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The facts on contraception


Contraception, also known as birth control, refers to a method, medication or device that a person uses to avoid unintended pregnancy. This article is to provide an overview of some of the most frequently used methods for contraception. Spiritual beliefs regarding the use of these methods or the question of when life begins is beyond the scope of this article. Suffice to say, contraception, sometimes called family planning, ranges from education about becoming pregnant to placement of birth control devices or prescriptions. All are services provided to our patients at the CPN Health Services Clinics.

One study of national pregnancy rates in the U.S. showed that five percent of women of reproductive age had an unintended pregnancy. That equals approximately 3.2 million pregnancies that occurred despite the fact that many of these women reported using some form of birth control. 43 percent of these unintended pregnancies were terminated. No method of contraception is perfect and each woman must balance the advantages and disadvantages of each method and choose the one she is most comfortable with and will be most reliable in using

Many birth control methods provide other medical benefits other than the prevention of pregnancy. These benefits include the treatment of acne or improvement in painful or irregular menstrual periods for those taking birth control pills. Condoms, when used properly, also prevent sexually transmitted disease such as infection with gonorrhea or chlamydia and are available without charge at the CPN clinics.

The effectiveness of a birth control measure is highly dependent on its proper use. There is a large difference between the expected protection against pregnancy with typical use (missed pills or late shots) and that with perfect use (no missed pills or shots at all). Erratic or improper use will result in an increased rate of pregnancy despite the “use” of birth control. The more acceptable a method is to the patient, the more reliable the method will be over time.

Among couples attempting to avoid pregnancy, the percentage who continue to use a particular method for one year is approximately:

  • Under the skin hormonal implant — 84 percent (available at CPNHS) – possible side effects include blood clots or high blood pressure
  • Male condom — 43 percent (available at CPN pharmacy but currently requires a prescription)
  • Female condom — 41 percent
  • Hormone releasing IUD — 80 percent (available at CPNHS) – possible blood clots or high blood pressure
  • Copper containing  IUD — 78 percent
  • Ring, patch or the pill — 67 percent (all available at CPNHS) – may have side effects      including blood clots or high blood pressure
  • Diaphragm —  57 percent
  • Depo-Provera  — 56 percent (injection every 3 mos.) (available at CPNHS)
  • Fertility awareness based methods — 47 percent

In general, contraceptives can be placed in one of three categories

  • Most effective – Long acting contraceptives have best results and include a hormonal implant placed under the skin by a trained provider and hormonal IUD placed within the uterus, also placed by a trained provider. These measures may last up to 3-5 years and are reversible in that fertility usually returns promptly after removal.
  • Effective – Injectables such as Depo-Provera administered every three months, birth control pills and patches and self-placed vaginal rings.
  • Least effective – Diaphragms, condoms, spermacide, withdrawal and periodic abstinence (rhythm method).

Another category of contraception includes use of the “morning after pill” marketed as “Plan B” or “One Step” which are over the counter and available without a prescription for any age and does not require parental permission. The cost at a local pharmacy may be up to $50. These medications contain hormones that prevent pregnancy at a high rate if taken within three days after unprotected intercourse. They are not effective in women who weigh more than 170 lbs. They are available at the CPNHS clinics through the public health nurse and do not require a prescription or parental permission. Should a woman have participated in unprotected intercourse or been a victim of sexual assault and wish to avoid pregnancy, taking this medication offers substantial protection against getting pregnant but must be taken within three days, and preferably within the first 24 hours following the act.

Simply walk in to the clinic and request to see the public health nurse and advise her that you wish to receive a morning after pill and they will educate you about it and what you can expect. They can also offer other referrals if desired by the woman. Were a woman to be pregnant already and not be aware of it, there will be no adverse reaction to the fetus if the medication is taken anyway and a pregnancy test is not required to receive the pill. If you are already pregnant the morning after pill will have no effect on the pregnancy.

I encourage those who wish to find out more regarding contraception or birth control to make an appointment with one of our women’s health care providers. Young women (over 18), of reproductive age do not require parental permission to receive such services and all discussions or prescriptions or procedures are kept confidential unless records are specifically requested by the parents.