CHAPTER 6

Contraception

Copyright © 2017 by Nelson Education Ltd. 6-1

 CONTRACEPTION IN ANCIENT
TIMES
• ANCIENT GREEKS: MAGIC, SUPERSTITION, HERBS

• EGYPTIANS: FUMIGATING FEMALE GENITALIA; TAMPON

SOAKED IN HERBAL LIQUID AND HONEY; INSERTING A
MIXTURE OF CROCODILE FECES, SOUR MILK, AND HONEY

• SOUTH AFRICA: INSERT VEGETABLE SEED PODS

• AFRICA: INSERT A GRASSY CERVICAL PLUG

• PERSIA: INSERT ALCOHOL-SOAKED SPONGES

• GREECE: INSERT EMPTY POMEGRANATE HALVES

Copyright © 2017 by Nelson Education Ltd. 6-2
 CONTRACEPTION IN CANADA:
1800S AND EARLY 1900S?
• IN THE EARLY 1800S
• CONTRACEPTION TO CONTROL FERTILITY WAS
PROMOTED AS AN EFFORT TO REDUCE POVERTY
• CONTRACEPTION WAS CONSIDERED A PRIVATE AFFAIR
• DOCTORS WERE NOT EVEN ALLOWED TO PROVIDE CONTRACEPTIVE
INFORMATION

• IN THE 1930S:
• A NATIONWIDE DISCUSSION BEGAN TO LEGALIZE BIRTH
CONTROL
• SEVERAL INDIVIDUALS PLAYED A ROLE IN THE
LEGALIZATION OF CONTRACEPTION
6-3
• THE CANADIAN BIRTH CONTROL LEAGUE IN BRITISH COLUMBIA AND
MARY HAWKINS AND DOROTHEA PALMER OF ONTARIO
 CONTRACEPTION IN CANADA:
1800S AND EARLY 1900S?
• 1960S:
• BARBARA AND GEORGE CADBURY ESTABLISHED
PLANNED PARENTHOOD ASSOCIATION OF TORONTO
• PUSHED TO DECRIMINALIZE BIRTH CONTROL
• BECAME LEGAL IN 1969

• IN THE UNITED STATES, EARLY 1800S:

• MARGARET SANGER WAS THE FOUNDER OF PLANNED
PARENTHOOD
• MAIN ADVOCATE FOR CONTRACEPTION IN THE UNITED STATES

Copyright © 2017 by Nelson Education Ltd. 6-4

 CONTRACEPTION OUTSIDE
OF CANADA
In 2007, a total of 721
million women
worldwide were using
a contraceptive
method. Contraceptive
use ranges from 3
percent in Chad to 88
percent in Norway, for
a worldwide average
of 63 percent.

Copyright © 2017 by Nelson Education Ltd. 6-5

CONTRACEPTION IN CANADA TODAY

• SEVERAL METHODS OF CONTRACEPTION, OR

BIRTH CONTROL, ARE CURRENTLY AVAILABLE
• CONTRACEPTIVES USED IN CANADA MUST
BE FORMALLY APPROVED BY:
• HEALTH CANADA:
• CANADIAN GOVERNMENT AGENCY THAT HAS THE
POWER TO APPROVE OR REJECT THE USE OF
NEW DRUGS

Copyright © 2017 by Nelson Education Ltd. 6-6

 CHOOSING A METHOD OF
CONTRACEPTION
• LIFESTYLE ISSUES

• UNRELIABLE BIRTH CONTROL

• MYTHS AND FALSE INFORMATION

• LACTATIONAL AMENORRHEA METHOD (LAM):

• A METHOD OF AVOIDING PREGNANCIES BASED ON
THE POSTPARTUM INFERTILITY THAT MANY WOMEN
EXPERIENCE WHEN THEY ARE BREAST-FEEDING

