Topics In Brief
Contraception
This section of ReCAPP focuses on contraception. It includes:
- Various Forms of Contraception
- Teen Contraceptive Use
- Comparing Contraceptive Methods
- Resources to access more comprehensive information on contraception
- a Youth Skill titled "Getting Contraception," which is designed to help youth contact and get information from local clinics about various types of contraception
- a two-part Learning Activity, "Contraceptive Options," with a three-part goal — to help youth understand the benefits of abstinence, identify various methods of contraception and their local availability, and discuss the optimal time to communicate with partners about contraceptive use
- a Journal Link: New Study on Condom Use Among Males Highlights Need for Changing Attitudes and Improving Negotiation Skills
- Statistics related to contraception
- Self Study Quiz on Contraception
Various Forms of Contraception
The Need
From 1991 until 2006, there was a decrease of almost one third in the number of teen pregnancies. Studies suggest that these declines were due to both a decrease in the proportion of teens having sex and an increase in contraceptive use among teens having sex (Santelli J.S., Abma J., Ventura S., et.al. 2004, as cited in Teen Contraceptive Use from The National Campaign to Prevent Teen Pregnancy.) However, in 2006 the birth rate for teenagers 15-19 years old in the United States rose 3% to 41.9 births per 1,000 (www.cdc.gov/nchs/pressroom/07newsreleases/teenbirth.htm.) Furthermore, the U.S. has the highest rates of teen pregnancy and births in the western industrialized world: two to six times higher than Canada, France, Holland, Denmark, and Sweden (Hoffman, Saul, Ph.D., 2006. By the Numbers: The Public Cost of Teen Childbearing. Washington, DC: The National Campaign to Prevent Teen Pregnancy).
Given these facts, it is evident that there is an ongoing need to educate teens about their contraceptive options as well as the risks associated with not using contraception, i.e. pregnancy and STIs.
The Contraceptive Options
There are many effective contraceptive methods that are popular in the U.S. Some of the methods are used primarily by adults, such as vasectomy and sterilization. The contraceptive methods described here are the ones that are most likely to be used by adolescents and include methods that are always available to youth, such as abstinence or "outercourse," products that are available over-the-counter and contraceptive methods that are prescribed by a doctor or medical clinic
Always available:
- Abstinence/outercourse
Abstinence is not having vaginal, anal or oral sexual intercourse. There are different ways to have sexual intercourse — sexual intercourse occurs when there is genital-to-genital contact or penetration, or mouth to anus contact. "Outercourse" is any kind of sexual activity in which there is no penetration or genital-to-genital contact. It allows a couple to have intimacy and even have orgasms with one another without having sexual intercourse. With outercourse, no semen (the fluid that comes out of a man's penis during sex), vaginal fluids, or blood is shared between partners. Abstinence and outercourse help prevent a person from getting or passing on sexually transmitted infections — also called STIs for short — which are diseases, infections, or illnesses that can spread from one person to another through sexual contact. (Adapted from ARHP at: www.arhp.org/crc/abstinence.html.) - Withdrawal method
The withdrawal method is when the male withdraws his penis from the vagina before ejaculation. The hope is that fertilization will be prevented because the sperm do not enter the vagina. However, it is possible to get pregnant from pre-ejaculate fluid before the male withdraws his penis. It's also possible that the penis won't be withdrawn in time. As a result, this method carries a high risk of pregnancy, and it does not protect against the transmission of STIs.
Over-the-counter (OTC):
- Barrier methods
- Condoms
Condoms are the most commonly used method of contraception by both male and female teens. According to the 2002 CDC National Survey of Family Growth, condoms were the method of contraceptive use at first sex by 53% of teen girls and 61% of teen boys.
Male condoms, also known as "rubbers," are soft, very thin covers that fit over an erect penis. Condoms are usually made of latex, polyurethane, or sheep intestine. When a male ejaculates (or when fluid comes out of his penis), sperm go into the condom instead of into the vagina, mouth or anus. Condoms made of polyurethane or latex help protect against STDs, such as HIV/AIDS, gonorrhea, or syphilis, but sheep intestine condoms (skins) do not. Lubricate outside of condoms with a water-based spermicide to help ensure they do not break. (From ARHP at: www.arhp.org/crc/male-female-condoms.html.)
