10.5: Contraception and Abortion

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Jan 13, 2025
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- 10.4: Pregnancy and Infertility
- 10.6: Sexually Transmitted Diseases (STDs)

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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 (STDs); although all contraceptive methods are intended to reduce unwanted pregnancy, not all of them also protect against STDs. 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, although unlikely, is possible even if you are perfectly using contraceptive methods with high effectiveness.

Contraceptive Methods

Sexual partners need to discuss contraceptive options, asking questions such as:

Does either partner have allergies, such as a latex allergy?
Are the partners concerned about the 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 STDs need to choose contraceptive options that reduce the transmission of STDs which means choosing to use either a male condom or a 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 STDs. Couples who are in a long-term committed relationship and are not concerned about STDs 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 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 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 trick 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 the first year of typical use	Protect against STDs?	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 do you have to take or use
Abstinence (no sexual contact)	Natural- reversible	Unknown (0 for perfect use)	Yes	No medical side effects	No action is required, but it does take willpower. You may want to have a backup 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 is completed one time. No action is required after surgery
Male sterilization (vasectomy)	Surgical- permanent	Less than 1%	No	Pain, bleeding, risk of infection	Surgery is completed one time. No action is 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 is 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 is 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 is 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, nausea, 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	Taken 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, nausea, sore breasts, changes in your period, changes in mood, weight gain, and 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, nausea, sore breasts, changes in your period, changes in mood, weight gain, and 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), and 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 the 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), and 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 the vagina before sexual intercourse. Remove after intercourse.
Cervical cap with spermicide (FemCap®)	Barrier- reversible	17-29%	No	Irritation, allergic reactions, urinary tract infection (UTI), and 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 the vagina before sexual intercourse. Remove after intercourse (up to 2 days after).
Male condom	Barrier- reversible	13-18%	Yes	The condom may tear, break, or slip off. Irritation or allergic reactions to latex condoms	Put on the penis before sexual intercourse. Use it each time you have sex. Never use a male and female condom together.
Female condom (“internal condom”)	Barrier- reversible	21	Yes	The condom may tear or slip out. Irritation or allergic reactions could occur.	Insert into vagina or anus before sexual intercourse. Use it 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 backup birth control)	Depending on the 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), and vaginal infections. Using a spermicide often might increase your risk of getting HIV.	Use each time you have sex

Special Highlight: Instructions for Male Condom Use

A male condom is a thin, flexible sheath worn over the penis during sexual activity to prevent pregnancy and reduce the risk of sexually transmitted infections (STDs). When used correctly, male condoms are an effective form of contraception and protection against STDs. Follow these steps to use a male condom properly:

Before Use:

Check the Expiration Date: Ensure the condom is not expired. Using an expired condom increases the risk of breakage.
Inspect the Condom Packaging: Make sure the condom package is intact. Do not use a condom if the package is damaged, torn, or punctured.
Open the Package Carefully: Gently tear open the condom package along the perforated edge. Avoid using sharp objects like scissors or teeth to prevent damaging the condom.

How to Put on a Male Condom:

Ensure the Correct Orientation: Before unrolling the condom, check the direction of the roll. The condom should unroll easily over the penis, not roll up the other way.
Pinch the Tip: Hold the tip of the condom with your thumb and forefinger to leave space at the end (about half an inch). This space helps collect semen and reduces the risk of breakage.
Roll the Condom On: While continuing to pinch the tip, place the condom over the head of the erect penis. Roll it down the length of the penis until it covers the entire shaft, all the way to the base.

During Use:

Lubrication: Some condoms come pre-lubricated, but if extra lubrication is needed, apply only water-based or silicone-based lubricant. Avoid using oil-based lubricants (such as lotion or petroleum jelly) as they can weaken the condom and increase the chance of breakage.
Check for Air Bubbles: If you feel air trapped in the condom, gently press out the air to reduce the risk of breakage.

After Use:

Withdraw Carefully: After ejaculation, withdraw the penis from the partner's body while it is still erect. Hold the base of the condom firmly to prevent it from slipping off.
Dispose of the Condom Properly: Remove the condom carefully, avoiding spillage of semen. Tie the open end of the condom to prevent leaks and dispose of it in a trash bin. Do not flush condoms down the toilet, as they can cause blockages.

