BACKGROUNDER CONTRACEPTION

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1 BACKGROUNDER CONTRACEPTION DID YOU KNOW?» Approximately 85 out of 100 sexually active women who are not using any contraceptive method will get pregnant within one year. 1» Worldwide 38% of women who become pregnant have an unwanted pregnancy; 22% of these pregnancies end in abortion. 2 WHY DO PEOPLE CHOOSE TO USE CONTRACEPTION? The use of contraception, or birth control, significantly lowers the chances of becoming pregnant. People choose to use contraception for a variety of reasons:» They may have decided that they don t want to have children or would like to delay parenthood until a later point in life.» They may require contraception to help space the timing of the births of their children.» They may feel their family is complete, and therefore wish to protect against the possibility of becoming pregnant again. WHAT METHODS ARE AVAILABLE? OVERVIEW OF THE DIFFERENT METHODS OF CONTRACEPTIVES CURRENTLY AVAILABLE Hormonal The combined pill ( micropill ) The progestin-only pill ( mini-pill ) Intrauterine system ( IUS ) Implant Injection Contraceptive patch Vaginal ring Emergency pill * Barrier Intrauterine device ( IUD, coil ) Male condom Female condom Diaphragm plus spermicide Cervical cap plus spermicide Alternative Male Sterilization Female Sterilization Withdrawal ** ( coitus interruptus ) Natural Family Planning ( fertility awareness ) Note: * The emergency pill is not a regular method of contraception and should only be used in cases of emergency. ** All the methods listed above have different levels of effectiveness with the withdrawal method being the least reliable. 3

2 HOW DOES HORMONAL CONTRACEPTION WORK? Most hormonal methods of contraception contain a combination of estrogen and progestin which works by preventing release of an egg every month and by thickening the mucus at the entrance of the womb, thus making it difficult for the sperm to get through. Other methods contain progestin only, which also works by thickening the mucus, but also by changing the lining of the womb. In some women, it may also prevent ovulation. WHAT ARE THE ADVANTAGES AND DISADVANTAGES OF HORMONAL METHODS? Although hormonal methods all basically work in the same way, the way in which they are used or taken differs. Each method has unique advantages and disadvantages, however there are some overall points to consider. Hormonal methods are the most reliable form of protection against unintended pregnancy. There are a number of options available to suit different needs, for example:» variations in dose combination» different application forms» use of different types of progestins leading to added benefits beyond contraception» long-term reversible options in addition to the pill, which do not have to be taken daily Hormonal methods are easy to use. There are a number of non-contraceptive benefits, for example lighter and shorter periods, improvements in skin condition these benefits vary according to the respective method. Hormonal methods do not protect against sexually transmitted infections (STIs), and therefore should be used with a condom for optimal protection. Some women may experience side-effects it is worth exploring the reasons behind the symptoms as these differ across methods as there may be another method of hormonal contraception that will better suit a particular individual.

3 HOW DO BARRIER METHODS WORK? Barrier methods are designed to stop sperm from entering the womb. Barrier methods include both the male and the female condom and the intrauterine device (IUD). WHAT ARE THE ADVANTAGES AND DISADVANTAGES OF BARRIER METHODS? The advantages and disadvantages vary for each method, but there are some general points to take into account. Barrier methods provide an option for women who cannot or do not want to use hormonal contraception. The condom is the only form of contraception that offers protection against STIs if used properly. The IUD is a long-term method which means that it doesn t interfere with spontaneity and, unlike the pill, it doesn t have to be taken daily. Barrier methods offer protection against unintended pregnancy without acting on the natural hormone and fertility cycle, so no pharmacological side effects can occur. Some methods, e.g. the male and female condom, can interfere with spontaneity, sensation and pleasure. Barrier methods are less reliable at preventing unintended pregnancy than hormonal methods. Some methods (condoms) need practice to use effectively. HOW DO ALTERNATIVE METHODS WORK AND WHAT ARE THE ADVANTAGES AND DISADVANTAGES? WITHDRAWAL METHOD When having sex, the man has to take his penis out of the vagina before ejaculation. This is intended to stop sperm from entering the woman s vagina. A natural alternative to barrier methods and to hormonal methods. This method requires a high level of control from the man. Frequently fails as small drops of sperm can already escape from the penis into the vagina before the man ejaculates. Causes impairment of sexual climax. All alternative methods are less reliable than hormonal and barrier methods, particularly for inexperienced individuals.

