Reducing the U.S. abortion rate

Contraceptive (Birth Control)
methods for regulating fertility

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The need for contraceptives:

As late as the end of the 19^th century, the average woman had to have at least five babies in order to assure that two would reach adulthood. Medical science and public health have since drastically reduced death rates during pregnancy, delivery,  infancy, and childhood. Meanwhile people have become sexually active at a much earlier age -- typically 15 or 16 in North America. Women are delaying pregnancy until later in life in order to allow them to obtain education and develop their careers. Many want to limit their number of children to one or two. To achieve this, "...a fertile woman today must practice birth control throughout most of her potential reproductive years--as many as 30 of the roughly 36 years between menarche and menopause." ₁

Definitions:

Contraceptive techniques are used to prevent pregnancy. Abortifacient methods are used to terminate a pregnancy that has already begun.

Both pro-live and pro-choice advocates agree on the initial sequence of events leading to a developing fetus:

1. Ejection of one very lucky spermatozoon among hundreds of million of brother and sister speratozoa.
   
   
2. Ejection of a mature ovum from an ovary.
   
   
3. Fertilization of the ovum by sperm, usually in the fallopian tubes. The fertilized ovum is called a zygote. ₂
   
   
4. The ovum develops into a blastocyst, and usually moves into the uterus.
   
   
5. Implantation of the blastocyst in the wall of the uterus.
   
   
6. The blastocyst has perhaps a 40% chance of developing into an embryo, and eventually into a fetus and newborn.

Unfortunately, various individuals and groups have differing definitions of when pregnancy actually begins. 

	Pro-life advocates usually define the start of pregnancy at conception when the sperm merges its genetic material with the ovum, and a unique DNA is produced. They also believe that human personhood starts at that point.
	Physicians and the pro-choice movement define pregnancy as starting when the blastocyst implants itself to the uterine wall.

We will use the medical definition here.

These two definitions differ by about 12 days. This discrepancy is quite significant. A particular technique, like an IUD, might allow conception but inhibit implantation. This would be termed an abortifacient by the pro-life community and a contraceptive by everyone else.Researchers once thought that EC (a.k.a. emergency contraception, or morning-after pill) could inhibit both conception and implantation. But subsequent research shows that inhibiting implantation is extremely improbable or impossible. So EC is considered a contraceptive. However, many pro-life groups reject the findings of medical researchers and still claim that EC is an abortifacient.

How contraceptives work:

All contraceptive techniques are barrier methods. That is, they erect a barrier of some type that prevents pregnancy. 

	Sometimes the barrier is time: a couple estimates when the woman is about to release an ovum and does not engage in sexual intercourse for an interval before and after that event.
	Sometimes the barrier is mechanical in nature. For example, sperm are prevented from entering the womb by a layer of latex, as in a condom or diaphragm.
	Sometimes the barrier is chemical in nature. An emergency contraceptive pill will prevent ovulation, or will prevent fertilization.

The Roman Catholic and a very few very conservative Protestant denominations prohibit all but the time barrier methods. Only this method is considered natural and acceptable to these faith groups. Data on birth rates among Roman Catholic couples shows that their family size does not differ significantly from those of Protestant couples. This would seem to indicate that essentially all Roman Catholics are ignoring the instructions of their church.

Time-barrier methods: ₃

	No method: If no contraceptive method is used, a woman has about 1 chance in 50 of becoming pregnant with each act of sexual intercourse. Thus, a couple who enjoys sexual intercourse on a weekly basis will probably find themselves pregnant within a few months - perhaps after their first sexual contact.
	Withdrawal: This is sometimes called Coitus Interruptus: This involves the man trying to withdraw his penis before he ejaculates. Unfortunately this method is extremely unreliable. The man tends to be distracted at exactly the time when he needs to have his wits about him. Also, large numbers of sperm are present in the lubricating fluid that is discharged from the penis before ejaculation. They can cause pregnancy even without an ejaculation.
	Rhythm Method: The date that the woman will next release a mature ovum is estimated on the basis of the average length of her menstrual period, and the time of her last period. If successful, then the technique prevents live sperm and a live ovum from being present in the fallopian tubes simultaneously. This method has been jokingly referred to as "Vatican Roulette" because it is quite unreliable, and because it was at one time the only method approved by the Roman Catholic church. Any number of factors, including stress, can introduce irregularity into the timing of the release of the ovum, and make the method quite undependable.
	Billings Method: The woman observes her vaginal discharge on a daily basis. There are subtle changes in texture, quantity and color which indicate when ovulation is happening. Sexual intercourse is avoided for a while at that time.
	Body Temperature Method: The woman measures her body temperature. There is usually a small rise in temperature after ovulation. Sexual intercourse is avoided for a while at that time.

