Pro-Life Issues
Contraception
Contraception (often called birth control) are one or more actions, devices, or medications followed in order to deliberately prevent or reduce the likelihood of pregnancy. Some methods of birth control are also designed to end a pregnancy.
There are many contraceptive methods, including methods that are short- or long-acting, permanent or reversible, and hormonal or nonhormonal. The overwhelming majority of contraceptives are for use by women. There are few male contraceptives.
Contraceptives can be broadly classified as barrier, hormonal, intrauterine, and surgical.
Note: while there are no pictures or diagrams, anatomically correct terminology is used when describing the various types of contraceptives.
Types of Contraception: Barrier
Barrier methods place a physical impediment to the movement of sperm into the female reproductive tract.
The most popular barrier method is the male condom, a latex or polyurethane sheath placed over the penis. The condom is also available in a female version, which is made of polyurethane. The female condom has a flexible ring at each end - one secures behind the pubic bone to hold the condom in place, while the other ring stays outside the vagina.
Cervical barriers are devices that are contained completely within the vagina. The contraceptive sponge has a depression to hold it in place over the cervix. The cervical cap is the smallest cervical barrier. Depending on the type of cap, it stays in place by suction to the cervix or to the vaginal walls. The diaphragm fits into place behind the woman's pubic bone and has a firm but flexible ring, which helps it press against the vaginal walls.
Spermicide may be placed in the vagina before intercourse and creates a chemical barrier. Spermicide may be used alone, or in combination with a physical barrier.
Types of Contraception: Hormonal
Hormonal contraceptives all use hormones or a combination of hormones to prevent ovulation (the release of the egg); to thicken the cervical mucus to slow down the sperm and make it more difficult to reach the egg; and thirdly, if the first two methods fail, by changing the lining of the uterus, thereby preventing implantation of the fertilized egg (embryo), resulting in a chemical abortion. No hormonal contraceptive prevents ovulation all the time; therefore all are abortifacients (something that causes pregnancy to end prematurely and causes an abortion) at least some of the time. .All hormonal contraceptives require a prescription.
Oral contraceptives are the most widely used form of birth control. "The Pill" contains estrogen and progestin. Progestin-only pills (the "mini-pill") is also available. One pill is swallowed every day. Between 10% and 20% of the time, the pill does not prevent ovulation, and the 'mini-pill' allows ovulation at least 40% of the time.Side effects include increased risk of pelvic inflammatory disease, which may lead to sterility and death; infertility; cervical cancer (double the risk for women who take the pill for five years or more and increased risk for younger first-time users); ectopic pregnancy; breast cancer (doubled risk for women who start younger and use it longer); blood clots; heart disease; stroke; birth defects (26 percent incidence rate for major malformations, 33 percent for minor); mood swings and depression; breast tenderness; weight gain.
Transdermal patch (Ortho-Evra) is a patch applied to the skin once a week for three weeks and then one week without the patch. Like oral contraceptives, it contains estrogen and progestin. Women who use the Ortho Evra patch receive a dose of estrogen that is 60% higher than that of birth control pills. When too much estrogen enters a woman's body, it can lead to serious birth control patch side effects. Women who use the patch are three times as likely to suffer blood clots as users of birth control pills. These side effects include weight gain, blood clots, strokes, deep vein thrombosis, heart attacks, pulmonary embolisms and even death.In November 2005, the FDA alerted consumers and health care providers about the problems associated with the Ortho Evra birth control patch and forced Ortho-McNeil (a subsidiary of Johnson & Johnson) to strengthen the drug's warning label. However, the warning to women regarding birth control patch side effects came too late for 23 women whose deaths were linked to Ortho Evra by the time the FDA published the caution. Many doctors have since recommended that women stop using the Ortho Evra patch in order to avoid serious birth control patch side effects, but there has not yet been an Ortho Evra recall.
Vaginal ring (NuvaRing) is a once-a-month contraceptive that consists of a small plastic ring that is inserted into the vagina and remains there for a three week period. Since NuvaRing was introduced to the market, users have reported more side effects than are usually seen with other hormonal forms of birth control. These NuvaRing side effect reports include incidences of blood clots, strokes, heart attacks, pulmonary embolism and death. NuvaRing is still on the market.
