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Bioethical Issues in Contraception

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Jenny Cabanto

on 22 October 2013

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Transcript of Bioethical Issues in Contraception

Contraceptives
http://www.healthofchildren.com
http://www.dictionary.com
"The deliberate use of artificial methods or other techniques as a means to prevent pregnancy as a consequence of sexual intercourse."
Contraception
"To
prevent
pregnancy by
interfering
with the normal process of ovulation, fertilization, and implantation. There are different kinds of birth control that act at different points in the process."
Purpose


Essentially, we don't want this:
3500 years ago: Egyptian women learn how to mix dates, acacia and honey into a paste, smear it over wool and use it as a pessary to prevent conception. (They weren't the only ones.)
1839: First modern rubber condoms, intrauterine devices, douching syringes and "womb veils" (all barrier devices).
1873: Congress deems birth control info "obscene" and outlaws its dissemination. U.S. is the only Western nation to criminalize contraception.
1880s: A large cervical cap is developed--an early version of the diaphragm, a physical barrier.
1800's
1916: Margaret Sanger opens America's first family-planning clinic, in Brooklyn (for 10 days).
1921: Sanger founds the American Birth Control League, which later becomes the Planned Parenthood Federation of America.
1930: Some bishops approve limited use of birth control; Pope Pius XI follows by affirming church teaching against contraception.
1938: Federal obscenity ban on birth control is lifted, but contraception remains illegal in most states.
1954: John Rock and Gregory Pincus conduct the first human Pill trial (50 women in Massachusetts).
Early 1900s
1960: the FDA approves Enovid, one of the first birth control pill
1965: the Supreme Court strikes down state laws that prohibit contraception for married couples; 6.5 million American women are on the Pill
1970: Concerns about the Pill's safety and side effects prompt Senate hearings
1980s: 10.5 million American women are taking the Pill (roughly 1 in 10)
Later 1900s
1998: FDA approves first emergy contraceptive. (Preven pills prevent pregnancy for up to 72 hours after sex)
2002-2003: 4 intra-uterine/skin-embedded contraceptive patches are developed, heralding huge advances in contraceptive technoology (NuvaRing, size of a dollar; Mirena, effective for years)
2010: Studies show that women on the Pill live longer, are less likely to die prematurely of all causes (including cancer and heart disease). Some 100 million women around the world use the Pill.
"Deliberate prevention of conception or impregnation"
Merriam-Webster Dictionary
Contraceptives: Then & Now!
Prior to any developed methods of birth control, women had to rely on male withdrawal, and on crude infanticide and abortion for backup.
The Menstrual Cycle
The ETHICS of CONTRACEPTION
Types of Contraception and Medical Issues
Religious Views
Ethics Guide
The Ethics of Contraception
Introduction
Moral case against contraception
Moral case for contraception
Duty to use contraception?
Moral Case for Contraception
Introduction to the
Contraception Debate
philosophical arguments such as the

"natural law"
argument
arguments based on different ideas of marriage, sex and the family
human rights arguments such as
'procreative liberty'
a woman's right to control her own body
human rights arguments about mass birth control programmes
arguments based on the good or bad consequences of birth control
(consequentialism)
arguments about the environmental and resource problems caused by over-population
religious arguments
Moral Case Against Contraception
Contraception is inherently
wrong
Contraception is unnatural
Contraception is anti-life
Contraception is a form of abortion
Contraception separates sex from reproduction
Contraception brings
bad consequences
These are consequentialist arguments against contraception.

