Our Bodies, Ourselves (45 page)
Read Our Bodies, Ourselves Online
Authors: Boston Women's Health Book Collective
In addition to buying and using condoms, men can help pay for doctors' visits and drugstore bills; be part of the decision to invest in a long-term, reversible method of contraception; remind us to take the pill each day; help to remove a diaphragm or insert spermicidal foam;
and check to see if supplies are running low. If you and your partner are sure that you will not ever want to have children, or your family is the right size as it is, a vasectomy may be a
suitable option
. The future holds even more opportunities for men to participate actively in birth control, as several new contraceptive methods for men are currently being developed (see
“Emerging Male Contraceptives,”
.
If you want to use a birth control method other than condoms and spermicides, you need to visit a health care provider. A good health care provider will give you a physical exam, go over your personal and family medical history, and discuss which methods may be a good fit for you. (For advice on how to find a provider or clinic, see
“For Teens.”
) If possible, find a health care provider who not only will talk with you but also will listen to what you have to say about your experience with birth control, as finding the best method may involve switching methods or pill brands a few times. If your provider won't work with you, try to find another provider who will. Although health care providers can offer helpful advice about which methods might work best for you, the choice is ultimately yours.
Because there is no one perfect method of birth control that is right for every woman, you need to consider your own needs and priorities. Factors to consider include safety and effectiveness, how much you are willing to risk an unintended pregnancy, how comfortable you are with the potential side effects, how the method is used, the type of relationship you are in, and the amount of money you can spend. If you have medical problems, chronic illnesses, or disabilities, you may have additional considerations. Insurance coverage or the types of birth control available at a particular provider or family planning center may also determine which methods are available to you.
© Nina Reimer
Male pelvic organs (side view)
Below are some questions to think about as you make your decision.
⢠Am I ready to have or interested in having sexual intercourse at this time in my life or at this point in my relationship?
⢠Given my lifestyle, what characteristics am I looking for in a method? Can I reliably use a method that I have to remember every day or week, or every time I have intercourse?
⢠How involved will my partner be in this decision and with the use of the method?
⢠How safe is this method for me and/or my partner? Do I have any medical or other reasons not to use the method?
⢠What are the potential side effects and risks of this method? Are these acceptable to me?
⢠How effective is this method in preventing pregnancy? What would be the consequences in my life if I got pregnant?
FOR TEENS
If you are a teenager, you may want to wait to start having sex for any number of reasons, or you may just want to hold off on the kinds of sex that present a risk of pregnancy. If you have already made the decision to have vaginal intercourse and don't want to get pregnant, you need to use birth control. Reading this book, talking with your friends and supportive adults, and visiting teen-friendly sexuality websites such as Scarleteen: Sex Ed for the Real World (scarleteen.com) can help you to make healthy choices about if, when, and with whom to have sex, as well as how to protect yourself if you decide to be sexually active.
Have a birth control method picked out and begin using it before the first time you have sexual intercourse. If there is a reproductive health clinic nearby, you can go there and speak with a medical provider. Most family planning clinics, such as Planned Parenthood, provide free or reduced-cost services and supplies. They are also completely confidential. That means no one else will know you have an appointment or are using birth control. You do not need permission from your parents or a guardian to make an appointment or get birth control. If you do not know where there is a clinic near you, you can search for one by zip code or state at Planned Parenthood's website (plannedparenthood.org) or call Planned Parenthood at 1-800-230-P
LAN
.
No matter what age you are, you can also buy safe and effective methods, such as condoms and spermicides, in most drugstores. Condoms are sometimes given out free in teen centers, clinics, or HIV prevention programs. Whatever method of birth control you choose, use condoms to protect yourself from sexually transmitted infections (STIs). This is especially important because men and women under age twenty-four have the highest rates of chlamydia and gonorrhea.
If you have not been using birth control and have had unprotected intercourse within the past five days, you can use emergency contraception (EC) to prevent pregnancy. For more information, see
“Emergency Contraception.”
⢠How effective is this method in preventing sexually transmitted infections?
⢠What are the noncontraceptive benefits to this method? Can it reduce menstrual cramps or help me in another way?
⢠How much will this method cost? Can I afford it consistently?
⢠What are my plans for a family? Am I using contraception to delay pregnancy? Am I done with childbearing? Am I choosing never to have children?
Will It Work?
Effectiveness of Birth Control Methods
Though choosing a method involves considering many factors, one of the most important is how well it works to prevent pregnancy.
A method's effectiveness is based on the probability of unintended pregnancy in the first year of use. Effectiveness is usually presented as two numbers:
Perfect use
reflects the effectiveness of the method when it is used exactly as directed, with perfect consistency;
typical use
is the effectiveness of the method when used by real people, who may use the method incorrectly or inconsistently. For example, the birth control pill has a perfect use effectiveness rating of 99.7 percent, which means that if one hundred women use the Pill correctly for a year, fewer than one will become pregnant. In typical use, howeverâwhen a woman may forget to take a pill or doesn't get supplies in timeâthe effectiveness is only about 92 percent, which means that about eight of every one hundred women, or one out of about thirteen women, will become pregnant in one year.