Injectable contraceptive (Depo-Provera) is a progestin-only hormonal contraceptive which is injected every 3 months. In addition to the side effects common to all hormonal contraceptives, prolonged use of Depo-Provera may result in loss of significant bone mineral density, increasing the risk of osteoporosis. This risk is more likely for those who have been taking it for longer than 2 years. It may take some women up to a year or two to conceive after they stop using this type of contraceptive. Other side effects include vaginal discharge and irritation, hair loss, and a change in sex drive.
Norplant consisted of a set of six small (2.4 mm x 34 mm) silicone capsules, each filled with 36 mg of levonorgestrel (a progestin used in many birth control pills) implanted under the skin in the upper arm and effective for five years. It was tkane off the U.S. market in 2000 due to side effects. It is still available in some countries. Norplant II ("Jadelle") consists of two capsules of 75mg of levonorgestrel, instead of six capsules. While approved for use in the United States, it is not marketed. In addition to the side effects of hormonal contraceptives, difficulty of removal, discomfort at the implantation site, excessive hair growth or loss, change in vision have all been reported in Norplant users. Long-term effects of Jadelle are not known.
Emergency contraception / morning after pill is covered extensively here.
Types of Contraception: Intrauterine
Intrauterine contraceptives work mainly by preventing the sperm from fertilizing the egg, though they also cause changes in the cervical mucus, and changes in the lining of the uterus. (They are also abortifacient at least some of the time.)
Intrauterine Device (IUD) is a T-shaped device that contains copper and sits inside the uterus which is inserted by a physician. It may remain for one to 10 years. Side effects: perforation of the uterus, cervix or bladder at the time of insertion, cramping and spotting during the first few weeks after insertion, pelvic infection which can lead to sterility, copper foxicity, anemia, continued pregnancy which may lead to premature birth or miscarriage, endometriosis. It is expelled (falls out) in up to 10% of women.
Interuterine System or hormonal IUD (Mirena) is basically an IUD that contains the hormone levonorgestrel, which is released slowly over time and acts on the lining of the uterus. Long term, it's primary method of contraception is as an abortifacient. It can be left in place for up to 5 years. It has all the potential side effects as an IUD.
Types of Contraception: Surgical
Sterilization is a permanent form of birth control that is extremely effective at preventing pregnancy. But it is difficult to reverse if a person changes his/her mind. Both men and women can be sterilized.
Female sterilization (tubal ligation) is a surgical procedure to permanently close or block the fallopian tubes. There are three methods:
- Laparoscopy: A camera is inserted through a small incision below the belly button and a second instrument is inserted through a small incision just above the pubic bone. The tubes are then blocked by applying a clip or a ring or by burning them.
- Mini-laparotomy: A small incision is made in the abdomen. The tubes are then blocked by applying a clip, a ring, by burning them, or by cutting out a small piece of the tube.
- Hysteroscopy: A small camera is inserted through the cervix into the uterus. Tiny plugs are inserted into the fallopian tubes where they enter the uterus. The plugs irritate the lining of the fallopian tubes, causing scarring that over time permanently blocks the tube. A special x-ray is done 3 months later to make sure that the tubes are blocked.
Possible risks of surgery include risk of anesthetic, bleeding, infection or damage to organs in the pelvis (bowels, bladder, blood vessels). There is a slightly higher risk of ectopic pregnancy. If a woman wants to reverse the procedure, it is expensive (on average $21,000) and effectiveness depends on the type of sterilization method use. Effective rates range from 40% - 70%. If a woman has reversal surgery and becomes pregnant, she has a higher change of having an ectopic pregnancy.
Male sterlization (vasectomy) is a surgical procedure to permanently close or block the vas deferens (the tubes that carry sperm to the penis). Possible short term surgery related complications include: pain & swelling, infection at incision sites. The surgery is not effective immediately and there needs to be a follow-up sperm analysis to verify no sperm are present in the semen. Reversing the vasectomy is expensive (on average, $10,000) and will lead to natural pregnancy 65% of the time.