Contraception carries health risks
The "contraceptive culture" is dangerous
Contraception prevents potential human beings being conceived
Contraception prevents people who might benefit humanity from being born
Contraception can be used as a eugenic tool
Contraception is often misused in mass population control programmes in a racist way
Mass population control programmes can be a form of cultural imperialism or a misuse of power
Contraception may lead to depopulation
This sounds odd to an age concerned about overpopulation but for substantial parts of the 1800s and 1900s this was a real fear.
Contraception leads to
"immoral behavior"
Contraception makes it easier for people to have sex outside marriage
Contraception leads to widespread sexual immorality
Contraception allows people (even married people) to have sex purely for enjoyment
Arguments based on life and the natural order
Contraception is
unnatural
the natural consequence of having sexual intercourse is conceiving a child
it is wrong to interfere with this
therefore birth-control is intrinsically wrong
Contraception is
anti-life
" life is a good thing"
Contraception is a form of
abortion
Some birth control techniques can operate by preventing the implantation and development of a fertilized egg.
Holders of this view
Opponents
there is some purpose to the processes of the universe
it is wrong to interfere with the natural order of the universe
this is a religious idea rather than a secular one - most scientists regard the idea that there is a purpose to the universe as nonsense
human beings interfere with the natural order of the universe all the time (for example when doctors cure illnesses) - sometimes the results are good and sometimes bad
Therefore birth control is only a wrong interference with the natural order of the universe if it produces a bad result
so it's necessary to look at the consequences of contraception to assess whether it is good or bad
that is a different argument, which has nothing to do with the natural order of the universe
Holders of this view
Opponents
there is some purpose to the processes of the universe
this is a religious idea rather than a secular one - most scientists regard the idea that there is a purpose to the universe as nonsense
it is wrong to interfere with the natural order of the universe
human beings interfere with the natural order of the universe all the time (for example when doctors cure illnesses) - sometimes the results are good and sometimes bad
Therefore birth control is only a wrong interference with the natural order of the universe if it produces a bad result
so it's necessary to look at the consequences of contraception to assess whether it is good or bad
that is a different argument, which has nothing to do with the natural order of the universe
contraception is morally wrong because:
life is a fundamental good - it is a good thing
those who use contraception are engaged in an intentionally "anti-life" act
because they intend to prevent a new life coming into being
they therefore have a bad intention
it is always morally wrong to do something with a bad intention
some birth control pills
most modern birth control pills can prevent implantation of a fertilised egg, even though this is not the main way they work
there is no way for the user to know after any act of intercourse whether the pill prevented implantation (or worked in some other way)
therefore using such pills always runs the risk of causing an abortion
it is wrong to run the risk of causing an abortion
the "morning-after" pill
this is also capable of operating by preventing implantation of a fertilised egg
the IUD
this can operate by preventing implantation of a fertilised egg
Arguments based on sexual behaviour and health
The danger of the "contraceptive culture"
Some people are concerned that "the availability of contraceptives leads to promiscuity which then leads to abortion".
Contraception carries health risks
Side effects
STDs
Contraception makes it easier for people to have sex outside marriage
Not
Human rights benefits
it's essential for "procreative liberty"
if people are not allowed a choice over whether or not to have children, their autonomy and freedom to control their lives is seriously restricted
Health benefits
it prevents the conception of unwanted children
and so reduces the number of possible abortions
it enables women whose health would be at risk if they conceived, to continue to have sex
the use of condoms helps prevent sexually transmitted diseases and HIV
Family benefits
it prevents the conception of children that a family cannot support
it enables people to avoid having more children than they want
it improves marriage because
it enables couples to enjoy the unitive function of sexual activity without being anxious about conceiving a child
it enables couples to have fewer children and thus spend more time together and with the children they do have
it reduces the cost of marriage (children are expensive)
Benefits for women
it promotes gender equality and the autonomy of women:
pregnancy and child-rearing affect women much more than men
women should have the right to choose or avoid these activities
any restriction of birth control is therefore sexual discrimination
it promotes gender equality and the autonomy of women:
it enables women to enjoy sexual activity on the same basis as men
any restriction of birth control is therefore a denial of women's right to sexual autonomy
without contraception a woman may find herself having regular pregnancies
this leads her to remain economically dependant on her partner
it enables women whose health would be at risk if they conceived, to continue to have sex
Demographic benefits
enables world population to be controlled and thus protects the environment and reduces poverty
Natural Family Planning and Fertility Awareness
"periodic abstinence methods"
no introduction of chemical or foreign material into the body or sustaining from sexual intercourse during a fertile period.

effectiveness varies greatly from 25% to 85%
refraining from sexual relations ; theoretical
0% failure rate
and is also the most effective way to prevent STIs ;
failure rate of 85%
(Cunningham et al, 2008)
Calendar (Rhythm Method)
requires a couple to abstain from coitus (sexual relations) on the days of a menstrual cycle when the woman is most likely to conceive (3 or 4 days before until 3 or 4 days after ovulation)
to calculate “safe” days: (shortest cycle) – 18
(longest cycle) – 11

Basal Body Temperature Method (BBT)
a day before ovulation: BBT falls about 0.5F
at the time of ovulation: BBT rises a full degree
problems with assessing BBT
Cervical Mucus Method
cervical mucus
before ovulation
: thick, does not stretch
ovulation:
copious, thin, watery, transparent, and stretches 1 inch before the strand breaks
(spinnbarkeit)
failure rate:
25%
(Burkman, 2007)
Symptothermal Method
cervical mucus + BBT ; mittelschmertz
Ovulation Detection
over-the-counter ovulation detection kit
detect the midcycle surge of luteinizing hormone (LH) that can be detected in urine 12 to 24 hours before ovulation
Lactation Amenorrhea
As long as a woman is breastfeeding an infant, there is some natural suppression of ovulation
Coitus Interruptus
Postcoital Douching
Hormonal Contraception
Oral Route
- pill, OCs, COCs
- synthetic estrogen combined with a small amount of synthetic progesterone (progestin)
- estrogen --> suppress folliclestimulating hormone (FSH) and LH --> suppressing ovulation- - - progesterone – complements estrogen
Transdermal Route
– patches that slowly but continuously release a combination of
estrogen and progesterone

- applied each week for 3 weeks; no patch applied on the
4th week = menstrual flow
Vaginal Insertion
– vaginal ring (NuvaRing)
- silicone ring that surrounds the cervix and continually releases a combination of estrogen and progesterone
- inserted vaginally and left in place for 3 weeks, then removed for one week (Roumen, 2007)
Implantation
- five subdermal implants (rods)
- rods contain etonogestrel, the metabolite of desogestrel, the same progestin that is used in the NuvaRing.
- Over the next 3 to 5 years, the implants slowly release the hormone, suppressing ovulation, stimulating thick cervical mucus, and changing the endometrium so that implantation is difficult.

Injection
- A single intramuscular injection of medroxyprogesterone acetate (Depo-Provera [DMPA]), a progesterone, given every 12 weeks inhibits ovulation, alters the endometrium, and changes the cervical mucus
> decrease in the permeability of cervical mucus --> limiting sperm motility and access to ova
> interferes with tubal transport and endometrial proliferation --> possibility of implantation is significantly decreased.


INTRAUTERINE DEVICES
- small plastic object that is inserted into the uterus through the vagina (Postlethwaite et al., 2007)
- Copper T380 (ParaGard) and LNG-IUS (Mirena)
- prevent fertilization as well as creating a local sterile inflammatory condition that prevents implantation
- When copper is added to the device, sperm mobility appears to be affected as well.
Chemical
Mechanical
Condoms
BARRIER METHODS
SURGICAL PROCEDURES
TYPES OF
CONTRACEPTION
Full transcript