Copyright © 2017 by Nelson Education Ltd. 6-7

 MALE CONDOMS
• HOW THEY WORK
• PLACE ON ERECT PENIS BEFORE VAGINAL PENETRATION,
EJACULATION IS RELEASED AND CONTAINED IN THE CONDOM
• EFFECTIVENESS
• 85% TO 98% WHEN USED CORRECTLY
• ADVANTAGES
• CARRIED DISCRETELY, OFFERS PROTECTION FROM STI, CAN BE
PURCHASED WITHOUT A PRESCRIPTION, INEXPENSIVE, MINIMAL
ADVERSE EFFECTS, REDUCE POSTCOITAL DRIP, CAN BE USED
WITH OTHER METHODS
• DISADVANTAGES
• DECREASE SPONTANEITY, SIZING ISSUES, MAY REDUCE MALE
SENSATION
• CROSS-CULTURE USE
6-8
• FOURTH MOST POPULAR CONTRACEPTIVE METHOD
 FEMALE CONDOMS
• HOW THEY WORK
• INSERTED INTO THE VAGINA BEFORE PENILE PENETRATION. THE INNER
RING IS SQUEEZED BETWEEN THE THUMB AND MIDDLE FINGER AND THEN
INSERTED INTO THE VAGINA. THE OUTER RING SITS ON THE OUTSIDE OF
THE VULVA.
• EFFECTIVENESS
• 79% TO 95%
• ADVANTAGES
• DISCREETLY CARRIED, OFFER SOME STI PROTECTION, PURCHASED
WITHOUT A PRESCRIPTION, REDUCE POSTCOITAL DRIP, CAN BE USED BY
THOSE WITH LATEX ALLERGIES, MINIMAL ADVERSE EFFECTS
• DISADVANTAGES
• DIFFICULT TO INSERT, UNCOMFORTABLE TO WEAR, DECREASE SENSATIONS,
MAY SLIP DURING VAGINAL INTERCOURSE
• CROSS-CULTURE USE 6-9

• NOT POPULAR IN DEVELOPING COUNTRIES

 FEMALE CONDOMS

Female condoms are inserted into the vagina like a tampon.

