Birth Control Methods: Explained
Birth control is a method to expand life options for women of childbearing age. Contraception choices for women and men target unwanted pregnancies. Sex education seeks to provide comprehensive birth control plans but does not aim to be disapproving or moralizing about behavior. Reducing unplanned pregnancy is the goal of birth control with a pragmatic approach to combat disinformation or lack of education. Millions of teenagers become pregnant each year and more than ¾ of those pregnancies are unplanned. Half of all pregnancies are unplanned.
Birth control does not seek to combat sexually transmitted diseases or attempt to moralize about out-of-wedlock births. Unintended pregnancy limits life options for women and men. Sex education and birth control tends to be controversial, but experience has shown that limiting the debate on moral issues can backfire. The developed world has had practice in this issue and most believe that sex education and birth control needs to be non-religious and comprehensive, accessible and possibly free of cost.
Federally and privately funded community organizations work in partnership to provide sex education and contraception. Public schools, corporations, foundations and religious groups deliver sex education with backing from government. A balance between government and private groups shifts and changes over time. Different countries have varying cultural and public health concerns, and continually seek to balance competing demands.
Birth Control Controversies
Controversies about sexual behavior have been around for a long time and will most likely continue to make headline news around the world. The U.S. and other developed countries have had about a hundred years of scientific advances, big government and sex education. Underdeveloped countries will most likely go through the same growing pains and controversies that developed countries have endured.
The main controversy has been the misconception that sex education leads to having sex. Sex education is a gateway, proponents of this view say. In that view, if government opens the door for a teenager, he or she will walk through it. This view persists despite the fact that there is no evidence that proves sex education leads to the activity. Detractors from this view, point to a deficit in conservative beliefs, and a refusal to acknowledge and speak about actual behavior and unpleasant truths.
Another controversy is the abstinence programs, where teenagers promise to be abstinent until marriage. Teenagers join abstinence movements in their school, community or church and promise not to have sex until marriage. However, these programs have come to be viewed as ineffective, a joke to some, but a resounding failure, overall. 88% of teenagers who pledged abstinence did engage in sex before marriage!
The problem for birth control advocates is that these teens often forego comprehensive sex education in favor of abstinence. Research shows that these teens start having sex earlier, and do not know how to use birth control or protection from venereal disease. The goal of abstinence was to aid in the social and psychological health of vulnerable teenagers, and to help them attain self-sufficiency. Instead, teenagers were provided with inaccurate information, were less likely to see a doctor, and less likely to use condoms. They ended up with unplanned pregnancies and spread more disease. In the U.S., many states gave up millions in funding for abstinence programs in favor of comprehensive education instead.
Sex education is a hot button issue in politics. The current President of the U.S., Barack Obama sees sex education as a family issue, not a part of politics. He states that not all agree on the issue of abortion, but all want to reduce the number of abortions. The Federal Government has long sought to stay clear of controversial views, but instead to frame the issue as part of a larger imperative to improve the nation’s public health. Federal, state and local governments in the U.S., and other countries, see sex education as an investment in workers that are healthy and productive.
The federal bureaucracy expanded in the 1930’s in the U.S. with new federal agencies and promotion of public health initiatives. Condoms were advocated as far back as the 1930’s, and soldiers had to go through sex education as part of their indoctrination into the armed services. Widespread venereal diseases and back room abortions were the targets of these early initiatives. The Federal Government dominated sex education even more under Johnson’s Great Society, when government took responsibility for the health of millions of Americans. The government linked health and sex education as a way to alleviate poverty.
By not engaging in the debate of “medicine vs. morality,” governments often avoid some of the more controversial aspects of sex education. In addition, governments and social programs alike, can avoid controversy by not publicizing some programs. Many programs have experienced a significant backlash. Some have considered sex education and birth control as a way to keep racial and class lines in place, with the poor and minorities dissuaded from reproducing. Others like Catholics consider sex education as an attack on their religious beliefs. Some people are opposed to the government’s involvement because federal, state and local governments also attempt to pass laws against certain sexual behaviors.
