Reproductive Choice Flashcards

1
Q

Family Planning

Overview

A

Educational, comprehensive medical, or societal activities which enable individuals to determine freely the number and spacing of their children, and selected the means by which this may be achieved.

One of the 10 great public health achievements of the 20th century

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2
Q

Intended Pregnancy

A
  • Affluent society less fertility
  • Improved maternal well-being
    • Earlier initiation of prenatal care
    • Less depression
    • Higher rates of breastfeeding
    • More likely to complete high school/education
  • Improved child health
    • Less likely to have low birth weight
    • Better mental and physical health
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3
Q

Unintended Pregnancy

A
  • Teenage pregnancy
    • U.S. teenage pregnancy rates 2x vs UK, Wales, Canada, and 8x vs Japan and Netherlands
    • Main reason is access to care
    • Public cost of unwanted pregnancies was ~$21 billion in 2010
  • Disparities in unintended pregnancies
    • ~45% of pregnancies in U.S. in 2011 were unintended
    • Black women > Hispanic or white woman
    • Women with lower family income
    • Unmarried women
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4
Q

Contraception

Efficacy

A
  • General efficacy
    • # of unplanned pregnancies that occur during a specified period of exposure and use
  • Pearl Index
    • # failures per 100 woman-years
    • (# preg. x 12 months) / (# women studied x # months) x 100 = Pearl Index
    • Assumes a constant failure rate over time
  • Life-table analysis
    • Failure rate for each month of use
    • Allows cumulative failure rate to be deduced
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5
Q

Natural Family Planning

A
  • Fertility awareness, periodic abstinence, or rhythm method
  • Indicators such as cervical mucus and basal body temperature used to delineate fertile window
  • Helps couples conceive as well as avoid pregnancy
  • Typical failure rate during first year of use is 25.3%
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6
Q

Withdrawal Method

A
  • Use is probably underreported
  • No protection from STIs
  • Typical failure rate for one year is 18.4%
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7
Q

Spermicide Alone

A
  • Nonoxynol-9, benzalkonium chloride
  • Requires application 10-30 minutes prior to intercourse
  • Postcoital douches do not work
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8
Q

Diaphragm/Cap/Sponge

A
  • A way to hold spermicide against the cervix
  • Low-cost, non-hormonal, woman-controlled
  • Must be placed before intercourse, and left in place 6 hours after intercourse
    • Effectiveness depends on fit (must be fitted by Gyn)
  • Typical use failure rate during first year is 16-32%
  • Affected by parity
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9
Q

Condoms

A
  • Only contraceptive method effective in prevention of HIV transmission
  • Must give instructions for effective use
  • Slippage, spillage, and breakage are concerns
  • Male condom (17.4% failure)
  • Female condom (27% failure)
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10
Q

Hormonal Contraceptives

A
  • Combined Oral Contraception (“The pill”)
  • Intravaginal Ring
  • Patch
  • Progestin-only Pills (“The mini-pill”)
  • Nexplanon/etonorgestrel implant
  • Depo-medroxy progesterone
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11
Q

Non-hormonal IUD

A
  • Devices:
    • Paragard TCu 380-A
  • Mechanism:
    • Sterile inflammatory response ⇒ ⊗ sperm capacitation, penetration, and survival
  • Slightly blood loss and menstrual pain
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12
Q

Hormonal IUD

A
  • Devices:
    • Mirena 52 mg LNG
    • Lilette 52 mg LNG
    • Kyleena 19.5 mg LNG
    • Skyla 13.5 mg LNG
  • Mechanism:
    • Sterile inflammatory response ⇒ ⊗ sperm capacitation, penetration, and survival
    • Progestin effects on endometrium
  • Blood loss; tx of hyperplasia, endometriosis, and dysmenorrhea
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13
Q

IUD Overall Efficacy

A
  • Failure rate in first year of use 0.2-0.8%
  • Expulsion rate 10%
  • Removal rate 15%
  • PID risk: 6x during first 20 days after insertion, but then normalizes
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14
Q

Sterilization

A
  • Male: vasectomy
    • Same-day procedure under local anesthesia
    • Reversible
    • Failure rate is 0.2%
  • Female: tubal ligation or salpingectomy
    • ⊗ Transport of egg to uterus
    • Performed during or immediately after delivery; or interval (general or regional anesthesia)
    • Benefits: non-hormonal, permanent
    • Risks: those of surgery, regret
    • Regret can approach 25% is certain populations
    • Failure rate is 0.7%
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15
Q

Abortion

Methods

A
  • First trimester
    • Medical – mifepristone plus misoprostol
    • Procedural – dilation and evacuation
  • Second trimester
    • Dilation and evacuation (curettage)
  • Benefits: unwanted pregnancy carries adverse effects for mom and child
  • Risks: bleeding, infection, uterine perforation
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