10.4: Contraception and Abortion

As you have learned, passion is one of the three components of love, as defined by Sternberg, and relates to physical attraction and sexual desire. When entering into a sexual relationship, it is important to understand the various ways you can protect yourself from unwanted pregnancy and sexually transmitted diseases (STD’s); although all contraceptive methods are intended to reduce unwanted pregnancy, not all of them also protect against STD’s. There are many forms of contraception to choose from whether it is meant to be permanent or temporary (reversible) and whether it prevents pregnancy by either adjusting hormones, placing a barrier between the sperm and egg, or abstaining during ovulation. How effective each method is at preventing pregnancy is impacted by how the couple uses the method. If a person uses the method perfectly, called Perfect Use Effectiveness, it will have a higher effectiveness than those who are considered typical users, called Typical Use Effectiveness. The only contraceptive method that is 100% effective is abstinence. Pregnancy is a possibility even if you are perfectly using contraceptive methods with high effectiveness. Unwanted pregnancies can be terminated through abortion.

Contraceptive Methods

It is important for sexual partners to discuss contraceptive options, asking question such as:

• Does either partner have allergies, such as a latex allergy?
• Are the partners concerned about transmission of sexually transmitted diseases?
• Can the female take hormonal birth control or are they contraindicated for them?
• Will it be challenging for the female to take a pill every day at the same time?
• Does either partner have religious beliefs that impact the use of contraception?

The answers to your questions may help in deciding which option to choose.

For example, couples who are concerned about STD’s need to choose contraceptive options that reduce the transmission of STD’s which means choosing to use either a male condom or female condom. Male condoms are much cheaper and easier to find than female condoms. It is important to understand that surgical, hormonal, or natural birth control options do not protect against STD’s. Couples who are in a long term committed relationship and are not concerned about STD’s and would like a long term contraceptive might choose a permanent surgical option or a long term option like an Intrauterine Device (IUD). Couples who have a latex allergy and still want to use condoms can choose lambskin or polyurethane condoms instead of the more commonly used latex condoms. Couples who are very concerned about unwanted pregnancies will want to choose a method with the highest effectiveness rate and ensure they use the method as perfectly as possible, they may also want to combine methods such as using birth control pills and condoms.

When choosing a contraceptive method it is important to understand the difference between surgical, hormonal, barrier, or fertility awareness methods.

• Surgical method (permanent option)
  • Permanent methods of birth control that are also referred to as sterilization. These methods are for those who are sure that they do not want to conceive a child. Women choosing a permanent method can have their fallopian tubes tied or closed off, called a tubal ligation, or they can choose to have a small tube inserted into the fallopian tubes, called transcervical sterilization, which irritates the fallopian tubes causing scar tissue to form and close off the tubes. Men commonly get a vasectomy which is an outpatient procedure in which the tube that carries sperm is cut.
• Hormonal method (reversible)
  • When a woman is pregnant they no longer release an egg each month and if there is no egg released, they cannot become pregnant. Hormonal methods reduce the chance of pregnancy by providing hormones to the woman that tricks the woman’s body into thinking they are pregnant, thus the egg is not released each month.
• Barrier method (reversible)
  • In order for pregnancy to occur the egg from a woman and the sperm from a man must meet. If the sperm fertilizes the egg then conception, or pregnancy, occurs. Barrier methods of birth control work by creating a barrier in which the egg and sperm cannot meet.
• FAM: Fertility Awareness Method (reversible)
  • In order for pregnancy to occur, the sperm from the male must meet the egg from the female. The egg from the female is typically released only one time per month, called ovulation, so the sperm has a limited time window to meet the egg. The FAM is based on avoiding sexual intercourse when it is most likely that the sperm and egg can meet. FAM must also take into consideration that sperm can live in a woman’s body up to 5 days.