Half of all teenagers are having sex. However, teenagers are now waiting slightly longer to have their first sexual encounter. The younger a person is when they have sex for the first time, the greater likelihood of contracting a sexually transmitted disease. STDs are rising in incidence, suggesting that even though teenagers are delaying their first sexual experience, they are not using condoms. Male and female African-Americans have higher incidences of unprotected sex. Researchers say that girls are more likely than boys to have unprotected sex their first time.
A teenager who is sexually active has a 90% chance of becoming pregnant within one year. In the U.S., 19% of girls who are having sexual intercourse become pregnant, with most of those pregnancies being unplanned and unwanted. Teenagers are much more likely than older women to have lapses in practicing contraception. Unwanted pregnancies are much higher in the U.S than in other developed countries. England, Canada and Wales have ½ the incidence of unplanned pregnancies than the U.S. Japan and the Netherlands have 1/10 the incidence of the U.S.
Experts believe that quantifying and explaining sexual behavior leads to a more realistic picture of the situation. Having a willingness to deny that young people are having sex will not stem unplanned pregnancies. Controversies and backlashes may be averted if parents, schools, religious groups, and governments have a realistic view of sexual behavior. Separating a teenager’s sexual behavior from moral arguments with a sober look at the reality, helps them lead healthy, disease-free and productive lives.
Parenting as a Choice
Birth control is a comprehensive menu of options to avoid unwanted pregnancy. No one has to have children. No government forces pregnancy on women. Pregnancy is a life-changing condition for the mother, father and extended family. Becoming a parent is an individual choice but affects the whole family and community. Birth control seeks to give an individual time to mature, achieve schooling or work training, and time to sort out the hopes and dreams that everyone has for their life. Birth control creates options and alternatives. Many options are available for women to control and plan their pregnancies.
New contraceptive methods are flexible, effective, with low side effects. All methods’ effectiveness are limited by the type of appeal they may find among women. Women’s preferences have not been well studied. The factors that determine choices are not known because of limited data and research. Companies seeking to expand options in birth control cannot often predict what women will like. Having a product that women like using is important as ease of use is critical for effectiveness.
The most effective birth control methods can fail at times. The birth control method must be carefully chosen and used properly each and every time. Lifestyle and sex habits, and future considerations should be examined. Consultation with a doctor or sex education professional can help individuals to choose. Long-acting reversible contraception(LARC) is preferred. Each method has advantages and disadvantages and is a highly individualized choice.
Choices will vary according to a person’s age, number of sex partners, frequency of sex, wishes for children in the future, and overall health. Effectiveness and possible side effects need to be considered. Above all, the method chosen should set the individual up for success. A busy person may have trouble remembering to take the pill. People who have sex infrequently may prefer using condoms and spermicide. Many women are uncomfortable with condom use but researchers have found that those who use both hormonal contraception and condoms have a higher degree of sexual satisfaction.
Comfort level with using the method may be the deciding factor in choosing contraception. A physician or health practitioner should explain the proper use. Birth control may take practice, adjustment and a learning period. Tips and tricks can be learned along the way. Some birth control methods can be obtained “over the counter” but many prescriptions, devices and procedures must be secured by a visit to a physician.
Many times individuals do not get proper advice as they may face racial, economic and gender discrimination which acts as a barrier to contraception. One study showed that 57% of women reported discrimination when seeking birth control advice. Discrimination is a social, financial and structural barrier to obtaining proper birth control. Other barriers for women include low resource settings of limited education, accessible and affordable options. Some women face pressure and rights abuse from partners, family, religious groups and even contraceptive groups supposedly trying to help.
Types of Birth Control
Individuals do not have sexat any time. It is the only perfect method to prevent pregnancy. However, the abstinence movement has failed. A majority of women are not successful in abstaining from sex. Choosing abstinence may not be practical and may in fact, be dangerous. Abstinence may preclude getting proper information about effective birth control. People in this group often have sex earlier than those who do not profess abstinence. They also do not use birth control as much, and do not use condoms as much, so pregnancies and sexually transmitted diseases are higher in incidence.
