1 10 7 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coverage from The McGill Tribune Description An account of the resource This collection holds articles from the McGill Tribune. We are not allowed to host copies of the articles for copyright reasons, but have decided to share the metadata fields, should one want to find them elsewhere. At the time of writing this, all issues of the McGill Tribune are available at <a href="https://issuu.com/mcgill_tribune">https://issuu.com/mcgill_tribune</a>. Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Volume 6 Issue 4 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Date A point or period of time associated with an event in the lifecycle of the resource 1986/09/30 Title A name given to the resource The Pill At McGill Format The file format, physical medium, or dimensions of the resource PDF Publisher An entity responsible for making the resource available McGill Tribune birth control letter to the editor reproductive health reproductive justice student health The McGill Women's Union Union for Gender Empowerment (UGE) Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coverage from The McGill Tribune Description An account of the resource This collection holds articles from the McGill Tribune. We are not allowed to host copies of the articles for copyright reasons, but have decided to share the metadata fields, should one want to find them elsewhere. At the time of writing this, all issues of the McGill Tribune are available at <a href="https://issuu.com/mcgill_tribune">https://issuu.com/mcgill_tribune</a>. Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Volume 6 Issue 5 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Date A point or period of time associated with an event in the lifecycle of the resource 1986/10/07 Title A name given to the resource Pill Confusion Creator An entity primarily responsible for making the resource Patricia E. Rachofsky Format The file format, physical medium, or dimensions of the resource PDF Publisher An entity responsible for making the resource available McGill Tribune birth control letter to the editor reproductive health reproductive justice student health The McGill Women's Union Union for Gender Empowerment (UGE) https://d1y502jg6fpugt.cloudfront.net/62030/archive/files/06323569e47adc49b2ea4b32c3114955.pdf?Expires=1792022400&Signature=KNDggXgkBaCOGwk1upPVgbSbyNTyLR4kmnPpbNavOaL2STYZvTuNtbO8K4ffcGmElISdSlCF6%7EilKLy5s5XTbfJhr91eAGIlhzCXebUW6w9lG-31BDJTKyy3WtdN4VRJcMCAw4DXQZ1RCO0zpb1mgCTnVAa6bkK7oVYwsrhVSRFXWF1AMCiCjLI%7EjWSVU4pcNWxR9qggPJY6GsGSVaf0wXNxvRNoxa-WG5aeiIwNcdkmUOfTiBUqJugbgfu8U1LhyZPx8bKxnQWC6bHKgfyVkK0S35q%7Eq38WBo%7EkCbT4c4F7GAwLSR13cbpauTUpK131fAietdS0DGr6h-QrwNMiRw__&Key-Pair-Id=K6UGZS9ZTDSZM 938de4f533d29424825fd19ed49b5fed PDF Text Text birth control handbook �NOT FOR SALE OR RESALE Birth Control Handbook 1st edition, October 1968 2nd edition, January 1969 2nd edition, 2nd impression, March 1969 3rd edition, (revised), September 1969 3rd edition, 2nd through 6th impression, November 1969 through May 1970 1st French edition, February 1970 4th edition (revised), August 1970 Published by the Arts and Science Undergraduate Society of McGill University. Copyright 1970 Donna Cherniak, Allan Feingold and the Students’ Society of McGill University Production by the workers of Journal Offset, Inc., Montréal. introduction The Birth Control Handbook was one of the first major publications to seriously challenge the much posited “Population Explosion” theory. In the introduction of the revised edition (September 1969) we suggested: “The: Population Explosion is only a threat to the supremacy of white nations which today, as in the past, are raping the ‘Third World for wealth, resources and human potential. The Population Explosion is the natural increase of ‘the black, ‘brown and yellow peoples of the world and therefore brings out fear in the world’s white minority, a minority. that has, through the ages, exploited all other races with a ferocity and viciousness incomparable to any other human injustice.” Mailing address: Birth Control Handbook, McGill Students’ Society, 3480 McTavish St., Montréal 112, Québec. Phone: (514) 392-8922 Cost: individual copies free, send 25¢ mailing and handling charges; bulk cost: $35.00 per thousand copies do not send money until invoiced Co-editors: Donna Cherniak and Allan Feingold Photography: André and Danielle Giguère (address requests for prints to editors). Montreal Women’s Liberation Movement - phone (514) 844-5838 Reproduction of any part or the whole of the Birth Control Handbook in any way is prohibited unless express consent of the editors has been granted. rica also relies on more subtle birth control methods to control the population of non-white people. One problem American scientists are running into is the ‘unwillingness of many people to control their fertility to suit their white oppressors. The obvious solution to this dilemma is the development of non-voluntary contraceptive methods or sterilization programs. In an article printed in Science (Oct. 24, 1969), Carl Djerassi, president of Syntex Research, states: “... in developing countries, the 2 year dropout figure with IUD’s or with the steroid oral contraceptives exceeds 50 percent... I am not convinced that any better results can be obtained with any method which requires a conscious act of conception control. For the populations of these developing countries it will be necessary to develop a procedure which produces, by a Reaction to that statement from the establishment press single administration of a birth-control agent, indefinite and right-wing doctors was immediate. To our critics, and (but reversible) sterility... ” Actually, such a chemical more importantly to our supporters, we promised more contraceptive is already being applied to non-white of the same in this edition. women in Third World nations. Injections of 150 mg. of a potent synthetic progesterone produce infertility for 8 to As most. people realize, the world is rapidly heading into 24 months, and in some susceptible women, sterility is a crisis situation. America tenuously maintains a false permanent. Women receiving this “contraceptive” are affluence and attempts to impose ‘law and order” on an told that the drug is 100%. effective for only 3 months. increasingly dissident population. The only hope for Scientists are using Third World women for experiments American capitalism is to hold its great resources, its with various mechanical and chemical sterilants. Djerassi neo-colonies in the Third World, against the increasingly realizes that such experimental programs, supported by frequent wars of national liberation. In Southeast Asia, companies such as his own, might be suspect: “…it American scientists and the military have developed the takes little imagination to predict what kind of major issue perfect population control method: massive murder of can develop from such a state of affairs, in which “Oriental human beings’. After returning from Southeast preliminary trials on human beings, under the auspices Asia, Professor Noam Chomsky explained: “It is of technically advanced countries, are performed first in important to understand that the massacre of the rural developing countries’, and: “Even within the United population of Vietnam and their forced evacuation is not States, some of the economically deprived black an accidental byproduct of the war”. The theory behind inhabitants of our urban ghettos attribute genocidal American strategy, is stated by Samuel Huntington, motives to family-planning programs in their areas. ” chairman of Harvard’s Government Department, when These “economically deprived black inhabitants” are he says | that the NLF is ‘“‘a powerful force which cannot correct in suspecting genocidal motives. A new and be dislodged from its constituency so long as the growing group in the United States, called “Zeroconstituency continues to exist.’” Chomsky comments population” supports forced sterilization programs ‘in that the American answer to a people’s war is to Third World Nations. Commenting on an Indian eliminate the people. (Ramparts, Aug. 1970). government proposal to sterilize all males with 3 or more children, Paul Ehrlich, author of the. Population Bomb Aside from bombs, napalm. and defoliants, Am and chief spokesman for Z-pop says: “We (the U.S. government) should have applied pressure on the Indian government to go ahead with the plan. We should have volunteered logistic support... Coercion? Perhaps, but coercion In a good cause.” James Ridgeway, editor of Hard. Times describes Ehrlich’s proposals as ‘‘therapeutic counter-revolution’’. The majority of people in the world. are starving. The real cause. of, this starvation: is unequal and unscientific distribution of wealth between the ‘“‘developed. nations’’. and the “underdeveloped nations’’. Ehrlich, his Z-pop-ers and all the other “neo-Malthusian bullshitters” are supposedly blind to the grain rotting in North American grain elevators, the farmers being paid not to grow food, the being dumped into the ground, the pigs being shot and’ buried. Never once do they mention that only in respect of the laws of capitalism can food be destroyed in a starving world. The Z-pop movement suggests that people are starving because they dare to be alive, if they were not alive they would not starve. The solution that they suggest is genocide. America realizes that Third World liberation movements are devoted to freeing.their people from the strangulation hold of American neo-colonialism and to an equitable redistribution of wealth. The next ten years are critical to liberation movements and America is using every weapon in its fascist arsenal to combat.them. The population control movement, supported by the Rockefeller and Ford foundations, is a weapon of imperialism. Let us not see. the Z-pop-ers as youth devoted to a cause, intent, on “saving the world”; for in reality, they are the dupes of the American monster pursuing a genocidal program. II The distortion of history is not new, but distortion of the history of women is a particular phenomenon. Women are usually considered sufficiently insignificant to omit from historical accounts;. therefore any actions of women considered important enough to misrepresent, demand further investigation. For most people, the name Margaret Sanger brings to mind a kind of Florence Nightingale image the frail young nurse (suffering from TB) who, after saving a woman from a butchered abortion only to see her die from a later attempt, devoted her life to. the dissemination of birth control information. Books printed a bit closer to her time express admiration of her courage more strongly, even recording her willingness to go to jail for her cause, but the overall impression is still far from the truth. Margaret Sanger, anarchist and active member of the American Socialist Party, published one of the first journals of women’s liberation, called Woman Rebel, which contained articles on political questions and on sex education. This journal and her pamphlet on Family Limitation were banned from the U.S. mails under the Comstock Law. Instead of facing trial for ‘‘obscenity’’, she chose to flee the country to continue her work. Margaret Sanger saw contraception as a prerequisite to the liberation of women. For her, voluntary motherhood would imply “a new morality - a vigorous constructive, liberated morality which would prevent the submergence of womanhood into motherhood. It would set its face against the conversion of women into mechanical maternity’’. This basic freedom would in turn be the “keynote of a new social awakening’. The birth control movement has been so co-opted that it not only ignores but often betrays many of the goals which its founder had envisioned. The humiliating treatment of non-married and young women who ask for birth control information is unjustifiable. The condescending attitude of male gynecologists toward women cannot be tolerated further. The general state of ignorance on all medical matters, but especially contraception is perpetuated by the medical profession to its financial advantage. Such gross irresponsibility would be unthinkable in a profession sincerely committed to the alleviation of human suffering, but it is perfectly consistent with.a profession committed only to the maintenance of its status and income. The issue of contraception still contains radical potential - what was true in Margaret Sanger’s day has not changed much. The quality of medical attention any woman receives is determined by her husband's or father’s social class, not by her own needs. While politicians academically debate the laws, their wives and mistresses are breaking them. The implications of effective contraception are important in the redefinition of women. Woman’s sexuality must no longer be considered secondary to man's. If bearing children becomes an option, certainly the role of socializing children can be seen as a matter of choice as well. The independence to choose one’s function within the society, rather than within the home is understandably frightening to many women. Such fears must be transformed into constructive action to oppose the forces of sexism. From the understanding of one’s own oppression as a woman comes a better understanding of the oppression of others also enchained in master-slave relationships. The Birth Control Handbook is produced not as a favor to an irresponsible medical profession nor as a favor to men who want an easy but “safe” lay, but as a political act. Organizations distributing the Handbook have a responsibility to continually raise the issues of women’s liberation whenever dealing with birth control. All women have a responsibility ‘to themselves and to their sisters to consider seriously how the politics of women’s liberation relate to their own lives - relationships with men, attitudes toward children, status at work, attitudes towards establishment politics and institutions, and most importantly, their relationships with other women. Margaret Sanger is only one of many heroic women whose devotion to the liberation of her sisters goes unrecorded. It is time to write our own history and to create a future adequate to our needs. Women interested in the Women’s Liberation Movement can contact the editors of the Handbook for information about action in their locality. �anatomy Female reproductive structures The female external genital organs, which are given the general name, vulva, include the following: Mons veneris: This latin term describes the cushion of fat over the pubic bone which, from puberty on, is covered with pubic hair. Labia majora: The folds of fat tissue on either side of the vaginal opening are called the labia majora or “major lips’. In children, the, labia majora completely cover and protect the genital organs; in mature women, the lips remain apart. The skin, covered with pubic hair, becomes moist and delicate closer to the vaginal opening. Labia minora: The “small lips’ or labia minora are folds of sensitive, reddish tissue between the labia When a woman is sexually excited, these small lips become slightly erect. ‘They join in front forming the prepuce which covers the clitoris. Clitoris: The clitoris, the most sexually sensitive of the female genitals, is located in front of (above) the urethral opening, and is partially covered by the prepuce. A homologue of the penis, the clitoris responds to stimulation becoming slightly enlarged and erect. Urinary meatus: ‘The meatus, found between the clitoris and the vaginal opening, is the opening of the urethra through which urine is released from the bladder. Bartholin’s glands: The purpose of these two small glands, situated in the labia minora on either side of the vaginal opening, is not clearly understood. They release only a drop or two of mucus‘ when a woman is highly excited sexually. Hymen: This elastic membrane, also called the ‘“maidenhead’’, is found at the vaginal entrance projecting from the vaginal wall. In most women, the hymen does not block the vaginal opening completely, allowing the menstrual flow to pass through. Rupturing of the hymen (loss of virginity) can be painless or quite difficult, and slight bleeding often occurs. Some women have the hymen broken medically before attempting sexual intercourse. certain birth control methods. Internally the uterus is lined with a thick spongy tissue called the endometrium which is cast off as the menstrual flow once every 28 days if pregnancy does not occur. The lower part of the uterus which extends into the vagina is called the cervix. The muscular cervix contains the cervical canal which serves as a passage between the uterus and vagina. The opening of the cervical canal into the vagina, the external os, is round before the first pregnancy, and slit-shaped afterwards. The opening into the uterus is called the internal os. Fallopian tubes: The two Fallopian tubes (oviducts) are attached high on either side of the uterus, and extend about 4 inches toward an ovary. At ovulation, a suction-like mechanism draws the egg toward the tube's fringed end; then rhythmic tubal contractions move the egg toward the uterus. Union of egg and sperm (conception, fertilization) occurs within the tube, which is less than 1/2 an inch in diameter. Ovaries: The two ovaries (female gonads) lie on either side of the uterus. At birth, 100,000 to 600, 000 immature egg cells (ova) each within a follicle are embedded deep within the body of the ovary. After puberty, the follicles move toward the ovarian surface; each cycle, several follicles develop but only one releases an egg ready for fertilization. The ovalshaped ovaries also release hormones which affect ovulation and development of the endometrium. The internal female reproductive parts are: Vagina: The vagina, located between the bladder and the rectum, is about 4 or 5 inches long. Normally its elastic walls touch each other but they stretch considerably during intercourse and even more during childbirth. When a woman is excited, lubricating mucous secretions pass directly from blood vessels in the vaginal wall into the vagina. Although externally the vagina is highly sensitive, the internal end has little sensitivity. The vagina ends in pockets about the cervix: those in front and back of the cervix are called the anterior fornix and posterior fornix respectively; those to the sides are called lateral fornices. Uterus: The womb or uterus lies between the bladder and the lower intestine. Before the first pregnancy, it is about 3 inches long and 2 inches across at the widest point, and its thick muscular walls practically touch each other. After each pregnancy, the uterus remains slightly enlarged as does the cavity within it. Normally the top triangular portion bends slightly forward, and the lower portion points down and back toward the spine. When the top bends too far forward or backward, the condition is known as anteflexion or retroversion respectively. This can cause problems during pregnancy, abortion and with The Gynecological Examination After puberty, a woman should have an annual gynecological examination. ‘The doctor begins this routine medical procedure by questioning the woman about her medical history, and that of her immediate family. Of special interest are: the nature of her menstrual cycle, experiences with or plans for pregnancy, and use of birth control. The woman is then left alone in the examining room to undress completely, and is given a disposable robe to wear. ‘I'he nurse records the woman's height, weight, blood pressure and draws a sample of blood for analysis. While the woman sits on the table, the doctor examines her head, neck, breasts, back, lungs, heart and abdomen. Then, the woman lies down and rests her legs in stirrup-like supports. A sheet placed over her lower body for the sake of modesty still affords the doctor adequate access to the vaginal area. For many procedures, the doctor inserts a metal speculum into the vagina to hold the vaginal walls apart. Cells for the Pap test, a routine procedure to detect cervical cancer, are obtained by gently scraping the cervix. An ‘internal’ or pelvic examination is done by inserting two fingers of a surgically gloved hand deep into the vagina, and, with the other hand on the lower abdomen, feeling the reproductive organs. �Male reproductive structures The penis and scrotum are the only parts of the male reproductive system which are external; the other structures rest within the lower pelvic area. Scrotum: The scrotum, a two-chambered sac lying behind the penis and between the legs, carries and protects the two testicles or testes. In sexually mature males the skin of the scrotal sac is wrinkled and covered with the pubic hair.. The scrotum normally hangs loosely away from the body so that a temperature below normal body temperature is maintained in the testicles. This lower temperature Is necessary for the production of sperm cells. In cold weather muscles in the scrotal wall contract to bring the testicles closer to the warmth of the testicles (testes): The two testicles are made up of tiny sperm-producing tubes called seminiferous tubules, and male hormone-producing cells called interstitial cells, lying between the tubules. At puberty, the tubules begin to produce millions of sperm cells continuously. Sperm production can continue until a man is eighty or ninety years old. Epididymis: The seminiferous tubules lead into an oval cushion of tissue called the epididymis which is connected to the upper part of each testicle. Vas deferens: The tubules making up the epididymis carry sperm cells into a single tube called the vas deferens (spermatic or seminal duct). The spermatic cord which consists of the vas tube intertwined with nerve and muscle fibers and blood vessels, can contract to pull the testes into the safety of the body. Ampulla (seed reservoir): Each vas deferens leads upward from a testicle into the pelvis, passes around the urinary bladder and enlarges just before the prostate gland to form the ampulla. Contractions of muscles in the walls of the vas deferens push sperm cells into the ampulla. Each ampulla is about an inch long and less than an inch wide. Seminal vesicles: Attached to the bottom of each ampulla is a gland called the seminal vesicle. These glands secrete a thick yellowish substance necessary for the survival of sperm cells and important in the composition of the final seminal fluid. Prostate gland and urethra: The two vas tubes join within the prostate gland and enter the urethra. The urethra is a tube which carries urine from the bladder to the opening of the penis. The prostate gland produces a white alkaline fluid which mixes with sperm cells and the secretions of the seminal vesicles during ejaculation. This prostate gland secretion makes up the majority of the final seminal fluid, also called the ejaculate. Muscle tissue covering the prostate gland contracts during ejaculation forcing semen through the urethra and out the penis. The number of sperm in each ejaculation varies greatly in different men. An average ejaculation contains 350 million sperm cells. Cowper’s glands:These two small glands join the urethra as it leaves the prostate gland. Cowper's glands secrete a few drops of colorless alkaline mucus during sexual excitement. Penis: The penis is a tubular organ made up of three bodies of erectile tissue which stiffen or ‘erect’ when filled with blood. Physical or mental sexual stimulation causes the penis to engorge with blood and to become erect. The adult male penis is normally about 3 1/4 to 4 3/4 inches long; however, when erect it is usually 6 to 7'2 inches long and about 1 1/2 inches wide. Since the female clitoris and not the vaginal barrel is the center of female sexual sensitivity the length or width of the erect penis has little effect on the amount of pleasure a woman receives during sexual intercourse. The skin covering the penis is loose and can move back and forth. At the base of the penis, this skin is covered with pubic hair. One body of erectile tissue expands at the top of the penis to form the glans. At birth, the glans is covered with the foreskin, which is routinely removed in many North American hospitals. The removal of the foreskin of male babies which is a Jewish and Moslem ritual is called circumcision. Circumcision prevents the accumulation of smegma, a waxy secretion which forms below the foreskin. Uncircumcised men must pull back the foreskin and wash away accumulated smegma regularly. The glans of the penis, whether or not it is covered by the foreskin, is highly sensitive to sexual stimulation. The urethra, which carries urine and, during ejaculation, semen, ends at the tip of the penis at the slit-like opening called the meatus. hormones and the menstrual cycle The endocrine system consists of various ductless glands and tissues, which release chemical substances called hormones directly into the blood stream. Because all hormones are interrelated, it is necessary to consider them in terms of hormonal interactions and balances, rather then individual substances. Hormones significantly affect all body functions: in fact, the endocrine system is considered a control mechanism for the entire body. The pituitary gland, located at the base of the brain, is the most important endocrine gland. The pituitary apparently regulates action of all other endocrine glands. Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) released by the pituitary, affect the ovaries (female gonads) and thus are known as pituitary gonodotropins. The gonads of each sex are also considered endocrine glands. The ovaries release sex hormones called estrogen and progesterone which play a major role in ovulation and in the cyclical development of the uterine lining. Puberty is the general term for all the physical and psychological changes a girl undergoes between the ages of 11 and 17, including the appearance of pubic hair, breast development, and distribution of fat tissue, especially about the thighs and hips. The first menstruation or menarche is only one of these many changes, stimulated by the production of pituitary gonadotropins. The average ‘menstrual cycle lasts approximately 28 days.’ Some women have consistently longer or shorter cycles; others, especially young women, have cycles which vary in length. The menstrual cycle can be influenced by a change in climate or emotional stress. The first day of the menstrual flow Is considered the beginning or day 1 of the menstrual cycle. Day 1 - day 5: menstrual phase The cycle begins with the shedding of the developed endometrium as the menstrual flow. Total blood loss during menstruation is about 2 to 4 ounces; most of the flow is fluid but occasional blood clots appear when the flow is heavy. The ‘‘period’’ lasts 3 to 7 days, usually heavy at first and tapering off at the end. �tip of the follicle becomes transparent and thin. A sudden increase in the amount of circulation LH causes the thinnest area on the follicle’s surface to.rupture, releasing the egg. The fringed end .of the Fallopian tube draws the egg into the tube. Movement of sperm through the cervical mucus is easiest at this time, due to estrogen-induced nutrient and alkaline levels. Once the egg has been released, LH stimulates the ruptured follicle to become a hormone-secreting gland called the corpus luteum. Day 15 - day 25: secretory phase Immediately after ovulation, the corpus luteum (yellow body) secretes progesterone which, along with estrogen released by the ovaries, stimulates further development of the endometrium. The endometrium becomes a rich bed of blood vessels and tissues in preparation for implantation of a fertilized egg. Estrogen and progesterone also affect the pituitary gland: both hormones block its production of FSH, and progesterone alone blocks the production of If the egg is fertilized, the placenta takes over the production of progesterone, blocking the release of pituitary gonadotropins, which in turn prevents the release of another egg throughout pregnancy. Women use either external sanitary napkins or internal tampons to absorb the flow. A napkin (pad) is attached to a belt which holds it in place against the vulva. Napkins should be changed regularly since blood gives off an unpleasant odor when exposed to air. Internal tampons are held in the vagina by muscles at the vaginal opening. When inserted correctly, tampons cannot be felt. Tampons should be changed as often as the flow necessitates. Women with the hymen intact (virgins) can use tampons without difficulty. When the flow is extremely heavy, two tampons can be used at once. The second is inserted beside the first, and the strings should be tied together. Some women prefer to use a tampon and sanitary napkin to absorb a very heavy flow. There is no reason whatsoever to prohibit sexual intercourse during menstruation. During menstruation, the hypothalamus (brain structure which controls involuntary body functions) stimulates the growth of several ovarian follicles each containing one egg, on the surface of each ovary. FSH: also stimulates the developing follicles to secrete estrogen. Three days before Thursday, maid’s day off, they met in their special place, the bench beside the pond in the park. Lisa was shy but determined to be straight and honest as was her nature. ‘‘I can’t do it with you.” ‘Aren't your parents going away?”’ ‘It's not that. Last night I got the Curse.”’ She touched his hand with pride. “Oh” ‘‘Don’t be sad. We had a long talk. I told her about us, too. You see, I’ve got to act like a lady now. Girls have to act older than boys.” ‘“Who’s sad?”’ She leaned back in the bench and took his hand. ‘‘But aren't you happy for me!”’ — she laughed — ‘‘that I got the curse? I have it right now!’’ - Leonard Cohen The Favorite Game Day 6 - day 13: proliferatory phase Estrogen released by the follicles causes the endometrium to proliferate and induces changes in the cervical mucus which permit easier. movement of sperm into the uterus. Estrogen also suppresses the pituitary's secretion of FSH. At about the 12th day, the pituitary begins to secrete Luteinizing Hormone (LH). One follicle develops more extensively than the others, protruding from the surface of the Ovary. Day 14: ovulation Ovulation is the release of one ovum (egg) from’ the protruding follicle. When the pituitary gonadotropins, FSH and LH, are in a particular ratio, the If fertilization does not occur, the corpus luteum starts to degenerate about day 25. Its cells are reabsorbed and replaced with normal ovarian tissue. As a woman gets older, reabsorption is not complete and scar tissue from the corpus luteum remains on the ovarian surface. Follicles which began to develop but did not rupture are also reabsorbed by the ovary. �Day 26 - day 28: secretory phase (premenstrual) Degeneration of the corpus luteum reduces the secretion of estrogen and progesterone. This low hormonal level causes the contraction of blood vessels leading to the endometrium, thus reducing the flow of blood to the tissue. The tiny veins and arteries of the endometrium break down, releasing blood, thus marking the beginning of the menstrual flow. The low hormonal level also stimulates the secretion of FSH by the pituitary gland, causing the whole cycle to begin again. The climacteric (change of life) The cycle described above continues, except during pregnancy and breastfeeding until the climacteric when the ovaries begin to fail. Menopause or the end of menstruation, the most noticeable event of. the “‘change of life’, occurs between the ages of 45 and 50. The process is gradual as ovulation becomes more irregular and infrequent. Once ovulation stops, progesterone is no longer released. Estrogen production is greatly reduced. Women under the care of a gynecologist usually receive hormonal “replacement therapy’ for the rest of their lives. Many women suffer from minor to severe depression and irritability during the change of life. Because western women are forced to compete as sexual objects, and are allowed no meaningful function within society, such problems take on an exaggerated importance. There is no reason why the climacteric should affect a woman's ability to function fully both mentally and physically or to enjoy sexual intercourse. Sexual intercourse Tne ability to enjoy sexual intercourse (coitus, ‘making love’, copulation, “having relations’, “having sex’’, etc.) develops with knowledge of the human body and with experience in social and sexual relations with others. The pleasure of sex without fear of pregnancy or moral sinfulness continues to be denied, especially to women, because of the repression of such knowledge and experience. Most couples engage in some form of sexual foreplay kissing, caressing, teasing, - before beginning sexual intercourse. Almost any part of the body Is sensitive to sexual stimulation, but especially the thighs, buttocks, breasts, nipples, neck and ears. Both partners can enjoy oral-genital contact. When sexually. aroused, the man’s penis and the woman’s clitoris become hard and erect, due to the engorgement of the tissue with blood. The woman’s vaginal walls separate, expand, and become moist with mucus. To begin coitus, either partner guides the man’s erect penis into the vaginal opening. Saliva Is always available as a lubricant if the vagina is too dry for comfortable intromission. Together, the man and woman move their bodies in such a way that the clitoris and the penis are stimulated, not necessarily simultaneously. Female orgasm Whether a woman comes to orgasm (the climax) through masturbation, manipulation, or coitus, the physiologic response is the same. Sexual sensitivity is centered in the vulva, specifically the clitoris, and not the vaginal barrel which contains many times fewer nerve endings. Stimulation of the clitoris causes engorgement of blood vessels in the genitals, and a general neuro-muscular tension. Other body changes in this excitement phase include: increased rate of breathing and of heart beat, breast enlargement, erection of nipples, upward movement of the uterus, and expansion of the vaginal walls. Sometimes a sexual flush (temporary skin rash) appears. At the plateau phase of excitement, these changes are accelerated, and, without distraction, the woman soon reaches orgasm - the pleasurable release of tension in the genitals and throughout the entire body. The vaginal walls especially near the opening, contract rhythmically. The uterus contracts pushing the cervix further into the vagina. As the tension is released, the body begins to return to its normal condition (resolution phase): but, if stimulation continues before sexual tension drops below the plateau level, the woman can ‘‘come’”’ again almost indefinitely. Women can experience long orgasms or a rapid series of orgasms without a return to the plateau phase. Male orgasm Male orgasm also involves the release of neuromuscular tension throughout the body. In the plateau phase when orgasm seems inevitable, the contents of the ampulla, seminal vesicles, and prostate gland combine to form the final seminal fluid. Muscles surrounding the urethra as it leaves the bladder contract so that urine cannot be released. During orgasm, the semen is forced out the tip of the penis through the urethra. The first muscular contractions are strong and their rhythm is the same as the woman’s vaginal contractions. The amount of ejaculate released influences the strength (but not necessarily the pleasure) of the orgasm. Other body changes are similar to those in women including muscles spasms, sexual flush, and a light film of perspiration. During the resolution phase after orgasm, the body changes disappear, at first suddenly, and then slowly taking up to several hours. The penis loses much of its erection, and a short time span (the refractory period) must pass before a man can have another orgasm. Positions The many imaginative positions for making love fall into one of two classifications: face to face, and intromission from behind. In face to face positions (to mention only a few), either partner can lie on top of the other, both can lie on their sides, one can sit over the other who is lying down, or both can stand or sit. When intromission occurs from behind, the man can lie on top of the woman, the woman can sit back on the man’s lap, the woman can crouch while the man kneels behind her, etc. Each position has its advantages and disadvantages such as: freedom of movement, depth of penetration of the penis, and stimulation of the clitoris. If a woman wishes to become pregnant, the couple should have intercourse face to face with the man on top. Rupturing the hymen (loss of virginity) should be done in a position in which both partners can easily control their movements. The hymen should be stretched gradually with gentle but constant penetration of the penis. Slight bleeding and some pain is common; however, some women feel no discomfort at all. There is no reason for prohibiting sexual intercourse during menstruation. The erect penis blocks the flow during intercourse, and a disposable cloth placed on the sheets can prevent possible staining when the man withdraws his penis. Some women have a slightly heavier flow after intercourse due to contractions of the uterus during orgasm. �conception At the time of ovulation, mucus in the cervical canal becomes more plentiful, thinner, and richer in nutrients, so that sperm cells can pass easily into the uterus. The union of egg and sperm (fertilization) is a highly complex process, the mysteries of which have yet to be fully understood. The following description of the fundamentals of conception is necessarily superficial. Sperm Sperm cells, produced in the seminiferous tubules of the testes, are moved by muscular contractions through the vas deferens for about three weeks until the mature cells reach the ampulla. Secretions from the prostate gland and seminal vesicles add both bulk and energy to the sperm cells, creating the final seminal fluid. Each sperm cell consists of a head, mid-piece, and tail. The head contains 23 chromosomes responsible for the hereditary characteristics from the father. The mid-piece and tail are made up of coiled fibers which contract and expand to move the sperm cell along. An average of 350 million microscopic sperm cells are released in one ejaculation. The life span of sperm within the female genital tract is approximately 48 hours. The egg Follicle Stimulating Hormone (FSH) released by the pituitary gland at the beginning of a woman’s cycle stimulates several ovarian follicles to grow. About the 12th day, the pituitary begins to release Luteinizing Hormone (LH) as well. When FSH and LH are in proper balance, one of the follicles ruptures, releasing an egg which is soon picked up by the fringed end of the Fallopian tube. The nucleus of the egg cell contains 23 pairs of chromosomes; as the egg matures, 1 chromosome from each pair is retained, and the other is discarded in a cluster called the polar body. The nucleus and the nourishing cytoplasm are surrounded by a thicker membrane, the zona pellicuda. Smaller cells from the ruptured follicle cling to its surface. Some of these cells are brushed off by hair-like cilia within the Fallopian tube as muscular contractions move the egg toward the uterus. If the egg is not fertilized withIn 24 hours of ovulation, it degenerates and passes out the body unnoticed. Fertilization During sexual intercourse, millions of sperm cells are ejaculated high into the woman’s vagina, near the alkaline environment of the cervix. Many sperm “swim” in the wrong direction; others are killed by the acid condition of the vagina, and still others are trapped in the folds of the vaginal walls. Those that pass through the cervical canal are moved toward the Fallopian tubes primarily by muscular activity of the uterus. Some sperm enter each Fallopian tube, only one of which holds an egg. Fertilization occurs in the Fallopian tube. The first sperm cells to reach the egg release a chemical which dissolves cells adhering to the zona pellicuda. Once the egg is exposed, one sperm cell bores through the cell membrane to the center of the cell. A second chemical reaction prevents any other sperm from entering the egg. As the fertilized egg (gamete) is moved down