Table \(\PageIndex{3}\) : Type, Effectiveness, Risk, and Use of Common Contraceptive Methods

Name(s)	Type	Percentage of unwanted pregnancy within first year of typical use	Protect against STD’s?	Side effects and risks* *These are not all of the possible side effects and risks. Talk to your doctor or nurse for more information.	How often you have to take or use
Abstinence (no sexual contact)	Natural- reversible	Unknown (0 for perfect use)	Yes	No medical side effects	No action required, but it does take willpower. You may want to have a back-up birth control method, such as condoms.
Female sterilization (tubal ligation, “getting your tubes tied”)	Surgical- permanent	Less than 1%	No	Pain, bleeding, risk of infection	Surgery completed one time. No action required after surgery
Male sterilization (vasectomy)	Surgical- permanent	Less than 1%	No	Pain, bleeding, risk of infection	Surgery completed one time. No action required after surgery
Implantable rod (Implanon®, Nexplanon®)	Hormonal- reversible	Less than 1%	No	Headache, irregular periods, weight gain, sore breasts. Less common risk includes difficulty in removing the implant	No action required for up to 3 years before removing or replacing
Copper intrauterine device (IUD) (ParaGard®)	Nonhormonal- reversible	Less than 1%	No	Cramps for a few days after insertion. Missed periods, bleeding between periods, heavier periods. Less common but serious risks include pelvic inflammatory disease and the IUD being expelled from the uterus or going through the wall of the uterus.	No action required for up to 10 years before removing or replacing
Hormonal intrauterine devices (IUDs) (Liletta, Mirena®, and Skyla®)	Hormonal- reversible	Less than 1%	No	Irregular periods, lighter or missed periods. Ovarian cysts. Less common but serious risks include pelvic inflammatory disease and the IUD being expelled from the uterus or going through the wall of the uterus.	No action required for 3 to 5 years, depending on the brand, before removing or replacing
Shot/injection (Depo-Provera®)	Hormonal- reversible	4-6%	No	Bleeding between periods, missed periods Weight gain Changes in mood Sore breasts Headaches Bone loss with long-term use (bone loss may be reversible once you stop using this type of birth control)	Get a new shot every 3 months
Oral contraceptives, combination hormones (“the pill” or “mini-pill))	Hormonal- reversible	7-9%	No	Headache, nasuea, sore breasts, changes in your period, changes in mood, weight gain, high blood pressure. Less common but serious risks include blood clots, stroke and heart attack; the risk is higher in smokers and women older than 35	Take at the same time every day
Skin patch (Xulane®)	Hormonal- reversible	7-9% May be less effective in women weighing 198 pounds or more	No	Skin irritation, headache, nasuea, sore breasts, changes in your period, changes in mood, weight gain, high blood pressure. Less common but serious risks include blood clots, stroke and heart attack; the risk is higher in smokers and women older than 35	Apply to skin for 21 days, remove for 7 days, replace with a new patch
Vaginal ring (NuvaRing®)	Hormonal- reversible	7-9%	No	Vaginal irritation and discharge, headache, nasuea, sore breasts, changes in your period, changes in mood, weight gain, high blood pressure. Less common but serious risks include blood clots, stroke and heart attack; the risk is higher in smokers and women older than 35	Insert into the vagina for 21 days, remove for 7 days, replace with a new ring
Diaphragm with spermicide (Koromex®, Ortho-Diaphragm®)	Barrier- reversible	12%	No	Irritation, allergic reactions, urinary tract infection (UTI), vaginal infections. Rarely, toxic shock if left in for more than 24 hours. Using a spermicide often might increase your risk of getting HIV.	Insert into vagina before sexual intercourse. Remove after intercourse. Get refitted if you gain or lose weight or give birth
Sponge with spermicide (Today Sponge®)	Barrier- reversible	12-27% 12% for those who haven’t had a child, 27% for those who have given birth	No	Irritation, allergic reactions, urinary tract infection (UTI), vaginal infections. Rarely, toxic shock if left in for more than 24 hours. Using a spermicide often might increase your risk of getting HIV.	Insert into vagina before sexual intercourse. Remove after intercourse.
Cervical cap with spermicide (FemCap®)	Barrier- reversible	17-29%	No	Irritation, allergic reactions, urinary tract infection (UTI), vaginal infections. Rarely, toxic shock if left in for more than 24 hours. Using a spermicide often might increase your risk of getting HIV.	Insert into vagina before sexual intercourse. Remove after intercourse (up to 2 days after).
Male condom	Barrier- reversible	13-18%	Yes	Condom may tear, break or slip off. Irritation or allergic reactions to latex condoms	Put on penis before sexual intercourse. Use each time you have sex. Never use a male and female condom together.
Female condom (“internal condom”)	Barrier- reversible	21	Yes	Condom may tear or slip out. Irritation or allergic reactions could occur.	Insert into vagina or anus before sexual intercourse. Use each time you have sex. Never use a male and female condom together.
Withdrawal — when a man takes his penis out of a woman’s vagina (or “pulls out”) before he ejaculates (has an orgasm or “comes”)	Natural- reversible	22	No	Sperm can be released before the man pulls out, putting you at risk for pregnancy.	Use each time you have sex
Fertility Awareness Method: Calendar, temperature, or rhythm method	Natural- reversible	24	No	Can be hard to know the days you are most fertile (when you need to avoid having sex or use back-up birth control)	Depending on method used, takes planning each month
Spermicide alone	Barrier- reversible	28 Works best if used along with a barrier method, such as a diaphragm	No	Irritation, allergic reactions, urinary tract infection (UTI), vaginal infections. Using a spermicide often might increase your risk of getting HIV.	Use each time you have sex