Mechanical-barrier methods:

	The condom is the most common mechanical contraceptive. It is a latex sleeve that is placed over the erect penis. If properly applied, this physical barrier almost certainly keeps sperm from entering the woman's body. It has the added advantage of drastically reducing the chances of either partner contracting a sexually transmitted disease (STD).
	Intra-uterine devices (IUDs) are believed to allow fertilization but prevent implantation. Pro-lifers consider an IUD to be an abortifacient; pro-choicers and physicians consider it a contraceptive. The two types that are currently available have a reported effectiveness rate of 99.4 and 99.9%. 8
	The diaphragm: This is a soft rubber cap that is inserted into the vagina and located over the cervix. It is often used with a spermicidal jelly or cream. It physically prevents sperm from entering the uterus, and kills any that come in contact with the spermicide.
	The cervical cap: This is like a diaphragm, except that it is smaller. It is shaped like a thimble and fits snugly over the cervix.

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Chemical-barrier methods:

Regular usage of the contraceptive pill is generally considered to prevent conception by inhibiting ovulation. It is a very popular method of birth control.

Emergency contraception (EC) or "the morning after pill:" Doctors sometimes prescribed multiple contraceptive pills in cases where a woman has had unprotected sex. These pills are now available as an emergency contraceptive kit. "Plan B™" is one such EC medication. The pills may prevent the release of an ovum if ovulation has not happened. Alternately, it may prevent it from being fertilized; in these cases, it acts as a contraceptive.

The use of contraceptives:

"...research indicates that 7% of all women aged 15-44 do not use contraceptives; these women account for about half of all abortions." ₄

Contraceptives are not effective at preventing pregnancy unless they are used consistently and correctly. A condom will not prevent conception if it remains in the man's wallet.

An overview of abortion was published in 2003-JAN by Physicians for Reproductive Choice and Health (PRCH) and the Alan Guttmacher Institute (AGI). They concluded that:

	More than 90% of couples report that "they use a contraceptive method during any given month, although not always correctly and [not] at every act of intercourse."
	53% of women "who have unintended pregnancies were using a contraceptive method during the month they became pregnant, although usually not correctly every time." 5

The Alan Guttmacher Institute conducted a study of women who had an abortion during the year 2000. They found that 46% of the women did not use a contraceptive method when they became pregnant. Eight percent had never practiced contraception. The women gave many reasons for not using contraceptives; some gave multiple reasons:

	33% said they did not think that they could become pregnant. There is a widespread but false belief that a woman cannot become pregnant with her first act of sexual intercourse.
	32% had concerns about the method chosen (side effects; past problems).
	26% had not expected to engage in intercourse.
	22% had not thought about contraception or had not yet begun using a method.
	12% had problems obtaining contraception supplies.
	5% were ambivalent about becoming pregnant.
	2% did not want their parents to know they were sexually active.
	1% had been forced to have sex. 4

Contraceptive methods used:

The Alan Guttmacher Institute reported that women who made use of federal Title X family planning programs and who used a contraceptive, adopted the following methods in 2001:

Method used	% of women
Oral contraceptives	45%
Injectable contraceptive	17%
Condom	13%
No method	7%
Unknown	4%
Pregnant	5%
Sterilization	3%
Other	2%
Spermicidal foam; contraceptive film	1%
IUD	1%
Hormone implant	0%
Cervical cap	0%
Natural methods	0%
Diaphragm	0%

Other methods included withdrawal, rhythm method, safe period by calendar, sponge, suppository, insert, douching, abstinence, etc. ₆

These data cannot be considered an accurate sampling for the entire female population of childbearing age. Some women would not become clients of family planning agencies because they:

	Use "natural" or time-barrier methods of contraception.
	Totally abstain from sexual intercourse.
	Are infertile and thus do not need to use contraception.

In addition, 65% of Title X family planning users have incomes at or below the poverty level. Their choice of contraceptive method may not be similar to the entire population of women of child-bearing age. ₇

Disclaimer:

This essay is intended to give an general overview of various methods of contraception. Do not rely upon this information when making personal decisions. Please consult your physician or a family planning clinic for professional advice.

References:

1. -Jill Schwartz and Henry Gabelnick, "Current Contraceptive Research," Perspectives on Sexual and Reproductive Health, Vol. 34, # 6, 2002-NOV/DEC.
2. -For definitions of many pregnancy-related terms, see our Glossary.
3. -The Sexual Health Infocenter has a Guide to Safer Sex which discusses safer sex tools and birth control topics. See: http://www.sexhealth.org/infocenter/GuideSS/GuideSS.htm
4. -Rebecca wind, "Emergency contraception (EC) played key role in abortion rate declines. In 2000 Alone, AGI Estimates EC Averted As Many As 51,000 Abortions," Alan Guttmacher Institute, 2002-DEC-17, at: http://www.agi-usa.org/pubs/archives/
5. "An Overview of Abortion in the United States," PRCH & AGI, 2003-JAN, at: http://www.agi-usa.org/pubs/abslides/
6. "Family Planning annual report: 2001 Summary; Part 1," Alan Guttmacher Institute, Page 28, at: http://www.agi-usa.org/pubs/FPAR2001.pdf  You need software to read these files. It can be obtained free from:  
7. Ibid, Page 24.
8. "More Women Opting For IUD Contraception. IUDs Improved Substantially Since Dalkon Shield," WXII12, at: http://www.wxii12.com/

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Last updated: 2010-JUN-20
Author: B.A. Robinson

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