The Female Condom is a safe, effective barrier method for preventing pregnancy and STIs, including HIV/AIDS. It is a lubricated polyurethane sheath shaped like the male condom, but has flexible rings at each end. The closed end is inserted into the vagina, while the open end remains outside, partially covering the woman's labia. Like the male condom, the female condom is available without a prescription and is intended for one-time use. Although it takes more practice to use than the male condom, the female condom provides women with more control in protecting themselves from pregnancy as well as STIs including HIV/AIDS. For more information on the female condom, check out the web site: www.femalecondom.org. - Dental dams
The dental dam, like a condom, is a barrier method that prevents exchange of bodily fluids. However, it is not a method of birth control. A dental dam is a square piece of rubber that is generally used by dentists during oral surgery and other procedures. It can also be used during sexual contact, often by women having sex with other women, to help protect from STIs including herpes, genital warts (HPV) and HIV. It is used during oral and anal sex by placing it over the opening to the vagina or anus. Dental dams are most often made of thin latex rubber; however, for those allergic to latex, they are also available in silicone. Although specially-made rubber dental dams are sold in surgical supply stores, kitchen plastic wrap can also serve as an effective dental dam. www.pamf.org/teen/sex/std/oral/dentaldam.html - Sponge
The Today Sponge® is a contraceptive sponge made of disposable polyurethane foam containing the spermicide Nonoxynol-9, the most commonly used form of spermicide in the U.S. (see Note on N-9 in "Spermicides" below.) It is soft, round, and about two inches in diameter, with a nylon loop attached to the bottom for removal. It can prevent pregnancy for 24 hours, regardless of the number of acts of intercourse, using three separate modes of contraceptive action: a barrier method blocking the entry of sperm into the cervix, continual release of spermicide and absorption of sperm by the foam sponge. It is inserted in the vagina up to six hours before intercourse. Users are counseled to leave the sponge in place for six hours after intercourse. Unlike other barrier methods, sponges do not protect you from STIs. (From ARHP at: www.arhp.org/crc/barrier-methods.html.)
- Condoms
- Spermicides
Spermicides are chemicals that kill sperm — including foams, creams, jellies, film, and suppositories. They are inserted deep into the vagina shortly before intercourse. Spermicides are also used with condoms. Contraceptive foams block the entrance to the uterus with bubbles and contain a spermicide, preventing sperm from joining with an egg. Contraceptive creams, jellies, film, and suppositories melt into a thick liquid throughout the vagina. They block the entrance to the uterus and contain spermicide. (From ARHP at: www.arhp.org/crc/spermicides.html)
Note: Nonoxynol-9 (N-9) spermicide (used alone or with a diaphragm or cervical cap) offers an important option for women who choose not to use hormonal birth control methods. However, N-9 may increase a woman's chances of getting infected if exposed to HIV when used more than once a day. N-9 contraceptive products increase HIV risk slightly by irritating the vaginal membranes and causing disruptions that make it easier for the virus to enter the blood stream. Other studies show that N-9 is even more irritating to rectal tissue than to vaginal tissue. (www.ourbodiesourselves.org/book/companion.asp?id=18&compID=19) - Emergency contraceptive pills (ECP)
Emergency contraceptive pills (ECP) prevent pregnancy after unprotected sexual intercourse. Plan B®, Plan B One-Step®, and Next Choice® (generic brand) are the designated ECPs available over the counter to consumers ages 17 and older throughout the US. In Maine, New Hampshire and Vermont, pharmacists are allowed to dispense these ECPs to consumers of all ages without a prescription. See Emergency contraception (EC) below for more details, as well as the Topic in Brief on EC.