the Fallopian tube, the nuclei of the sperm and egg fuse together to form one nucleus with 46 chromosomes. These chromosomes reproduce themselves and the cell divides in two. This division process continues until the gamete is a cluster of tiny cells, each with 46 chromosomes. Fats and other substances of the egg cell provide it with nourishment for 3 days as it travels down the tube to the uterus. For several days the egg cluster or blastocyst floats freely in the uterine cavity. About six days after fertilization, the blastocyst attaches itself to the endometrium, and buries itself by chemically dissolving a bit of endometrial tissue. Blood surrounds the cluster and nourishes it. Nidation (implantation) is complete by the 12th day after fertilization. One mass of cells from the blastocyst soon develops as the growing embryo; others become nutritive structures such as the placenta. Implantation often does not occur at all, and the fertilized egg degenerates. Determination of pregnancy Changes of the uterus As the ovarian follicles develop, estrogen is released by the ovaries. After ovulation, progesterone is released by the corpus luteum, the scar tissue on one ruptured follicle. Both hormones stimulate the endometrium (uterine lining) to “‘proliferate’’, preparing the lining to nourish a fertilized egg after implantation. If implantation does not occur the lining is shed as the menstrual flow. Usually, a woman first suspects that she is preg- nant when her menstrual period is overdue. The length of pregnancy is always calculated from the first day of her last menstrual flow: thus, if a woman is ten days late, and normally has her period every 28 days, she is considered 38 days or 52 weeks pregnant. A woman whose period is late but who does not wish to be pregnant should continue to use some kind of contraception until pregnancy has been confirmed by a doctor. �The two kinds of pregnancy tests both attempt to detect the presence, within urine, of a hormone called chorionic gonadotropin. This hormone is released In increasing amounts by the placenta, so that by the 6th week of pregnancy (when the period is 2 weeks overdue), some chorionic gonadotropin appears in the pregnant woman's urine. In the “biological test’’, some of the woman’s urine is injected into a laboratory animal such as the rat or rabbit. If chorionic gonadotropin is present, it causes a certain reaction (such as ovulation) in the animal. Such a reaction is defined as a positive result, meaning that the woman Is pregnant. This test takes at least six hours. In the “chemical test’’ a test chemical is added to a sample of urine. The presence or absence of a chemical reaction determines if the test is negative or positive. The chemical test takes only 2 to 20 minutes. Both tests are highly accurate but false positives and especially false negatives do occur. Pregnancy tests are not accurate for premenopausal women. Hospital laboratories are often more accurate than drugstores in their tests. Hospital tests are also much less expensive. oral contraceptives Few scientific achievements have had greater social impact than the development of the oral contraceptive. The Pill is presently used by approximately 18.5 million women, about 8.5 million of whom live in North America. The Pill is the closest thing to the “ideal contraceptive” available, and its popularity reflects a changing social and political mood of a whole generation of women. The oral contraceptive is 100% effective when taken as instructed, relatively “safe”, easily reversible, and in the control of the woman; however, use of the Pill does present certain difficulties Taking one pill every day is a nuisance, appreciated by few not taking oral contraceptives. Minor annoying side effects are common, although transient, in the first three months of use. Most importantly, the oral contraceptive constitutes an endocrinological insult to the female body which in rare instances can lead to serious disease and even death. Nevertheless, on the basis of available scientific findings, the editors of this publication are convinced that the benefits of oral contraception outweigh its dangers. Accepted human activities such as pregnancy and childbirth, or even travel in automobiles carry much greater risks to health and life. Many drugs used more commonly than oral contraceptives, such as aspirin or penicillin, are potentially more dangerous than the ‘Pill; however, relief of pain and combatting infection are accepted as Important in our society. Until recently, contraception, with its gifts of sexual freedom and physical health for women, has not been appreciated For a positive confirmation of pregnancy, a woman should see a gynecologist for an internal examination. Private doctors are expensive, but family planning centers, university health services, and hospital gynecological clinics are more reasonable. Women under 18 can often get cooperation at the adolescent clinic of a children’s hospital. Several signs of early pregnancy which a doctor or paramedical specialist can detect during an internal examination are: darker color of the vulva and vagina, softness of the uterine isthmus (area between the cervix and uterine body), softness of the cervix, and size of the uterus. If the doctor is not positive of the diagnosis or suspects that the woman is not pregnant, the woman can be given synthetic progesterone, either orally or by injection, which raises the hormone level in the woman’s blood stream. If the woman is not pregnant, the following drop in the hormonal level causes withdrawal bleeding. Such pills cannot abort a fetus: they can only bring on a late period. These pills cost approximately $3 at reputable pharmacies. as an important medical achievement. In the beginning of this century, Margaret Sanger, one of the greatest fighters for the liberation of women, wrote, “No woman can consider herself free until she can determine the number of children she will have”. In the winter of 1950 Margaret Sanger convinced Dr. Pincus to accept a grant of $2,100 from the fledgling Planned Parenthood Federation which she had founded. Millions of dollars of corporation money soon went to research executed by Pincus and a colleague, John Rock: nevertheless, credit for the initiation of the first research project goes to one of the most noble women of this century, Margaret Sanger. Pincus and Rock experimented with synthetic estrogens and progesterones, and eventually produced for the G.D. Searle Company. Originally, Knovid contained 10 mg. of a synthetic progesterone called norethynodrel and as much as .22 mg. of synthetic estrogen called ethinyl estradiol. In 1956, Rock, Pincus and a third doctor, Celso Garcia. selected 265 Puerto Rican women “from the low Income population living in a housing development project in a slum clearance area’’ for the first significant human trials. Officially, Puerto Rican women were chosen because of their “high pregnancy rate’; in fact, these poor, non-white women were used as Guinea pigs since G.D. Searle hesitated to test such potent medication on white American women. Ironically, during the tests these women received better medical attention than they had ever had. The Puerto Rican tests revealed that Enovid prevents pregnancy, and that women do not drop dead after ingesting norethynodrel and ethinyl estradiol. By 1960, on the basis of scanty scientific information, the United States Food and Drug Administration (FDA) authorized the G.D. Searle Co. to market Enovid. By the end of the first Pill decade, 8 pharmaceutical companies had entered the profitable oral contraceptive market, and more than 20 brands of the birth control pill were produced. Description There are two kinds of oral contraceptives: the combination pill and the sequential pill. A series of the combination oral contraceptive consists of 21 (20 in some brands) identical pills each containing synthetic estrogen and progesterone. A sequential oral contraceptive series is made up of two different kinds of pills. The first 11, 14, 15 or 16 pills (depending on the brand) contain only synthetic estrogen, and the next 10, 6, 5, or 4 pills contain a combination of estrogen and progesterone. Synthetic hormones stimulate the same body reactions as do natural hormones. There are 2 kinds of synthetic estrogen and 9 different synthetic progesterones. I'he two estrogens, mestranol and ethinyl estradiol, have almost identical properties; however the effects of ethinyl estradiol are more highly localized at the reproductive system. For example, ethinyl estradiol has less effect on glucose tolerance than does mestranol. Although ethinyl estradiol is probably the better estrogen, mestranol is used more commonly. Mestranol is used in Knovid, Ortho Novum, Norinyl (including Norquen and Noriday), CQuens, and Ovulen. Ethinyl estradiol is used in: Norlestrin, Provest, Oracon, Ovral, and Demulen. The quantity of estrogen in each pill is more important than the kind. Several years ago it was discovered that not more than .05 mg. of estrogen in each pill is necessary to ensure 100% contraceptive effectiveness. Also, when such ‘‘low dose estrogen pills” are used, risks of serious complications are significantly reduced. In December 1969 the British Committee on Safety of Drugs officially recommended that brands of oral contraceptives containing more than .05 mg. of estrogen should not be used. In the words of the British Medical Journal, British pharmaceutical companies “were quick to take the hint’, and withdrew from the market all combination pills containing more than 05 mg. of estrogen. American pharmaceutical companies have produced low dose brands, but have refused -to withdraw high dose pills from the market. Most synthetic progesterones are produced by chemically changing the synthetic male sexual hormone, testosterone. Depending on the chemical process used, the resulting progesterone is either estrogenic or antiestrogenic. With estrogenic progesterones, at least some of the hormone is changed by the body into estrogen. Norethynodrel, the progesterone component of Enovid, is the only commonly used estrogenic progesterone. Estrogenic progesterones should not be used since they introduce unnecessary estrogen. On the other hand, antiestrogenic synthetic progesterones, like natural progesterones, counter the effects of estrogen. The antiestrogenic qualities of synthetic progesterones add to the contraceptive effectiveness of the Pill. Depending on the kind and quantity of synthetic hormones used, a particular brand of combination pills can be estrogenic or anti-estrogenic. All low dose combination pills are distinctly anti-estrogenic, which counteracts side effects and complications related to estrogen (most side effects are estrogen-related). In contrast, sequential pills are distinctly estrogenic; not only do all sequential pills contain more than .05 mg. of estrogen in each pill, but the anti-estrogenic effect of progesterone is absent for most of the 21 pill cycle. Also, in contrast to combination medication, sequential oral contraceptives are not 100% effective, with reported failure rates of 1 to 2% annually. In Britain in 1966, sales of sequential pills made up only 3% of the total sales of oral contraceptives. In North America, where the Eli Lilly Company has maintained a strong promotional campaign for C-Quens (the original sequential pill) the various brands of sequential pills have not lost as much of their market.: Sequential oral contraceptives should be ordered off the market. Women taking sequential pills (C-Quens, Oracon, Ortho Novum SQ, Ovex, Miniquen, Secrovin) should see a gynecologist and ask for a change of prescription. �How the Pill works A healthy woman who is not pregnant or breast feeding menstruates approximately once every 28 days. Soon after menstruation begins, the hypothalamus (part of the brain) stimulates the pituitary gland to secrete a hormone called Follicle Stimulating Hormone (FSH) into the blood stream. FSH stimulates the growth of several ovarian follicles, and the secretion of estrogen by these follicles. A few days after the first release of FSH, the pituitary also begins secretion of Luteinizing Hormone (LH). Around the 14th day of the menstrual cycle, a sudden increase of LH secretion causes one follicle to rupture and release an egg. After ovulation, the ruptured follicle changes into a gland called the corpus luteum which begins to secrete progesterone. As the quantity of estrogen and progesterone increases in the blood stream, the pituitary secretes less FSH and LH. If the egg is fertilized, the corpus luteum as well as the placenta secrete large quantities of progesterone throughout pregnancy. Estrogen and progesterone block the pituitary’s secretion of FSH and LH, and ovulation cannot occur during the nine months of pregnancy. Overlapping pregnancies are thus prevented. The oral contraceptive mimics the body’s defences against pregnancy by creating a hormonal pseudopregnancy within a woman’s body. Each pill of a series contains enough estrogen and progesterone to block secretion of FSH and LH, thus preventing ovulation. In addition, progesterone causes secondary changes which make pregnancy unlikely even if the pituitary “escapes” the effects of the synthetic hormones. Progesterone causes the cervical mucus to become thick and impenetrable, preventing sperm cells from entering the uterus. Progesterone also disrupts the cyclic growth of the uterine lining, making it unreceptive to a fertilized egg. Since sequential oral contraceptives are primarily estrogenic, secondary progesterone-dependent effects are not produced, resulting in the 1% to 2° failure rate of sequential pills. Medical examination and prescription Oral contraceptives, like all potent medication, must not be used by certain women. Proper medical screening can spot women for whom oral contraception would pose unacceptable risks. A complete medical history must be taken before prescribing an oral contraceptive. Questions which must be asked include: 1. Does the woman have, or has she ever had: a blood clotting disease such as thromboembolism, thrombophlebitis, pulmonary embolism, ‘stroke’’, retinal thrombosis; migraine headaches; heart disease or defect; endocrinological disease or disorder such as thyroid dysfunction or diabetes; liver disease such as jaundice; kidney disease; asthma; epilepsy; or any significant psychiatric problem such as severe depression? 2. Is there any inheritable disease in the woman’s family’? Has the woman’s mother ever had any form of cancer, migraine headaches, high blood pressure, or varicose veins’ If the woman has any sisters, similar information about their medical histories can be relevant. 3. Has the woman ever been pregnant? How many times? How many live babies, abortions or miscarriages has she had? Has the woman had complications during pregnancy, such as toxemia, varicose veins, or liver disease? 4. At what age did the woman have her first menstrual flow’? What is the average length of her menstrual cycle and of the flow itself? Does she experience cramps, fluid retention, breast swelling and tenderness, or mood changes before, during and/or after menstruation? Women who have or who have had: thromboembolism, thrombophlebitis, pulmonary embolism, a *“stroke’’, retinal thrombosis, heart disease or defect, severe endocrine disorder, recurrent jaundice of pregnancy, or any form of cancer must not take oral contraceptives. The synthetic estrogen delivered by the Pill can worsen existing conditions of these diseases or increase a woman’s susceptibility to a relapse. Women who have had: mild endocrine disorder, liver disease such as jaundice, or kidney disease can take the oral contraceptive if: (a) an endocrine disorder is well under control, (b) kidney or liver. disease is completely cured. Women who have or who have had: migraine headaches, high blood pressure, varicose’ veins, asthma, epilepsy, any significant psychiatric problem, or diabetes can take an oral contraceptive, provided that they are closely supervised medically, and that periodic tests are taken to ensure that the Pill’s estrogen is not worsening their condition. If the Pill causes migraine headaches to become more severe or more frequent, the woman must stop taking the medication. If high blood pressure or varicose veins are adversely affected by oral contraception, the woman must stop taking the medication. If fluid retention occurs as a side effect to the Pill, asthma or epilepsy can be adversely affected. For women with asthma or epilepsy, diuretics can be prescribed, and only anti-estrogenic pills should be used. Women with existing psychiatric problems must be followed by a psychiatrist while taking oral contraception. Women with minor depression before menstruation often find their symptoms relieved while taking the Pill. Prediabetic women, or women with active diabetes should have an annual or semi-annual glucose tolerance test, and should use an oral contraceptive containing ethinyl estradiol as its estrogenic component. Once the medical history is taken, the doctor performs a general and a gynecological physical examination. ‘he woman’s blood pressure and weight must be recorded, samples of blood and urine must be taken, and a careful breast examination and a Pap test (for cervical cancer) must be performed. A doctor has a variety of brands to choose from when prescribing oral contraceptives. The following brands are the best available: Ovral, Ortho-Novum 1/50, Norinyl 1, Norlestrin, and Demulen. All contain .05 mg. of estrogen and 1 mg. or the equivalent of progesterone (Ovral contains 25 mg. of a particularly potent progesterone). If a woman suffers exceptional symptoms of natural estrogen excess (nausea, vomiting, fluid retention and breast tenderness) during pregnancy or before menstruation, the doctor may suggest a pill containing a larger quantity of progesterone. Norilestrin 2.5, and Provest contain more than 1 mg. of progesterone but not more than .05 mg. of estrogen. All women taking oral contraceptives should have an annual gynecological examination, including a Pap test. Personal use of the Pill Most oral contraceptives are taken in a series of 21 pills. This produces a convenient “three weeks on, one week off’ cycle of medication. To begin taking the Pill, a woman must wait for a menstrual flow. Counting the first day of her flow as day 1, the woman takes the first pill of a series on day 5. One pill is taken at about the same time daily for 21 days. The woman counts 7 days after taking. the last pill. On the 8th day, she takes the first pill of her next series. Thus, if a woman takes the first pill of her first series on a Tuesday, she takes her last pill of that series on a Monday, and takes the first pill of the next series on the Tuesday of the following week. The ‘starting day’ (i.e. the day that the first pill is taken) is the same day of the week for every series. Some oral contraceptives come in 28 day series. The first 21 pills contain the synthetic hormones. The last 7 pills are placebos - pills that contain nothing other than sugar. A woman taking a 28 pill series takes one pill every day, beginning a new package the day after taking the last (28th) pill. If one pill is forgotten it should be taken as soon as it is remembered, even if this means taking two pills on the same day. If taking the pill is incorporated into routine daily activities (e.g. “waking up’, “‘supper’, ‘“‘going to bed’’) a woman Is less likely to forget a pill. If a combination pill is forgotten for not more than 24 hours, the chances of pregnancy are close to zero. If more than one combination pill is forgotten, or if one sequential pill is forgotten, the forgotten pills should be taken when remembered and another contraceptive method should be used for the rest of the cycle. Most birth control pills are packaged in “blister envelopes’. Each pill is enclosed in an individual blister of clear plastic on a small cardboard sheet. The blister envelope is contained in a plastic container with rows of holes in the bottom. To obtain a pill, the woman pushes down on the plastic blister, and the pill pops out of the hole in