Important Tips:

Use a new condom for each act of intercourse (vaginal, anal, or oral). Never reuse a condom.
If the condom breaks or slips off during intercourse, stop immediately and use a new condom.
Condoms should be stored in a cool, dry place, away from heat, sunlight, and sharp objects, which can weaken the material.

When used consistently and correctly, male condoms are highly effective in preventing pregnancy and reducing the risk of STDs.

Abortion

Abortion refers to the medical procedure that ends a pregnancy. This can occur either through medication or surgical intervention, depending on how far along the pregnancy is and the method chosen by the individual and their healthcare provider. The primary purpose of abortion is to terminate the development of the fetus, either voluntarily or due to medical necessity.

Abortion can be classified into two main types: medication abortion and surgical abortion. The method used often depends on the gestational age of the pregnancy, the individual's health, and personal preferences. Both methods are safe when performed by a qualified healthcare provider.

Medication Abortion

A medication abortion involves using drugs to end a pregnancy. This method is typically used in the early stages of pregnancy, usually up to 10 weeks of gestation. The process usually involves two medications:

Mifepristone (RU-486): This pill blocks the hormone progesterone, which is essential for maintaining a pregnancy. Without progesterone, the pregnancy cannot continue.
Misoprostol: Taken 24-48 hours after mifepristone, misoprostol causes the uterus to contract and expel the pregnancy tissue.

Medication abortion is typically done at home after taking both medications, although some individuals may choose to have it done in a healthcare setting. The process can involve cramping, bleeding, and the passage of tissue, which is similar to a heavy period.

Surgical Abortion

A surgical abortion involves a medical procedure to remove the fetus from the uterus. Surgical abortion methods are typically used after the first trimester, but they can be performed later depending on the stage of pregnancy. There are several surgical techniques, including:

Aspiration (Suction) Abortion: This method is most commonly used in the first trimester, typically up to 12 weeks of gestation. It involves the use of a suction device to remove the pregnancy tissue from the uterus.
Dilation and Curettage (D&C): This method is often used for pregnancies between 6-14 weeks. It involves dilating the cervix and using a surgical instrument called a curette to scrape the lining of the uterus.
Dilation and Evacuation (D&E): This procedure is used after 14 weeks of gestation and involves a combination of suction and surgical instruments to remove the fetus and placenta from the uterus. It requires dilation of the cervix and is typically performed in a clinic or hospital.
Induction Abortion: In rare cases, particularly for later-term pregnancies, induction abortion may be used. This method involves administering medications to induce labor, resulting in the delivery of the fetus. It may be used in cases of severe fetal abnormalities or when the pregnancy poses a risk to the mother's health.

Safety and Risks

Both medication and surgical abortions are generally safe when performed under the care of a qualified healthcare provider. However, like any medical procedure, there are risks involved, including infection, excessive bleeding, injury to the uterus or cervix, and emotional or psychological effects. It is important to consult a healthcare provider to fully understand the potential risks and benefits before proceeding with an abortion.

The decision to have an abortion is a deeply personal one, and individuals need to consider their physical, emotional, and psychological health. Counseling and support services are often available for those who may need help during this decision-making process.

Special Highlight: 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,” and 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 before 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 occurred before 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 rates 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 were 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 for up to 11 weeks, whereas an aspiration abortion is performed in a hospital or clinic and can be done for 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.

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Special Highlight: Instructions for Male Condom Use

Before Use:

How to Put on a Male Condom:

During Use:

After Use:

Important Tips:

Medication Abortion

Surgical Abortion

Safety and Risks

Special Highlight: Abortion and Roe V. Wade

Contraception and Abortion

Contraceptive Methods

Special Highlight: Instructions for Male Condom Use

Before Use:

How to Put on a Male Condom:

During Use:

After Use:

Important Tips:

Abortion

Medication Abortion

Surgical Abortion

Safety and Risks

Special Highlight: Abortion and Roe V. Wade

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