From the doctor or clinic:
- Barrier methods
- Diaphragms
Diaphragms are soft, dome-shaped rubber cups that fit inside the vagina and are placed against the cervix. The diaphragm must be prescribed and initially fitted by a health care professional and is most effective when used with a spermicide. Diaphragms do not protect from STIs. (From ARHP at: www.arhp.org/crc/barrier-methods.html ) - Cervical caps
Cervical caps are soft rubber cups with a round rim that fits snugly around the cervix. It is smaller than a diaphragm and uses suction to stay in place. The cap must be prescribed and initially fitted by a health care professional and is most effective when used with a spermicide. The cervical cap prevents sperm from entering the uterus. It is inserted into the vagina, anytime before intercourse. Cervical caps do not protect from STIs. (From ARHP at: www.arhp.org/crc/barrier-methods.html )
- Diaphragms
- Hormonal methods
- Oral contraceptives ("the pill")
Oral contraceptives also know as the pill, contain hormones that prevent pregnancy. The combination pill contains estrogen and progestin and the mini pill contains progestin-only. Today's pills are safe and effective for most women, if taken as prescribed. The pill does not protect against STIs. For more information, go to www.arhp.org/crc/oral-contraceptives.html.
A pill called Seasonale® is similar to the traditional oral contraceptive pill. It provides the same combination of hormones and is taken orally. However, it has the added benefit of providing women with less frequent periods by decreasing their menstrual cycles to every three months. Other brand names for this type of contraceptive include Jolessa®, Quasense® and Seasonique®. They each have slightly different side effects and costs. For more information on Seasonale, go to: www.seasonale.com/home.aspx. - Depo-Provera® (the birth control injection)
The Depo-Provera shot is an injection of the hormone progestin into a woman's body that prevents pregnancy for three months. The progestin protects a woman from pregnancy by preventing the ovaries from releasing eggs and thickening the cervical mucus, blocking the sperm from joining with an egg. Depo-Provera works best when administered regularly, every 12 weeks. The cost of Depo-Provera can run $35–$100 per injection, plus any exam fees.
The main benefits of Depo-Provera are the fact that it is one of the most effective methods of birth control available (over 99% effective) and it is convenience — one injection provides three months of protection and there is no need for a daily pill or preparation before intercourse. The most common side effect is irregular bleeding. All potential side effects must be considered carefully because once administered, the side effects can last for three months. Depo-Provera does not offer any protection against STIs. For more information on Depo Provera, go to www.arhp.org/crc/injectables.html. - Transdermal contraceptive patch ("the patch")
ORTHO EVRA® is the brand name of an adhesive patch that delivers pregnancy-preventing hormones through the skin. A woman wears each patch for one week at a time for three consecutive weeks. The fourth week is patch-free, which allows her to have her menstrual period. The patch does not offer protection from STIs.
Note: Hormones from ORTHO EVRA get into the blood stream and are processed by the body differently than hormones from birth control pills. Users will be exposed to about 60% more estrogen if they use ORTHO EVRAthan if they use a typical birth control pill containing 35 micrograms of estrogen. In general, increased estrogen may increase the risk of side effects. In January 2008, the U.S. Food and Drug Administration (FDA) approved additional changes to the ORTHO EVRA label to include the results of a new epidemiology study that found that users of the birth control patch were at higher risk of developing serious blood clots, also known as venous thromboembolism (VTE) than women using birth control pills. VTE can lead to pulmonary embolism. For more information on ORTHO EVRA, visit: www.orthoevra.com. - Vaginal ring
The NuvaRing® acts like a time-release capsule in the form of a ring. It is a flexible ring, two inches in diameter, which a woman folds and inserts in her vagina once a month. Once inserted, the ring slowly releases hormones (estrogen and progestin) for three weeks. Approved by the FDA at the end of 2001, this method contains hormones similar to those in birth control pills, so their advantages — and disadvantages — are similar. It does not offer protection from STIs.
