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					Chapter Thirteen

Contraception and Abortion
                  Agenda

 Discuss History and Considerations
  Associated with Methods
 Discuss Contraception Methods
 Discuss Abortion
   Class Exercise: Contraception Values
               Clarification
 Complete the handout entitled “Contraception
  Values Clarification.
 After you have completed the handout,
  discuss your response in small groups.
                Introduction
 Majority of U.S. pregnancies are not planned
  and most are a result of not using
  contraception
 Factors increasing motivation to use
  contraception:
   good communication with partner,
   lower cost,
   effectiveness rates,
   frequency of intercourse,
   motivation to avoid pregnancy,
   side effects,
   openness about sexuality
Contraception: History

  Contraception in Ancient Times
Contraception in the U.S.: 1800s and
            Early 1900s
  Contraception Outside the U.S.
    Contraception in Ancient Times


 Ancient Greeks: magic, superstition, herbs
 Egyptians: fumigating female genitalia,
  tampon soaked in herbal liquid & honey,
  inserting a mixture of crocodile feces, sour
  milk, & honey
 South Africa: insert vegetable seed pods
 Africa: insert a grassy cervical plug
 Persia: insert alcohol soaked sponges
 Greece: insert empty pomegranate halves
 Contraception in the U.S.: 1800s and
             Early 1900s
 Concern in early 1800s was to curb poverty
  by controlling fertility
 1873 Comstock laws prohibited dispersing
  information about contraceptives, including by
  doctors
    Contraception use is affected by

 Social issues – e.g. desired family size
 Economic issues
 Knowledge & misinformation
 Religion
 Gender roles & power – in some areas, men
  make the contraceptive decisions; for some it
  is the responsibility of both
Choosing a Method of
   Contraception
   FDA Approval Process
     Lifestyle Issues
          FDA Approval Process


 The U.S. Food and Drug Administration
  (FDA) must formally approve the method
 10-14 year process to develop a new
  contraceptive drug
 Drug company submits a new drug
  application demonstrating safety in animal
  tests & a desire to conduct human trials
         FDA Approval Process


 3 phases
   Phase 1: 20-80 volunteers to test
     effectiveness
   Phase 2: several hundred to test
     effectiveness, side effects, risks
   Phase 3: hundreds to thousands are tested
     for generalization
 Animal trials are conducted throughout the
  process
     Class Discussion: Lifestyle Issues
       Associated with Contraceptive
 The following factors seem to be associated
  with choosing a contraceptive method:
   Own health & risks
   Number of sexual partners
   Frequency of intercourse
   Risk of acquiring a STI
   Responsibility level
   Method cost
   Advantages & disadvantages of the
     method
 Discuss influence of each.
Contraception Methods
 Barrier Methods: Condoms and Caps


 Prevent sperm from entering the uterus
 Barrier Methods:
  Condoms
  The Diaphragm
  The Contraceptive Sponge
  The Cervical Barriers
                 Condoms


 1850 – latex condoms available in the U.S.
 $10-$15/dozen
 Non-expired condom is rolled onto an erect
  penis (foreskin pulled back), ½-inch empty
  space at the tip
 Water-based lubricants for latex condoms
 Condom grasped at base when withdrawing
 Latex condoms have lower rates of slippage
  & breakage, and offer better STI protection
                 Condoms


 In 1994, female polyurethane/nonlatex
  condoms were available
 $2 each
 7 inches long with 2 flexible rings
 Inner ring squeezed and inserted close to the
  cervix
 Outer ring lies outside the vagina
 Adequate lubrication is necessary
                Condoms


 Effectiveness rates
   Latex condoms: 85-98%
   Female condoms: 79-95%
 Latex & polyurethane protect against STI
  transmission
 Lambskin condoms block sperm, but contain
  holes large enough for viruses to pass
  through
 Heat can damage condoms
                Condoms


 Advantages:
  STI protection
  Encourages male participation
  Inexpensive
  No prescription necessary
  Can reduce premature ejaculation
  Can reduce postcoital drip
  No medical side effects
                 Condoms


 Disadvantages:
   Reduces spontaneity
   Can reduce sensation
   Female condoms can be difficult to use,
    uncomfortable, noisy
 Female & male condoms should never be
  used together
 Popular in some countries, not used in others
              The Diaphragm