*
(See
“Comparing Birth Control Methods.”
)
METHODS WOMEN CAN USE WITHOUT PARENTS OR PARTNERS KNOWING
There are times when women need a birth control method that can be used without a partner's knowledge. A recent study of Planned Parenthood clients in Northern California found that nearly one in seven women had a partner who tried to interfere with her efforts to prevent unwanted pregnancy.
1
Birth control sabotage can include hiding birth control pills or flushing them down the toilet, intentionally breaking condoms, and removing contraceptive rings or patches.
There are other times when we don't want people besides our partner to know we are using birth control. For example, if you are a teen, you may be concerned about your parents finding out. If you need to keep your birth control private for any reason, you have some good options.
Totally Invisible: Depo-Provera Shot
This injection of a hormone in your upper arm every three months is one of the most private methods available and is over 99 percent effective if you get your shots at the right time. No one, not even your partner, will know about it unless you decide to tell. It may be challenging to get to the clinic four times a year without someone close to you knowing, but it may also be easier than hiding a pill you have to take every day. (For more information on
Depo.
)
Only You Know It's There: Implant
This matchstick-size rod is placed just under the skin of your upper arm and is over 99 percent effective. After a nurse or doctor inserts it, you'll have a bandage for a few days and may have some bruising around it. Once it's healed, no one can see that the rod is there. Someone would have to know exactly where to feel your arm to find it. (For more information on
the implant
.)
Your Partner May Know, but No One Else Will: IUD and Ring
An IUD is a small device that a doctor places in your uterus that provides over 99 percent effective contraception. Partners can sometimes feel the threads that help a doctor remove the device when you're ready. The threads are at your cervix, inside your vagina. (For more
information on IUDs
.)
The ring, which you can insert yourself, rests near your cervix and releases a small amount of hormone for 92 percent effective contraception. If you're worried about a partner knowing about it or you don't like it there during sex, you can take it out and keep it in a safe, clean place for up to three hours a day. (For more information on
the ring
.)
If You're Hiding Birth Control from Your Partner
Whether or not you use birth control may be a private decision, and it's okay to use it privately. However, feeling that you are not safe unless you hide your birth control from your partner is not okay. If you're in this situation, you are not alone. You can read about others' experiences at Know More Say More (knowmoresaymore.org). A partner who loves and respects you will also respect your decision to use birth control. (To learn more about how to get out of a controlling relationship, see
“Intimate-Partner Violence,”
.)
How well a method will work for you will be determined by a number of factors:
⢠The perfect use effectiveness of your chosen method
⢠How consistently and correctly you use your chosen method
⢠How often you have intercourse (a woman who has intercourse every day is at greater risk of pregnancy than a woman who has intercourse only occasionally)
⢠Your age and fertility (younger women are more likely than older women to become pregnant from a single act of intercourse)
To lower your risk of unplanned pregnancy:
⢠Be sure you have access to your method.
⢠Be sure you have complete and correct information about the use of your method.
⢠Use your method consistently and correctly.
⢠Use two methods together to greatly lower your risk of pregnancy. If one of the two methods is a condom, this also provides protection from sexually transmitted infections.
⢠Have an
emergency method
available for backup if your method fails or if you have unprotected intercourse.
⢠If your greatest concern is highly effective, long-term, and reversible protection, use a method such as long-acting injections, implants, or an IUD.
⢠If you are using a barrier or nonmedical method, be aware of your fertile time and avoid intercourse or use extra protection during this time.
In general, methods of contraception are safe for healthy reproductive-aged women, although some methods pose health risks for women with particular medical conditions.
When you are considering a particular method, it's important to look at both its contraindications and its side effects. Contraindications are the physical conditions or circumstances that make a method a poor or dangerous choice for a particular woman. For example, it is contraindicated for a woman who is over age thirty-five and smokes to use birth control pills, because they would put her at increased risk of developing a blood clot that could lead to a heart attack or stroke. As another example, having current breast cancer is a contraindication for using any hormonal method. A contraindication means that by using that particular method of birth control you may increase your risk of a serious health problem.
Side effects are the changes that can occur as the result of using a particular medication or device. Side effects can be mild or severe, and can vary greatly from person to person. For example, possible side effects of hormonal methods include changes in bleeding patterns, breast tenderness, and mild headaches. A side effect of some barrier methods may be an increase in urinary tract infections. Some side effects go away completely after a short period of time and some last the whole time you are using the method. Many women experience no side effects at all. For most women, negative experiences with birth control are due to side effects rather than contraindications. In the sections below on individual methods, the subheading “Health Concerns” includes both the method's side effects and the contraindications.
One thing to keep in mind when choosing a method is that brand-new birth control products have not been tested as extensively as those that have been used for decades. The Food and Drug Administration (FDA) approves all methods of birth control, and products that receive FDA approval have undergone up to ten years of rigorous research. However, it can take twenty years or more for some complications to become apparent, especially those that are rare but serious. Drug manufacturers spend a lot of money promoting and marketing new methods, trying to convince you that they are the best. But new, heavily marketed brands are not necessarily any better than older methods, and they may pose risks that are not yet known.