Abortion and Roe v. Wade

“Jane Roe,” a woman who wanted to safely and legally end her pregnancy, challenged a Texas statute that made it a crime to perform an abortion unless the woman’s life was in danger. In the ruling, the U.S. Supreme Court recognized for the first time that the constitutional right to privacy “is broad enough to encompass a woman’s decision whether or not to terminate her pregnancy” (Roe v. Wade, 1973). Roe v. Wade has come to be known as the case that legalized abortion nationwide. On June 24, 2022, after upholding this constitutional right for nearly 50 years, the U.S. Supreme Court ruled that “the Constitution does not confer a right to abortion,” thus voted to reverse their decision, leaving the ability to have an abortion to state law. It is estimated that about half of the states in America will either completely ban, or severely reduce, access to a legal and safe abortion.

There is no way to know how many women died receiving illegal abortions prior to the legalization of abortion in 1973. However, since the early 20th century, researchers, scientists, and doctors have attempted to estimate the number of illegal abortions performed and the corresponding death rate. Some estimates state that it could have been as low as 200,000 illegal abortions to 1.2 million illegal abortions performed each year causing as many as 5,000 to 10,000 annual deaths.

Although we do not know exactly how many deaths occured prior to the legalization of abortion in 1973, we do know that after 1973 when abortions were legal they were very safe causing less than 1 death per 100,000 people. Legal abortions are so safe that in 2018 there were only two deaths total from complications of an abortion. Thus, the death rate before 1973 and after were very likely dramatically different. The rate of complication for abortion is less than childbirth itself, and even lower than wisdom teeth removal.

Legal abortions in the U.S. are not only safe, but also very common. In the US, in 2019, there were 195 abortions per 1,000 live births, meaning about one out of every five pregnancies was terminated through abortion^[7]. In 2019, the majority of abortions occurred early in gestation (≤9 weeks), when the risks for complications are lowest. In addition, over the past 10 years, the number of abortions performed ≤9 weeks’ gestation increased from 74.8% in 2010 to 77.4% in 2019. Abortion can be completed with medication or by a procedure which is often called surgical abortion or aspiration abortion.

A committee of the National Academies of Sciences, Engineering, and Medicine reviewed the data available and confirmed in their report in 2018 that all forms of abortion including medication and aspiration abortion are safe and effective and that the only factors decreasing safety are those decreasing access^[8][9]. A medication abortion can be completed at home, is non-invasive, and can be done up to 11 weeks, whereas an aspiration abortion is performed in a hospital or clinic and can be done up to 16 weeks.

It will be years before data is available to understand how the U.S. Supreme Court’s decision to overturn the constitutional right to an abortion may impact women’s health across the U.S., especially on a state-by-state basis where access may lead to health disparities.