Contraception

Contraception, also known as common referred to as birth control, has been traditionally viewed as a way to prevent pregnancy. However some methods can also be used as STI prevention methods and as treatment for hormonal imbalance and other medical conditions.

The history of sexual and reproductive health is deeply rooted in racism and injustice at the hands of medical institutions and scientists. We urge you to examine the fields of public health and medicine and the history it has within communities of color, low income areas, and within immigrant communities. In discussions of health equity we must remember and analyze the impact of injustices such as the Tuskegee Syphilis Study and the cruel experimentation on Black women that were instrumental in the creation of modern day gynecology. Contraception also has a dark history of racism- including some of the methods we will discuss in the options sections – specifically oral contraceptives, LARCs, and sterilization.

The current access to oral contraceptives would not have happened without the Puerto Rico Pill Trials. Researchers John Rock and Gregory Pincus of Harvard University brought trials of oral contraceptives to the island in the 1950s to run human trials. They failed to fully inform the trial participants that it was a clinical trial for an experimental drug and of the dangerous side effects. They ignored the reports of serious side effects in a rush to get the pill to market. They targeted low income and people with low education attainment to prove that it was not too “complicated” for people in inner cities and other countries to use. 

Long acting reversible contraceptives (LARCs) have gained increasing popularity in the past 50 years. Among these includes Depo Provera also known as the shot. In the US and abroad, women of color were used as test subjects for the shot and suffered drastic side effects including cancer and some even died during the trials. Despite not having FDA approval, they conducted clinical trials among primarily low-income Black women without getting their consent. Although it has gained approval and is in use today, it has been linked to increased STI rate and even cases of sterility.

Involuntary sterilization has been used as a tactic of population control in the US since its creation.  It has been primarily against poor folks, people of color (especially Black, Latinx, and Indigenous communities), immigrants, those with mental illness, and those with disabilities. These sterilizations would often occur in hospitals after a person had given birth without their consent. There were federally funded sterilization programs in over half of the state during the 20th century. These racist, classist, and ableist programs aimed to eliminate any and all future children that would not fit into the ideal, white American dream.

Knowing the history of reproductive health, particularly contraception, is important in understanding the disparities and structural barriers that have contributed to these disparities.

Types of Contraception

There are generally 5 main types of contraception. Within these categories, there are thousands of options! 

Maybe this is a drop down menu type situation?

Long Acting Reversible Contraception (LARCs)

  • Intrauterine Device (IUD)
    • There are 2 types: hormonal and copper
    • A small, T-shaped device that gets inserted by a healthcare provider into the uterus
    • Can remain in place for years: 3-6 for hormonal & up to 10+ for copper
    • Very effective in preventing pregnancy (failure rate <1%)
  • Implant
    • A rod-shaped implant about the size of a match 
    • Implanted in the upper arm right under the skin
    • Lasts up to 5 years
    • Very effective in preventing pregnancy (failure rate <1%)

Hormonal Methods

These methods are highly effective if used perfectly- but given human error, there are higher failure rates than with LARCs

  • “The Shot”: Depo-Provera
    • Injection given in the arm or buttock
    • Given once every 3 months
    • Typical use failure rate: 4%
  • Oral Contraceptives
    • 2 types: Progestin-only (POPs)- “the mini pill” & Combined oral (COCs) “the pill”
    • 1 pill taken every day at the same time 
    • Typical use failure rate: 7%
  • The Patch
    • Plastic patch that sticks to the skin like a bandage
    • Placed on upper body, outer arm, lower abdomen, or buttock
    • New patch applied once a week
    • Typical use failure rate: 7%
  • The Ring
    • Thin, flexible ring 
    • Placed inside vagina
    • Replaced every 3 weeks
    • Typical use failure rate: 7%

Barrier Methods

  • Condoms
    • 2 general types: external and internal
    • 1-time use
    • Help reduce the risk of pregnancy AND STIs
      • “Lambskin” and “Natural” condoms do not provide the same level of protection as synthetic condoms from STIs
    • Failure rate with typical use: 13% (external), 21% (internal)
    • See condom usage section for more details about use
  • Contraceptive Sponges
    • Soft foam sponges filled with spermicide
    • Inserted into vagina before sex involving potential contact with sperm
    • Left in for at least 6 hours (but no longer 30 hours after)
    • Failure rate with typical use: 16%
  •  Spermicide
    • Available in many forms: foam, cream, film, gel
    • Placed in vagina no more than one hour before sex involving potential contact with sperm
    • Left in place for 6-8 hours after
    • Failure rate with typical use: 21%
  • Diaphragms
    • A shallow, flexible latex or rubber cup
    • Inserted into vagina before sex involving potential contact with sperm and used with spermicide
    • Remains in place for 6-8 hours after sex
    • Health care provider measures to order one that is the correct size
    • Replaced every 1 to 2 years
    • Failure rate with typical use: 17%
  • Cervical Cap
    • Thin silicone cup
    • Inserted into vagina before sex involving potential contact with sperm and used with spermicide 
    • Remains in place for 6-8 hours after 
    • Health care provider measures to order one that is the correct size
    • Replaced every 2 years
    • Failure rate with typical use: 14%

