrorism ­ 1992 TO clinic bombed ­ 1994 VAMD shot ­ 1995 Hamilton MD shot ­ 1997 Winnipeg MD shot ­ 2000 VAMD stabbed (x2) o same guy from 1994 ­ Guy who did the shooting killed a Gynecologist from NY ­ Abortion access remains inconsistent o Unequal access to abortion clinics o Especially in rural areas o No abortion services in PEI o Some provinces will not reimburse you if you travel to a different clinic Contraceptive Behaviour ­ Sexuality plays out at junction of reality and behaviour ­ Woman partner method fit ­ “I am a legit sexual being with contraceptive needs” (SelfAcceptance) ­ Acquire information: school, internet ­ Talk about it ­ MD, Pharmacist, buy domes ­ Feeling of relief: Consistent practice ­ Shifting preventative scripts: contraception, safer sex ­ Self Acceptance of Sexuality—Anticipating Intercourse o Contraceptive needs Internet Based Contraceptive Education ­ Anonymous ­ Accessible ­ Affordable ­ Sexualityandu.ca – masexualite.ca 60% 15-17 year olds always use contraception (4% unplanned pregnancy) ­ Oral Contraceptive onset  condom offset ­ Shifting is common ­ More sex partners = less consistent condom use Stop Using Condoms? ­ Stability of a relationship ­ Monogamy ­ STI testing Shifting Scripts: Permanent COntracepton ­ Sterilization Alternatives ­ Pregnancy ­ Abstinence ­ Hand jobs ­ Oral sex Canadian Contraceptive Study Human Sexuality Midterm 2 ­ Oral contraceptives gone generic ­ Competitive ­ Market research panel Canadian Women’s Familarity ­ Condoms and the Pill most recognized ­ Same with withdrawl ­ Some know of morning after ­ Some know of diaphragms Methods Currently Used Single ­ Pills 51% and Condoms, 32% withdrawl 7% ­ 80% of Canadians women will use oral contraception at some point Married ­ the Pill, 21% Condoms 15%, Sterilization 22%m 11%f, Withdrawl 6%, No method ­ Pill: effective, easy, doesn’t interfere with sex, recommended ­ Condoms: effective, easy, recommended, doesn’t interfere (male) ­ Condoms: easy few side effects, convenient, use when needed, prevents STIs (f) ­ Pill and Condoms: effective, easy, recommended, prevents STIs ­ Sterilization: effective ­ Womens Satisfaction with Current Method: o Pill most satisfied, then dome and pill then sterilization, least satisfied with condoms ­ Partner satisfaction (reported by women) o Same results as above Sterilization ­ Most people married 35-44 Trends in Canadian Contraception ­ Pill: most popular ­ Condoms: Not as popular o Worrisome because of HIV, Chlamydia and gonorrhea Contraceptive Methods Male Condoms ­ Ancient Egyptian and Roman depictions of sheaths for contraception ­ Falloppious prescribed linen condom to prevent syph ­ Vulcanization of rubber by Goodyear on 1844 popularized condoms, but also led to criticism of condoms ­ $8 per dozen ­ Perfect user effectiveness: 98%; typical user effectiveness about 82% o Use everytime o Put on before intromission o Hold at base when withdrawing o Contraceptive foam and dome together is almost 100% effective o Leave space at top for ejaculate o Condoms come in many sizes Human Sexuality Midterm 2 o Lots of guys prefer baggy condoms Diaphragm ­ Vaginal barrier, latex or silicone ­ Egyptian papyrus used a hollowed out lemon ­ Cervix side filled with spermicide ­ Prevents sperm from getting through ­ Should be left in place for 8 hour after sex ­ Use foam for additional sex ­ Fitted by a physician ­ Hard to find FemCap, Lea’s Shield, Sponge ­ Cervical Caps: Fem Cap, Lea’s shield, Sponge ­ Physical barrier ­ Chemical barrier ­ About 80% effective Female Barriers Female Condom ­ Polyurethane sheath ­ Inserted like diaphragm ­ About 80% effective ­ $2-4 per condom ­ STI prevention ­ Noisy ­ Spontaneity issues ­ Be careful of putting penis on outside of female condom Contraceptive Pill ­ Pill (21 28 84 daily) ­ Patch (Evra weekly) ­ NuvaRing (monthly) ­ Depo Provera (3 monthly) o Progestin only o Bone density issues ­ Estrogen: pill keeps E levels high, FSH levels low, no ovulation ­ Progesterone: pill keeps cervical mucus thick, endometrium thin ­ When stopped, hormones low, endometrium shed (withdrawl bleeding)xs ­ Almost 100% effect if takenAS prescribed ­ Cost variable $12/25 a cycle ­ Does not prevent STIs ­ Not linked with mood change or weight gain ­ Blood clot risks, slight increase in breast cancer ­ Prevents ovarian and endometrial cancers, also anemia NuvaRing Oral Contraceptives ­ Only 5% worry about missing a pill but o 62% users missed at least one pill during the past 6 months Human Sexuality Midterm 2 o of those who missed pills, 4.3 pills were missed over last 6 months IUD ­ History of use in camel caravans ­ Copper/Progesterone bearing device inserted through cervix into uterus ­ Prevents fertilization of egg, Mirena also thins endometrium, thickens cervical mucus ­ 99% effective ­ Lasts 5 years or more ­ Cramping, discomfort on insertion, increased infection rate of infection for 20 days ­ No increase PID or ectopic pregnancy, but IF pregnancy occurs it will likely be ectopic ­ Increased menstrual flow, dysmennorrhea, Mirena lessens menstrual flow FertilityAwareness Methods ­ Calendar Method o Ovulation occurs about 14 days before menstruation o In a cycle that is always 28 days long ovulation would occur betwn days 13-15  Add 3 days before that