Contraception and Pregnancy (Ch.7)

Question 1

pro-choice movement

Answer 1

A movement whose followers believe that a
woman has the option to choose whether or not to terminate her pregnancy.

Question 2

Ancient Forms of Birth Control

Answer 2

Silphium: a plant used in ancient Greece for preventing pregnancy, was so popular that it eventually became extinct during the third or second century BCE.
Deadly substances, including mercury and arsenic: ingested for contraception in
many ancient cultures (Connell, 1999).
Barrier methods: in ancient Egypt, for example, women inserted tampons soaked in crocodile dung, honey, and various other substances thought to prevent conception into their vaginas before intercourse.

Question 3

China’s One-Child Policy

Answer 3

1978, reated in order to alleviate
the social, economic, and environmental problems of over-
population that China was facing, successful, In some rural
areas, there are exceptions if the first child is a girl or if the
child has some sort of disability. Multiple births (e.g., twins) are also allowed. It has been
estimated that the policy prevented 300 million to 400 million
births between 1979 and 2010.

Question 4

intra-crural intercourse

Answer 4

Rubbing the penis between the partner’s
thighs; “called soma in some southern African communities”; alternative to penetrative intercourse

Question 5

A Brief History of Birth Control in Canada

Answer 5

using, selling, and disseminating contraception was treated as a crime under Canada’s Criminal
Code of 1892 because it was thought that contraception “corrupted morals.” Under this law, a
person could serve up to two years in jail if she or he was found guilty of using contraception

the first birth control clinic opened in Hamilton, Ontario, in 1932

Prime Minister Pierre Trudeau, the use of birth control was removed from the Canadian Criminal Code; this shift reflected Trudeau’s popular position that “the state has no business in the bedrooms of the nation.” At that time it became legal for doctors to prescribe the birth control pill for contraceptive purposes; it had previously been available only as a remedy for “menstrual problems.”

Question 6

perfect use vs typical use

Answer 6

Ideal situation in which
the birth control method
is followed 100 per cent
accurately, / Realistic situation in
which some people will
inevitably make mistakes
in use, perhaps because
they are misinformed,
intoxicated, tired, or
forgetful.

Question 7

Margaret Sanger (1879-1966)

Answer 7

an American nurse and activist who
strongly believed in educating women about
contraception. She coined the term birth con-
trol, in 1914, to mean the voluntary control of
conception by mechanical and/or chemical
means

Question 8

hormonal contraceptives

Answer 8

Mechanism of Action: Inhibits ovulation; thins endometrium to help prevent implantation; thickens cervical mucus to trap sperm

Pros: Menstrual cycle regulation; reduced menstrual flow; decreased acne; reduced symptoms of premenstrual syndrome
(PMS); decreased risk of endometrial and ovarian cancer; increased bone mineral density

Cons: Possible temporary hormonal side effects, such as spotting between menses, breast tenderness, headaches,
decreased levels of desire, nausea, and the perception of weight gain and mood changes; slightly increased risk of breast
and cervical cancer; expensive; do not protect against STIs

Combination Oral Contraceptive Pill (estrogen and progesterone), Transdermal Contraceptive Patch, NuvaRing

Question 9

Combination Oral Contraceptive
Pill (estrogen and progesterone)

Answer 9

Failure Rate: Perfect 0.3%, Typical 8%

The pill is taken daily at the same time, either a break for menstruation every 21 days or continuously.

Pros: easy to take

Cons: difficult to remember to take/ take on time

Question 10

Transdermal Contraceptive

Answer 10

Failure Rate: Perfect 0.3%, Typical 8%

One patch applied on the skin every week for three weeks, then break for 1 week for menstruation.

Pros: need to remember only once a week

Cons: possible skin irritation from patch

Question 11

NuvaRing

Answer 11

Failure Rate: Perfect 0.3%, Typical 8%

Ring inserted into the vagina and placed at the cervix for 3 weeks, then removed for 1 week for menstruation.

Pros: need to remember only once per month

Cons: possible increased risk of vaginitis; interfernce with intercourse reported by 1 to 2.5% of women

Question 12

Progestin-Only Hormonal Contraceptives

Answer 12

Mechanism of Action: May inhibit ovulation; thins endometrium to help prevent implantation: thickens cervical mucus to trap sperm

Pros: Chance of developing amenorrhea; appropriate for women who cannot tolerate estrogen methods: appropriate for
women over the age of 35 who smoke; suitable for use while breastfeeding; may reduce menstrual flow, menstrual cramps,
and symptoms of PMS

Cons: Potential irregular bleeding; possible hormonal side effects (see “cons” of combination hormonal contraceptives); do
not protect against STIs

mini-pill, depo-provera, iud

Question 13

Mini-pill

Answer 13

Failure Rate: Perfect 0.3%, Typical 8%

Pill taken at approx. same time every day without breaks for menstraution.