 Not widely used, almost 0% in 2002
 Made of latex or silicone
 Many sizes and shapes; a fitting by a health
  care provider is necessary
 $20-$35 diaphragm, $13 spermicidal
  jelly/cream, office visit charge
 They can last for many years
Diaphragms come in a variety of different shapes and sizes and must be fitted by a health-care
provider.
               The Diaphragm


 Diaphragm rim is covered in spermicidal jelly
  & a tablespoon of jelly is placed in the dome;
  it is folded in half and inserted into the vagina
  with the front rim tucked under the pubic bone
 It should not be felt & should cover the cervix
 It can be inserted up to 6 hours prior to
  intercourse
 Left in for at least 6-8 hours, no more than 24
 After use it is washed with soap & water
Instructions for proper insertion of a diaphragm.
              The Diaphragm


 84-94% effective, lower for those who have
  given birth
 Advantages:
   Increases spontaneity
   Some STI & PID protection
   Reduces risk of cervical dysplasia &
     cancer
   Does not affect hormonal levels
   Relatively inexpensive
              The Diaphragm


 Disadvantages:
   Physician fitting and prescription
   Insertion & removal involves touching the
    genitals
   Increased risk of toxic shock syndrome
    and urinary tract infection
   Postcoital drip
 Low usage outside the U.S.
       The Contraceptive Sponge


 The Today contraceptive sponge was taken
  off the market for a decade due to issues with
  the manufacturing plant; reintroduced in 2005
 Available over the counter in one size
 The sponge covers the cervix & contains
  spermicide; it blocks, absorbs, & deactivates
  sperm
 One box of 3 sponges is $13
The Today contraceptive sponge was back on the market in late 2005 in the United States.
              The Diaphragm


 Sponge is moistened with water to activate
  the spermicide, folded in half, & inserted to
  cover the cervix
 Can be inserted up to 24 hours in advance,
  with intercourse occurring as many times as
  desirable in that time period
 Must be left in at least 6 hours after
  intercourse
 75-89% effectiveness rates
Instructions for proper insertion of a contraceptive sponge.
             The Diaphragm


 Advantages:
  No prescription necessary
  Can have intercourse several times within
    24 hours
  Increase sexual spontaneity
  Do not affect hormonal levels
  Disposable
              The Diaphragm


 Disadvantages:
   Increased risk of toxic shock syndrome &
    urinary tract infection
   Cannot be used while menstruating
   Requires touching of the genitals
   High expense if frequently used
   Some men can feel it
 Low usage rates in other cultures
           The Cervical Barriers


 Thimble-shaped, silicone barriers that fit over
  the cervix
 Block entrance to the uterus & deactivate
  sperm with the spermicide
 Fitting by a health care provider is necessary
 Two types:
   FemCap
   Lea’s Shield
The FemCap is a silicone cup shaped like a sailor’s hat that fits securely over the cervix.
Lea’s Shield is a silicone cup with a one-way valve and a loop for easier removal.
          The Cervical Barriers


 $15-75 plus cost of spermicide
 Left in place for 8 hours after intercourse
 After use, it is washed with soap & water
 Not to be used during menstruation
 86% effectiveness rate, lower for those who
  have had children
          The Cervical Barriers


 Advantages:
  Left in place for up to 48 hours
  Do not affect hormonal levels
  Immediately effective
  Not permanent
  One-way release valve in Lea’s Shield
    reduces risk of toxic shock syndrome
          The Cervical Barriers


 Disadvantages:
  Abnormal Pap smears
  Increased risk of urinary tract infections
  Increased vaginal odors
  Cervical damage
  Increased postcoital drip
  Fitting is necessary
  Some male partners feel it & may dislodge
    it
           The Cervical Barriers

 Widely used in England
 Lea’s Shield is available over the counter in
  Germany, Austria, Switzerland, & Canada
  Hormonal Methods for Women: The
      Pill, the Patch, and More
 Changing hormonal levels can deter
  production of ova, fertilization, and
  implantation
 Hormonal Methods for Women: The
     Pill, the Patch, and More

