Prophylactic Toolbag Diana Koster, M.D. Arranged Parenthood of New Mexico April 14, 2010Slide 2
Goals Provide: Contextual data about U.S. high schooler pregnancy rates Updated medicinal data regenerative human services needs contraception LARC (long-acting reversible contraception) Emergency contraception Comfort in part as instructors and advisors of teenagersSlide 3
Unintended Pregnancy in U.S . (per 1000)Slide 4
U.S. Contrasted with Europe Sexual introduction is proportionate. Pregnancy and STIs are more continuous among US high schoolers than among (most) European adolescents. (New Mexico #1 in high schooler pregnancy.) US teenagers have more accomplices. Utilization of contraception is less in U.S. than in other created countries. US high schoolers more averse to utilize therapeutic (i.e., best) contraceptives .Slide 5
Births in Women Under 20 (per 1000)Slide 6
Teens in U.S. what\'s more, EuropeSlide 7
No Contraception finally Intercourse (per 1000)Slide 8
Missed PillsSlide 9
Obstacles to Healthy Sexuality Ignorance Parental uneasiness Teacher/guide distress Lack of clarity about how best to convey messages Lack of access to secret administrations Incomplete cerebrum development Abstinence-just training (rather than forbearance based instruction)Slide 10
Abstinence-based Abstinence as favored for teenagers Accurate preventative data for future Proven effective Abstinence-just Abstinence until marriage No prophylactic training Inaccurate Unsuccessful Refusal abilities Abstinence EducationSlide 11
Myth # 1 Abstinence and contraception can\'t both be educated effectively. Showing our childhood about contraception will make them turn out to be sexually dynamic.Slide 12
American Academy of Pediatrics " Reduction of unintended pregnancy is best accomplished by procedures that incorporate… powerful projects to defer and decrease sexual movement… .Strategies to lessen spontaneous pregnancies ought to incorporate enhancing the learning, openness, and accessibility of contraception administrations, including crisis contraception." Policy Statement in Pediatrics, Vol. 116 No. 4 Oct 2005Slide 13
Support for Comprehensive Sexuality Education National Institutes of Health Institute of Medicine Centers for Disease Control American Medical Association American College of Obstetrics and Gynecology Society for Adolescent MedicineSlide 14
Goals of Sexuality Education Promote great basic leadership sentiments of solace suitable results Pregnancy avoidance/delay Prevention of STDs/STIsSlide 15
Myth # 2 Minors must have parental assent/authorization to acquire contraception.Slide 16
New Mexico Law (dense) Minors of all ages may get regenerative medicinal services without parental consent. Such care incorporates contraception and testing and treatment for sexually transmitted diseases. Sexual movement under age 13 must be accounted for to CYFD.Slide 17
Myth # 3 There are 100% compelling anti-conception medication strategies. Any individual who gets pregnant utilizing anti-conception medication "botched."Slide 18
Contraceptive Effectiveness (communicated as disappointments per 100 ladies years of utilization)Slide 19
Contraceptive Continuation ( at one year)Slide 20
Myth #4 Birth control is risky.Slide 21
Safety of Contraception Use of a legitimately chose preventative strategy is constantly more secure for a lady than pregnancy .Slide 22
Myth #5 Making crisis contraception (effectively) accessible will increment flighty conduct.Slide 23
Emergency Contraception ("next day contraceptive") Provides opportunity to forestall spontaneous pregnancy and to begin customary prophylactic consideration Is not the "fetus removal pill" – (ovulation disturbed or postponed) Is medicinally ok for all Can be utilized as a part of expansion to "standard" technique Is accessible "behind-the-counter" for > 17, by remedy for < 16 (not science-based) Does not build hazard taking Forms incorporate Plan B/Plan B 1-Step Next Choice Birth control pills in exceptional dosagesSlide 24
Emergency Contraception " The sooner, the better" Advance arrangement perfect – cf. fire douser Available at: Planned Parenthood Public Health Department School-based wellbeing focuses (?) Pharmacies www.not-2-late.comSlide 25
Myth #6 To utilize (hormonal) contraception securely, a lady should first have a complete physical exam and lab testing including a Pap smear and STD testing.Slide 26
Complete history Testing – Pap, STDs Complete exam Pelvic Breast check Thyroid exam Heart and lungs Blood weight, weight Targeted history Testing – variable, age-particular Exam – variable, age-particular, usually,none required for adolescent beginning anti-conception medication "Yearly Exam" Then NowSlide 27
Advantages to New Approach Provides chance to teach patients/understudies concerning singular medicinal services needs Avoids trepidation of pelvic as hindrance to start of contraception Makes contraception more reasonable Allows contraception to be begun rapidly Spends social insurance dollars all the more fittingly :Slide 28