The inner ring is pushed up inside the vagina until it reaches the cervix,
while the outer ring hangs about an inch outside of the vagina. 6-10
 CERVICAL BARRIERS:
DIAPHRAGMS & CERVICAL CAPS
• HOW THEY WORK
• INSERTED INTO THE VAGINA BEFORE INTERCOURSE AND FIT OVER THE
CERVIX CREATING A BARRIER SO THE SPERM AND OVA CAN NOT MEET
• EFFECTIVENESS
• 84% TO 94% - MORE EFFECTIVE IN WOMAN WHO HAVE NOT GIVEN BIRTH
• ADVANTAGES
• DISCRETELY CARRIED, IMMEDIATELY EFFECTIVE, DO NOT AFFECT
SPONTANEITY OR HORMONE LEVEL
• DISADVANTAGES
• REQUIRE PRESCRIPTION, NO PROTECTION FROM STI, DIFFICULT TO
INSERT/REMOVE
• CROSS-CULTURE USE
• USED MORE OFTEN IN DEVELOPED COUNTRIES
6-11
 CONTRACEPTIVE SPONGE
• HOW IT WORKS
• A ONE-SIZE-FITS-ALL SPONGE THAT COMBINES A
CERVICAL BARRIER AND SPERMICIDE
Insertion of a contraceptive
sponge:
(a) Take it out of the packaging
(b) Moisten with water
(c) Wring out extra water
(d) Fold in half
(e) Insert the sponge into the
vagina as far as it will go
(f) Check to feel the cervix is
covered by the sponge
Copyright © 2017 by Nelson Education Ltd. 6-12
 CONTRACEPTIVE SPONGE
• EFFECTIVENESS
• 68% TO 80% - WOMEN WHO HAVE NOT HAD CHILDREN HAVE HIGHER
EFFECTIVENESS RATES
• ADVANTAGES
• DISCREETLY CARRIED, IMMEDIATELY EFFECTIVE, DOES NOT AFFECT
SPONTANEITY OR HORMONE LEVELS, CAN BE PURCHASED WITHOUT A
PRESCRIPTION
• DISADVANTAGES
• NO PROTECTION FROM STI, MAY BE DIFFICULT TO INSERT/REMOVE,
REQUIRES GENITAL TOUCHING, INCREASES POSTCOITAL DRIP, CAN
NOT BE USED DURING MENSTRUATION, MAY CAUSE FOUL ODOR IF
LEFT IN PLACE TOO LONG, MAY INCREASE RISK OF URINARY TRACT
INFECTIONS AND TOXIC SHOCK SYNDROME
• CROSS-CULTURE USE
• MOST POPULAR IN EUROPEAN COUNTRIES
6-13
 BIRTH CONTROL PILLS
• HOW THEY WORK
• SYNTHETIC HORMONES REPLACE NATURAL HORMONES BUT IN DIFFERENT AMOUNTS
• INCREASE IN ESTROGEN AND PROGESTERONE PREVENTS PITUITARY GLAND FROM
SENDING HORMONES TO BEGIN OVUM MATURATION
• HORMONE LEVELS ARE SIMILAR TO WHEN A WOMAN IN PREGNANT
• THICKENS CERVICAL MUCUS (INHIBITS MOTILITY OF SPERM) AND REDUCES BUILD UP
OF THE ENDOMETRIUM
• EFFECTIVENESS
• 92% TO 99.7% - DECREASED EFFECTIVENESS IN OVERWEIGHT WOMEN
• ADVANTAGES
• HIGHLY EFFECTIVE, DOES NOT INTERFERE WITH SPONTANEITY, INCREASES
MENSTRUAL REGULARITY, REDUCE THE FLOW OF MENSTRUATION, CRAMPS,
PMS AND ACNE
• DISADVANTAGES
• NEED PRESCRIPTION, NO PROTECTION FROM STI, NAUSEA, HEADACHES,
DECREASED SEXUAL DRIVE, EXPENSIVE, HAVE TO REMEMBER TO TAKE
• CROSS-CULTURE USE 6-14
• THIRD MOST POPULAR CONTRACEPTIVE METHOD
 HORMONAL RING
• NUVARING:
o A HORMONAL METHOD OF BIRTH CONTROL
THAT IS A ONE-SIZE-FITS-ALL PLASTIC RING
o INSERTED INTO THE VAGINA ONCE A MONTH
o RELEASES A CONSTANT DOSE OF ESTROGEN
AND PROGESTIN
o LOWEST AMOUNT OF HORMONE RELEASED
WHEN COMPARED WITH OTHER HORMONAL
BIRTH CONTROL METHODS

Copyright © 2017 by Nelson Education Ltd. 6-15

 HORMONAL RING
• HOW IT WORKS
• LIKE BIRTH CONTROL PILLS AND THE PATCH, THE RING INHIBITS OVULATION,
INCREASE CERVICAL MUCUS AND CHANGE UTERINE LINING
• EFFECTIVENESS
• 92% TO 99.7%
• ADVANTAGES
• DOES NOT INTERFERE WITH SPONTANEITY, REDUCES THE FLOW OF
MENSTRUATION, CRAMPS AND PMS, MAY OFFER SOME PROTECTION FROM PELVIC
INFLAMMATORY DISEASE AND VARIOUS CANCERS
• DISADVANTAGES
• PRESCRIPTION IS NEEDED, NO PROTECTION AGAINST STIS, NOT RECOMMENDED
FOR WOMEN WHO SMOKE, OVER THE AGE OF THIRTY-FIVE, HAVE CARDIOVASCULAR
ISSUES, MIGRAINES OR ISSUES WITH DIABETES OR PANCREATIC FUNCTION
• CROSS-CULTURE USE
• REQUIRES GENITAL TOUCHING AND SOME CULTURES DO NOT LIKE THAT

6-16
 HORMONAL PATCH
• ORTHO EVRA PATCH
• A THIN, PEACH-COLOURED PATCH
• STICKS TO THE SKIN AND TIME-RELEASES
SYNTHETIC ESTROGEN AND PROGESTIN
INTO THE BLOODSTREAM TO INHIBIT
OVULATION