 Combined-Hormone Methods
  Birth Control Pills
  Hormonal Ring
  Hormonal Patch
 Progestin-Only Methods
  Subdermal Implants
  Hormonal Injectibles
     Combined-Hormone Methods

 Combination of estrogen & progesterone
 Can repress ovulation and thicken cervical
  mucus
             Birth Control Pills


 Federally approved in 1960
 Most popular contraceptive in the U.S. and
  around the world
 Most studied type of medication
 Combination birth control pills are $12-25 per
  month
 Designed to mimic a menstrual cycle, with 21
  days of hormones and one off week
 Bleeding is medically induced
             Birth Control Pills


 Some take 2 to 3 packs of active pills in a row
  to reduce the number of menstrual periods
 Seasonale – 84-day active pill with 7-day
  placebo
 Reducing periods can help those with heavy
  bleeding and cramping
 60% of women prefer to not have a period
             Birth Control Pills


 Increase in estrogen & progesterone prevent
  the pituitary from sending hormones to ripen
  the ovaries
 Cervical mucus thickens & endometrium
  buildup is minimal
 The body is tricked into thinking it is pregnant
 May experience other signs of pregnancy that
  usually disappear within a few months
             Birth Control Pills


 Initially prescribed a low-dose estrogen pill;
  increased if breakthrough bleeding occurs
 Monophasic pills contain the same dose of
  hormones in each pill
 Multiphasic pills vary in hormone amount
 Triphasil pills have 3 sets, each week the
  hormonal dosage increases
 92-99.7% effective
 Need to take it each day at the same time
            Birth Control Pills


 Advantages:
  High effectiveness rate
  Doesn’t interfere with spontaneity
  Reduced menstrual flow, cramps, & PMS
  Increased menstrual regularity
  Reduced risk of ovarian cysts, uterine &
    breast fibroids, facial acne, ovarian &
    endometrial cancers, PID, benign breast
    disease
            Birth Control Pills


 Disadvantages:
   No STI protection
   Female’s responsibility; taken daily
   Can be expensive
   Lower effectiveness if overweight
   Not appropriate for smokers
 Used throughout the world, although not
  popular everywhere; some places have it
  over the counter
              Hormonal Ring


 NuvaRing introduced in 2003
 Plastic ring inserted into the vagina once a
  month for 3 weeks, removed for 1 week
 Affects the body as combination pills do
 Body heat & moisture activate a constant
  dose of estrogen & progesterone; lower dose
  than pills
 $30-35 per month
 99.7% effective
The NuvaRing is inserted deep into the vagina; moisture and heat cause it to time-release hormones
that inhibit ovulation.
             Hormonal Ring


 Advantages:
  High effectiveness
  Doesn’t interfere with spontaneity
  Reduces menstrual flow, cramps, PMS
  Increases menstrual regularity
  Protection from ovarian & endometrial
    cancer and ovarian cysts
  Fertility restored upon removal
              Hormonal Ring


 Disadvantages:
  Comfortable touching genitals
  No STI protection
  Side effects that typically disappear with
    regular use: breakthrough bleeding, weight
    change, breast tenderness, nausea, mood
    changes, changes in sexual desire,
    increased vaginal irritation & discharge
 No data on cross-cultural use
              Hormonal Patch


 Ortho Evra patch is a thin, peach colored
  sticker attached to the skin with time-released
  hormones
 Placed on buttock, stomach, or upper torso
  for 3 weeks, no patch for the 4th week
 Affects the body as combination pills do
 $30-35 per month
 99.7% effective, lower if weigh more than 198
  pounds
The Ortho Evra patch is worn on the buttock, abdomen, or upper torso for three weeks each month.
            Hormonal Patch


 Advantages:
  High effectiveness
  Doesn’t interfere with spontaneity
  Reduces menstrual flow, cramps, PMS
  Increases menstrual regularity
  Protection from ovarian & endometrial
    cancer and ovarian cysts
             Hormonal Patch


 Disadvantages:
  No STI protection
  Side effects similar to hormonal ring
  Skin irritation
  Change in vision, discomfort to contact
    wearers
  Collects lint
  Nearly impossible to conceal from partner
 No data on cross-cultural use
        Progestin-Only Methods