Pros: easy to take

Cons: must be taken at the exact same time (within 3 hours) each day

Question 14

Depo-provera

Answer 14

Failure Rate: Perfect 0.3%, Typical 8%

Intramuscular injection by a health care provider every 3 months

Pros: need to remember only once every 3 months; reduced risk of endometrial cancer, endometriosis, chronic pelvic pain and PMS

Cons: potiental wieght gain and mood changes; decrease in bone mineral density (which may improve after discotinuing)

Question 15

hormonal IUD

Answer 15

perfect and typical: 0.2%

small t-shaped device with slow-release hormone instered into the uterus by a physician and a plastic string passes out through the cervix so that the woman can feel it is in place.

pros: not having to think about contraception for 5 years, significantly lower dose of hormones than with OC pills, fewer side effects; significantly reduced menstrual flow

cons: 30% of women report benign ovarian cysts, rare risk of uterine perforation or infection during insertion; expsore to stis while using iud increased risk of PID

Question 16

non-hormonal iud

Answer 16

Mechanism of Action: Makes uterine environment inhospitable to sperm;
inhibits implantation

Failure Rate: Perfect: 0.6% (most failures occur in the first 3 months of use)

Small T-shaped device inserted into the uterus by a physician, with
a plastic string passing out through cervix so that the woman can feel it is in place

Pros: Lasts for 5 years; reduced risk of endometrial cancer; no hormonal side effects

Cons: Possible irregular bleeding; increase in blood loss during menstruation;
exposure to STIs while using this method is associated with an increased risk of is 4
PID; possibility of expulsion or uterine perforation

Question 17

Cervical Barrier Methods

Answer 17

Mechanism of Action: Create barriers at the cervix so sperm ‘cannot get through: ‘spermicide ‘used with these methods.
provides additional protection by killing some sperm

Pros: No hormonal side effects

Cons: Increased risk of toxic shock syndrome (TSS); no STI protection; unsuitable for women with recurrent vaginal or urinary tract infections (UTIs); may be difficult for some women to insert

Question 18

Female Condom.

Answer 18

Mechanism of Action: Creates a physical barrier to trap sperm
Failure Rate: Perfect: 5%, typical: 21%

Inserted into vagina up to 8 hours before intercourse, with flexible
ring end at cervix; outer portion covers the vulva

Pros: Protects against STIs (it provides more protection than the male condom
does against STis that are transmitted by skin-to-skin contact); made from
polyurethane (and therefore safe to be used by individuals with latex allergies); no
prescription needed; can be used for anal intercourse (by removing the inner ring)

Cons: Bulky apperance, crinkly or suction noises during intercourse; expensive

Question 19

Male Condom

Answer 19

Mechanism of Action: Creates a , physical barrier to trap sperm
Failure Rate: Latex: perfect: 2% (0.1% when combined with hormonal
contraceptives); typical: 15%; polyurethane and silicone have a higher frequency of
breakage and slippage; nonoxynol-9 spermicidal condoms were once thought to be
more effective but are no longer recommended because they can irritate vaginal/
anal lining, increasing the risk of infection

Rolled onto the penis; must be used with a
water-based lubricant (oil-based lubricants weaken the condom structure and can
result in breakage)

Pros: No prescription needed; help protect against STIs; many universities and
community health centres offer free condoms; putting the condom on can be
incorporated into sex play

Cons: Effectiveness decreases if not stored correctly or if expired; non-latex condoms
are fairly expensive; complaints of reduced sensitivity (a small amount of a water-soluble
lubricant inside the condom, as well as a thin condom, may reduce such complaints)

Question 20

Contraceptive Sponge

Answer 20

perfect: 9%, typical 16%

moisten with water; lasts 12 to 24 hours; removed 6 to 8 hours after last ejaculation

pros: no prescription, one size fits all, less messy, can be used multiple times

cons: high failure rate

Question 21

Lea Contraceptive

Answer 21

8.7% with spermicide, 12.9% without

placed against cervix, removed 6 to 8 hours after intercourse, can be reused for approx. 6 months

pros: up to 8 hours of protecttion; one size fits all, no prescription

cons: must be cleaned after each use

Question 22

Cervical Cap

Answer 22

perfect 9%, typical 20%

held in place against the cervix by suction

pros: safe for latex allergies; can be left for 72 hours

cons: can be dislodged during intercourse; may cause vaginal odour

Question 23

Diaphragm

Answer 23

perfect 6%; typical 16%

intersted up to 6 hours before intercourse and removed within 24 hours; replaced every 2 years

pros: reduced incidence of cervical dysplasia

cons: difficult to find the spermicidial cream necessary for use with diaphragms; prescription only, significant body weught changes

Question 24

Spermicides

Answer 24

perfect 18%, typical 29%

needs to be paired with barrier method, only effective for one act of intercourse

A contraceptive substance
that kills sperm to prevent
impregnation.