interval (long lived previously deposited sperm)  Add 2 days after that interval (for long lasting eggs)  Abstain from day 10 to day 17 of the cycle o If cycle is not perfectly regular, keep cycle records for 6-12 months o Calculate length of shortest and longest cycle  Subtrat 18 days from shortest cycle  Subtract 11 days from longest cycle  If cycle varied from 26 to 30 days (not uncommon), abstain from intercourse day 8-19 of cycle ­ Basal Body Temperature Method o Take T first thing in the morning o Drops on day of ovulation, rises next day o Intercourse safe 3 days after ovulation  NB: only identifies post ovulatory safe period  Good for conceiving pregnancy ­ Cervical Mucus Method st o Abstain from 1 day discharge through peak days until four days after peak days ­ Effectiveness Varies Considerable o Perfect use 2-5% o Actual use quite variable Emergency Contraception Progesterone only pills ­ Plan B, NorLevo ­ Available without prescription Human Sexuality Midterm 2 ­ Highly effective within 5 days after unprotexted intercourse ­ The faster, the better ­ Interferes with ovulation, sperm fitness, fertilization, and endometrium ­ Will not abort already fertilizated egg ­ Nausea—treat with Gravol Copper IUD ­ Inserted by physician within 7 days of unprotected intercourse Male and Female Sterilization ­ Vasectomy: o Vas deferns cut, occluded o Local anesthtic, outpatient o 15 minute procedure o minimal side effects, cheap o essentially 100% effective (Must use other method until sperm count verified) o Ejaculate appears unchanged o Could bank sperm of desired o Should be considered irreversible but 50% success with vasovasectomy ­ Tubal Ligation (Female): o Surgery (via small ab incision or through the cervix) o Fallopian tubers are identified, cut, and tied or clipped or occluded o No hormonal changes or effects o Almost 100% effective o Side effects of surgery, uncommon o Should be considered irreversible, some success with tubal reconnection o More costly and invasive than vasectomy InducedAbortion: Termination of Pregnancy ­ Induced abortion o Unplanned/wanted pregnancy o As a result of sexual assault o Prenatal genetic testing indicated major fetal anomaly o Sex selectin (not in Canada) ­ Methods of abortion o Vacuum aspiration  First trimester  Cervical dilation (laminaria)  Local anesthetic  Vacuum aspiration  Usual reaction relief  Little evidence of strong psychological after effects  Relevant comparison: women denied abortion o Medical abortion  First trimester • Mifepristone (RU 486) Human Sexuality Midterm 2 • Methatrexate • Misoprostol o Dilation and Evacuation  14 – 24 weeks o Induced labour  Second trimester o Few providers—not required training in obstetrics—gynaecology Correlates of Repeat TherapeuticAbortion ­ Series of 1221 women presenting for first or second or subsequent therapeutic abortion ­ Women approached on arrival for appointment ­ 1145 women completed survey (94% response rate) ­ repeat abortion rate 32% (n=360 women) ­ Those seeking repeat procedures were more likely to: o Have been using contraception o Have been using an effective method ­ History of IPV ­ History of Sexual Violence READING NOTES – CHAPTER 7 History: - Most in lecture - Use of contraceptives was illegal until 1969 – til Pierre Trudeau o 1969 amendments to Criminal Code of Canada also allowed abortion under restrictive circumstances Reasons for contraception: - Adolescent Pregnancy o 2005 Canada – 30,498 pregnancies; 414 girls under 15 - Overpopulation o 1900 pop’n 1.6 billion – took millions of years to reach o 1950 increased to 2.5 billion o 1999 6 billion o experts maintain it will reach 8.9 bill by 2050 Methods, Side effects, and Effectiveness of Contraceptives: - Hormonal Methods o Combination Pill – pills contain both estrogen and progestin (synthetic progesterone) – doses higher than natural levels  Taken for 21 days, with no pill or placebos for seven days after then repeat cycle • Variations: Seasonale o 84 days of combined hormones and 7 days placebo o woman has period only once in 3 months o approved in 2007  Works by preventing ovulation Human Sexuality Midterm 2 • Estrogen levels too high to produce Follicle Stimulating Hormone (FSH) • Progesterone inhibits Luteinizing Hormone (LH) which prevents ovulation by regulating o Also keeps cervical mucus thick to block sperm o Alters uterine lining making egg implantation unlikely  Effectiveness: • Perfect user failure rate 0.3% • Typical user failure rate 8% - primarily due to forgetting to take a pill or not taking it at same time each day  Side Effects • Blood clotting – particularly women over 35 who smoke • High blood pressure • No evidence of promoting infertility; protects from endometrial and ovarian cancer • May aggravate existing cancers like Breast • More than five years benign liver tumours risk increases • Susceptible to Vaginitis (vaginal inflamations) • More susceptible to Chlamydia and Gonorrhea • Psychological effects: 20% of women on pill report irritability and depression o Triphasic Pill  Contains steady level of estrogen, but three phases in levels of progesterone  Side effects; reduces hormonal effects like blood clotting • Still has vaginitis and depression effects of pro
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