 Do not contain estrogen and can be used by
  women that cannot take estrogen, such as
  those who are breastfeeding & smokers
 Over time, may eliminate periods
 May cause slight weight gain, bloatedness, &
  breast tenderness
        Progestin-Only Methods


 Minipill/POPs (progestin-only pills)
  Inhibit ovulation and thicken mucus
  Fewer side effects than combination pills
  92-99.7% effective
  More expensive than combination pills
  Can cause irregular bleeding
  Higher rate of ectopic pregnancies if get
    pregnant while taking the minipill
           Subdermal Implants


 Constant dose of progestin is time released
  for up to 5 years
 Norplant is no longer available
 Jadelle is FDA approved but not marketed in
  the U.S.
   2 silicone cylinders implanted in the
     forearm in a 10 minute procedure; $500+
 Implanon is a single-rod approved in 2004
 Fertility restored upon removal
           Subdermal Implants


 Suppresses ovulation, thickens cervical
  mucus, unreceptive endometrium
 99.95% effective, decreases after the 3rd year
 Lower effectiveness rates if over 154 pounds
 Advantages:
   Effective, long-lasting, reversible
   Simple implantation procedure
   No estrogen side effects
   Decreased menstrual flow, cramping
           Subdermal Implants


 Disadvantages:
  Expensive implantation fees, arm pain,
    painful removal, possible scarring
  Irregular bleeding, cramping
  Headaches, nausea, dizziness, weight
    change, rash, acne, hair growth or loss
  Vision problems
 Popular in South Africa
           Hormonal Injectibles


 Depo-medroxyprogesterone acetate (Depo-
  Provera) – synthetic progesterone
 Most popular non-oral contraceptive
 Injected into the arm or buttock muscle every
  3 months
 $30-125 per injection
 Works within 24 hours
 Fertility resumes 10 months after last injection
          Hormonal Injectibles


 97-99.7% effective
 Advantages:
   Long lasting injection
   Moderately expensive
   No estrogen
   Decreased menstrual flow & cramping
   Decreased risk of endometrial & ovarian
    cancers
   Allows for spontaneity
           Hormonal Injectibles


 Disadvantages:
   Office visits every 3 months
   Irregular bleeding
   Fatigue, dizziness, weakness, headaches
   Appetite increases
   Decrease in bone density
   Risk of liver, cervical, and breast cancers
   Long return to fertility
 Low usage rates in many countries
     Chemical Methods for Women:
             Spermicides

 Spermicides come as foams, gels,
  suppositories, creams, foaming tablets, films,
  and capsules
 Inserted into vagina with applicator or finger
  10-30 minutes prior to intercourse
 $5-10 over the counter
 Can also help reduce STIs
 Likely to see microbicides introduced that will
  protect from HIV & other STIs
     Chemical Methods for Women:
             Spermicides

 71-82% effective
 Effectiveness is reduced if tampons or
  douches are used within 6-8 hours
 Foam is more effective than other varieties
 Advantages:
   Over the counter
   Provide lubrication
   Some protection from STIs
   No serious side effects
    Chemical Methods for Women:
            Spermicides

 Disadvantages:
  Used each time
  Increased postcoital drip
  May produce allergic reactions, skin
    irritations
  Increased risk of urinary tract infections
  Unpleasant taste
 Widely used in some countries, and not used
  much in other countries
Intrauterine Methods for Women: IUDs
               and IUSs

 Intrauterine Device (IUD)
   ParaGard Copper T – can be left in for 12
     years
 Intrauterine System (IUS)
   Mirena – IUD that contains time-released
     progestin; can be left in for 5 years
 Most IUD & IUS users are 35 or older
 $150-300 plus office visit
Intrauterine Methods for Women: IUDs
               and IUSs

 IUDs & IUSs create a slight infection in the
  uterus that obstructs sperm mobility
 Progesterone from the IUS also affects the
  endometrium, hampering implantation
 Health care providers insert the IUD
 Each month the woman must check for the
  string to assure it is still in place
 99.2-99.9% effective, lower if never pregnant
Insertion of an IUD.
Intrauterine Methods for Women: IUDs
               and IUSs
 Advantages:
  Least expensive method over time
  Allows for spontaneity
  Decreases menstrual flow (Mirena)
  Long lasting effects
Intrauterine Methods for Women: IUDs
               and IUSs