Pros: All but the VCF can also function as a lubricant; no prescription needed; can
reduce the risk of PID

Cons: Many spermicides contain nonoxynol-9, which may be irritating to the skin
and can increase the risk of infections, including STI transmission; they can be
messy; taste is not appealing; many take 10 to 15 minutes to take effect and are
effective for only about an hour

Question 25

Female Sterilization—Tubal Ligation

Answer 25

Mechanism of Action: Prevents the egg and: sperm from ever meeting because fallopian tubes are severed

Failure Rate: 0.5%

Surgery done either laparoscopically (most common) or transcervically; the surgeon seals the fallopian tubes
through burning, clipping, cutting, or tying; a backup form of birth control should be used for 3 months following the procedure

Pros: Not having to think about contraception again

Cons: Does not protect against STIs; requires general anaesthesia and may entail post-operative side effects; possible increased risk of ectopic preenancy

Question 26

Male Sterilization—Vasectomy

Answer 26

sperm from entering ej ejaculate because vas deferens is severed

Failure Rate: 0.05% after physician clearance has been given;’ sperm will still be in the ejaculate for 10 to 30 ejaculations
following the surgery

Surgery done either through a small puncture in the scrotal skin or through one or two incisions in the scrotal
skin; the surgeon removes a 1.5 cm segment from each end of the vas deferens, and the ends are sealed with a suture, cauterization, or clips; a backup form of birth control should be used until two consecutive negative semen samples are produced

Pros: Relatively simple procedure with very few complications and no general anaesthesia; most studies do not find
evidence of increased risk of testicular cancer; reversal surgery is available

Cons: Does not protect against STIs; potential side effects and short-term complications associated with surgery, such as
infection and local pain; following surgery, semen analysis needs to be done to ensure effectiveness

Question 27

amenorrhea

Answer 27

Absence of menstruation.

Question 28

chronic pelvic pain (cpp)

Answer 28

Chronic or recurrent
pelvic pain that apparently
has a gynecological origin
but for which no definitive
cause can be found.

Question 29

Vaginitis

Answer 29

An inflammation of the
vagina, usually due to
infection, that can result
in discharge, irritation,
and pain of the vagina
and vulva.

Question 30

toxic shock syndrome
(Tss)

Answer 30

Aserious but uncommon
bacterial infection,
originally associated with
tampon use but now known
to have an association with
some contraceptive barrier
methods.

Question 31

rhythm method

Answer 31

A calendar-based
method of family
planning that estimates
the start and end of the
fertile time based on
past cycle lengths and
involves abstaining from
intercourse during the
fertile time.

Question 32

Information-
Motivation-
Behavioural Skills (imB)
model

Answer 32

social psychology
model that identifies
three major components
(information, motivation,
and behavioural skills)
that may directly or
indirectly affect sexual
health behaviours.

Question 33

therapeutic abortion

Answer 33

abortion performed
when the mother’s life
is at risk, the pregnancy
is likely to cause severe
physical or mental
health consequences
in the mother, or the
fetus has a congenital
disorder associated
with a significant risk of
morbidity.

Question 34

elective abortion

Answer 34

An abortion performed
for reasons other than
maternal or fetal health.

Question 35

Abortion around the World

Answer 35

While it is legal in North America, most European
countries, China, India, and South Africa, it remains illegal
in most African, South American, and Central American nations unless there is a threat to maternal life, health, or mental health (and in some cases exceptions are made for
rape or fetal defects). Abortion is illegal with no exception in
El Salvador, Malta, and Vatican City

Question 36

gestation

Answer 36

In mammals, the period
of time in which a fetus/
embryo develops in the
uterus, beginning with
fertilization and ending
at birth.

Question 37

Medical (Non-surgical) Abortions

Answer 37

performed up to seven weeks following the last menstrual period,
but they can be done up to the ninth week of gestation;

Question 38

Surgical Abortions

Answer 38

Manual Vacuum Aspiration: flexible plastic tube is inserted through the woman’s cervix, and a
syringe attached to the tube removes the contents of the uterus by creating suction.

Vacuum Suction Curettage: sixth to the fourteenth week of gestation - woman’s cervix must be dilated,
either with laminaria tents (thin tubes made of sterile, dry seaweed that slowly expand as they
absorb fluid) or progressively larger rod-like dilator instruments. Once the cervix has been dilated,
a tube is inserted through the opening and into the uterus. The contents of the uterus, including
the fetal tissue, are then suctioned out, and a curette is used to gently scrape the uterine lining to
ensure that all of the tissue has been removed

Dilation and Evacuation: thirteenth through sixteenth weeks of
gestation, though it can be performed up to the twenty-fourth week. The procedure is similar to vacuum suction curettage, but it is more complicated because of the increased size of the fetus, and it must be done in a hospital under general anaesthetic.

Second- and Third-Trimester Abortions: equire feticide to ensure
that the fetus is not born alive. This can be done with an injection of a substance to stop the
fetal heart. The fetus is then typically removed through the cervix with the assistance of med-
ical devices such as forceps.

Question 39

feticide

Answer 39

A deliberate act that
causes the death of a
fetus.