Contraception

Importance of Contraception

Did you know that approximately 45% of unplanned pregnancies are attributable to the lack of any contraception being used. A surprisingly high 55% of unplanned pregnancies are a result of ineffective birth control? Effective and well-planned birth control is essential to preventing unplanned pregnancies and is vital in protecting yourself from exposure to sexually transmitted diseases (STDs).

Contraception and African American Women

Today’s African American woman is setting and achieving goals in record numbers. Talented sisters are excelling in education, business, the arts, sports, and almost any other endeavor that one can think of. Child bearing is also a goal that many of us share and balancing our personal and professional lives with respect to this goal is important. Hopefully, we will be able to have children when we are best able to give them the love, emotional, spiritual, and financial support that they deserve.

Recent data from the National Center for Health Statistics indicates that we have work to do in our communities with respect to education about pregnancy and contraception. Data reveal that despite a decline of 21% from 1991-96, the birth rate for African American adolescents was still twice that of White Americans. Increased knowledge and awareness is the first step in improving these numbers!

Methods of Contraception

There are many methods of contraception. One may be better suited for your lifestyle than another, or you may choose to use a combination of methods. An open discussion with your doctor and your partner will help you choose which method or methods might be best for you. Remember that abstinence is also an option!

Non-hormonal (Natural) Contraception

Type	How Used	Advantage	Disadvantage	Failure Rate
Coitus Interruptus (Withdraw)	Withdraw of the penis from the vagina before ejaculation.	Convenient, no cost.	Dependent on the male, requires discipline and motivation. Provides no protection from STDs.	14%-27%
Natural Family Planning	Avoiding intercourse during a woman’s fertile period.	No cost.	Can be a complex method. No protection from STDs.	14%-27%

Barrier Methods

Type	How Used	Advantage	Disadvantage	Failure Rate
Condoms (Latex, Polyurethane, or Lamb skin). Latex is best, polyurethane for people with latex allergy.	Condom holds sperm, preventing its deposition into the vagina. Female condoms are also available.	Protection against STDs including gonorrhea, herpes, chlamydia, and HIV.	Motivation is essential. May decrease sensation for some. A new condom should be used each time.	Approx. 12%
Diaphragm (A circular spring covered with latex rubber. Fits in the vagina, covering the cervix.)	Used in combination with a spermicide. Can be inserted before intercourse and left in place 8 hours after intercourse.	Some protection against STDs, tubal infertility, and cervical cancer.	Must insert before each episode of intercourse, spermicide must be reinserted with repeated intercourse. Fitting is required.	12%-39%
Cervical Cap (Similar to the diaphragm but much smaller. Only covers the cervix.)	Used with spermicide, placed over the cervix prior to sex. Can be left in place as long as 72 hours.	Non- hormonal method.	Fitting required. May dislodge during or after intercourse.	Higher failure rate than with the diaphragm.

Intrauterine Devices (IUDs): What Are They?

Intrauterine Devices (IUDs) are devices placed in the uterus to prevent pregnancy. IUDs interfere with the passage of sperm through the uterine cavity, preventing fertilization. There is also a minor action in preventing the fertilized egg from implantation in the uterus.

How Are IUDs Used?

A doctor in an office setting inserts IUDs. There are two types of IUDs commonly used, the Copper T (Paraguard) or Progestasert (progesterone containing). The Copper T can be left in place for 10 years. Progestasert must be changed annually.

Health Concerns

Risk of Infection:

In the past IUDs were associated with significantly increased rates of infections such as Pelvic Inflammatory Disease (PID). A PID is an infection involving the uterus, fallopian tubes, and/or the ovaries. Today’s IUDs do not pose the same rates of infection as those of the past. Currently, the risk of developing Pelvic Inflammatory Disease (PID) is increased during the first 20 days after insertion. Thereafter, the risk of developing PID is the same as in the general population (those without IUDs). It is important to report to any signs of infection to your doctor (fevers, vaginal pain or discharge, abdominal pain, etc.)

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IUDs are moresuccessful at preventing uterine pregnancies than ectopicpregnancies(inectopic pregnancies, the fertilized egg implants outsideof the uterus). If you become pregnant using an IUD, it isimportant to be evaluated for the presence of an ectopic pregnancy.

Who Should Not Use IUDs?

If you have a history of Pelvic Inflammatory Disease,multiple sexual partners, a large fibroid uterus, copper allergy (for theCopperTIUD), or chronic immune suppression, then IUDs are probably not the best method of contraception for you.

Advantages/DisadvantagesIUDs area highly effective method of birth control, but women can experienceincreased menstrual flow and cramping during their periods.

Failure Rate:
2.5%-4.5%

Hormonal Contraception

Type	How Used	Advantage	Disadvantage	Side Effects	Failure Rate
Oral Contraceptives (The Pill) Several different pills to choose from.	Combination pills: 21 day packs—take pills for 21 days and then have 7 day break (at which time your period occurs. 28 day pack-take a pill each day, pills 22-28 are without hormone.	Very Effective. Reduces ovarian cancer, endometrial cancer, ectopic pregnancy, functional ovarian cysts and can decrease discomfort of periods.	Motivation is essential, as you must take daily pills. Cost may be prohibitive for some. Does not protect from STDs. Fertility may be delayed 3-6 months after discontinuation.	Variable. Some experience nausea, breast tenderness, weight gain, and mood changes. Symptoms usually decrease after three months of use.	0.1%-3%. Women with blood clotting disorders, heart disease, strokes, active liver disease, known or suspected breast cancer, and smokers over 35 should not take the pill
Depo-Provera	A synthetic hormone injected every 3 months	Very effective and convenient.	3-8 pound weight gain over several years. Irregular bleeding. (sometimes heavy, sometimes spotting.) After use for 1 year, 50% of women no longer have periods.	Irregular menstrual cycle, headache, abdominal discomfort, acne, nervousness.	0.3%-0.4%
Norplant	A synthetic hormone released from capsules inserted into the arm.	Very effective, protects against pregnancy for 5 years.	Requires surgical insertion and removal. Cost may be prohibitive.	Irregular bleeding, headache, acne, weight gain, facial hair.	0.2%-1.1%

Surgical Contraception

Tubal Ligation is a surgical procedure involving cutting, tying, banding, clipping or burning the fallopian tubes.

* Timing: can be done immediately after delivery, during cesarean section, or anytime thereafter.
* Benefits: decreased risk of ovarian cancer.
* Advantage: high efficacy, convenient form of birth control (after the procedure).
* Disadvantage: It is a surgical procedure that, for the most part, is permanent.
* Reversal: dependent upon amount of tube remaining after initial procedure. Success rates vary from 30 - 75%.
* Failure Rate: 0.8 - 2%

Empowerment Points

* Deciding what method of birth control is right for you is not a simple decision. You need to know what is available and what is the best method for you based on your lifestyle.
* An open discussion with your doctor and partner can help decide which method is best for you.
* No matter what method you use, you should always practice measures that will protect you from sexually transmitted diseases.
* The only sure way not to get pregnant, AND not to get a sexually transmitted disease it not to have sex (abstinence).