the bottom of the package. Most package designs include a calendar mechanism in the package which makes it possible to tell at a glance if the day’s pill has already been taken. The combination Pill provides 100‘, contraceptive protection from the first pill of the first series. If a woman is changing her brand of pill from a higher dose of estrogen to a lower dose, another birth control method should be used for the first 2 weeks of the first low dose series. Reversibility of contraceptive action The oral contraceptive is easily reversible. When pregnancy is desired, the woman finishes a pill series, and does not start another series. Sixty to 75% of women who stop taking the Pill to become pregnant achieve their aim within three cycles of the last pill, and 90‘% become pregnant within one year. The pregnancy rate is the same in women who have never taken oral contraceptives and who are attempting to become pregnant. Babies born to women who have use a oral contraceptives are not affected by the medication. In a small, undetermined percentage of women who stop taking the Pill, ovulation and menstruation are delayed for a month or two, and in some reported cases, for as long as a year. This condition of post-Pill amenorrhea (lack of menstruation) has been named the “‘oversuppression syndrome’. Amenorrhea following discontinuation of the Pill is more likely to occur In women who have irregular menstrual cycles before using oral contraception. The probable cause of post-Pill amenorrhea is a lingering, oversuppression of the hypothalamus by the Pill’s synthetic progesterone. Almost all cases of oversuppression disappear by themselves without medication. If amenorrhea continues for more than 6 months, cortisone acetate or clomiphene citrate (brand name: Clomid) is used to bring on ovulation and menstruation. Clomid is highly effective if there Is enough natural estrogen in the bloodstream. If the level of estrogen is low, skull X-rays are taken to make sure that a coincidental tumor does not exist, and supplementary human gonadotropins are then given to induce ovulation. Prolonged post-Pill amenorrhea responds quickly and easily to treatment with Clomid, or, if necessary, human gonadotropins. It is unlikely that the incidence of oversuppression increases In women taking oral contraceptives for prolonged periods. The practice of discontinuing oral contraception every 2 years to determine if ovulation occurs spontaneously is medically useless and often results in unwanted pregnancy. Side effects Oral contraceptives are potent medication and induce many body changes other than the suppression of ovulation. A side effect is any reaction or body change unrelated to the purpose for which a drug is taken. For the sake of consideration, side effects are listed below in three classifications: nuisance side effects, metabolic changes, and serious complications. Nuisance effects Most nuisance effects induced by oral contraception are related to estrogen. Such effects are common during the first 3 cycles of medication while the body is adjusting to the new hormonal! �Estimates of risk of death to women in England 1966 levels, and they usually disappear by the 4th cycle. If any side effect persists for longer than 3 cycles, or becomes severe, the prescribing doctor should be consulted. The majority of women taking low-dose oral contraceptives do not experience any side effects, or are bothered only by minor, ‘transient effects. Psychological factors play a large part in the incidence of minor effects. If any side effect is expected, it is almost certain to appear. Nausea sometimes accompanied by vomiting or stomach cramps is the Pill’s most common side effect. If it occurs, nausea appears within a day or two of the first pill taken, and recurs at the beginning of the following cycle. Such side effects can be avoided by: a. taking the daily pill after a full meal; b. taking the pill just before going to sleep; or c. taking the pill with a glass of milk or a mild antacid. Fluid retention can occur as a result of estrogens effects on the body’s retention of salts. A general “bloated feeling’, cramping or swelling of the legs, breast discomfort, rapid weight gain, and generalized itching are minor symptoms of fluid retention. Fluid retention can adversely effect migraine headaches. If a woman experiences severe headache, dizziness, and blurry or double vision shortly after starting the Pill, she should immediately consult the prescribing doctor, and stop taking the medication. Fluid retention is harmless except to women with migraine headaches, epilepsy, high blood pressure, vascular disease, or heart defect or disease. Fluid retention can be alleviated by a low salt diet, restricted water intake and, if necessary, a diuretic. Chloasma is the rarest of estrogen-related nuisance effects. Chloasma, also called the ‘‘mask of pregnancy appears as “giant freckles’ on the face. Pill related chloasma is more common in women who experience chloasma during pregnancy, and in women frequently exposed to strong sunlight. Leukorrhea is an estrogen-related, harmless white or clear, excessive vaginal discharge. If vaginal discharge becomes bothersome, a gynecologist should be consulted. Estrogen deficiency and progesterone excess side effects occur if a Pill is too highly anti-estrogenic for a particular woman. Such side effects include: mood changes, including depression and changes in sexual desire; increased appetite and weight gain; fatigue; decrease 1n amount and duration of menstrual flow; oily scalp and skin (sometimes leading to acne); changes in facial or body hair distribution; and breast enlargement. Progesterone related side effects, although usually minor, either remain constant or become worse with each’ successive cycle. A doctor should therefore be consulted. Recent evidence suggests that mood changes including depression might also be estrogen-related. Estrogen seems to cause a deficiency of a vitamin called pyridoxine. Recent experiments indicate that pyridoxinereplacement therapy significantly improves cases of Pillrelated depression. Breast enlargement is the most common progesteronerelated side effect. After an initial size increase, breast size remains constant until the Pill is discontinued, at which point the breasts return to normal size. lf a woman is taking a Pill that delivers: more than 1 mg. of progesterone daily, progesterone-related side effects can usually be eliminated by switching to an oral contraceptive with less progesterone (not to a Pill with more estrogen). Breakthrough bleeding and spotting (bleeding between periods) are the only common progesterone deficiency side effects. If they occur, such bleeding episodes usually disappear by the fourth cycle. In persistent cases a pill with a higher dose of progesterone can be prescribed. Metabolic effects The biochemical activities which keep all organisms alive are collectively. called metabolism. The oral contraceptive causes more than 50 biochemical changes within the female body. Similar biochemical changes occur during pregnancy, and most are not noticeable; however, in susceptible women, pregnancy-related and Pill-related metabolic changes can causes disease, and in rare cases, even death. Insulin production and glucose tolerance can be adversely affected by estrogen produced naturally during pregnancy or delivered by the Pill. Insulin is a hormone necessary to the body’s digestion of sugar. A low level of circulating insulin leads to a disease called diabetes mellitus. The Pill does not cause diabetes, but it may aggravate an existing condition of low glucose tolerance. Diabetes is a hereditary disease, and a woman whose blood relatives have diabetes should have a glucose tolerance test before starting the Pill, and an annual test while taking the medication. Liver function is affected by pregnancy and by the Pill. In susceptible women, the hormones of pregnancy can cause “recurrent jaundice of pregnancy’. The oral contraceptive can induce a similar disease process. In one year, about 1 woman in 10,000 Pill users experience jaundice, which is characterized by extreme itchiness and a yellow discoloration of the skin, fingernails and eyes. Jaundice responds well to therapy. Fat metabolism is altered by estrogen of pregnancy or of the Pill. Estrogen causes an increase in the amount of fat and fatty proteins circulating in the bloodstream. This is a potentially dangerous effect. especially if maintained for long periods, since an increase in circulating fats such as cholesterol is associated with an increased incidence of atherosclerosis, a vascular disease in which arteries are clogged with layers of fat. To date, increased incidence of atherosclerosis has not been found in women taking the Pill. Further research is necessary. Lactation is adversely affected by the Pill. Women who intend to breastfeed should not use oral contraception immediately after child-birth. Serious complications Certain metabolic changes in women taking the Pill can lead to serious complications, and even death. The incidence of such complications is very low. Thromboembolism: The various kinds of thromboembolism are diseases in which an unnecessary clot forms within a blood vessel, obstructing the flow of blood and starving body tissues. Thromboembolism can have serious and even fatal consequences. During pregnancy, estrogen causes an increased level of blood clotting chemicals (called ‘‘factors’’) within the blood serum, creating a condition of hypercoagulability. Blood loss during and after childbirth is greatly reduced by the blood’s increased capacity to coagulate. Hypercoagulability also increases a woman’s susceptibility to thromboembolism. Estrogen delivered by oral contraception causes increased susceptibility of the same magnitude. In 1968 three English scientists, M.P. Vessey, R. Doll and H.W.H. Inman presented carefully collected statistics evaluating risks of fatal and nonfatal thromboembolism to women taking oral contraceptives. The excess death rate from thromb embolism was estimated to be 1.3 per 100,000 users aged 20 to 34 and 3.4 per 100,000 users aged 35 to 44. It was also estimated that 47 women in 100,000 users are admitted to hospital every year for non-fatal thromboembolic disease. Among non-users of the Pill, only 5 in 100,000 are admitted every year. When corrected for error, this reveals a nine times greater risk of non-fatal thromboembolism for Pill users. A recent paper, prepared by the same scientists, reveals that the excess death rate is significantly reduced in women using only low dose preparations (pills containing not more than .05 mg. of estrogen). An American study organized by Philip Sartwell of the U.S. Food and Drug Administration, and presented in the 1969 FDA report on the Pill, reveals findings which are approximately the same as the British ones. The Sartwell study also indicates that high dose and sequential pills provide additional risk. These findings are not in themselves very frightening. Many daily activities carry far greater risks of injury or death. The risks of Pill-related thromboembolism are analyzed by Dr. D.M. Potts, Medical Secretary of the International Planned Parenthood Federation (London) who writes: ‘The risk of death from thromboembolic disease can be evaluated in two ways. Firstly, it can be reviewed against a medical background. Nearly every effective drug has a disease and even a death rate when used on a large scale, and the Pill is no exception. When a woman engages in sexual intercourse she takes a calculable risk with her life either as a result of possible pregnancy or as a result of procedures she adopts to prevent or interrupt pregnancy. The chart below sets out this risk In women of different ages. Deaths following the use of IUDs are only beginning to be assessed but it seems likely that they will be as frequent as those with the Pill. When allowance is made for the higher failure rate of IUDs, use of the Pill in both younger and older age groups proves to be associated with a lower death rate than any other procedure. In other words, a woman who takes oral contraceptives has more chance of being alive one year later than her sisters who choose to have a baby or use some other form of contraception (assuming a failure rate for other methods). Secondly the Pill can can be looked at in its social context. For many women there is no alternative . RISK OF DEATH WITH VARIOUS CONTRACEPTIVE METHODS �form of contraception that offers the degree of effectiveness, acceptability and convenience which the Pill offers. Many aspects of social behavior carry a much greater risk. Tobacco and alcohol, ~ which society demands for its comfort and pleasure, are associated with a very heavy mortality and morbidity and their consequences constitute a significant part of medical practice. From the point of view of the health of society it would be more justifiable to have oral contraceptives in slot machines and restrict the sale of cigarettes to a medical prescription. The Pill and vascular disease: Estrogen causes blood pressure increase in susceptible women. There are several recorded cases of “stroke’’ in women taking the Pill. A stroke is the rupture of a blood vessel leading to or from the brain. High blood pressure increases the chance of stroke. Severe, debilitating headache is a stroke symptom. If severe headache is experienced while taking the Pill, a doctor should be consulted to rule out the possibility of stroke. Although a significant relationship has not yet been demonstrated, it is believed that risk of stroke ls increased, probably only slightly, in women taking the Pill. The Pill and cancer: Massive doses of estrogen have been used in gynecology for more than 30 years. No increase in any form of cancer as a result of this medication has been observed. Estrogen of pregnancy produces cellular changes in the cervix, which look very much like cellular changes of early cervical cancer. After pregnancy, the cervical cells regain their normal appearance. The Pill induces similar cellular changes, and some scientists | believe that the oral contraceptive increases the risk of cervical cancer. On the other hand, the Pill might provide a protective effect against uterine and breast cancer. On the basis of presently existing information, no definite conclusions can be reached as to the effects of oral contraception on the incidence of cancer. Oral contraception carries distinct sexual connotations, and any consideration of the Pill’s risks is complicated by the existing social ethic which views sexuality, and especially female sexuality, as evil. All potent medication carries risks of disease and death, but the thing that marks the Pill for special consideration is the freedom of sexual choice that it provides to women. Some women’s liberation groups have adopted an “Off the Pill” position, demanding that the oral contraceptive be withdrawn. A better course of action, already taken up by some, is to demand development of an even safer contraceptive method, and to attack the giant pharmaceutical corporations for their incredible profit margins, racist experimental programs and medically unacceptable marketing standards. A special publication on the Pill, for distribution through women’s liberation groups, is being prepared by the editors of this publication. condom The condom, a sheath worn on the penis during sexual intercourse, is a widely used, effective, mechanical contraceptive. The condom is also known “prophylactic”, “‘rubber’’, ‘“‘safe’, ‘‘French letter’’. or simply ““contraceptive’’. Most condoms manufactured today are made of thin, strong latex rubber: condoms made from animal membrane are also available. Rubber condoms are approximately 0.0025 inches thick, 1 inch wide and 7 inches long. At the open end of the sheath the rubber is thicker, forming an elastic ring which keeps the condom from slipping off the penis. The condom is either plainended or tipped with a “‘teat’ meant to receive and hold ejaculated semen. There are no “sizes” for condoms, since all are considerably elastic. Skin condoms, produced from sterile animal membrane, first appeared in England during the eighteenth century. Since the development of the latex rubber process in the 1930’s, skin condoms have been largely replaced by the cheaper and equally effective rubber sheaths. The principal advantage of skin condoms is that natural membrane is a better conductor of heat than a film of rubber, and therefore interferes less with sensation. Skin condoms are packaged in plastic or aluminum capsules containing water, glycerine and a preservative. Rubber condoms are packaged in paper envelopes, cardboard boxes or aluminum foil. Most rubber condoms are sold dry and powdered: but at least one company distributes lubricated rubber condoms sealed between strips of aluminum foil. Association of the condom with prostitution and prevention of venereal disease has resulted in a reluctance on the part of many men and women to use this birth control method. In addition there exists a widespread misconception that the condom is an unreliable contraceptive when compared to other methods. In fact, statistics reveal that when properly used, the condom is as effective as the diaphragm and jelly method. The condom method of birth control does have an Important inherent disadvantage - it is a contraceptive used by the male partner alone. If the male sexual partner is reliable, and both man and woman accept this contraceptive method, there is no problem; however, not all men are trustworthy, and certainly not at all times. Since it is the woman who bears the consequence of unwanted pregnancy, women are more likely to appreciate the importance of using some form of contraception during all acts of sexual intercourse. The mechanical nature of the condom also provides potential problems. Some men and women do not like using a ‘device’ during sexual intercourse, claiming it disrupts spontaneity. If this is the sincere feeling of either partner the condom should be avoided. On the other hand. many men and women incorporate unrolling of the condom into the enjoyable routine of sexual foreplay. Many men claim that the condom dulls sexual pleasure. Physiologically, this claim is highly questionable. Modern condoms are extremely thin and. transmit sensation very well. Men who insist that the condom interferes significantly with sexual sensation are usually refusing to accept responsibility for birth control. The condom does have several important advantages: it is harmless, very simple to use, and easily available. If the male sexual partner is willing to take on the responsibility of contraception seriously, the condom is the best birth control method for occasional or unexpected sexual intercourse. Aside from contraception, the condom does provide some protection against venereal diseases such as syphilis or gonorrhea. The condom is probably the most commonly used mechanical contraceptive in North America. Fight hundred million to one billion condoms are sold every year in Canada and the U.S. Since 1938 the United States Food and Drug Administration (FDA) has supervised the manufacture of condoms. FDA enforcement and automated manufacturing and testing techniques contribute to the maintenance of very high quality levels. Use The condom must be worn throughout sexual intercourse since pregnancy can result from an early, unexpected ejaculation. If the condom is not pre-rolled, it should be rolled just before use. The condom should not be completely rolled up - a half an inch should be left at the closed end to receive ejaculated semen. If the condom being used is already rolled when purchased (most rubber condoms are pre-rolled), it should be unrolled half an inch. The condom is then unrolled over the erect penis. The half inch space left at the end of the condom (or the “‘teat’’, if the condom has one) should be squeezed while unrolling, so that air if not trapped In the closed end. It the man it not circumcised. he must pull back the foreskin before unrolling the condom. Properly unrolled, the condom covers the whole penis, with the half inch extension (or teat’) hanging limply