Starting the Pill (and other hormonal contraception) It is great restorative practice to settle on choices concerning remedy of anti-conception medication pills to ladies construct exclusively with respect to a cautious wellbeing history and a circulatory strain estimation . - World Health OrganizationSlide 29
Myth #7 A conception prevention strategy must be begun when a lady is having her period.Slide 30
Beginning Birth Control Any prophylactic technique might be begun at whatever time in a lady\'s cycle the length of it is sensibly sure that she is not pregnant.Slide 31
Myths #7-9 Teens can\'t utilize IUDs. Ladies who have not had babies can\'t utilize IUDs. Unmarried ladies can\'t utilize IUDs.Slide 32
Ideal Contraceptive Easy – little/no consideration required Highly powerful Few/no reactions No medicinal dangers Effective for quite a long time Rapidly reversible STD/STI counteractive action Private ONE WITH WHICH USER IS COMFORTABLE!!Slide 33
LARC (long-acting reversible prophylactic) Intrauterine contraception IUD – Paragard IUS – Mirena Implant – ImplanonSlide 34
Tiers of Contraceptive Effectiveness IUDs, insert, sanitization DMPA ("shot") Pills, patches, rings Everything else -David Grimes (adjusted)Slide 35
IUC/IUD/IUS (Intrauterine Contraceptive/Device/System ) Effective for 5 or 10 years Private Convenient Cost powerful Paragard: ~$500 for a long time or ~$50 every year Mirena: ~$600 for a long time or ~$120 every year Generally viewed as improper for adolescents. Why? Old information from past gadgetsSlide 36
IUD/IUS/IUC As successful as sanitization Minimal client exertion Makes sperm not able to prepare egg (Paragard), thickens bodily fluid and smothers ovulation (Mirena) Appropriate strategy for youngsters Five (Mirena) or ten-twelve (Paragard) years of security No STD/STI assurance yet does not bring about PID (pelvic incendiary ailment)Slide 37
Implanon As viable as cleansing Minimal client exertion Progestin-just embed like Norplant Thickens bodily fluid and stifles ovulation Continuous low levels of hormone Three years of insuranceSlide 38
Other Hormonal Contraception Pills – numerous brands with changing measurements Combined = estrogen + progestin Mini-pill = progestin just Patch = OrthoEvra Ring = NuvaRing Shot = DepoProvera (DMPA) * * * * * * Emergency contraception (Plan B/Next Choice)Slide 39
Oral Contraceptive Discontinuation 28% stop by 6 months 33-half cease by 1 year Reasons for end range from separation with accomplice to dread of therapeutic dangers to uncomfortable reactions and incorporate powerlessness to bear the cost of anti-conception medicationSlide 40
Hormonal Contraception SAME (or fundamentally the same as): components of activity dangers (no estrogen dangers with minipill and DMPA) benefits viability DIFFERENT: conveyance framework true adequacy (?)Slide 41
Noncontraceptive Benefits of hormonal contraceptives Reduces: torment with periods Irregularity of periods measure of blood misfortune and accordingly pallor Decreased danger of malignancy of uterus ovary Lessens danger of generous bosom malady rheumatoid joint painSlide 42
Oral Contraceptive "The Pill" Estrogen and progestin taken in low dosages day by day for three weeks with one without hormone week every cycle Suppresses ovulation and thickens cervical bodily fluid Modern low measurements - less symptoms, hypothetical viability = 99+% Increased disappointment with late or missed pillsSlide 43
Myths # 10-16 The Pill causes: skin inflammation weight pick up tumor sterility coronary illness birth surrenders hindered development in a high schoolerSlide 44
Myths # 17-19 A lady ought to go off contraception intermittently to "give her body a rest." There is a breaking point to what extent it is ok for a lady to utilize contraception. A lady ought not be on a preventative unless she is sexually dynamic.Slide 45
Fears about Hormonal Contraception Inappropriate, taking into account old information or perceptions. Estrogen use in smoking lady > 35 year old is the genuine threat for hormonal contraception Hormonal contraception is amazingly alright for most solid ladies 20 times more secure than pregnancy and labor 33 times more secure that driving a vehicle Decreases the danger of a few genuine sicknesses and the seriousness of a few othersSlide 46
Ortho Evra (Contraceptive Patch ) Skin patch with the same sort of hormones as in the anti-conception medication pill Requires week by week, not every day consideration May have higher "true" viability on the grounds that less demanding to use than pills Less queasiness than pill, uncommon skin botheringSlide 47
Myth # 20 Ortho Evra is a risky anti-conception medication technique; it causes strokes in numerous ladies.Slide 48
NuvaRing Vaginal ring containing same sort of hormones as contraception pills Lower levels of systemic hormones Requires month to month, not every day or week by week consideration May have higher "true" adequacy in light of the fact that less demanding to use than pills .:tsli
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