Emergency Contraception

Emergency contraception should not replace regular contraceptive methods as it is not as effective as methods used before or during sex. These methods should be used is you have had unprotected sex with possibility of pregnancy. This means that you did not use a contraceptive method at all or the method you used failed (ie broken condom).

  • Copper IUD
    • Most effective method
    • Can be inserted within 120 hours after unprotected sex
    • Nearly 100% effective
    • Lasts for 10+ years
  • Emergency Contraceptive Pills - “Morning After Pill”
    • Hormonal pills- 1 or 2 doses depending on brand
    • Can be taken up to 5 days after unprotected sex
    • Available over the counter
    • The sooner you take them after unprotected sex with risk of pregnancy, the more effective

Sterilization

These are permanent forms of birth control that usually requires surgery:

  • Sterilization implant
    • Nonsurgical method that blocks the fallopian tube
  • Tubal ligation
    • Surgical procedure where the fallopian tubes are cut, tied, and sealed
    • Failure rate: 0.50%
  • Vasectomy
    • Surgical procedure that cuts, closes, or blocks the vas deferens 
    • Failure rate: 0.15%

How to Properly Use Barrier Contraceptives

To achieve the maximum level of protection, there are a few steps you need to take when using these types of barrier methods!

Fast Facts

  • You should only use condoms and dental dams once
  • Only use one condom at a time
    • Using two can actually increase the risk of them breaking
  • Change condoms every time you switch from one kind of sex to another ( like anal to vaginal)
  • DO NOT use oil-based lube (Vaseline, baby oil, essential oils) on latex condoms
    • It can weaken them and cause them to break
  • Condoms and dental dams can expire
    • Be sure to check before use
  • Storage matters!
    • It is best to keep them in a cool, dry place where they cannot get punctured
  • Flavored barriers should not be used for penetration
    • They can cause irritation and yeast infections

Proper External Confom Use

  1. Examine the packaging
    1. Look at the expiration date, see if there are any holes or damage
  2. Carefully open the package
    1. Teeth or scissors could break the condom
  3. Place the condom on the head of the penis or sex toy while also holding the tip to squeeze any air out
  4. Roll the condom down to cover the entire penis or sex toy
  5. Keep the condom on until you are done using it
  6. When taking it out, hold the rim of the condom at the base of the penis or toy. Then withdrawal
    1. This reduces any chance for contact for greater protection against STIs and unplanned pregnancy
  7. Carefully take off the condom and dispose of it

Proper Internal Condom Use

  1. Examine the packaging
    1. Look at the expiration date, see if there are any holes or damage
  2. Carefully open the package
    1. Teeth or scissors could break the condom
  3. Place the thick, inner ring at the closed end of the condom
  4. While holding the outside of the condom at the closed end, squeeze the ring together with the thumb and forefinger to insert it into the vagina or anus
  5. Push the inner ring as far up as possible
  6. Make sure the condom is not twisted and that the outer ring remains outside of the body
  7. To remove, twist the outer ring and pull the condom out
  8. Dispose after use

Proper Dental Dam Use

Dental dams are latex or polyurethane sheets that can be used during oral sex as a barrier between the mouth and vagina or anus during sex to reduce the risk of STIs.

  1. Examine the packaging
    1. Look at the expiration date, see if there is any damage
  2. Carefully open and remove the dental dam from the packaging
  3. Place dental dam flat to cover the area
  4. Once finished, dispose of it

A healthcare provider can help you decide which method is best suited for your wants and needs. You can also book a consultation with Mickey at the Health Advocacy and Promotion Center here on campus to talk about contraceptive options!

Abortion

The choice to have an abortion is one that be made by you and a healthcare provider. In the ever-changing political climate of our world, the stigma surrounding choice is something that can be daunting. You are not alone! About 1 in 4 people capable of getting pregnant will have an abortion by the time they are 45. The decision to have an abortion or not to is extremely personal- you are the only person who can make it. Finding accurate information regarding the issue is difficult. Here we have gathered some and on the Resources page you can find even more.