Note: On August 22, 2008 the Judicial Panel on Multidistrict Litigation (JPMDL) granted a petition filed by plaintiffs in 11 NuvaRing federal court lawsuits seeking creation of a NuvaRing multidistrict litigation (MDL). Their claim is that NuvaRing use is associated with serious side effects resulting from blood clots, such as pulmonary embolism (PE) and deep vein thrombosis (DVT) as well as strokes and heart attacks, with some events resulting in death. As of December 2010, there have been no NuvaRing lawsuit settlements, and suits continue to be filed by women. The first trials in federal court will not begin until the spring or summer of 2012. For more information about the NuvaRing, visit the manufacturer's web site at: www.nuvaring.com. - Under-the-skin implant
Implanon® is a thin, flexible plastic implant about the size of a cardboard matchstick. It is inserted under the skin of the upper arm and protects against pregnancy for up to three years. Implanon was approved by the FDA in 2006 for salle in the US, and more and more health care providers are being trained to insert and remove this contraceptive device. (The former implants, Norplant and Jadelle, are no longer available in the US.) Like several other methods of birth control, such as the birth control shot, Implanon releases a hormone — progestin. The progestin in Implanon works by keeping a woman's ovaries from releasing eggs, i.e., ovulating. Pregnancy cannot take place if there is no egg to join with sperm. The hormone in the implant also prevents pregnancy by thickening a woman's cervical mucus. The mucus blocks sperm and keeps it from joining with an egg. Implanon does not offer protection from STIs. (www.plannedparenthood.org/health-topics/birth-control/birth-control-implant-implanon-4243.htm) - Emergency contraceptive pills (ECP)
The emergency contraceptive pill — often called "the morning after pill" — prevents pregnancy after unprotected sexual intercourse. It does not protect against sexually transmitted diseases. For greatest effectiveness, ECPs should be taken as soon after unprotected intercourse as is practical. The "designated" ECPs are called Plan B®, Plan B One-Step®, and the generic brand, Next Choice®. They contain only the hormone progestin. Since they contain no estrogen, they have fewer side effects and most women can safely use them, even if they cannot use birth control pills as their regular method of birth control. Some regular birth control pills can be used as ECPs when they are taken in particular dosages.
For more information, see ReCAPP's Topic in Brief on Emergency Contraception.
- Oral contraceptives ("the pill")
- Uterine implants
- Intrauterine devices (IUDs)
The Copper-T® IUD is a small soft, flexible plastic and copper device that is shaped like a "T" and about 1-1/2 inches wide, or the size of a quarter. It can be left in the uterus for up to 12 years. It is more than 99% effective in preventing pregnancy by preventing an egg from planting itself in the uterine lining. It does not contain any hormones and may increase monthly bleeding and cramping in the first few months of use. The IUD does not offer protection from STIs. For more information, go to: www.safeandeffective.org/pages/sites/default/files/LARC-Copper-T-IUD-Fact-Sheet-English.pdf
Emergency contraception: The Copper-T IUD can be inserted up to five days after unprotected intercourse to prevent pregnancy. Insertion of a Copper-T IUD is much more effective than using ECPs or mini-pills, reducing the risk of pregnancy by more than 99%.
Intrauterine systems (IUS)
An intrauterine system known as the Mirena IUS® is now available. Unlike the IUD, the IUS decreases monthly bleeding and cramping. Made of light plastic, the t-shaped Mirena works like many other types of intrauterine contraceptive systems. It is fitted by a health care professional and remains in the womb for up to five years. It gradually releases a very small amount of levonorgestrel (one of the hormones commonly found in the birth control pill) every day to prevent pregnancy and is more than 99% effective. In the Mirena, however, a muchlower dose is released than when you take the Pill (about 1/7th strength), and it goes directly to the lining of the womb rather than through the blood stream where it may lead to the common progesterone-type side effects. The IUS does not offer protection from STIs, and the IUS cannot be used for emergency contraception. For more information, visit: www.womens-health.co.uk/mirena.htm.
- Intrauterine devices (IUDs)
- Fertility awareness-based (FAB) methods
A fertility awareness-based (FAB) method (sometimes referred to as "natural family planning") is a way for a woman to find out what days during her menstrual cycle she either is or is not likely to get pregnant. The days she is likely to get pregnant are called "fertile" days.
FAB is done by keeping track of the changes that occur in a woman's body during the menstrual cycle. To avoid getting pregnant, a woman should not have sexual intercourse on her fertile days, unless she or her partner uses a barrier birth control method, such as a diaphragm or condom. FAB methods do not protect from STIs. For information on a variety of FABs, go to http://www.arhp.org/crc/fertility-awareness.html.