This method can be chosen when a woman would like a more natural approach to birth control. A schedule is kept indicating the days when a woman is most likely to be ovulating. On the days when the woman is most fertile, abstinence, a condom or other barrier method can be used. Keeping a written schedule is very important for this method to work. A woman is fertile on the day of ovulation, 5 days beforehand and 3 days after ovulation. Other factors to be measured and considered include taking body temperature every day and checking the cervical mucous from the vagina. Temperature will rise slightly and cervical mucous will be clear on the first day of ovulation.
Condoms for men are the only proven method to prevent sexually transmitted diseases including HIV/AIDS. The female condom is not widely used and data is lacking for its effectiveness in preventing disease transmission. The male condom is often used in tandem with other contraceptive methods. Condoms are more effective with a vaginal spermicide, which kills the sperm. Only latex or polyurethane condoms are protective against STD’s and viruses like HIV, hepatitis B, and herpes.
Condoms are used during a sex act and depend on negotiations between both participants. Negotiations sometimes fail in the heat of the moment, and the condom may not be used. Condoms are not the preferred method of birth control for this reason. Some women and their partners may also have preferences for condom use or non-use based on their sexual pleasure. Different types of materials and lubricants can increase or decrease pleasure.
Males put a thin, flexible sheath made from latex, polyurethane, or lambskin over their erect penis. Sperm is captured at the tip of the condom which prevents the sperm from entering the woman’s vagina. A condom can be put on right side out or inside out. If no pre-made collection pouch is built into the condom tip to collect sperm, users can leave a little extra material at the top to catch sperm. A new condom should be used for every instance of sex.
Spermicides are often used with a condom by the female, in order to provide backup protection. Condoms can break from being old, improperly worn or due to the application of lotions, baby oil and petroleum jelly for lubrication. Lubricated condoms are available as well as non-lubricated condoms. Different sizes are available as well. Females who want to be self-reliant, prepared and in control of the sexual situation, can carry their own condoms.
Women can use a condom made especially for them. This type of birth control fits inside the vaginal canal and is not used with a male condom. The condom is made of similar materials as the male condom and has similar care instructions. A woman can insert the condom up to 8 hours before sex. However, some education and practice may be necessary for proper effectiveness.
A soft, disk-shaped device made out of polyurethane foam containing spermicide, is inserted into the vagina to block the cervix. Sperm is blocked and neutralized. Women can use the sponge for 24 hours as long as the sponge is left in place for 6 hours after the sexual event. After those 30 hours, the sponge must be taken out.
Diaphragm, Cervical Cap, and Cervical Shield
These devices block the sperm from entering the opening of the womb and reaching the egg. Diaphragms, caps and shields are latex or silicone devices prescribed and fitted by a doctor. Spermicide is used in conjunction with these devices for additional protection. Like the sponge, cervical blocking devices should be left in place for several hours afterwards to prevent pregnancy, and taken out after that. Women using these methods of birth control may have irritation, urinary tract infections and toxic shock from leaving the device in too long.