Copyright © 2017 by Nelson Education Ltd. 6-17

 HORMONAL PATCH
• HOW IT WORKS
• INHIBITS OVULATION, INCREASES CERVICAL MUCUS, RENDERS THE UTERUS
INHOSPITABLE TO IMPLANTATION
• EFFECTIVENESS
• 92% TO 99.7% - MAY BE LESS EFFECTIVE IN WOMEN WHO ARE OVER WEIGHT
• ADVANTAGES
• DOES NOT INTERFERE WITH SPONTANEITY, INCREASE MENSTRUAL REGULARITY,
REDUCES MENSTRUAL FLOW, CRAMPS AND PMS
• DISADVANTAGES
• FOUND TO EXPOSE WOMEN TO HIGHER LEVELS OF ESTROGEN, PROVIDE NO
PROTECTION FROM STI, INCREASED RISK OF DEVELOPING BLOOD CLOTS
• CROSS-CULTURE USE
• NOT A LOT OF DATA AT THIS TIME

Copyright © 2017 by Nelson Education Ltd. 6-18

 PROGESTIN-ONLY PILLS
• SIMILAR TO COMBINATION BIRTH CONTROL PILLS,
EXCEPT:
• THEY CONTAIN A PROGESTIN HORMONE ONLY
AND NO ESTROGEN – CALLED “MINIPILL”
• ARE TAKEN EVERY DAY WITH NO HORMONE-FREE
DAYS
• CHANGE A WOMAN’S MENSTRUAL CYCLE, WHICH MAY
RESULT IN CHANGES TO FLOW AND FREQUENCY OF
PERIODS, AS WELL AS INCREASE IN BREAKTHROUGH
BLEEDING
Copyright © 2017 by Nelson Education Ltd. 6-19
 PROGESTIN-ONLY PILLS
• HOW THEY WORK
• INHIBIT OVULATION, THICKEN CERVICAL MUCUS, DECREASE
FALLOPIAN TUBE CILIA MOVEMENT AND BUILD UP THE
ENDOMETRIAL LINING
• EFFECTIVENESS
• 92% TO 99.7%
• ADVANTAGES
• LOWER OVERALL HORMONE LEVEL
• CAN BE USED SAFELY BY ALMOST ALL WOMEN AND MAY ELIMINATE
PERIODS ALL TOGETHER
• DISADVANTAGES
• NEED TO TAKE THE PILL SAME TIME EVERY DAY, NO STI
PROTECTION, HIGHER RATE OF ECTOPIC PREGNANCIES
• CROSS-CULTURE USE 6-20

• NO DATA
 SUB-DERMAL IMPLANTS
• SURGICALLY INSERTED UNDER THE SKIN

• NORPLANT WITHDRAWN FROM MARKET IN 2002

• PROGESTERONE-ONLY BIRTH CONTROL

• NO SUB-DERMAL IMPLANTS AVAILABLE IN CANADA

AT THIS TIME

Copyright © 2017 by Nelson Education Ltd. 6-21

 HORMONE INJECTABLES
• PROGESTERONE-ONLY BIRTH CONTROL

• DEPO-PROVERA
• APPROVED IN 2004

• INJECTED IN THE MUSCLE IN THE ARM OR BUTTOCKS

EVERY THREE MONTHS

• BEGINS TO WORK WITHIN TWENTY-FOUR HOURS

Copyright © 2017 by Nelson Education Ltd. 6-22

 HORMONE INJECTABLES
• HOW IT WORKS
• SUPRESSES OVULATION, THICKENS CERVICAL MUCUS, CHANGES
ENDOMETRIAL LINING
• EFFECTIVENESS
• 97% TO 99.7%
• ADVANTAGES
• DOES NOT INTERFERE WITH SPONTANEITY, REDUCES MENSTRUAL FLOW,
CRAMPING AND PMS, DOES NOT CONTAIN ESTROGEN, LAST FOR THREE
MONTHS
• DISADVANTAGES
• NEED PRESCRIPTION AND OFFICE VISIT,
• CROSS-CULTURE USE
• MORE COMMONLY USED IN LESS DEVELOPED COUNTRIES