Even though many teens do not use FAB, this is a method of contraception that can be explained to them as one potential option.
Teen Contraceptive Use
According to the 2006 – 2008 National Study of Family Growth (NSFG) conducted by the CDC and published in June 2010, the trends in teen contraceptive use at first sex for teens aged 15-19 are similar for males and females. However, what is also noteworthy is the finding that across the board, male usage of contraception is higher than female usage. Even more significant is the statistic that only 13% of males reported using no method of contraception when they first had sex as compared to 21.5% of females using no contraception. What is encouraging is that contraceptive use increased for both females and males between 2002 and 2008. Usage for males increased from 82% to 87%, and for females from 75% to 78.5%.
The 2010 NSFG report also states that condoms are by far the most used contraceptive method by teens, with 81% male usage and 68% female usage at first sex. Dual methods of contraception (condom and hormonal) was at 19% for males and 14% for females.
Comparing Contraceptive Methods
Check out the comparison chart below to see birth control methods and their effectiveness. Remember that effectiveness increases if methods are combined, such as by using a condom and the pill. (From Association of Reproductive Health Professionals at www.arhp.org/contraception)
A Woman's Guide to Understanding Today's Birth Control Choices:
Note: HCP stands for Health Care Provider
|
From www.arhp.org/contraception
More Information/Resources
Organizations and Web Sites with Information on Contraception:
- Advocates for Youth: Cultural Competency, Adolescent Reproductive & Sexual Health
2000 M Street NW, Suite 750
Washington, DC 20036
Phone: 202.419.3420
Fax: 202.419.1448
This webpage provides numerous fact sheets on adolescent reproductive health for multiple youth populations (e.g. African American, Latino, Asian, GLBTQ and others. The webpage also provides lesson plans and links to other resources.
www.advocatesforyouth.org/culturalcompetency.htm - Association of Reproductive Health Professionals (ARHP)
1901 L Street, NW, Suite 300
Washington, DC 20036
Phone: 202/466-3825
Fax: 202/466-3826
www.arhp.org/success/ - Bixby Center for Global Reproductive Health
The Bixby Center at UCSF promotes reproductive health, family planning and the prevention of STIs, including HIV, worldwide. The Center for Reproductive Health Research and Policy at UCSF created a series of fact sheets on Latino youth.
bixbycenter.ucsf.edu/ - Food and Drug Administration (FDA)
This website of the FDA offers information about specific drugs and their side effects.
www.fda.gov/medwatch/ - Feminist Women's Health Center
14220 Interurban Ave South #140
Seattle, WA, 98168
www.fwhc.org/
www.birth-control-comparison.info/ - Mysistahs
MySistahs, a project of Advocates for Youth, is a website created by and for young women of color to provide information and offer support on sexual and reproductive health issues.
www.mysistahs.org - National Campaign to Prevent Teen and Unplanned Pregnancy, The
1776 Massachusetts Ave., NW, Suite 200
Washington, DC 20036.
Phone: (202) 478-8500.
Fax: (202) 478-8588
www.theNationalCampaign.org - National Library of Medicine
www.nlm.nih.gov/medlineplus/birthcontrolcontraception.html - Planned Parenthood Federation of America
434 West 33rd Street
New York, NY 10001
Phone: 212-541-7800
Fax: 212-245-1845
www.plannedparenthood.org/health-topics/birth-control-4211.htm - Sex, Etc.
Sex, etc. is a national magazine and website on sexual health written by teens, for teens from the Center for Applied Psychology at Rutgers, the State University of New Jersey.
www.sexetc.org/page/about_us/ - TeenWire.com
Teenwire.com, a project of Planned Parenthood, is a sexual health website for teens about sex so that teens can use the information to make their own responsible choices and reduce the risk of unintended pregnancy and sexually transmitted infections. The LGBTQ page has links to articles and answers to many questions from "Ask the Expert."