- Oral contraceptives (OCs) are known as “the pill,” and contain estrogen and progestin. The pill is the most common form of contraceptive among women under 29. However, this group also has a high number of abortions suggesting limitations in effectiveness for the pill. Researchers suggest that IUDs would be more beneficial for this age group. The pill causes hormonal changes to take place in the woman’s body. Ovulation is circumvented and an egg is not released. The pill also causes changes in the womb lining and cervical mucus to discourage sperm from flourishing. The pill has many variations with different types of hormone releasing mechanisms as well as a progestin-only pill (“Mini-pill”). The pill was introduced to the public in the early 1960s, with over 300 million women having used it. Psychological well being is not often affected by use of the pill. Some long time users may have some dissatisfaction, irritability, lost interest in people, earlier waking, lost interest in sex, worries about health, and alcohol dependence. Older women, women with blood clots, a history of cancer, and those who are on other medications, may be advised to find an alternate method of birth control. Side effects include an increased pregnancy risk for overweight women. Weight gain is not a proven side effect. Some women may feel dizziness or an upset stomach. Risks include stroke, heart attack and high blood pressure. Women who smoke should not use the pill. The pill does not appear to increase the risk of HIV/AIDS by creating an environment for the virus to thrive. Experts say that a risk of cancer is not greater for women who use the pill, however women who use the pill for more than 8 years may have a greater risk. The evidence also suggests that the pill may even have some cancer protective effects which may last for at least 15 years after stopping. Weight gain in pill users may be a myth. Researchers found that women taking the pill did not gain any more weight than women in the same age group who did not take the pill. Women on the pill who did gain more weight were from lower socioeconomic groups. While most women do not gain weight, body fat may increase slightly as muscle mass decreases. Regular exercise and healthy eating habits may reduce these risks. Compliance with taking oral contraceptives is problematic and partly responsible for the high rates of unintended teenage pregnancies. Half of all women miss one or more pills in each cycle. A quarter of those taking the pill miss two or more doses, giving them three times the risk of an unintentional pregnancy.
- The Hormonal Patch, brand name Ortho Evra, is a transdermal skin patch that releases progestin and estrogen into the bloodstream. The ovaries are prevented from releasing eggs and the cervical mucus thickens to keep sperm from being viable. The patch is placed on the arm, upper body, abdomen or buttocks. The patch must be replaced once a week for three weeks. The fourth week is a rest period from hormones in order to have a normal menstrual cycle.
- The Hormonal Injection, brand name Depo-Provera, is an injection of progestin, or depot medroxyprogesterone acetate (DMPA) every 3 months. It works like the pill and the patch by stopping the egg from being produced and changing the mucosal environment. About 400,000 teens and 2 million American women use DMPA because of the low failure rate, low cost and ease of use. Injections are not favored for long term use. Side effects may include weight gain, sore breasts, headaches and osteoporosis. Researchers found that women getting shots over three years gained an average of 11 pounds and their body fat percentage increased by 3.4 %. The rate of weight gain depended on the length of time the shots were being taken. Women were able to lose the weight after switching to nonhormonal contraception.
- The Vaginal Ring, brand name NuvaRing, is a thin, flexible ring inserted into the vagina. Users wear the ring for three weeks. When menstruation starts, the ring is removed and a new one put in after menstruation stops. The ring has a similar action to the others, in that it releases the hormones progestin and estrogen, stopping the ovaries from releasing eggs. Side effects are similar to the pill and some swelling or irritation in the vagina.
Long-acting Reversible Contraceptive (LARC)
LARC methods or Implantable Devices are highly effective against pregnancy, however some experts caution that their use may lead to reduced condom use and sexually transmitted infections (STIs). Implanted devices are favored because they are user-independent. In other words, the user does not have to take any action after the implantation, in order to be effective. Human error, like forgetting to take a birth control pill, is eliminated. Implanted devices account for 5-15% of contraceptive methods, and experts would like to see their use dramatically increase. Fertility is regained when the device is removed. Women who use these devices show the lowest incidence of Female Sexual Dysfunction (FSD) compared to women taking hormonal contraceptives who have the highest risk of FSD.
Misperceptions about the IUD persist and continue to shape use of the device. In the 1970s the Dalkon Shield caused serious health problems and resulted in legal action for the manufacturers. Use of the devices declined until the U.S. took it off the market in the 1980s. Since then, newer devices have emerged with few side effects and high degree of reliability. Only 1% of women in the U.S. use this method. 4.6% of women in Australia use it and 6% of women in the U.K rely on it. China is the main user with half of all users being Chinese.
Implantable rods, brand name Implanon, are matchstick-sized devices surgically placed under the skin of the upper arm. Progestin is released to change the lining of the uterus and make it inhospitable for sperm. It can also stop the ovaries from releasing eggs and is effective for up to 3 years. Some women who are obese or overweight may not do well with this device. Side effects are acne, weight gain, ovarian cysts, headaches, upset stomach, and mood changes including depression and loss of interest in sex.