Copyright © 2017 by Nelson Education Ltd. 6-23

 CHEMICAL METHODS FOR
WOMEN
• SPERMICIDES COME IN A VARIETY OF FORMS
(CREAMS, SUPPOSITORIES, GELS, FOAMS,
FOAMING TABLETS, CAPSULES AND FILMS)
• MANY CONTAIN NONOXYNOL-9
• AVAILABLE OVER THE COUNTER
• CAN BE USED ALONE OR IN CONJUNCTION
WITH ANOTHER CONTRACEPTIVE METHOD

Copyright © 2017 by Nelson Education Ltd. 6-24

 CHEMICAL METHODS
• HOW IT WORKS
• CONTAIN TWO COMPONENTS
1. INERT BASE (JELLY, CREAM, FOAM OR FILM)
2. SPERMICIDE
• EFFECTIVENESS
• 71% TO 82% - FOAM IS MOST EFFECTIVE
• ADVANTAGES
• AVAILABLE OVER THE COUNTER, DO NOT INTERFERE WITH HORMONES, CAN BE INSERTED
DURING FOREPLAY, PROVIDE LUBRICATION, MINIMAL ADVERSE EVENTS, CAN BE USED WHILE
BREASTFEEDING
• DISADVANTAGES
• MUST BE USED EACH TIME ENGAGE IN SEXUAL ACTIVITY, INCREASE IN POSTCOITAL
DRIP, UNPLEASANT TASTE, CAN CAUSE VAGINAL SKIN IRRITATION AND URINARY
TRACT INFECTIONS
• CROSS-CULTURE USE
• VARIES ACROSS CULTURES

Copyright © 2017 by Nelson Education Ltd. 6-25

 INTRAUTERINE METHODS
• INTRAUTERINE DEVICE (IUD)
• A SMALL DEVICE MADE OF FLEXIBLE PLASTIC THAT IS
PLACED IN THE UTERUS TO PREVENT PREGNANCY

Insertion of an
intrauterine device:
(a) IUD is inserted
through a tube into the
uterus
(b) tube is removed
(c) IUD is in place

6-26
 INTRAUTERINE METHODS
• HOW THEY WORK
• PARAGARD PLACED IN THE UTERUS AND CAUSES AN INCREASE IN COPPER IONS AND ENZYMES WHICH
IMPAIRS SPERM FUNCTION AND PREVENTS FERTILIZATION
• MIRENA TIME-RELEASES PROGESTIN – THICKENS CERVICAL MUCUS, INHIBITS SPERM SURVIVAL,
SUPRESSES THE ENDOMETRIUM
• EFFECTIVENESS
• 99.2% TO 99.0%
• ADVANTAGES
• LESS EXPENSIVE OVER TIME, DO NOT INTERFERE WITH SPONTANEITY AND CAN BE USED
DURING BREASTFEEDING
• MIRENA REDUCES OR ELIMINATES MENSTRUAL FLOW AND CRAMPING
• DISADVANTAGES
• MODERATELY PAINFUL INSERTION AND REMOVAL
• MAY CAUSE IRREGULAR BLEEDING PATTERNS AND SPOTTING
• NO PROTECTION FROM STI
• SMALL RISK OF UTERINE PERFORATION
• CROSS-CULTURE USE
• SECOND MOST POPULAR METHOD OF CONTRACEPTION 6-27
NATURAL FERTILITY METHODS
• FERTILITY AWARENESS-BASED METHODS
• INVOLVE IDENTIFYING A WOMAN’S FERTILE PERIOD
AND EITHER ABSTAINING FROM VAGINAL
INTERCOURSE OR USING ANOTHER CONTRACEPTIVE
METHOD DURING THIS TIME