4 NATURAL METHODS These methods involve some means to find out when a woman is at her most fertile, so that she can be extra careful or avoid sex altogether during these times. This can be done by using techniques such as keeping a daily record of the woman s body temperature using a special fertility thermometer. A combination of techniques is recommended to increase the effectiveness of this method. A natural alternative to barrier methods and to hormonal methods based on the natural hormone and fertility cycle. Using this technique requires a significant level of motivation and a clear understanding of how to monitor fertility. Natural methods of contraception do not take into account fluctuations in the cycle. Many circumstances in everyday life can influence the rhythm of the menstrual cycle, making reliable calculation of the fertile and infertile days impossible. STERILIZATION Sterilization is only for people who have decided that they definitely do not want children, neither now nor in the future. It is considered to be a permanent, non-reversible method of contraception. Therefore, it is not recommended as a method of choice for young adults.

5 HOW CAN THE EFFECTIVENESS OF DIFFERENT TYPES OF CONTRACEPTION BE EVALUATED? Some contraceptive methods are more reliable than others, and the choice of contraceptive method impacts the ability to avoid an unintended pregnancy. The Pearl Index is the most common technique used in clinical trials for measuring the effectiveness of a birth control method. It is named after Raymond Pearl, who introduced it in Usually two Pearl Indices are published from studies on birth control methods:» typical use, which also refers to failure rates for people who do not consistently or always correctly use their birth control method;» perfect use, which refers to failure rates for those who use it consistently and always correctly. Method Male condom 4-9 Female condom 10 Combined pill 4-9 Progestin-only pill 4-9 Patch 4-9 Injection 4-9 Implant 10 IUD 10 IUS 4-9 Vaginal ring 4-9 Diaphragm 4-9 Cap 10 Male sterilization 10 Female sterilization 4-9 Withdrawal method 4-9 Natural method 10 Pearl Index *-26* *** The following table compares the percentage of women experiencing an unintended pregnancy during the first year of contraceptive method use when the method is used perfectly Both consistent and correct use can vary greatly, depending on such characteristics as age, income, users desires to prevent or delay pregnancy, and culture. * Before a woman has given birth. ** After a woman has given birth. *** Varies according to natural methods used. *For a given method of contraception, the Pearl Index is defi ned as the total number of unplanned pregnancies which occur per 100-woman-years of use. Thus, a Pearl Index of 0.2 indicates that two pregnancies occur in 1000 women using the method for one year, or ten pregnancies in 500 women using it for ten years.

6 HOW CAN PEOPLE ACCESS CONTRACEPTION? Access to contraception varies from country to country and depends on the chosen method. The age at which people can start getting contraception also varies, as do payment requirements. Usually, contraception can be obtained through a doctor, specialist clinics such as a family planning clinic, health centers and pharmacies. If hormonal contraception is required, it is necessary to first go to a doctor or a nurse to take a full medical history to assess suitability, and regular medical check-ups are imperative. IUS, IUD and implant need to be inserted by a specially trained healthcare professional (gynaecologist), the injection also needs to be administered by a healthcare professional, and the diaphragm and cap need to be fitted by a healthcare professional as well. Professional advice is also advisable for those using natural family planning techniques. References 1. Trussell J. Contraceptive efficacy. In Hatcher RA, Trussell J, Stewart F, Cates W, Stewart GK, Kowal D, Guest F. Contraceptive Technology; Seventeenth Revised Edition. New York, NY : Irvington Publishers, The Alan Guttmacher Institute: Facts in Brief Induced Abortion Worldwide Creatsas G (1993). Sexuality: sexual activity and contraception during adolescence. Curr Opin Obstet Gynecol 5 (6): Leidenberger FA. Klinische Endokrinologie fur Frauenarzte. Berlin, Germany: Springer Verlag, Baltzer J, Mickan H. Gynäkologie: Ein kurzgefasstes Lehrbuch/Kern. Neubearbeitete Auflage. Stuttgart, Germany, Georg Thieme Verlag, Organon. NuvaRing (etonogestrel/ethinyl estradiol vaginal ring) Available at: (accessed 5 October 2003) 7. Ortho-McNeil Pharmceutical Inc. Ortho Evra (Norelgestromin/ Ethinyl estradiol transdermal system) Available at: (accessed 5 October 2003). 8. Ortho-McNeil Pharmaceutical Inc. Ortho Tri-Cyclen Lo tablets (norgestimate/ethinyl estradiol) Available at: (accessed 5 October 2003). 9. Speroff L, Darney PD. Periodic Abstinence. A clinical guide for contraception. 3rd edn. Philadelphia, PA: Lippincott Williams and Wilkins, Trussell J. Contraceptive efficacy. In Hatcher RA, Trussell J, Stewart F, Nelson A, Cates W, Guest F, Kowal D. Contraceptive Technology; Eighteenth Revised Edition. New York, NY : Ardent Media, 2004.