I want to dedicate this month’s column to the abundance of new and improved contraceptive choices now available to women. Such was not always the case. Reliable contraception (the Pill) did not arrive until 1960. Before then, women relied on nothing more than bulky and fragile condoms, the unreliable rhythm method, and good luck to avoid unwanted pregnancies. Hasty and unhappy marriages resulted when those methods failed and many young women’s dreams of education and career terminated because their pregnancies could not—Roe v Wade did not grant women sovereignty over their bodies until 1973!
How different is our personal landscape today. The new millennium rang in scientifically sound methods of birth control our mothers could not even imagine. We have pharmaceutical choices as well as barrier methods, and better understanding of our bodies’ subtleties resulted in even more reliable natural methods of conception control. Though this column outlines the newest and brightest stars on the pharmaceutical scene, I encourage you to explore all your options and make your decision in concert with your partner(s) and your health care provider(s).
So what’s new? There’s a lot of buzz about the new low-dose pill named Seasonale that allows us freedom not only from worry about unintended pregnancy but also from more than four periods a year. Another option is Lybrel, a low-dose estrogen and progesterone pill taken every single day, eliminating periods altogether and therefore the attendant fluctuations of our hormonal cycles, a boon to those who suffer PMS, migraines, acne, etc. It will be available to us here in Canada next year.
Don’t want to bother with taking pills at all? Or worried that you may forget to take them every single day? A smoker over thirty-five? Not to fret. Perhaps you’d be interested in trying the NuvaRing , a slim, flexible circle you insert into your vagina once a month. It releases a low dose hormone that mimics the effect of the oral contraceptive. What could be easier?
Actually, I have an answer to that. If you have already given birth to a child, you may want to consider an IUD. I can hear you now, complaining of the cramping and the long bloody periods. But, wait. IUDs aren’t what they used to be. The Mirena is an easy-to-insert model that releases just enough progesterone to keep you from becoming pregnant while keeping your periods cramp-free and light in volume. Gone are the days of the Dalkon Shield, recalled like a bad Buick. Women now have real choices about how to regulate their fertility and their menstrual cycles, and they can do so with a high degree of confidence about their physical safety. Hallelujah!
But, you say, you’re not in a steady relationship and you require birth control protection only irregularly? Yes, we have answers for you, too. You might want to investigate the spermicidal sponge. Wasn’t that around years ago, you ask? Yes, it was. Seems water at the plant that manufactured the Today Sponge was contaminated and, rather than invest in the necessary cleanup, the company closed the plant. Consumer demand being what it is, the competition began marketing their own brands and now even the original Today brand sponges are available, but only in Canada. Note well: the effectiveness of the sponge is severely compromised in the presence of yeast-fighting medications, and it works far better in women who have not borne a child.
Add to these recent additions the pharmaceutical storeroom of condoms, diaphragms, cervical caps, contraceptive jellies and foams, natural family planning methods, ‘traditional’ birth control pills (makes me smile), IUDs, and sterilization methods for men and women (some reversible), and we can appreciate how vast are our options for choosing conception. If given proper information, each of us can be responsible for our body and treat parenting as the privilege it should be. Could it be that those who carried placards in the ‘60s bearing the Utopian ideal “Every child a wanted child” might see their dream realized? Science and education could make it so.*
*Below you will find an email communication from Dr Linda Hendrixson (Assistant Professor, Health Education Department, East Stroudsburg University) regarding statistics on the efficacy of various birth control techniques. It’s fairly dry reading, but offers current and accurate data that can help us determine our best choices.
I have the 17th edition of Contraceptive Technology-1998. It lists the failure rate for typical use of “periodic abstinence” (just avoiding intercourse during ovulation) as 25% (% of women experiencing unintended pregnancies in the first year of use). So, typically, it’s 75% effective, so to speak.
CT lists the failure rate for perfect use of “periodic abstinence” as between 1% and 9% (91%-99% effective) depending on which fertility awareness-based method is used:
Calendar method: Typical use=13% failure rate. Perfect use=9% failure rate.
Ovulation method-assessing cervical mucus: Typical use=20% failure rate. Perfect use=3% failure rate.
Sympto-thermal (measuring basal (resting) body temperature + assessing cervical mucus): Typical use=20% failure rate. Perfect use=3% failure rate.
Post-Ovulation ( I presume this means restricting intercourse only to the days after ovulation has occurred): Typical use=no failure rate noted. Perfect use=1% failure rate.
It must be noted, however, that CT takes its typical use failure rates from national surveys done in 1976, 1982, and 1988. Perfect use failure rates are the best “guesstimates” of the authors. Obviously, more up-to-date data are needed for typical use failure rates for this and other methods discussed in CT. Perhaps the 18th edition, recently published, sheds more light on the subject.
Regarding continuous abstinence, the goal of abstinence-only programs: Advocates for Youth carries a report dated 9/27/2004 called “Five Years of Abstinence-Only-Until Marriage Education: Assessing the Impact,” which is a good analysis of short-term and long-term effects of a number of these programs in thirteen states. From the conclusion of the study: “. . .none of these programs demonstrates evidence of long-term success in delaying sexual initiation among youth exposed to the programs or any evidence of success in reducing other sexual risk-taking behaviors among participants.” It is a worthwhile report to read.
So far, then, continuous abstinence, at least among youth in many abstinence-only education programs around the country, is showing a high typical use failure rate.