• RHYTHM METHOD
• A CONTRACEPTIVE METHOD THAT INVOLVES CALCULATING
THE PERIOD OF OVULATION AND AVOIDING SEXUAL
INTERCOURSE AROUND THIS TIME

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NATURAL FERTILITY METHODS
• SYMPTOTHERMAL METHOD
• INVOLVES MONITORING BOTH CERVICAL MUCUS AND
BASAL BODY TEMPERATURE TO DETERMINE OVULATION
• BASAL BODY TEMPERATURE (BBT)
• THE BODY’S RESTING TEMPERATURE USED TO CALCULATE
OVULATION IN THE SYMPTOTHERMAL METHOD OF
CONTRACEPTION

• NATURAL FAMILY PLANNING

• INVOLVES CALCULATING OVULATION AND AVOIDING SEXUAL
INTERCOURSE DURING OVULATION AND AT OTHER UNSAFE
TIMES

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NATURAL FERTILITY METHODS
• HOW THEY WORK
• WITH SYMPTOTHERMAL METHOD A WOMAN TAKES HER BBT EVERY
MORNING BEFORE SHE GETS OUT OF BED AND RECORDS IT ON A CHART.
CHANGES IN HORMONAL LEVELS CAUSE BODY TEMPERATURE TO INCREASE
IMMEDIATELY BEFORE OVULATION. REMAINS ELEVATED UNTIL
MENSTRUATION BEGINS.
• EFFECTIVENESS
• 88% TO 97%
• ADVANTAGES
• PEOPLE WHO CAN NOT USE BIRTH CONTROL, NO SIDE EFFECTS
• DISADVANTAGES
• AFFECTS SPONTANEITY, NO PROTECTION FROM STI, TAKES TIME
AND COMMITMENT
• CROSS-CULTURE USE
• POPULAR AROUND THE WORLD 6-30
 WITHDRAWAL & ABSTINENCE

• WITHDRAWAL OR COITUS INTERRUPTUS

• A CONTRACEPTIVE METHOD THAT INVOLVES
WITHDRAWAL OF THE PENIS FROM THE VAGINA
BEFORE EJACULATION

• ABSTINENCE
• ONLY 100% EFFECTIVE METHOD ON CONTRACEPTION

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 WITHDRAWAL & ABSTINENCE
• HOW THEY WORK
• BEFORE EJACULATION, THE MALE WITHDRAWS HIS PENIS
FROM THE VAGINAL OPENING
• EFFECTIVENESS
• 73% TO 96%
• ADVANTAGES
• FOR THOSE WHO ARE RELIGIOUS OR CAN NOT USE ANOTHER METHOD
• DISADVANTAGES
• NO PROTECTION FROM STI, MAY CONTRIBUTE TO EJACULATORY
PROBLEMS, CAN BE STRESSFUL AND DIFFICULT TO USE
• CROSS-CULTURE USE
• POPULAR THROUGHOUT THE WORLD

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 FEMALE STERILIZATION

• TUBAL STERILIZATION
• SURGICAL PROCEDURE
• FALLOPIAN TUBES ARE CUT, TIED, OR CAUTERIZED
SO THE SPERM AND OVUM NEVER MEET

• CAUTERIZATION
• INVOLVES BURNING OR SEARING THE FALLOPIAN
TUBES

• LIGATION
• INVOLVES THE TYING OR BINDING OF THE FALLOPIAN
6-33
TUBES
 MALE STERILIZATION
• VASECTOMY
• A SURGICAL PROCEDURE IN WHICH EACH
VAS DEFERENS IS CUT, TIED, OR CAUTERIZED FOR
PERMANENT CONTRACEPTION

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EMERGENCY CONTRACEPTION
• REFERRED TO AS:
• “MORNING AFTER” CONTRACEPTION
• EMERGENCY CONTRACEPTIVE PILLS
• EMERGENCY CONTRACEPTION, SUCH AS NEXT CHOICE,
MUST BE TAKEN WITHIN 72 HOURS TO PREVENT PREGNANCY.

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