at the end. Care must be taken not to tear the condom with finger nails, rings or any rough object. When inserting the penis the male should avoid catching the extension or teat on the outside of the vagina, since it is possible to thrust a hole through the side of the sheath if the tip becomes caught. Occasionally there is insufficient moisture in the vagina to allow for easy entry of the penis, especially if it is covered by a dry rubber condom. Forcing the penis into a relatively dry vagina can be uncomfortable and irritating for the woman. Such problems can be avoided by the use of an artificial lubricant or a pre-lubricated condom. A commercial spermicidal preparation (contraceptive foam, cream or jelly) is a good lubricant to use, since it also provides contraceptive protection. Other non-greasy jellies, such as surgical jelly, can also be used. Of course, saliva is the most readily available and cheapest lubricant of all. Vaseline or any kind of petroleum jelly or oil should never be applied to rubber condoms, since these materials destroy rubber. Unless a pre-lubricated condom is’ used, the lubricant is applied to the outside of the sheath after it has been unrolled onto the penis. Following male orgasm and ejaculation, there is always a partial or significant loss of erection. As long as the upper open end of the condom remains tight against the penis, sexual intercourse can continue; however, if loss of erection is significant and the condom does not fit firmly against the penis, semen can leak out of the open end, or the condom can slip off the penis, into the vagina. In such cases. the male partner should hold the upper part of the condom tight against the base of his penis, and withdraw from the vagina. If the condoms slips off the penis, it should be removed from the vagina immediately, with the open end held tightly closed. The condom is removed by stretching the ring at the open end and pulling down. The condom should be checked immediately after removal. If for some reason the condom has burst, the woman should immediately insert an applicator-full of vaginal spermicide into her vagina, or, if that is not available, douche with water. In such clear-cut cases of contraceptive failure, pregnancy can be avoided if the woman takes a large dose of the female hormone estrogen shortly after intercourse. Such an after-the-fact contraceptive is commonly used for special cases - such as women who have been raped. Although not all gynecologists are familiar with this �use of estrogen, many emergency clinics in large city hospitals have estrogen available for this purpose. Estrogen in high doses is a potent drug and cannot be administered casually. Some doctors suggest that the condom should always be used in combination with a vaginal contraceptive foam, cream or jelly. This extra precaution reduces the chances of conception should the condom break; however, condoms bought from drug stores or pharmaceutical companies can be assumed to be reliable. Years ago doctors suggested that all condoms be tested before use. Blowing the condom up like a balloon was the most commonly suggested test. Considering present-day quality control maintained by reliable manufacturers, such testing by the user is likely to do more harm than good. With modern condoms, the number of sheaths damaged during testing is usually greater than the number of defective condoms found. Good quality condoms can be used several times. If the condom is to be reused, it should be dropped into a bedside glass of water after removal from the penis. A soon as is convenient, the condom should be carefully washed in warm soapy water. Rubber condoms should be dried and powdered with cornstarch. Skin condoms can be kept in a mild solution of household boric acid and water. A condom that is reused should be tested for leaks before each use. If the condom is not to be reused it can be flushed down the toilet. Condoms should never be kept in a wallet or pocket since the combination of moisture and heat provided by contact. with the body deteriorates and eventually rots the condom. Condoms are best kept in the small cardboard containers in which they are usually sold. Without excessive heat or moisture condoms can be stored for up to two years. Both rubber and skin condoms are meant to cover the entire penis. Another kind of condom, called the “tip condom” or condom cap, covers only the glans of the penis. ‘T'1p condoms should never be used since they are likely to slip off after male orgasm. Cost Condoms should be bought only from drug stores, pharmaceutical companies or family planning agencies. ‘Those sold in men’s washrooms, gas stations or from peddlers are likely to be of inferior quality. Condoms can be bought by anyone, without a prescription. The most common drug store price is $1.25 for 2 rubber condoms. Lubricated rubber condoms cost about $1.50 for 3. Skin condoms can cost $1.00 or more each. Rubber condoms bought in quantity from manufacturing companies or family planning associations cost 25 to 35 cents for 3. intrauterine devices The effectiveness of an intrauterine (within the uterus) device to prevent conception has been known for over 2000 years. Hippocrates, the ancient Greek doctor described a device which was inserted into a woman's uterus through a hollow lead tube passed through the cervix (entrance to the womb). For centuries Arabian and Turkish camel drivers inserted small round pebbles into the uteri of their camels before going into the desert to prevent the camels from becoming pregnant during the long journey. In this century, Grafenberg, a German doctor, reported in 1930 of his use of an intrauterine contraceptive device made of silkworm gut, wound into a ring and inserted into the uterus. Grafenberg’s major contribution was the development of a device with a structure such that it remained only in the uterus and was not continuous with the cervical canal or vagina. Similar devices used in the beginning of the 20th century had structures which led into the uterus from the cervical canal. Grafenberg claimed that such structures served as ladders for the upward movement of bacteria from the vagina into the uterus. Devices with such “bacterial ladders” caused a great deal of infection and discomfort for many women. Because of complications with devices other than the Grafenberg ring, intrauterine contraception was neglected, until in 1959, two doctors working independently reported considerable success with modifications of the original Grafenberg device. Only recently have doctors begun to devote serious attention to IUD’s (or IUCD’s). It took many years for the medical profession to forget its prejudice against anything lying within the uterus even though ‘reports on the Grafenberg ring made it clear that infection was not a common complication. Description Today there are three basic kinds of IUDs: closed devices such as the Hall-Stone ring, the Ota ring, the Zipper ring, the Birnberg bow, and other modifications of Grafenberg’s original design; more recently developed open devices such as the Lippes loop, the Margulies coil and the Saf-tcoil: and closed-plane devices such as the Majzlin spring and the Dalkon shield. The open devices and the closedplane IUDs are safer and easier to insert. Closed IUDs should no longer be used. Some different JUDs are illustrated above. Most of the modern, safer devices, except the Majzlin spring, are made of flexible plastic. The new synthetic plastics are being used for various kinds of human surgery and repair as well as for IUDs since the body does not react to their presence. The malleability of plastics provides an additional advantage IUDs made of such materials can be straightened out and threaded into very thin introducers (inserters) which can then be inserted into the uterus through the cervix with little or no pain. The malleability of plastic also allows for great latitude in design and may prove very useful in evolving the “‘ideal design’’. The plastic tube molded into the IUD design usually has a core of metal salts so that if the position of the device must be determined exactly, an X-ray will reveal the IUD (X-rays only show the presence of dense structures such as bone, metal, or metal salts, but not plastic itself). Although there is much disagreement as to which is the best IUD available, the Lippes loop (size D, a little more than 1 inch across) is the most widely used. The Lippes loop is preferred because of low expulsion, pregnancy and side effect rates associated with its use. The more recently developed Saf-tcoil and Majzlin spring are both about as safe and as effective as the loop. Very recent research claims that the newly introduced Dalkon shield might be the best IUD of all, however much more research must be done before the shield can be accurately evaluated. Insertion of the device The insertion of an IUD 1s usually a simple, rapid, and more or painless procedure. After a general physical examination, the �woman lies back on the examining table with her legs in stirrup-like supports so that her vaginal area is exposed, and her thighs are apart. With a special Instrument (speculum) the vaginal walls are gently separated and the cervix is exposed. A cancer smear test (the Pap test routine in all gynecological examinations) is made by scraping the cervix gently (cells picked up are later examined under a microscope). The doctor has previously determined whether the pelvic organs (uterus, bladder, rectum) are normal and whether the uterus is angled forward or backward. A sterile uterine probe (see diagram) is then carefully passed into the uterus to ensure that the cervical canal is not obstructed and to recheck the uterine position. As the diagram shows, the IUD is threaded into a sterile plastic introducer (if it has not already been ‘“loaded’’). The loaded Introducer is inserted through the cervical canal and is advanced to the lowermost portion of the uterus, Just beyond the entrance of the triangular slitlike cavity. Sometimes it is necessary to grasp the cervix with an instrument to steady it before inserting either the probe or introducer. As the cervix is grasped the woman feels a pin- prick sensation, however pain is rarely experienced. Pressure is put on the plunger of the introducer and the IUD is pushed into the uterine cavity where it regains its original shape. The introducer is withdrawn leaving two nylon threads which are connected to the device, protruding into the upper vagina. The threads are trimmed so that only an inch or two remains beyond the cervix. An IUD can be inserted at any time during the menstrual cycle, but it is best introduced on the first day of a menstrual. period. This has several] advantages: the most important is that insertion at that time can not interfere with an early or unsuspected pregnancy since if the woman is still menstruating, she has not yet ovulated that month and cannot be pregnant. Also insertion of the IUD may cause a slight amount of bleeding from the uterus, and this spotting is not an additional problem during menstruation. In addition the cervical canal is open wider during menstruation than during other parts of the woman’s cycle. As soon as the IUD is inserted, it begins to prevent conception. If a woman is changing from birth control pills to an IUD, she may be advised to take the pills for one month longer, since most accidental pregnancies which occur with the IUD, begin during the first month of use. Also continued use of oral contraceptives reduces the amount of menstrual bleeding or spotting which may be increased during the first month of IUD use. If the nylon appendage connected to the IUD is properly trimmed, neither the male nor the female is at all aware of the device during coitus. Insertion of IUDs for women who have not had children After a woman has a child, miscarriage or abortion, her uterus remains slightly enlarged and her cervix slightly dilated permanently. Many doctors refuse to insert an IUD into the smaller, tighter uterus of a nulliparous woman (never been pregnant) because of severe pain which often occurs during and immediately after insertion. Some research is presently being done with various drugs meant to reduce the pain of insertion for nulliparous women. Many if not most women who have never been pregnant also experience some pain from cramps for the first few days after IUD insertion. This pain is sometimes not more severe than that experienced from normal menstrual cramps; in some other cases it can be accompanied by fainting or be so severe that removal] of the device is necessary. All nulliparous women have a greater tendency to expel the device spontaneously from their uterus. Failure rates of the IUD are also significantly higher for nulliparous women. Removal Removal of devices with nylon “tails” is simple. The doctor pulls gently on the threads extending into the vagina, and the device usually slips out easily. Women should not attempt to do this themselves since occasionally the cervical canal is obstructed or the IUD is lodged in the uterine wall, and an unskilled tug could cause injury. For devices without an appendage, the doctor inserts a small blunt hook into the uterus, catches the IUD, and pulls it. Expulsion and required removal of IUDs The muscles of the uterus run in two different ways (diagonally and transversely) and when the uterus contracts it does so in a rhythmical way. These contractions cause the IUD to be pushed out of the uterus of certain women. At present there is no sure way of knowing which women are likely to expel the device. Between 10 and 12 percent of all women who receive IUDs spontaneously expel the device in the first year of use. Most expulsions occur in the first 3 months that the device is in the uterus. Expulsions of the IUD usually occur, if at all, during menstrual bleeding. Women using IUDs should check the surface of their menstrual tampons or pads to ensure that the device has not been passed out with menstrual blood. If the IUD has a nylon appendage, the woman should check for its presence after each period and at least once a week. If the nylon thread or beads cannot be felt, the doctor should be consulted and another method of contraception should be used until a new device can be inserted. If a woman expels an IUD from her uterus she can have another one inserted. The chances that this same woman will expel the device again are very high - 50° of women who receive a second IUD expel it from their uterus. The Lippes loop, because of its design compresses easily and is least likely to be pushed out of the uterus by a single muscular contraction. Beyond the of women who spontaneously expel the IUD, another 8 to 10% of women have the device removed because of troublesome ‘side effects which are described below. Side effects Minor side effects to the IUD are common but not serious. Usually, these side effects disappear after the first month or two of use, however all side effects should be reported to the doctor who inserted the IUD. Side effects include: minor or severe pain similar to pain from menstrual cramps; irregular bleeding during the month (spotting); and very heavy menstrual bleeding for the first few cycles after insertion. The extra heavy bleeding for the first few menstrual cycles following insertion seems to be a common experience. It should be reported to the doctor but it is not serious. Sometimes drugs are prescribed to lessen the bleeding. Pelvic pain and regular or extra-heavy bleeding account for most of the 8% to 10% of IUDs which are removed either as a result of the doctor’s decision or the insistence of the patient. in the abdominal cavity, is not dangerous. Since the body does not react to the IUD, it is usually left where it is. If however, a closed device perforates there is a risk that it will catch a loop of one of the intestines and obstruct the passage of food or waste material. (This is why closed devices are no longer used). Surgery is always performed to retrieve a closed IUD, should it perforate. Similar surgery must be performed if an open device perforates only half-way, leaving a dangerous, rigid “hook” protruding through the uterine wall. There have not been any cases reported of cervical or uterine cancer occurring as a result of IUD use. On the basis of presently available information, it can be said that IUDs do not cause cancer. Serious complications Should an IUD fail and a woman become pregnant with Pelvic Inflammatory Disease PID (any infection’ of the a device still in place, there is no danger to the baby. pelvic organs) occurs as a complication to the IUD in 2% Usually the device is left in the uterus and is only to 4% of women wearing a device. Usually, an incident removed when the baby is delivered. There are no of IUD - related PID is a relapse of some previously reports of abnormalities in babies born to women with existing infection, such as gonorrhea. In such cases, the IUDs in place. insertion of an IUD is enough to weaken the natural defences of the uterus, and bacteria which had been How the IUD works kept in check multiply and cause clinical signs of Many conflicting theories have been suggested in infection. Commonly used IUDs are sterilized before attempts to explain the contraceptive action of the LUD. distribution and sterile techniques are maintained by The exact mode of action is still not. understood. most doctors _ during insertion, to reduce the risk of One widely accepted theory suggests that the IUD PID. If PID occurs in a woman wearing an IUD, it can interferes with the dynamic muscular balance of the usually be treated without removing the device. Women cervix, uterus and Fallopian tubes. It is suggested that who have had a pelvic infection previous to IUD sperm transport up into the tubes and ovum transport insertion can safely use a device but must make sure down toward the uterus are disrupted by the IUD’s that the infection has been totally eliminated. effects on uterine and tubal muscles. Once in. approximately 2,500 IUD insertions, the device Another group of explanatory theories concentrates on does not remain in the uterus, but goes through the cellular changes in the uterine lining, the endometrum. uterine wall into the abdominal cavity. Such uterine if the cyclic development of endometrial cells is perforation is usually the result of error on the part of the disrupted, implantation of a fertilized egg is impossible. inserting doctor or technician: however, some IUDs are One group of theories is primarily biochemical, and pushed through the uterine wall by contractions of the suggests that when an IUD is present, the uterine” uterine muscles themselves. Whatever the cause, environment is chemically hostile to a fertilized egg. complete perforation of an open device; with the IUD A recently presented theory suggests that abnormally itself floating freely high concentrations of macrophages develop �within the uterus when an IUD is present. Macrophages are normal body cells which attack invading cells such as bacteria, by phagocytosis. (A phagocyte is a cell, such as a white blood cell. that can “swallow” another cell, and thus destroy it). Macrophages normally do not exist within the uterine cavity, and their presence might destroy a fertilized egg. IUDs do not cause early abortion nor do they prevent pregnancy by creating a low-grade infection in the uterus. Effectiveness The efficiency of the IUD is considerably less than the oral contraceptive pill. At best, only 1.5 to 3 women out of 100 become pregnant during the first year after insertion of the IUD. Failure rates tend to decline with further years of use. Many doctors report a contraceptive failure rate of much higher than 3.0. With some devices, up to 8 or 9 women out of 100 become pregnant during the first year after the IUD is inserted _ IUDs are most effective for women who: have had several children, and are older than 30 years of age. Age is the more important factor. For example, in one study on the Lippes loop, 5.19. of women 15-24 years old at time of insertion became pregnant within the first year. In the same study, only 4.1% of the women 25-29 years old, and 2.96% of women 30-34 