🫦Intro to Human Sexuality Unit 9 – Contraception and Abortion

Key Concepts and Terminology

• Contraception involves methods or devices used to prevent pregnancy, including hormonal, barrier, and natural methods
• Abortion is the termination of a pregnancy, which can be induced through medical or surgical procedures
• Reproductive rights encompass the legal and ethical principles surrounding an individual's autonomy over their reproductive health decisions
• Family planning involves the conscious effort to control the timing and spacing of pregnancies, often through the use of contraception
• Unintended pregnancy refers to a pregnancy that is mistimed, unplanned, or unwanted at the time of conception
• Contraceptive prevalence rate (CPR) measures the proportion of women of reproductive age who are using, or whose sexual partner is using, a contraceptive method at a given point in time
• Maternal mortality refers to the death of a woman during pregnancy, childbirth, or within 42 days of termination of pregnancy from causes related to or aggravated by the pregnancy or its management
• Reproductive coercion involves behavior that interferes with an individual's reproductive health decisions, such as sabotaging birth control or pressuring someone to become pregnant

Historical Context

• Ancient civilizations, such as the Egyptians and Greeks, used various methods for contraception and abortion, including pessaries, herbs, and surgical procedures
• In the 19th century, the first rubber condoms were manufactured, and the birth control movement gained momentum with the work of activists like Margaret Sanger
• The development of hormonal contraception in the 1950s and 1960s, particularly the birth control pill, revolutionized family planning and women's reproductive autonomy
• The landmark U.S. Supreme Court case Roe v. Wade (1973) legalized abortion nationwide, recognizing a constitutional right to privacy in reproductive decisions
  • However, subsequent cases, such as Planned Parenthood v. Casey (1992), allowed for increased state regulation of abortion
• The Mexico City Policy, also known as the Global Gag Rule, has been enacted and rescinded by various U.S. administrations, affecting funding for international organizations that provide or discuss abortion services
• Advancements in long-acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs) and implants, have expanded contraceptive options and effectiveness
• The availability of emergency contraception, like Plan B, has provided a way to prevent pregnancy after unprotected sex or contraceptive failure

Types of Contraception

• Hormonal methods, such as the pill, patch, ring, shot, and implant, use synthetic hormones to prevent ovulation and thicken cervical mucus
• Barrier methods, including male and female condoms, diaphragms, cervical caps, and sponges, physically block sperm from reaching the egg
• Intrauterine devices (IUDs) are small, T-shaped devices inserted into the uterus that prevent fertilization or implantation
  • Hormonal IUDs release progestin to thicken cervical mucus and suppress ovulation
  • Copper IUDs create an inflammatory reaction toxic to sperm and eggs
• Sterilization, such as tubal ligation for females and vasectomy for males, provides permanent contraception by surgically blocking the fallopian tubes or vas deferens
• Natural family planning methods, like the rhythm method and symptothermal method, involve tracking fertility signs to identify fertile days and avoid intercourse or use backup contraception during that time
• Emergency contraception, such as Plan B or Ella, can be used after unprotected sex or contraceptive failure to prevent pregnancy by delaying ovulation
• Dual protection, using both a barrier method and another form of contraception, offers protection against both pregnancy and sexually transmitted infections (STIs)

How Contraception Works

• Hormonal methods work by releasing synthetic estrogen and/or progestin to suppress ovulation, thicken cervical mucus, and thin the uterine lining
  • The pill is taken daily, while the patch is changed weekly, and the ring is replaced monthly
  • The shot (Depo-Provera) is administered every three months, and the implant (Nexplanon) is effective for up to five years
• Barrier methods physically block sperm from reaching the egg, with some (like condoms) also protecting against STIs
  • Diaphragms and cervical caps are used with spermicide and must be fitted by a healthcare provider
  • The sponge contains spermicide and can be bought over-the-counter
• IUDs work by either releasing hormones or creating an inflammatory reaction that is toxic to sperm and eggs, preventing fertilization and implantation
• Sterilization procedures surgically block the fallopian tubes (tubal ligation) or vas deferens (vasectomy) to prevent the egg and sperm from meeting
• Natural family planning relies on identifying fertile days by tracking basal body temperature, cervical mucus, and/or menstrual cycle length to avoid intercourse or use backup contraception during the fertile window
• Emergency contraception delays ovulation by delivering a high dose of synthetic hormones, preventing fertilization or implantation if taken within 72-120 hours of unprotected sex, depending on the specific medication

Effectiveness and Side Effects

• Contraceptive effectiveness is measured by the failure rate, which is the percentage of women who experience an unintended pregnancy within the first year of typical use
  • Perfect use failure rates reflect effectiveness when the method is used correctly and consistently every time
• Long-acting reversible contraceptives (LARCs), such as IUDs and implants, have the lowest failure rates (<1%) and are the most effective reversible methods
• Hormonal methods have typical use failure rates ranging from 4-7%, with the implant and shot being the most effective and the pill and ring being less effective due to user error
• Barrier methods have higher typical use failure rates, with condoms at 13%, diaphragms at 17%, and sponges at 14-27% depending on parity
• Natural family planning methods have typical use failure rates of 2-23%, with the symptothermal method being the most effective when used correctly and consistently
• Sterilization has a failure rate of <1% but is considered permanent and may not be easily reversible
• Common side effects of hormonal contraception include irregular bleeding, headaches, nausea, breast tenderness, and mood changes
  • Serious complications, such as blood clots, are rare but can occur with some hormonal methods
• Barrier methods may cause allergic reactions to latex or spermicide, and some users report reduced sensation or interruption of sexual activity
• IUDs may cause cramping, spotting, and heavier periods, with rare complications including perforation of the uterus or expulsion of the device
• Sterilization procedures carry risks associated with surgery, such as infection, bleeding, and anesthesia complications