Intrauterine devices (IUDs), brand names ParaGard or Mirena are long-lasting and used often by women over the age of 35. They are considered underutilized by other women. An IUD is a small, T-shaped device inserted in a woman’s uterus by a physician. Levonorgestrel-releasing IUDs, a hormone releasing IUD, is very effective in preventing pregnancy and reducing menstrual bleeding. Levonorgestrel IUD’s also have a lower incidence of bleeding than copper devices. However, these hormone releasing IUDs may be too expensive for developing countries. Side effects may include bleeding between periods, cramps, pelvic inflammation, tears in the uterus and future infertility.
Female sterilization is the second most commonly used form of contraception, more common among married women and women over 30 years of age. Because of its permanence, the decision-making process for this method is more complex. Women can often feel regret after the procedure. However, it is a safe and effective form of permanent birth control.
The surgical procedure cuts, ties, or seals the fallopian tubes. The egg is prevented from going down the fallopian tubes and being vulnerable to insemination by the sperm. Many different methods for sterilization exist. One new method called essure is a non-surgical procedure. A spring-like device is inserted through the vagina and uterus into the fallopian tubes. Scar tissue forms around the spring in about 3 months and prevents the egg from entering the fallopian tubes. Side effects may consist of pain, bleeding, complications from surgery, and ectopic (tubal) pregnancy.
Males desiring sterilization can have an operation on the vas deferens to stop sperm from exiting the penis through the seminal stream (ejaculate). Sex is still not safe for about 3 months after the operation, as some sperm stays in the system for that time period. Couples must use an alternate form of birth control to prevent pregnancy during those three months.
Emergency Contraception (ECP)
ECP was approved by the U.S. Food and Drug Administration a decade ago, but was approved in other countries prior to that. Named the “morning after” pill, this type of birth control is used in emergency situations. Sometimes women forget to take the pill, do not use a condom, the condom broke or she was forced to have sex. When a woman has sex without protection she can buy an over the counter remedy which stops the egg from being viable. This method should be used within 5 days after having unprotected sex. Side effects include nausea, stomach pain, fatigue, headache, and vomiting. Experts caution that emergency contraception is not an antidote to the problem of unintended pregnancies, but its use does not provoke riskier sexual behavior.
Researchers say that physicians can do a better job of counseling women about birth control. IUD’s especially are underutilized, according to experts. This situation exists because physicians are often undereducated and inexperienced in their use. Physicians claim that they feel uncomfortable discussing IUDs with patients and that patients are not interested in IUDs anyway. 99 % of physicians prescribe oral contraceptives, but only 39% of physicians recommend IUDs. Only 24% percent of physicians had inserted an IUD in a patient. Those physicians who were comfortable discussing IUD use, and who had experience inserting the device, had considerably more practice in their residency years.
Emergency room physicians are also misinformed and lose valuable chances to prescribe emergency contraception to patients who need it, another study found. 43% of physicians who responded to a survey, answered half of the questions wrong. Physicians commonly believe that ECP must be taken within 1 day after unprotected sex. However, ECP is effective for up to 5 days. The lack of education about emergency contraceptive leads to a reluctance to prescribe the remedy, researchers surmise. Adult woman in the U.S can purchase the drug by themselves, but women younger than 18 are required to have a prescription. However, in the U.K. women under 18 do not require a prescription and that has done little to change the rate of teenage pregnancies.
Emerging Possibilities for Birth Control
The main goal of researchers and medical companies is to find dual-purpose contraceptive agents that combine birth control with protection against sexually transmitted diseases (STDs). A contraceptive agent that immobilizes but does not kill sperm, and reduces STDs by altering the microbicidal activity in the womb is a one novel approach. Other novel methods focus on new non-hormonal contraceptives for women.
Researchers seek to present alternatives to a woman taking potent hormones every day. One approach is to target the few days each month when a women is fertile, and use “pregnancy blocking” molecules.