 Disadvantages:
  No STI protection
  Risk of uterine perforation and PID
  Irregular bleeding
  Painful insertion & removal
  Increased menstrual flow and cramping
  May be expelled from uterus
  May cause discomfort to the partner
 Widely used through most of the world
 Natural Methods for Women and Men

 Natural Family Planning and Fertility
  Awareness
 Withdrawal
 Abstinence
 Natural Family Planning and Fertility
             Awareness

 Involves a woman charting her menstrual
  periods and determining ovulation by daily
  monitoring of basal body temperature and
  checking cervical mucus
 Body temperature rises 0.4-0.8°F before
  ovulation & remains elevated until
  menstruation
 Cervical mucus is thin, stretchy during
  ovulation
 Natural Family Planning and Fertility
             Awareness

 Abstinence is practiced during ovulation
 Or a form of birth control is used during
  ovulation (fertility awareness)
 Mostly used by women spacing pregnancies
  that are not as concerned about prevention
 Ovulation kits can also be used
 75-99% effective
 Natural Family Planning and Fertility
             Awareness

 Advantages:
  Useful if other methods are not acceptable
    for religious reasons
  Inexpensive
  Educates about the menstrual cycle
  Encourages partner communication
  No side effects
 Natural Family Planning and Fertility
             Awareness

 Disadvantages:
  No STI protection
  Restricts spontaneity
  Low effectiveness
  Takes time & commitment
  Several cycles need to be recorded before
    it is reliable
 Widely used in many countries, particularly
  Catholic countries
                Withdrawal


 Also called coitus interruptus
 Just before ejaculation, the male withdraws
  his penis and ejaculates outside of the
  woman
 73-96% effective
 Sperm may remain in urethra from previous
  ejaculations & impregnate without the male
  ejaculating inside of the woman
                Withdrawal


 Advantages:
  Useful if other methods are not acceptable
    for religious reasons
  No costs
  Good if couples aren’t concerned about
    prevention
               Withdrawal


 Disadvantages:
  No STI protection
  Low effectiveness
  May lead to premature ejaculation
  May be stressful
  Requires trust & restraint
 Widely used in many countries
                Abstinence

 Refraining from sexual intercourse
 100% effective
 Protects against STIs
     Permanent (Surgical) Methods


 A woman may be fertile until 50-51 years
 A man may be fertile most of his life
 Sterilization in one of the safest & most
  effective contraceptive methods
 Surgery that is typically irreversible
 Two types:
   Female Sterilization
   Male Sterilization
            Female Sterilization


 Also called tubal sterilization or getting “tubes
  tied”
 A small incision is made under the navel or
  lower in the abdomen
 Both Fallopian tubes are blocked through
  cauterization, rings, bands, clips, plugs, or
  clamps, or the tubes may be cut
 This procedure uses general anesthesia as
  outpatient surgery or after childbirth
Essure is a permanent method of contraception.
           Female Sterilization


 A woman still ovulates, but the egg can’t
  enter the uterus
 $2000-5000
 Risks: anesthesia side effects, bleeding,
  infection, injury to other organs
 Reduces risk of ovarian cancer
 Most widely used birth control method in the
  world
             Male Sterilization


 A vasectomy impedes the travel of sperm
  through the vas deferens
 Cheaper, safer, & simpler than tubal
  sterilization
 Two ¼ to ½ inch incisions are made in the
  scrotum and the vas deferens is snipped,
  clipped, or cauterized under local anesthesia
 20 minute procedure
 The man ejaculates semen without sperm
In a vasectomy, each vas deferens is clipped, cut, or cauterized. A vasclip uses a flexible plastic clip to
block the vas deferens.
             Male Sterilization


 After surgery, sperm for 20 more ejaculations
  remains
 Sperm counts are checked 2-3 months later
  to check sterility
 $300-750
 Risks: swelling, bruising, internal bleeding,
  infection
 99-99.9% effective
     Permanent (Surgical) Methods


 Advantages:
  High effectiveness
  Permanent
  Allows for spontaneity
 Disadvantages:
  Expensive, irreversible surgery
  No STI protection
 Widely used throughout the world
         Abortion

      The Abortion Debate
Why Do Women Have Abortions?
      Abortion Procedures
      Reactions to Abortion
       Teens and Abortion
Cross-Cultural Aspects of Abortion
         Class Exercise: Abortion

 A fertilized egg is a human being from the moment
  the sperm and egg unite.
 The rights of the fetus always take precedence over
  the rights of the mother.
 Parental consent should be required for teenagers
  seeking abortion.
 Spousal consent should be required for married
  women seeking abortion.
 I support a woman’s right to choose in any and all
  circumstances.
 I support a woman’s right to choose if the
  pregnancy resulted from a rape.
 I support a woman’s right to choose if the
  pregnancy resulted from contraceptive failure.
                  Exercise (cont.)

