TAKE HOME ESSAY #13: METHODS OF CONTRACEPTION
Various methods of birth control have been practiced for thousands of years, yet most of these primitive methods were highly unreliable or not effective. Not until the 19th century were more reliable methods of contraception developed, even more developments in the 20th century have recently led to methods of contraception, which are the most effective ever. Effectiveness is the most important factor to consider when choosing a method of contraception for you and your partner; the side effects should also be considered. Effectiveness is measured in terms of its failure rate, or probability of failure. "This probability is calculated by determining the number of sexually active women out of 100 who become pregnant in the course of a year while relying on a particular method" (Allgeier and Allgeier, 1995, p.305).
The effectiveness of the contraceptive is measured in terms of both the theoretical and the actual failure rate. "Theoretical failure rate is the number of failures that occur when the method is used correctly" (Allgeier and Allgeier, 1995, p.305). The failure is due to the method of contraception not performing properly, such as breaking of a condom. In contrast, "The actual failure rate is the total number of pregnancies that occur as a result of either failure of the method or failure to use a method correctly" (Allgeier and Allgeier, 1995, p.305), such as improper placement of the diaphragm on the cervix because of improper installation. Lack of education on contraceptive use is one of the main reasons that the actual failure rate is usually higher than that of the theoretical failure rate. In the following pages I will discuss the various types of contraceptives used in today's societies along with their advantages and disadvantages.
The diaphragm is a dome shaped cap made from a soft rubber, which is designed to fit inside the vagina and cover the cervix. It was the first method of contraceptive widely used by women. It fits over the cervix and behind the pelvic bone, and keeps sperm from entering the uterus. The diaphragm should be used with spermicide, which is placed around the edge of the device to increase its effectiveness; the spermicide can be bought without a prescription unlike the diaphragm. The diaphragm should be inserted into the vagina with an applicator at least 2 hours before intercourse and left there for six to eight hours proceeding intercourse. The theoretical failure rate for this method is 6 per 100, while the actual failure rate is 18%. One advantage to this method is that the spermicide can kill many organisms that cause various STDs. A drawback of this method is not being able to have unplanned sex, because the diaphragm must be inserted two hours before coitus. (Allgeier and Allgeier, 1995)
The contraceptive sponge is made of polyurethane and contains a spermicide, which is released gradually overtime. After being inserted into the vagina and positioned against the cervix, like the diaphragm. The sponge will absorb and kill sperm for at least 24 hours. This is an advantage of this method, the long period of time that each application is effective, and need not be reapplied during each act of coitus during that 24-hour period. A disadvantage to this method is an elevated risk of toxic shock syndrome. This device has a theoretical yearly failure rate of 9%, and an observed failure rate of 36%. (Allgeier and Allgeier, 1995)
The next method of contraception is the condom, which is the only reliable, temporary method of male contraception widely available without a prescription. A condom is a sheath placed over the erect penis for prevention of pregnancy and the transfer of STDs. It's usually made of latex and is put on prior to intercourse to prevent sperm from entering the vagina. Some condoms also come with a spermicide solution placed on the condom to increase its effectiveness. The theoretical failure rate is 3 out of 100, and the actual failure rate around 12%. One disadvantage to condoms is that improper treatment, such as heat exposure can deteriorate the latex, can cause the condom to break. There are many more advantages to condom use, such as prevention of STDs; they are also easily accessible and easy to use. There is a female version of the condom, which works in the same way and is twice as thick, but it is reported that they are not as comfortable as male condoms. (Allgeier and Allgeier, 1995)
Like the condom, contraceptive foams and suppositories can be purchased without a prescription, and also need to kept out of heat because it will reduce their effectiveness. The foam or suppository must be placed on an applicator and inserted into the vagina 10 minutes prior to coitus. After ejaculation occurs the foam or suppository should be left in the vagina from anywhere between 2 to 8 hours depending on the foam or suppository. It works by both killing and or immobilizing the sperm, and it also provides a physical barrier because of its thick consistency. The failure rate is high at 21 per 100 women; this is one of the main disadvantages to this method, in addition these foams can irritate to genital tissue in some people. It can be can a major advantage to use these foams and suppositories with a condom to increase its effectiveness. (Allgeier and Allgeier, 1995)
Oral contraceptives, which were first made widely available in the 60's, were the first form of contraceptive, which didn't require some type of device be placed in the vagina or on the penis. Currently, 40% of women who are sexually active in the U.S., age 15 to 44 use this method of contraception. The "the pill" which requires a prescription, contains progestin and estrogen, hormones which inhibit ovulation of the ovaries. Usually, the women takes one pill a day for 21 days, then stops for seven days to permit menstrual bleeding, then the cycle is repeated. This form of contraceptive is highly effective, with a maximum failure rate of 3%. As long a the pill is taken everyday at the same time without missing any days the effective rate will remain at about 3%. Oral contraceptives alter the reproductive system instead of blocking sperm like most other contraceptives. Because this method alters the reproductive system there is the increased possibility for side effects, which are mostly minor. The side effects include weight gain, breast enlargement and tenderness, emotional depression, nausea, headaches, and shouldn't be used by smokers because of the increased risk to cardiovascular problems. This is a highly desirable method because it's coitus-independent, and has a high rate of effectiveness. (Allgeier and Allgeier, 1995)
Hormone implants work in the same way as oral contraceptives, they inhibit the ovulation of the ovaries and thicken of the cervical mucus. A well-known hormone implant, Norplant was approved by the FDA in 1990, which consists of six thin, flexible capsules about the size of a dime. These capsules are inserted just under the skin of a woman's arm, usually after some local anesthesia. Over a period up to 5 years the capsules continuously release a synthetic progestin into the bloodstream, and this method will start working within 24 hours after insertion. The Norplant is just one of many types of hormone implants. One of the major advantages to this method is its extremely low failure rate, at .09 out of 100 women. Hormone implants have the same drawbacks as oral contraception, such as headaches, nausea, and dizziness, including the possibility that the implant is physically noticeable. (Allgeier and Allgeier, 1995)
The last method known as an intrauterine device or IUDs is actually placed inside the uterus through the cervical opening. It is a small plastic and/or metal device that is placed inside the uterus by a trained physician. Its not quite clear how it works, yet many believe that the IUD may prevent normal development of the uterine lining, making it difficult for a fertilized egg to implant in the uterus. IUD's have a very low failure rate ranging form .6 to 2 per 100 women, which is one of its major advantages. There are many more disadvantages to this method including considerable pain during insertion, puncturing of the uterus (although rare), increased cramping, increased chance of a uterus infection, and greater risk of infertility. (Allgeier and Allgeier, 1995)
All of these methods are much more effective than no contraception, even though some may have negative side effects, and can create some uncomfort. Yet, these methods will not be as effective as they should unless people are provided with the proper education on how to use the devices and an understanding of how they work. If people would increase their awareness to the use of contraceptives then the actual failure rate may become closer to that of the theoretical rate.