years old became pregnant in the same time period. Women who must not become pregnant should not rely on the IUD unless abortion is an acceptable and available option. Acceptability Considering the 10 to 12%. of women who expel the IUD within one year after insertion, the 8 to 10% who must have it removed in that same period, and the 2% to 3% (at least) who become pregnant, the IUD is an acceptable method of contraception for only about 75% of women in the first year. Acceptability goes down to about 50% within years. For those women who can use the IUD.: it is probably the best method available - it is safe, easy to use, cheap, does not require repeated action (like taking a pill daily) and does not interfere with the act or enjoyment of sexual intercourse. With the advent of statistically significant reports linking oral contraceptives with an increased incidence of death and disease from thromboembolic illness, some women have strongly advocated the use of the IUD in preference to the Pill. Failure rates for the IUD of 1% to 2%, and a naive belief that the IUD is “harmless” have been repeated over and over again. It is absurd to believe that the pharmaceutical and plastic corporations producing IUDs have any more concern for the lives of individual women, than do the pharmaceutical corporations producing the Pill. The IUD is neither harmless nor as effective as the manufacturing companies claim. It is not possible at this point to determine exactly how many women die as a direct result of IUD use (possibly from perforation); it is known however, that many women die during or after normal pregnancy (about 300 per million pregnancies), and that. some women using an IUD become pregnant. As a result of contraceptive failure, 30,000 to 80,000 pregnancies occur every year in 1,000,000 IUD users. Thus, in 1,000,000 women using the IUD for one year, 9 to “4 women die as a result of pregnancy, and beyond these.deaths, an undetermined number of women die as a result of criminal abortion. Reversibility The contraceptive effect of an IUD is completely reversible. When the device is removed the woman can have children again. The IUD and genocide The IUD is cheap to manufacture, easy to insert, and in large scale terms is very effective. Not more than 8 to 9 women out of 100 will become pregnant during the first year of use. Women who do not use any contraceptive method usually do get pregnant within one year - 90 women in 100 will become pregnant In one year if they do not try any method to control their fertility. Since the growth of large populations in nations of the Third World (Africa. Latin America, parts of Asia, etc) represents a threat to the power and world dominance of such countries as the United States, considerable attention is being directed at the IUD by these “nations. Scientists, working with grants from such organizations as the Population Council, a private American foundation supported by the Ford Foundation, John D. Rockefeller I, and other private donors, are attempting to develop more effective IUDs which can be inserted by only semi-skilled personnel. By advocating “voluntary sterilization” and use of the IUD, the governments of the United States, Britain and other western powers are attempting to control by contraception the numbers of non-white people, just as white people from Europe eliminated large numbers of red Indians by importing European diseases for which the Indian had no antibody (immunity) resistance. One important characteristic that the IUD shares with sterilization is that the effectiveness of the method cannot be controlled directly by the individual woman who carries the IUD in her uterus. Both sterilization and IUDs are used much more extensively in countries other than the western nations. Of the 8 million IUDs used, only 1 million are carried by U.S. women. In contrast, of the 18.5 million pill users ‘in the world, at least 8.5 million live in the U.S. and an additional .5 to 1 million in the United Kingdom. Large scale use of contraceptive measures, applied to women who may not want to control their fertility, approaches genocide and ceases to be birth control. diaphragm and jelly The diaphragm and spermicidal ‘jelly method is a relatively popular and effective mechanical form of contraception. The soft rubber diaphragm with a spring rim is fitted as a mechanical barrier to the cervix, preventing sperm from entering the cervical canal: the front end fits snugly behind the pubic bone, the dome covers the cervix and the back end rises into the posterior fornix, a small pocket behind the cervix. A spermicidal preparation (cream or jelly) smeared on the surface of the device acts as a chemical contraceptive; it kills sperm which pass the diaphragm rim or remain in the folds of the vaginal wall. Some doctors question whether the device actually blocks the cervix or merely serves as a platform for the spermicide. Even so, it is always fitted as a barrier to the cervix. device by hooking her finger under the front rim, and pulling down and out. The woman then learns to insert the device herself. A teaspoonful of spermicidal jelly or cream is smeared on the upper surface of the diaphragm (dome up or down, depending on the woman’s anatomy). Spermicide must not be placed on the rim since this increases the possibility of displacing the diaphragm during coitus. With one hand, the woman squeezes the diaphragm into a long narrow Shape. With the other hand holding the vaginal lips apart, she inserts the compressed device into the vagina until the far rim passes the cervix. She then pushes the front rim up behind the pubic bone and checks that the cervix is completely covered. Plastic or metal inserters facilitate insertion, especially for women who have short fingers or dislike handling themselves. The diaphragm is hook Medical examination and prescription Each woman must be individually fitted for the diaphragm by a gynecologist or a family planning clinician. Nonprescription, “‘one size fits all” diaphragms should not be trusted. A virgin (woman with hymen intact) can be fitted for a diaphragm; however, sexual intercourse stretches the vagina slightly, and she should be refitted shortly after her first act of intercourse. Fitting should be checked at least every two years and after any of the following circumstances: childbirth, miscarriage, any operation (surgery), and a gain or loss of more than ten pounds. The doctor must perform an internal pelvic examination to choose the size and type of diaphragm most suited for an individual woman. The woman is asked to examine herself internally so that she learns to recognize the edge of the pubic bone and the cervix, important for proper fitting. Then, the doctor inserts a sample diaphragm and asks the woman to examine it in place. She should be able to recognize the cervix through the rubber and the position of the front rim. The woman removes the ed to notches on a rod which the woman inserts into the vagina. When she twists the rod, the device is released. Most inserters have a blunt hook at one end for removal. The rod is hooked to the front rim of the device which is then pulled down and out Use The diaphragm is most easily inserted while crouching, squatting, lying down, or standing with one foot raised. The diaphragm may be inserted not more than two hours before sexual intercourse. If more than two hours goes by before coitus, an applicator full of spermicide should be inserted into the vagina, or the device should be removed to place more spermicide on the diaphragm’s surface. A woman can walk around, bathe, or urinate with a diaphragm in place but she should recheck its position after a bowel movement. After an act of sexual intercourse, an additional application of cream or jelly must be inserted into the vagina by means of an applicator before each additional coitus. �The diaphragm must remain in place for at least six hours after the last act of sexual intercourse. and can be left in place as long as 24 hours. A facial tissue or towel can be used to absorb any fluid leakage from the vagina. Spermicidal creams and jellies do not stain. After removal, the device should be washed with mild soap and water, dried, and powdered with corn starch. Douching is unnecessary but if desired must be postponed at least six hours after intercourse. Occasionally the woman should examine the diaphragm for holes and cracks, especially near “the rim. Filling the device with water and checking for leaks, or holding the device to the light are two goodd tests. The diaphragm can be used during menstruation: however, conception is highly unlikely at that time. If positioned correctly the diaphragm cannot be felt by either sexual partner during coitus. Djaphragms made of plastic are available in case of an allergic reaction to rubber. Also, the brand of spermicide should be changed if either partner ‘is allergic to the kind being used. The diaphragm is ineffective if left in a dresser drawer or purse, however, human frailty is not ‘the only reason for its potential failure. The device can ship out of position for a number of reasons. improper fit, cream on the rim, expansion of the vaginal walls during sexual stimulation, and frequent insertions of the penis. The diaphragm is. much more easily displaced in coital positions where the woman is above the man. The contraceptive foams are packaged under pressure in aerosol cans or vials while the creams and jellies come in tubes. A special applicator is sold with the can or tube of spermicide. Two brands of vaginal foam are marketed in North America, and their brand names, “‘Delfen’”’ and “Emko’, have become synonymous with “contraceptive foam’’. Since vaginal foams are both easier to use and more effective, there is no reason why creams or jellies should be used at all. All vaginal spermicides have a high failure rate and should not be used by women who must not become pregnant. The vaginal spermicide contraceptive method is not as effective as the diaphragm and jelly or the condom. As can be seen in the diagram, withdrawing the applicator half an inch from the end of the vagina positions the open end of the applicator close to the cervix. When the plunger is pushed, the foam flows out of the applicator next to the cervix. Applicators which come with creams or jellies can be screwed onto the mouth of the tube. The applicator is filled by squeezing the tube. Otherwise, creams and jellies are used in the same way as foams. Foams, creams or jellies must be inserted not more than one hour before sexual intercourse. If more than one hour elapses between the insertion of a vaginal spermicide and sexual intercourse, another applicator-full of spermicide must be inserted. If the woman gets up from bed or goes to the toilet Cost The cost of fitting a diaphragm by a private doctor is about $15 to $25, and considerably less at a hospital or family planning clinic. The device itself, which is obtainable only by prescription costs about $4. A tube which contains about 20 applications costs approximately $3. vaginal spermicides The insertion of a sperm-killing chemical into the vagina before sexual intercourse is an ancient contraceptive practice. More than 3.500 years ago an unKnown Egyptian writer suggested a mixture of honey and acacia tips (a vegetable gum) as a vaginal spermicide. Through the ages different preparations of harmless substances have been used as vaginal contraceptives. Today, several simple-to-use vaginal contraceptives are available. These contraceptive preparations are made up of two components: a spermicidal (sperm-killing) chemical and a harmless, bulky base. The spermicide kills sperm cells deposited in the vagina and the base mechanically blocks the cervix. so that even if some sperm cells are not killed they cannot enter the cervical canal. In Canada and the United States only three forms of vaginal spermicides are readily available: foams. creams and Jellies. Spermicidal foaming tablets and spermicidal suppositories are also marketed but are more difficult to obtain, especially in Canada, Neither foaming tablets nor spermicidal suppositories are as effective as the least effective of the foams, creams or Jellies, and therefore should not be used. The spermicidal foams are more effective in preventing pregnancy than either the creams or jellies. Once inserted into the vagina, the foam spreads quickly and evenly over the cervix, and forms an effective barrier. The creams, and especially the Jellies, often fail to spread properly over the cervix and are therefore more likely to fail as contraceptives Messiness”” is another problem more often associated with the creams and jellies than with the foams. Many women complain of leakage or dripping from the vagina during or after sexual intercourse while using cream or jelly. On the other hand, vaginal spermicides have several advantages. The preparations are harmless, can be obtained from almost any drug store without prescription, do not involve a “device’ such as a diaphragm or condom and are easy to use properly. Use To use the contraceptive foam, a woman first shakes the can or vial and then fills the applicator by pushing the open end of the applicator tube down onto the nozzle of the container. As the foam rises in the tube of the applicator the plunger is pushed up. When the plunger has risen to the top of the tube, the applicator is full. The woman lies down and gently pushes the applicator into her vagina as far as it will go. The woman then pulls the applicator back (out) half an inch and pushes down on the plunger. �after Insertion of a vaginal spermicide but before sexual intercourse, another applicator-full of spermicide must be inserted. rhythm Leaking from the vagina before, during or after sexual intercourse can be controlled by pressing a facial tissue or clean towel against the vaginal opening. Vaginal spermicides do not permanently stain clothing or sheets. If a douche is desired, it must be delayed for at least 6 hours. Not all sperm cells deposited during sexual Intercourse come into contact with the spermicide immediately, and many sperm can live on In the vagina for several hours after the ejaculation. Douching cannot remove all the sperm cells from the vagina, but it does dilute and remove most or the spermicidal preparation. In any case. douching is not necessary after use of a vaginal spermicide, since the natural cleansing processes of the vagina are sufficient. (Except for certain medical purposes, douching is never necessary). After sexual intercourse, the ‘woman can get up or go to the toilet without affecting the contraceptive action of the spermicide. After use, the plastic applicator should be dropped into a bed-side glass of water and should be washed eventually in warm soapy water. If the spermicide dries within the applicator, it hardens and sticks to the sides. If this happens, the applicator can be soaked: until the spermicide softens. Since the applicator is made of soft plastic, it cannot be boiled. The rhythm method (periodic continence, safe period, Ogino method) is simply the abstinence from sexual intercourse each cycle on those days when a woman is most likely to become pregnant. Used alone, it is not an effective birth control method, but it is helpful in determining the possibility of pregnancy in case of failure of another method. Women who must not become pregnant should not rely on this method. Also, it should not be used by women who have irregular cycles, especially for any of the following reasons: age (under 22 or approaching menopause), recent miscarriage or childbirth, breastfeeding, or emotional problems. The rhythm method should be attempted only under the guidance of a doctor or family planning advisor. To be successful, the rhythm method must be accepted by both the woman and her regular sexual partner, if she has one. Otherwise resulting frustration can threaten the relationship, or a sexual encounter may be imposed on the woman when she should abstain. Women whose sexual experiences are sporadic should not depend on the rhythm method, since the fertile period and a particular unexpected opportunity may frequently coincide. Use To calculate the fertile period when pregnancy is most likely, a woman must consider several factors: approximate time of ovulation, life span of sperm cells, and life span of the egg. Ovulation occurs at the middle of the cycle, usually about 14 days before the onset of the next menstrual flow. Therefore conception is least likely at the beginning and end of a woman’s cycle, and most likely at mid-cycle. Sperm can survive in a woman’s body for about 48 hours after ejaculation; the egg lives only about 24 hours after ovulation. Therefore. a woman using the rhythm method must not have sexual intercourse from 2 days before the earliest chance of ovulation until one day after the latest possible chance. This fertile or ‘‘unsafe’ period can be calculated in several ways. Side effects Some men and women are allergic to one or several brands of vaginal spermicides. If allergic irritation occurs a doctor should be consulted and the brand of spermicide changed. Vaginal spermicides cannot cause cancer or any other diseases. The calendar method This method of calculation assumes that ovulation occurs approximately 12 to 16 days before a woman’s next menstrual flow. Also, intercourse must be prohibited 2 days before this 5 day span and 1 day afterwards to account for sperm and egg survival. For a woman with a regular menstrual cycle, the total period of abstinence (theoretical fertile period) is always 8 days long. Most women are not always regular; the length of the cycle varies one or several days in either di Should a vaginal contraceptive fail, the baby is in no way affected by the spermicide. Basal Body Temperature during the menstrual cycle Cost In Canadian and U.S. drug stores contraceptive foam “kits” (including applicator) are sold for $4.00 to $4.50. Refills of the foam alone sell for about 50 or 60 cents less than the complete kit. A can or vial of contraceptive foam contains about 20 applications of the preparation. Vaginal creams and jellies are less expensive selling for about $2.50 for a complete kit. There are about 25 applications in a tube of cream or jelly. Contraceptive foams, creams and jellies can be obtained at lower prices from discount drug stores, hospital pharmacies and family planning centers. If, then, there are serious motives to space out births, which derive from the physical or psychological conditions of husband and wife, or from external conditions, the Church teaches that it is then licit to take into account the natural rhythms immanent in the generative functions, for the use of marriage in the infecund periods only, and in this way to regulate birth without offending the moral principles which have been recalled earlier. — From Encyclical Letter of Pope Paul VI Humanae Vitae. �rection. In order to use the rhythm method without error, a woman must first keep a record of her menstrual cycle for 8 months, using some other birth control method at this time. Marking the first day of the menstrual flow as day 1, a woman records the length of each cycle. After doing so for 8 cycles, she calculates the unsafe period for the 9th cycle as follows: subtract 19 from the length of the shortest cycle to find the first unsafe day: and subtract 11 from the longest cycle for the last unsafe day. A woman must not have intercourse from the first to the last unsafe day. The chart above calculates the fertile period for cycles of varying lengths. A woman must continue to record the length of each cycle and base her calculations on the most recent 8 cycles. Thus, the unsafe period for the 10th cycle is based on the shortest and longest cycles between the 2nd and 9th cycles; for the 11th, it is based on those between the 3rd and 10th cycles: and so on. The temperature method A woman’s body temperature is higher during the second part of her menstrual cycle. Progesterone, released by the corpus luteum after ovulation, causes a rise in body temperature. Also, a temperature drop occurs about 48 hours before ovulation, although this drop is not always as noticeable