 I believe abortion is justified if the woman feels that
  she is not ready for this child.
 I believe abortion is justified if a serious birth defect
  has been detected via amniocentesis.
 I believe abortion is justified if the couple already has
  5 children and the woman unexpectedly becomes
  pregnant again.
 I believe abortion is justified if parents of two boys
  discover they are pregnant again with a third boy,
  and they were really hoping for a girl.
 I believe abortion should be legal.
 There should be a mandatory 24-hour waiting period
  for all women seeking an abortion.
 Adoption could solve the problem of “unwanted
  children.”
The Abortion Debate

  Pro-Life versus Pro-Choice
    Historical Perspectives
 Legal versus Illegal Abortions
       Pro-Life versus Pro-Choice


 Pro-life supporters: an embryo at any stage of
  development is a person and aborting a fetus
  is murder
 Pro-choice supporters: it is a woman’s choice
  and the government should not control her
  body
 No gender differences in abortion attitudes
         Historical Perspectives


 Abortion has been practiced throughout time
  in many societies
 Religion has determined attitudes for most of
  western history
 In 1965, all U.S. states banned abortion with
  some exceptions
 Illegal (back-alley) abortions were often
  performed in unsanitary conditions and
  produced many complications, even death
          Historical Perspectives


 In 1973, Roe v. Wade protected a woman’s
  right to have an abortion in the 1st trimester
 2nd trimester abortions regulated by states
 3rd trimester abortions can be limited or
  banned by states, unless a woman is at risk
 In 1992, the Supreme Court gave states the
  right to restrict abortions through waiting
  periods, mandatory counseling, parental
  consent, public funding limitations
         Historical Perspectives


 In 1994, Supreme Court barred anti-abortion
  demonstrators from getting within 36 feet of
  an abortion clinic
 Louisiana has the most restrictions
 New York, California, & Washington state
  have been most protective of their abortion
  laws
     Legal versus Illegal Abortions

 Since legalization in 1973, deaths from
  abortion decreased significantly
Video: “If these Walls Could Talk”
   Why Do Women Have Abortions?


 Baby would interfere with life goals
 Lack financial resources
 Poor relationship with the father
 Don't want others to know they had sex
 Partner and/or family pressure
 Fetal deformity or risk to mother’s health
 Rape
 54% of women who had an abortion used
  contraception when they became pregnant
           Abortion Procedures


 One of the most common surgical procedures
  in the U.S.; most performed in abortion clinics
 Surgery involves risks
 Most serious risks are uterine perforation,
  hemorrhaging, cervical laceration, infection,
  complications with anesthesia, death
 Risks increase with the use of general
  anesthesia and the further along the
  pregnancy is
          Abortion Procedures

 First-trimester Surgical Abortion
 Second-trimester Surgical Abortion
 Medical Abortion
   Mifepristone (RU-486)
   Methotrexate
   First-Trimester Surgical Abortion


 Vacuum aspiration – before 14 weeks
  gestation
 Usually an outpatient surgery with local
  anesthesia
 88% of abortions
 Woman lies on examining table, feet in
  stirrups
 Speculum is placed in the vagina, cervix is
  anesthetized, & dilation rods open the cervix
    First-Trimester Surgical Abortion


 A cannula that is attached to a vacuum
  aspirator is put into the cervix, the content of
  the uterus is emptied
 Takes 4-6 minutes, with a few hour stay after
 After she needs to rest, bleeding and
  cramping is likely
 Risks: excessive bleeding, infection, uterine
  perforation
  Second-Trimester Surgical Abortion