Abortion Methods and Procedures

• Medical abortion involves taking medications, typically mifepristone followed by misoprostol, to terminate a pregnancy up to 10-11 weeks gestation
  • Mifepristone blocks the hormone progesterone, causing the uterine lining to break down and the cervix to soften
  • Misoprostol causes uterine contractions to expel the pregnancy tissue
• Surgical abortion procedures vary depending on the stage of pregnancy and include aspiration abortion and dilation and evacuation (D&E)
  • Aspiration abortion, typically performed up to 14-16 weeks gestation, involves dilating the cervix and using suction to remove the pregnancy tissue
  • D&E, used after 14-16 weeks, involves dilating the cervix and using instruments to remove the pregnancy tissue
• Induction abortion, rarely used in modern practice, involves administering medications to induce labor and delivery of the fetus
• Possible complications of abortion include incomplete abortion, infection, hemorrhage, and cervical or uterine injury, but serious complications are rare when performed by trained healthcare providers
• Pre- and post-abortion care includes counseling, informed consent, pain management, and follow-up to ensure complete termination and address any concerns

Legal and Ethical Considerations

• Abortion laws vary widely by country and, in the United States, by state, with some jurisdictions imposing restrictions such as mandatory waiting periods, parental consent for minors, and gestational age limits
• The U.S. Supreme Court's decision in Roe v. Wade (1973) established a constitutional right to abortion, but subsequent cases have allowed for increased state regulation
• The principle of reproductive autonomy holds that individuals have the right to make decisions about their reproductive health without interference or coercion
• Ethical debates surrounding abortion often focus on the moral status of the fetus, the rights of the pregnant person, and the circumstances under which abortion may be justified
  • Some argue that abortion is permissible in cases of rape, incest, or when the life or health of the pregnant person is at risk
• Healthcare providers may have the right to refuse to participate in abortion care based on personal or religious beliefs, but they have an ethical obligation to refer patients to other providers and not obstruct access to care
• Conscientious objection by healthcare providers has been a point of contention, with some arguing that it can limit access to abortion services, particularly in underserved areas
• The principle of justice in healthcare requires that all individuals have equitable access to reproductive health services, including contraception and abortion, regardless of socioeconomic status or geographic location

Cultural and Religious Perspectives

• Attitudes towards contraception and abortion are influenced by cultural, religious, and societal norms, which can vary widely across different communities and regions
• Some religious traditions, such as the Roman Catholic Church, oppose most forms of contraception and consider abortion to be morally impermissible
  • Other religious views may permit contraception and abortion under certain circumstances or prioritize the well-being and autonomy of the pregnant person
• Conservative cultural norms may stigmatize contraception and abortion, viewing them as promiscuous or irresponsible, while more progressive norms may frame them as essential components of reproductive healthcare
• In some cultures, male partners or family members may exert control over reproductive decisions, limiting individuals' ability to access contraception or abortion services
• Societal expectations surrounding gender roles and motherhood can influence attitudes towards contraception and abortion, with some viewing them as a threat to traditional family structures
• Cultural and religious beliefs can intersect with political ideologies, shaping laws and policies that regulate access to reproductive health services
• Efforts to change cultural attitudes and reduce stigma surrounding contraception and abortion often involve community outreach, education, and advocacy by healthcare providers, activists, and religious leaders

Access and Availability

• Access to contraception and abortion can be limited by various factors, including geographic location, financial constraints, and legal restrictions
• In many areas, particularly rural or underserved communities, there may be a shortage of healthcare providers who offer contraceptive services or perform abortions
  • This can result in individuals having to travel long distances or face significant barriers to obtaining care
• The cost of contraception and abortion services can be a significant barrier for many individuals, particularly those who are uninsured or underinsured
  • Some countries and insurance plans cover contraception and abortion under healthcare benefits, while others require out-of-pocket payment
• Laws and policies that restrict abortion, such as mandatory waiting periods, parental consent requirements, and gestational age limits, can delay or prevent access to care
• Telemedicine and online services have emerged as a way to expand access to contraception and abortion, particularly in areas with limited in-person healthcare options
  • However, these services may be subject to legal restrictions and raise concerns about privacy and quality of care
• Advocacy efforts aim to increase funding for family planning services, expand insurance coverage for contraception and abortion, and remove legal and policy barriers to access
• Improving access to comprehensive sex education and contraceptive counseling can help individuals make informed decisions about their reproductive health and prevent unintended pregnancies

Future Developments and Research

• Ongoing research aims to develop new contraceptive methods that are more effective, convenient, and accessible, such as male hormonal contraception and non-hormonal vaginal rings
• Efforts to improve existing contraceptive methods focus on reducing side effects, increasing user satisfaction, and expanding the range of available options
  • For example, research is exploring ways to minimize bleeding and cramping associated with IUDs and to develop longer-acting injectable contraceptives
• Advancements in abortion care include the development of new medications, such as more effective and safer alternatives to mifepristone and misoprostol
• Telemedicine and self-managed abortion have the potential to expand access to abortion services, particularly in areas with limited in-person healthcare options
  • Research is needed to assess the safety, efficacy, and acceptability of these approaches and to address legal and regulatory challenges
• Studies are investigating the social, economic, and health impacts of unintended pregnancy and abortion, as well as the factors that influence contraceptive use and decision-making
• Implementation research aims to identify effective strategies for increasing access to and uptake of contraception and abortion services, particularly among underserved populations
• Efforts to develop new male contraceptive methods, such as hormonal pills or injections and reversible vas occlusion techniques, aim to expand contraceptive options and promote shared responsibility in family planning
• Ongoing research seeks to understand and address the complex social, cultural, and political factors that shape attitudes and policies surrounding contraception and abortion