as the following rise. Thus temperature change as an indicator of ovulation can be used to determine the unsafe period. Since body temperature also varies with daily activity, a woman takes her temperature before getting out of bed or beginning any activity each morning. This is known as the basal body temperature (BBT). Special thermometers with fine gradations are available for this purpose. To familiarize herself with her typical cycle, a woman records her basal body temperature daily as shown in the chart for at least six months beforehand. She notes any other factors, such as a cold or restless night, which might affect the morning’s temperature. She continues recording the BBT as long as she uses this method. The absolute fertile period is calculated from day of the cycle (onset of menstruation is day 1) until 3 days after the rise in basal body temperature. This is the unsafe period when sexual intercourse is prohibited, according to the temperature method. Calendar-temperature method The absolute fertile period calculated by the temperature method can be quite long, depending on a woman's cycle. The combination of the calendar and temperature methods often shortens this unsafe period. Also, if the basal body temperature is affected by other factors such as illness, a woman can rely on the calendar method for that cycle if she has kept an accurate menstrual history. In the combined method, the first unsafe day is calculated from the shortest cycle (using the chart provided): and the last unsafe day is the third day after a noticeable rise in the basal body temperature. coitus interruptus Coitus interruptus, also known as “withdrawal’” or “being careful” is the oldest method of birth control still commonly used today. Withdrawal is mentioned in Genesis, the first book of the Old Testament, written about 3,000 years ago. Coitus interruptus is difficult to use properly and has a very high failure rate. Women who must not become pregnant should not rely on their partner’s use of this contraceptive technique. Use “Coitus interruptus” means interrupted sexual intercourse a good description of this contraceptive technique. When coitus interruptus is used sexual intercourse continues until just before the male orgasm. When the male feels his ejaculation coming on, he withdraws his penis from his partner’s vagina and external genitalia before ejaculating. It is important that the male withdraws his penis completely and ejaculates away from his partner’s vagina. Sperm cells can move on their own, and if deposited anywhere between the labia majora (external vaginal lips) they may be able to continue up the vagina and into the uterus. Contrary to common belief, more than just one particular woman has become pregnant while still virginal. The hymen need not be broken before pregnancy can occur. Sexual intercourse can be resumed after the male’s ejaculation, if the male can maintain an erection. The tip of the penis should be carefully wiped, and if the man is not circumcised, the foreskin should be withdrawn and the penis wiped again. As a contraceptive technique, coitus interruptus has several inherent defects. Most importantly, it is the male partner alone who determines the contraceptive effectiveness of the method. Not all men are trustworthy, and few can be depended upon at all times. The assurance, “I’ll be careful’ means nothing to a woman who knows that her partner will not physically suffer the consequences should a ‘“‘mistake’ occur. Not all men are physically able to use coitus interruptus successfully. Effective coitus interruptus involving withdrawal before ejaculation, requires the man to be aware of when ejaculation will occur: however complete ejaculation in a single emission (one powerful gush) is the ejaculatory pattern in not more than 50‘. of men. The other half of the male population usually expels semen sporadically or in a slow stream. Whether such men are aware of the exact moment when semen first begins to escape, or whether they feel only the last portion of the ejaculation is not known. Aside from ejaculatory pattern, men differ as to timing of ejaculation. About 50% of all men ejaculate within 2 to 5 minutes after the beginning of sexual intercourse, while the other 50% can continue coitus for 5 to 20 minutes before reaching orgasm. Men who ejaculate within 5 minutes of the beginning of coitus have more difficulty withdrawing from the vagina properly. Both men and women face still another physiological obstacle when attempting to use withdrawal. As orgasm approaches, men and women experience mild to extensive loss of consciousness during which coltal movements lose their voluntary character. This condition can last several seconds, and a conscious action such as withdrawing the penis can be impossible. If intercourse continues uninterrupted for too long, one or both of the sexual partners may, slip into this -semiconscious stage, and forget about withdrawal. Side effects For many years some doctors, especially those who opposed birth control in general, warned. of possible ill effects of coitus interruptus. Modern medical and statistical research has revealed that coitus interruptus is physically harmless. Psychologically, on the other hand, withdrawal can lead to problems, especially for women. In Western societies most women take longer to reach orgasm during sexual intercourse than their male partners. Therefore, coitus interruptus often involves interruption before a woman can reach orgasm. If the male partner can maintain an erection after ejaculation, sexual intercourse can be resumed; however. not all men can or want to continue coitus. Withdrawal thus often means frustration for the woman unless masturbation or clitoral manipulation brings the woman to orgasm. Aside from the simple factor of timing, the woman may fear, often justifiably, that the male will not withdraw his penis before ejaculating. Concentrating on the possibility of an unwanted pregnancy is not conducive to sexual enjoyment and orgasm. Men can also experience psychological or sexual problems related to coitus interruptus. If the man sincerely wants to protect his sexual partner from pregnancy he may find himself in a constant state of fear throughout the sexual act, afraid that withdrawal at the right time will not be possible. For all the problems associated with coitus interruptus, this contraceptive technique is not without its advantages. Withdrawal costs nothing and is always available. The consistent use of coitus interruptus does reduce the frequency of pregnancy. Even so, given the existence of cheap, easily available mechanical, chemical and hormonal contraceptives, coitus interruptus should no longer be considered a valuable birth control alternative. other methods So-called contraceptive methods which are, for all practical purposes, ineffective need not be considered extensively by this handbook. These methods include: immediate postcoital douching, total self-restriction of female orgasm known as “holding back’, prolonged nursing, and coitus reservatus. There are serious drawbacks to use of the douche as a contraceptive method. If there is to be any possibility of effectiveness for conception control, the douche must be used immediately after intercourse — an unpleasant interruption for the woman, More significantly, at that time, the pressure of the douche might easily force concentrated sperm into the cervical orifice; sperm could very well continue and effect fertilization. On the other hand, if the pressure of the douche is inadequate to distend the vagina, sperm remain untouched in the vaginal crevices. For these reasons the douche should not be considered a contraceptive method, and must not be used for conception. It should be noted that too frequent douching is harmful since it destroys protective bacteria in the vagina. The strong coal tar “feminine hygiene’’ disinfectants should never be used. If not mixed properly, they will burn the tissues. It is a relatively common belief that if the female partner “holds back” and does not permit herself to achieve orgasm during coitus, pregnancy is impossible. This belief is based on the misconception that women, like men. ejaculate in orgasm a substance that is necessary for fertilization. While it is true that there is a release of fluids when a woman reaches sexual climax, these fluids simply facilitate the swimming movement of sperm. In the partial absence of these secretions (absence is never complete), sperm can still reach the Fallopian tubes and fertilize an egg. There have been many pregnancies in women who nave never had orgasm. There is no truth to the belief that as long as a woman is nursing a baby she cannot conceive. Because of hormonal balances, during early months of breast feeding ovulation may be delayed, but this protection does not last long, nor is it reliable. The practice of coitus reservatus is similar to coitus interruptus (withdrawal). The essential difference is that whereas in coitus interruptus the male partner does not allow himself to achieve orgasm and ejaculate within the woman’s body, in coitus there is no ejaculation. The male does not withdraw, but remains in sexual contact during the female partner’s orgasm and gradually his erection subsides. Such control for an hour or longer, it has been reported, requires training; further it is highly probable that some sperm will escape through the erected penis even though the male partner does not ejaculate. The control that is necessary for utilization of coitus reservatus a sa contraceptive method cannot be maintained by many men. the same psychological and physiological arguments against coitus interruptus are directed against coitus reservatus. �effectiveness new methods The Pill is only an interim solution to the problem of hormonal contraception. Although the oral contraceptive appears safe for the vast majority of users, it does constitute an endocrinological insult which can lead to side effects, disease, and, in rare cases, even death. Several experimental contraceptive devices and drugs, some of which are described below, may eventually replace the Pill. The pregnancy rate for any period of time during which a particular birth control method is used is an expression of the failure rate of that method. The Pearl formula is a standardization of contraceptive failure rate. The above formula assumes that ovulation occurs 13 times a year, thus providing 13 chances for conception. Thirteen is multiplied by 100 to provide an easily definable “per cent’ figure - thus 1300. “One hundred woman years” standardizes the pregnancy rate in terms of the number of times conception is possible during a year’s period of exposure. The formula assumes regular heterosexual contacts, no intervening pregnancies or periods of breast feeding, and ovulation during each menstrual cycle. Thus, if 60 women use one contraceptive method for 10 months, and five conceptions occur, the formula would reveal a failure rate of: I3X 5 /600 = almost 11% Two different failure rates are often provided for each contraceptive method, ‘‘theoretical failure rates’’ and “clinical failure rates’. The theoretical failure rate reveals the effectiveness of a method if it is used absolutely consistently and according to instructions. The clinical failure rate states the effectiveness of a method used under average conditions by average people. The theoretical rate can be accurately determined for only two contraceptive methods - the Pill and the IUD. With the Pill, it is possible to objectively determine if a woman has taken one pill every day for 21 days in a cycle; and with the IUD it is similarly possible to objectively determine if the device is in place in the uterus. Since all other contraceptive techniques are not totally divorced from the sexual act, it is not possible to make objective observations as to the consistency or accuracy of personal use. In the chart, theoretical failure rates and clinical failure rates are presented only for the oral contraceptive and the IUD. For all other methods, only clinical rates are provided. Listings are approximations, and are subject to great variation. A listing should be read: “... pregnancies in 100 women using the....... method for 1 year’’. When considering the meaning of effectiveness statistics it should be remembered that the most important variable is ‘‘individual failure’. Oral contraceptives can be 100% effective: however this is meaningless if a woman forgets to take 1 or more pills. Similarly, the condom theoretically provides 100% protection against conception. The chart above reveals, however, that an average failure rate for the condom is 10 to 15 per year. In terms of effectiveness, the main difference between the oral contraceptive and the condom is that the former provides many fewer opportunities for individual failure than does the latter. When choosing a contraceptive method, personal beliefs, preferences and hang-ups must be considered, since they affect “individual failure’. If a woman is afraid of the oral contraceptive, it is likely that she will “forget” a pill every so often. If a man believes that a condom dulls sexual sensation, or if he really does not care whether or not his partner becomes pregnant, he may occasionally “forget” to wear the sheath. The continuous progesterone pill (‘‘mini-pill’’) Kistrogen is responsible for most side effects associated with the Pill. Experiments are being performed with an oral contraceptive which contains only .05mg of a potent synthetic progesterone in the daily pill. One pill of a progesterone oral contraceptive series is taken every day, in contrast to the 3 weeks on, 1 week off regimen of the estrogen-progesterone pill. The “minipill’’ eliminates side effects and endocrine changes caused by estrogen. Unfortunately it is associated with another set of side effects resulting from the absence of estrogen. Estrogen as a component of the combination Pill regulates the user’s cycle, and helps prevent ovulation. When progesterone is used alone as an oral contraceptive, menstrual cycles are disrupted, and ovulation still occurs. Chlormadinone acetate (CA) is the most commonly used progesterone in minipill preparations. CA is highly antiestrogenic, and causes localized changes in the genital tract making conception unlikely. When a woman is taking a continuous progesterone contraceptive, mucus in the cervical canal becomes thick and impenetrable to sperm. Progesterone also disrupts the cyclical development of endometrial cells, making the whole endometrium unreceptive to a fertilized egg. Even so, pregnancies do occur In women taking the progesterone-only pill. Although scientists working for pharmaceutical companies claim otherwise, the minipill’s failure rate is at least 5 to 6 a year. To be effective, the minipill must be taken at the same time every single day without fail. To forget even one pill can expose a woman to pregnancy. The minipill is unacceptable to many women because of its high failure rate and high incidence of extremely irregular menstruation. If these problems can be eliminated, the minipill might replace the estrogenprogesterone preparations. Several chlormadinone acetate preparations have already been on the market in England and Canada. These pills were withdrawn in England because long term tests revealed the development of breast nodules (tumors) in female dogs given CA for several years. The significance of these findings is questionable, since dogs metabolize sex hormones differently than do humans or monkeys. Breast nodules have not been observed in monkeys treated with CA, nor are the breast nodules discovered in bitches clearly cancerous. Further experiments will probably result in the return of CA products to the general market. The “morning after” pill An effective “after the fact’ oral contraceptive has been available for several years. If a woman takes a large dose of natural estrogen called stilbestrol within 24 hours of an unprotected act of sexual intercourse, implantation of the fertilized egg (if there is one) is disrupted. Stilbestrol is given to victims of rape, but can be obtained in simple cases of unplanned and unprotected intercourse, or in clear cases of contraceptive failure (e.g. ruptured condom). The “‘morning after’ pill as it now exists, usually causes severe vomiting and nausea. Also, use of large doses of estrogen is presently being avoided. Progesterone injections Injections of 150 mg. of a potent, long acting progesterone have been used as a contraceptive technique for several years. Unlike the progesterone only pill, the injection method is usually 100% effective. The synthetic progesterone used probably causes an over-suppression of the hypothalamus, blocking the secretion of LH. It can take 12 to 21 months after a progesterone injection for the hypothalamic suppression to wear off, although 100°. protection against conception is only provided for 3 months. Many scientists believe that in some cases hypothalamic suppression induced by progesterone injection may never wear off, leaving a woman sterile. Progesterone injections have not been widely used in Canada and the U.S. The majority of experiments have been performed on nori-white, poor women, living in Third World nations. Since the possibility of permanent infertility is rarely explained to such women, experiments with progesterone injections often constitute non-voluntary chemical sterilization programs. The progesterone injection technique is associated with a high incidence of extremely irregular menstruation. If this side effect, and the possibility of sterilization can be eliminated, the injection technique would be a good contraceptive. Silastic implantations Another progesterone-only contraceptive technique being experimented with widely on Third World women involves the implantation, under the skin, of a tiny plastic “pillow” filled with progesterone. Silastic, used in making the pillow, releases progesterone at a slow continuous rate. To implant the plastic capsule, which is about as big as a pencil tip, a small area of skin on the inside of a woman’s arm is locally anesthesized. A large bore needle carrying the capsule is then injected leaving the capsule under the skin. The capsule can be removed In a similar way. Side effects associated with this method are similar to those complicating use of progesterone injections. Silastic intravaginal-ring This is a highly promising method. A silastic �ring, of about the same diameter as a diaphragm, and filled with a synthetic progesterone, is inserted into the vagina on the first day of menstruation. When properly placed, the ring cannot be felt by the woman or her sexual partner. The ring is left in the vagina for 21 days and the progesterone which is absorbed into the blood stream through the vaginal walls, has a localized effect on the genital tract. After 21 days, the woman removes the ring, and menstrual-like bleeding begins a few days later. Preliminary reports on this method indicate low side effect levels and regular menstruation. The once-a-month pill A more convenient form of the combination oral contraceptive is under investigation. A form of ethinyl! estradiol (estrogen), which is picked up from the digestive system and stored in fat cells, is used in combination with a long acting synthetic progesterone. Effectiveness of this pill appears to be high and side effect levels low; however, the hormonal. balance of this pill is estrogenic. Antiestrogenic oral contraceptives are associated with a lower incidence of metabolic changes and serious complications, and so the future of this method is questionable. Pill for men Experiments with several non-hormonal drugs used to prevent sperm production have not yet been very fruitful. Vaccinations When the body is “invaded” by a toxic chemical or disease organism (e.g. bacteria) white blood cells and specialized blood serum chemicals attack the invader. In the course of the subsequent biological battle, the body’s defences become specialized ‘against the particular invading chemical or organism. This specialization process, called the development of immunity, is highly complex and hardly