 Between 14-21 weeks
 11% of abortions
 Reasons for a late abortion: medical
  complications, fetal deformity, divorce/marital
  problems, miscalculation of due date,
  financial or geographic problems
  Second-Trimester Surgical Abortion


 Dilation & evacuation procedure: 13-16
  weeks
 Similar to vacuum aspiration, but in a hospital
  under general anesthesia
 15-30 minute procedure
 More complicated than 1st trimester, with
  more pain, blood loss, & cervical trauma
 Second-Trimester Surgical Abortion


 Induced labor procedure used in late 2nd
  trimester
 Needle inserted into amniotic sac and drains
  the fluid; the sac is injected with saline or
  prostaglandin
 Fetus is delivered 19-22 hours later
 Can be painful emotionally & physically
 Risks: nausea, diarrhea, cervical problems,
  uterine rupture, risk of death
 Second-Trimester Surgical Abortion


 Hysterotomy – used in emergency situations
   Abdomen is opened to remove the fetus
   Similar to a cesarean section, with a 5-7
     day hospital stay
 Hysterectomy – removal of the fetus and
  uterus
   Rarely used
             Medical Abortion


 Two drugs:
   Mifepristone (RU-486)
   Methotrexate
 They are used with a prostaglandin to
  produce contractions and expel the contents
 2-3 office visits are required; $350-650
 Advantages over surgical abortion: no
  anesthesia; it seems more like a miscarriage
 Increased risk of bacterial infection
                   RU-486


 An antiprogestin that inhibits progesterone
  production, breaking down the uterine lining
 3 RU-486 pills are taken; 2 days later the
  prostaglandin is taken, which produces
  uterine contractions
 95-97% effective
 Can be used up to 9 weeks gestation
 Mifepristone produces bleeding within 4-5
  hours, and it continues for up to 13 days
               Methotrexate


 Methotrexate produces bleeding that may last
  1 month or more
 It is injected and ceases the development of
  the zygote cells
 The prostaglandin produces contractions and
  expels the uterine contents
 Can be used up to 9 weeks gestation
        Reactions to Abortion

 Women’s Reactions
  Physiological Symptoms
  Psychological Symptoms
 Men’s Reactions
            Women’s Reactions


 Physiological symptoms:
  Surgeon General’s report found
    physiological health consequences
    (infertility, miscarriage, premature birth, low
    birth weight) no more common in women
    who have had abortions compared to the
    general population of women
  Immediately following the procedure:
    cramping, heavy bleeding, nausea
           Women’s Reactions


 Psychological symptoms:
  A woman’s feelings are often correlated
    with her society’s views on abortion
  There is little known about reactions to
    medical abortions
  Many women cycle through feelings of
    relief, happiness, shame, guilt, fear of
    disapproval, regret, anxiety, depression,
    doubt, anger, sense of loss, sadness
           Women’s Reactions


 10% of cases a woman has severe feelings
 Factors in severe psychological symptoms:
   Young
   Lack family or partner support
   Persuaded to have an abortion or difficult
    time making the decision
   Strong religious & moral background
   Medical or genetic reasons for abortion
   History of psychiatric problems
             Men’s Reactions


 Abortion may cause couples to break up or
  may increase communication in a relationship
  and strengthen it
 Supportive partners are more positive
  following the procedure
 Men can feel sadness, a sense of loss, fear
  for partner’s well being, isolated, angry
 Men lack counseling services to help them
  through this time
            Teens and Abortion


 Some states require parental notification or
  consent
 In lieu of that, they may request a judicial
  bypass option
 In states without mandatory parental
  involvement, 75% of minors involve at least
  one parent in the process
  Cross-Cultural Aspects of Abortion


 About 40% of worldwide pregnancies are
  unplanned
 20% are aborted
 Lowest abortion rates are in Ireland,
  Netherlands, Belgium, & Spain
 Highest abortion rates are in Cuba, Vietnam,
  Romania, & India
 1.3 million abortions each year in the U.S.
  Cross-Cultural Aspects of Abortion


 25% of countries have strong restrictions on
  abortion
 20 million unsafe abortions occur each year
  by taking drugs, inserting objects into the
  vagina or flushing it with liquids, or forcefully
  massaging the abdomen
 Medical abortion is widely used outside the
  U.S.

				
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