Other research has focused on male-oriented contraception. Many men are taking an active interest in birth control. They want a reliable method for themselves to prevent unplanned pregnancies. Researchers and governments seek to reduce teenage fatherhood in order to help them increase their chances of obtaining at least a high school education.
Current methods for men only include condoms and vasectomy. Current methods being researched include shots, implants, or gels. A male hormonal contraceptive clinical trial of an androgen preparation was conducted in China. Men had monthly injections for thirty months, of 500 mg of a formulation of testosterone undecanoate (TU) in tea seed oil. Only 1 in 100 cases of pregnancy were reported, similar to effective rates in female contraception. Study results also found this method safe in the short term with few side effects. However, long-term use is still being studied.
Most experts agree that finding non user-dependent methods is the answer to consistent and reliable birth control. Long acting reversible contraceptives (LARCs) are favored, such as implanted devices that last between three months and three years, are not dependent on patients taking them correctly and therefore much more reliable.
With half of teens in high school being sexually active, experts are promoting more confidential counseling for teenagers and the “Quick Start” method. Adolescents and adults need differing developmentally appropriate care. Seeing a physician one-on-one allows an adolescent to address concerns and behaviors that may impact them in later years. The “Quick Start” method allows teenagers to start hormonal contraceptives regardless of the day of their menstrual cycle. Physicians are being advised to be aware that girls may have trouble taking daily pills, so a weekly or monthly pill schedule, IUDs and implants should be discussed.
Studies have also shown that parental consent for birth control should be completely eliminated. Teenagers do not seek health care, contraception, STD testing, and prenatal care when parental consent is required. Physicians feel that teenagers are mature enough to give their own informed consent for medical services and birth control.
Free contraception, in one study in Norway, halved the abortion rate. The rate of contraception did not rise, meaning that new cases of women seeking birth control did not rise. However, women had less lapses in dosing. Researchers conclude that because birth control was free, the women were more likely to use it and were happier because of it.
The U.S. Department of Health and Human Services has instituted a new program for birth control and other female-oriented health services. Half of all women delay preventive care because they cannot afford it. The federal government believes free services make sense to keep women healthy, and to keep women and their babies healthy. Private insurance companies will be required, starting on Aug. 1, 2012 to cover women’s health services without a co-pay or deductible. Co-pay or deductible-free services include:
- FDA approved birth control methods, including emergency contraception such as the morning-after pill.
- breast-feeding support
- well-woman visits
- screening for gestational diabetes
- domestic violence screening
While the most common form of birth control is the hormone releasing “pill”, but studies show that compliance and proper use is often poor. Many women, especially teenagers, miss one or more doses. Missing doses increases the risk of pregnancy and leads to unnecessary abortions. Experts now agree, that the previously unsafe IUD is safe in its present form. The IUD is now considered the birth control method of choice because it involves little effort by the woman. The device is implanted and the woman can forget about it. There are few risks associated with the device and experts hope the usage increases dramatically.
Birth control has little effect on sexually transmitted disease. Only a male condom is proven to prevent the transmission of HIV/AIDS, herpes, hepatitis, chlamydia and others. Women seeking to prevent STD’s and prevent pregnancy should use a dual-method. A birth control method should be chosen, and condom use discussed and implemented with her partner.
Birth control should be used until the time is right to become pregnant. Women should complete schooling or job training, and be financially and emotionally secure, either with or without a partner present. Understanding the complexities of having a child, need not come as a surprise and a burden when an unplanned pregnancy occurs. Having children can be an exhausting and endless job. Having children is an entirely separate consideration than bonding with another person in the form of sexual contact. Birth control options make available to everyone that crucial separation.
Relationships are a critical part of life. Finding someone special to share life with, is almost always central to an individual’s health and happiness. Sexual relationships can deepen and strengthen bonds between people. Sex itself, is proven to promote health and long life. However, the price tag or the responsibility can be very high without proper planning to prevent an unwanted and unprepared for pregnancy.