www.teenwire.com/topics/lesbian-gay-bisexual-transgender.php - YouthResource
YouthResource, a project of Advocates for Youth, is a website by and for gay, lesbian, bisexual, transgender and questioning (GLBTQ) young people. It takes a holistic approach to sexual health and exploring issues of concern to GLBTQ youth. www.youthresource.com
Organizations with Pamphlets and Videos on Contraception:
- ETR Associates
4 Carbonero Way
Scotts Valley, CA 95066
1-800-321-4407
www.etr.org/pub/ - Journeyworks Publishing
PO Box 8466
Santa Cruz, CA 95061-8466
1-800-775-1998
www.journeyworks.com
Suggested Books, Curricula, Resource Guides, Articles, and Reports:
- Adolescent Sexual Health Education: An Activity Sourcebook (2007)
Card, J., T. Benner
Springer Publishing Company
www.socio.com/srch/summary/misc/paspubl4.htm - Becoming a Responsible Teen (BART) (Revised 2005)
St. Lawrence, J.S.
ETR Associates, Santa Cruz, CA
pub.etr.org/SearchCategoryResult.aspx?id=270000 - CDC Report on Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, National Survey of Family Growth 2006–2008 Series 23, Number 30, June 2010.
www.teenstxt.com/downloads/2_CDC_US_Teens_Sexual_Activity_2006_2008.pdf - Focus on Youth: An HIV Prevention Program for African-American Youth (12-15) (2008)
ETR Associates, Santa Cruz, CA
pub.etr.org/SearchCategoryResult.aspx?id=270000 - Health Smart High School (or Middle School): HIV, STD & Pregnancy Prevention (2004)
Chase, J., W. Kane, S.K. Telljohann, N. Lezin
Includes Teacher Guide, Actions Student Book and Health Facts Books
ETR Associates, Santa Cruz, CA
pub.etr.org/SearchCategoryResult.aspx?id=270000 - Kaiser Family Foundation Daily Reproductive Health Report
www. Kaisernetwork.org/daily_reports/rep_repro.cfm - Our Bodies, Ourselves for the New Century: A Book by and for Women (rev. 2005)
by The Boston Women's Health Book Collective
Touchstone Books, Simon & Schuster
www.ourbodiesourselves.org/publications/obos.asp - Power Through Choices — Sexuality Education for Youth in Foster and Group Care (2001)
A 10-session curriculum designed to help prevent pregnancy, HIV and STIs.
National Resource Center for Youth Services — NRCYS
www.nrcys.ou.edu/catalog/product.php?productid=116 - Reducing the Risk (5th Edition 2011)
Barth, R.
ETR Associates, Santa Cruz, CA
pub.etr.org/SearchCategoryResult.aspx?id=270000 - Safer Choices (Rev. 2007)
Fetro, J., Barth, R., and Coyle, K.
ETR Associates, Santa Cruz, CA
pub.etr.org/SearchCategoryResult.aspx?id=270000 - Sex Education, Teenage Pregnancy, Sex in Islam and Marriage
This article speaks about sex education from a cultural perspective. It makes the argument that youth should be taught about sexuality, as ignorance does not protect them in any way. Included in the text are suggested topics for a sexuality curriculum for Muslim youth. Click on "Sex Education" at the bottom of the page to access a more extensive file on "Sex Education: An Islamic Perspective."
www.themodernreligion.com/misc/sex/s2.html - SIECUS has lessons, curricula, research, and professional development opportunities.
This website also has additional facts, statistics and lesson plans on contraception.
www.SexEdLibrary.org - YouthNet Program
The YouthNet Program (2001-2006) was the USAID-funded global technical leadership program for youth reproductive health and HIV/AIDS prevention. The Christian and Muslim manuals contain six workshops and a participant handbook designed for adults, including parents. The manuals encourage open discussion about sexuality, reproductive health, and HIV in the context of faith communities. They are not designed to promote religion.
www.infoforhealth.org/youthwg/pubs/youthnet.shtml - Youth Peer Education Toolkit (The) (2005)
United Nations Population Fund, New York, NY
Includes five resources designed to help program managers and master trainers of youth peer educators to implement reproductive health and HIV/STD prevention programs.
www.infoforhealth.org/youthwg/peeredtoolkit.shtml