understood. If the same chemical or organism attacks again, specialized “‘antibodies” carried by the blood serum, destroy the invader without exhibiting disease symptoms. It may be possible to immunize (“vaccinate’’) a woman against a particular man’s sperm. Sperm cells are actually invading bodies; however, they are not normally attacked within the female body since they do not, under normal circumstances, induce immunization. If a woman could be immunized against sperm, antibodies would attack and destroy sperm cells when they enter the Fallopian tubes. Not all antibodies are maintained for the whole life of the organism. For example, smallpox antibodies “wear out” in a few years, and booster shots are needed to redevelop immunity. Vaccination against sperm need not be permanent, and various techniques could be used to determine when re-lmmunization is necessary. If the vaccination method can be perfected, it would be preferable to hormonal contraception. sterilization Sterilization, a surgical procedure for the permanent prevention of conception, is usually advised in the following situations: when another pregnancy could endanger a woman’s life or health: when the parents have already produced a child with an inherited nervous or physical disease, such as hemophi- lia; where physical, mental or emotional factors prevent the couple from caring for the child pro- perly; when a couple considers their family complete and wishes absolute protection from further pre- gnancy. Hospital policy varies on this question, however age of the woman is usually a decisive factor. female sterilization There are four possible surgical methods to sterilize a woman. An oophorectomy, the removal of the ovaries, is never done because of the importance of the chemical hormones they produce. Hysterectomy, or removal of the uterus is of course a complete barrier to pregnancy but is advised only if the uterus itself is diseased. The ovaries themselves are generally left in place in the younger woman. Many doctors disapprove of hysterectomy as a sterilizing procedure on two grounds: it involves major abdominal surgery with all the implications therein, and the early loss of the uterus can have bad psychological effects. In general, unless diseased, the complete removal of the Fallopian tubes, called a salpingectomy, has been given up in favor of a more simple technique, commonly known as “tying the tubes’’. The most common method of sterilization, tubal ligation, which involves tying off the Fallopian tubes, effectively prevents the egg from reaching the uterus, and the sperm from travelling into the tube. Through a small incision on the abdominal wall the tubes are brought into view, are cut and the ends tied. The operation may be performed within twelve hours after normal delivery, when the uterus is enlarged and therefore the tubes are easily reached. After caesarean section the operation is done immediately after repairing the uterine incision. In both cases the procedure hardly lengthens the hospital stay. When a woman has not been pregnant for several months, an interval sterilization may be performed abdominally, as discussed above, or by making an incision in the vagina through which either a tubal ligation or hysterectomy can be done. Tubal ligation is a highly successful operation with a failure rate of about one in 250 (somewhat higher when done after caesarean section). Less than 50% of the attempts at reversibility have been successful. Until improved methods allow for greater reversibility, the operation must be considered permanent. Male Sterilization Sterilization may be performed on the male in two ways. Castration, removal of both testicles, is never done on normal individuals because it produces impotence and eliminates sexual desire, as well as affects secondary masculine traits. It is considered only in the case of serious diseases such as cancer or tuberculosis. The most common method of male sterilization, an operation known as a vasectomy, has no effects on a man's sexual desire or virility, except perhaps to enhance it by relieving him from fears of having another child. The operation involves severing the vas deferens thereby preventing the passage of sperm from the testicles to the penis. Since the contribution of the testes accounts for only: about 1/10 of the volume of the total ejaculate, the actual quantity of seminal fluid is not appreciably diminished. A small incision is made in the upper and lateral region of the scrotum, directly over the spermatic cord. The cord itself is cut and the vas deferens is separated from the blood vessels and nerves. Two ligatures are put a small distance apart around the vas deferens and the portion between them is cut out. The incision is closed with sutures and a temporary dressing applied. The entire operation done either in a hospital or doctor’s office takes approximately 20 minutes. Men are sometimes advised tO wear a suspensory for a few days to hold the testicles up so that traction on the wound is not painful. Male sterilization cannot be depended on for contraception for the first three weeks after vasectomy, during which time sperm produced before the operation may still be present in the semen. After this time a semen specimen is examined under a microscope to check for the complete absence of sperm. In about 1% of the cases the severed ends of the vas deferens grow together and continue to transport sperm. Therefore it is advisable to have a semen specimen examined about every six weeks for the first six months after which such precautions are no longer necessary. Attempts to restore fertility after a vasectomy have been successful in only about 50% of cases. Reversible methods are being sought such as use of a silicon injection which hardens to form a removable plug. Sterilization operations were performed by Nazi doctors n Jews in World War Il. Today, the United States legal system manages to sterilize “welfare mothers” (usually black people) who have had illegitimate children. In Delaware a Senate committee recommended that welfare mothers with 2 or more illegitimate children should be sterilized. In New York, judges offer women the choice - either be sterilized or receive no more welfare. Like the IUD, sterilization is used more extensively in Third World nations. Since male vasectomy is a quick, simple operation, it is considered invaluable in the con- trol of Third World populations. In India where vasectomies are performed in train stations, 5,500,000 have been ‘voluntarily sterilized’’. Pakistan is initiating a program to sterilize 50,000 men a month. �abortion There are only 4 safe medical abortion procedures. The first two, dilatation and curettage (D. & C), and vacuum curettage are used until the 12th or 13th week of pregnancy; after this time either the saline technique or hysterotomy, both of which require a hospital stay, must be used. Dilatation and Curettage Before beginning a D. & C. the doctor (or paramedical specialist) conducts an internal examination to verify the pregnancy and check the angle of the uterus. A speculum holds the walls of the vagina apart throughout the operation. A uterine sound is passed through the cervical canal into the uterus to ensure that the canal is not blocked and to estimate the measurements of the uterus. A local anesthetic is sufficient to block pain occurring during the operation. The most commonly used form, the paracervical block is also used frequently during childbirth. The chemical (xylocaine or carbocaine) is delivered by injection at the back of the vagina behind the cervix. The injection itself is not painful. Nerves leading from the cervix are numbed by the anesthetic, and sensation from the uterus and especially the cervix is “blocked before it reaches the spine. Since a local anesthetic does not affect other body functions, the woman should eat normally before the operation to avoid fainting. The cervical canal must be dilated (widened) to permit the introduction of surgical instruments. This can be done in a number of ways. In the traditional method, the doctor passes a series of increasingly larger polished metal rods (Hegar’s dilators) into the cervical opening. The first is about the width of a thin soda straw, and the last is about the width of a finger. The cervical tissue stretches more easily in women who have had children. A]though the anesthetic blocks severe pain during cervical dilation, women sometimes feel cramps similar to menstrual cramps. Dilation of the cervical canal can also be accomplished by an instrument with two rounded tips which are inserted into the canal; by applying pressure to the handle. the tips separate, causing the tissue to stretch. This expansion technique takes only several seconds but occasionally it is more uncomfortable than Hegar’s dilation. Once the canal is dilated the doctor inserts a curette (surgical instrument with spoon-like tip) into the cavity of the uterus to scrape loose the embryo and placenta. Loosened portions of embryonic material are removed from the uterus with a long surgical grasping instrument called an ovum forceps. The entire operation takes about 10 to 15 minutes. Vacuum curettage. This modern method of abortion, also called uterine aspiration, was first developed in China. It is quickly replacing the D. & C. as standard procedure since it 1s quicker, involves less blood loss, less risk of uterine perforation, and requires less anesthetic. Preparation for vacuum aspiration is exactly the same as that for a D. & C., including the internal examination, paracervical block, and cervical dilation. Some doctors prefer to dilate the cervix with a ‘‘vibrodilator which attaches to some vacuum operating units. Vibration of a soft metal cone held in the cervical canal dilates the canal almost instantly to an exact size; however, many doctors continue to use one of the older methods of dilation since the vibrodilator makes a loud noise which can be upsetting to the patient. Once the canal is dilated, the doctor inserts a hollow tube called the vacurette into the uterus until it touches the amniotic sac. The vacurette is connected by transparent plastic tubing to a collection bottle. The vacuum pressure is turned on for 20 to 40 seconds, and the doctor observes the passage of fetal and placental tissue into the collection bottle. When the uterus is emptied, the doctor feels a slight tug on the vacurette. In order to ensure that no placental tissue is left in the uterus, the doctor goes over the uterine lining with a curette as in a D. & C. This is especially important In pregnancies close to the 12 week limit, and when the uterus is positioned abnormally. Operating unit for vacuum curettage. �are carefully repaired. Some doctors insist on delivery by caesarean section for all pregnancies after a hysterotomy, since the uterine wound can rupture due to labor contractions. Hysterotomy is quickly being replaced by the simpler “salting out’’ method. Prostaglandins Prostaglandins are a group of chemically related fatty acids found in human seminal fluid. The use of certain prostaglandins to terminate pregnancy is still in experimental stages. The drug is delivered intravenously for up to 24 hours. Since prostaglandins stimulate smooth muscle tissue, uterine contractions begin and eventually expel the fetus and placenta. This technique seems promising, especially after the 12th week, and may eventually replace the saline abortion technique. Women should not confuse this technique with offers from unscrupulous ‘‘abortionists’” for injections to induce abortion. At the moment no such injection or pill exists. Recuperation from vacuum curettage is almost immediate. Some women want to lie down for a few minutes, others have cramps similar to menstrual cramps, and still others feel perfectly normal. Women who get up from the operating table too quickly sometimes faint. A woman will have menstrual-like bleeding for a day to a week after an abortion. She may se either pads or tampons, whichever she prefers. The first real menstrual flow begins 3 to 6 weeks after the abortion. Since it is difficult to tell exactly when she becomes fertile again, a woman must consider herself subject to another pregnancy immediately, and begin to use some form of birth control. A woman who wishes to go on the Pill should consult a gynecologist and obtain a prescription before the operation. She may take the first pill of a series within 5 days after the abortion: otherwise, she must wait until her next menstrual flow. A woman must not douche after an abortion. The cervix remains slightly dilated and a douche can force fluid into the uterine cavity. Other than the restriction on douching, there is nothing that a woman cannot do after an abortion. Some women wish to rest for an hour or two: others go about their everyday business without interruption. There is no restriction on sexual intercourse so long as proper birth control measures are taken. some doctors automatically prescribe anti biotics such as penicillin after an abortion: others who do not believe in such prophylactic treatment give antibiotics only if a woman shows signs of infection, since it is more difficult to cure infection which develops despite antibiotics. Fever and pain in the pelvic area are symptoms of infection. Infection after a properly performed abortion is fairly simple to cure; however, it is serious. If fever, pain, or uncontrollable bleeding occurs after an abortion, a woman must see a doctor or go to a hospital emergency clinic immediately. Intra-amniotic hypertonic saline (“salting-out"’) This method of inducing miscarriage, used after the fourteenth week of pregnancy, requires a hospital stay of several days. A small area of skin a few inches below the navel is locally anesthetized. A long needle is inserted through the abdominal wall and into the uterine cavity. Several ounces of amniotic fluid are withdrawn and replaced with an equal quantity of a strong saline (salt) or glucose (sugar) solution. This solution kills the fetus and prevents the release of placental hormones. Within 24 to 48 hours the woman goes into labor and miscarries. Hysterotomy (miniature caesarean section) Hysterotomy involves major surgery with a hospital stay of about one week. An incision is made in the abdominal wall just above the pubic bone. A second incision is made in the uterine wall, and the fetus and placenta are removed. Both incisions Availability of abortion Archaic and oppressive laws continue to prevent all but rich women in North America from obtaining abortions on demand. Nevertheless, there are several radical and liberal groups who have taken on the responsibility of finding legal or illegal abortions for all women. Usually these groups have three options: helping women through the red tape and humiliation of applying to a hospital board; finding qualified illegal abortionists; and arranging the abortion in a state where legal process is simple. Such groups concentrate their energies in different areas, depending on their political perspective, and on the particular abortion situation in their community. Referral through the Women’s Liberation Movement is probably the quickest and least traumatic. Radical or community clinics and the occasional student health service are also quite cooperative. The Clergymen’s Council on Abortion and family planning agencies vary greatly in each community: in some places these groups do referrals but in others they have not gotten past talking about it. DANGER There are only 4 methods of abortion which can be Fluids inserted into uterus: considered safe. Competent, medically trained * Soap suds * Alcohol abortionists, whether they are acting legally or not, never use methods described below. These methods * Potassium Permanganate * Lye involve extreme pain and can lead to permanent * Lysol disability, infection, or death : * Pine Oil Severe burning of tissues - haemorrage - shock - death Oral Means: * Ergot compounds - overdose is, poison - can cause Air pumped into uterus: Collapse from gas emboli in the blood stream. fatal kidney damage Sudden violent death. * Quinine Sulphate - can cause deformities in fetus or death to mother Injections into Uterine Wall: . * (Estrogen - useless) * Ergot * (Castor oil - useless) * Pitocin Nothing that is swallowed can cause abortion without * Sodium Pentothal also causing death or severe disability to the mother Other Means: Vacuum Cleaner - connected to uterus - not to be confused Solids inserted into uterus with vacuum aspiration - is fatal almost immediately extracts uterus from pelvic cavity. * Physical exertion such as lifting heavy objects, running * Knitting Needles *Catheters etc is useless. *Coat Hangers *Gauze (packing) * Falling down stairs - severe injury to mother but no *Slippery Elm Bark *Artists Paintbrushes abortion. *Chopsticks * *Curtain Rods Butcher abortions are deadly - only doctors or other *Ballpoint Pen *Telephone Wire *Pastes specially trained personnel can safely use one of the 4 methods of abortion - all other methods can cause death but rarely induce abortion If you have used on yourself or have allowed to be used,.any of the above methods of abortion go to the Common danger of perforation of womb and blad- nearest hospital immediately. der - death from infection or haemorrhage. �The new Canadian abortion law has been in effect for over a year, but the availability of abortion goes unchanged. The law only legitimizes the few abortions which hospitals have been permitting all along. In effect, the law allows for abortion if a continued pregnancy would threaten the life or health of the women. “Life or health” is defined by a board of three doctors, all of whom are usually male. The interpretation of the law to justify abortions which male doctors consider. justifiable and to prevent those of which they disapprove borders on absurdity. For example, the law does not permit abortion for possible fetal malformations. Nevertheless. many doctors believe that a woman who is exposed to German measles during the. early months of pregnancy should be aborted, since her baby is likely to be born deformed. The formal reason given tor such an abortion is ‘possible or existing anxiety to the woman due to potential fetal abnormalities” . Yet the same. doctors refuse to grant abortions to women who simply do not want a child be the reason social, economic, physical, emotional. or political. The Canadian law requires approval of a three member hospital board on each abortion case: bu the law does not demand that every accredited hospital establish such a board. Also, by law the procedure must be performed in a hospital: up to the third month this is medically’ unnecessary, and serves only to put the cost of abortion beyond the means of many women The doctors who send desperate women away without granting a legal abortion seem to have no qualms about treating these same women in the emergency clinic for the results of self-induced or butcher abortions. Some of these women die, others are permanently sterile, and many. undergo experiences too brutal and horrifying to be believed. The situation.in the United States is not much better. In the majority of states, abortion is legal if pregnancy threatens the life of the. mother. Twelve states (Colorado, California, Georgia, Maryland, New Mexico, North: Carolina, Arkansas, Kansas. Oregon, Wisconsin, Hawaii and New York) have liberalized their laws to a certain degree. The first five require the approval of a hospital board. Some always include a residency requirement whereas others demand it only in cases of rape or incest (since crimes have to be proven according to state law). The New York law, passed by only one vote, is considered the most liberal of American abortion laws. The existence of such laws does not make it easy to obtain an abortion in these states. Where hospital boards exist, there is a strong conservatism maintained to prevent the hospital from acquiring a reputation “as an “easy” place to get an abortion. Doctors who are intimidated. by their superiors hesitate even to bring a case to the board. In New York, where the law does not demand hospitalization, many county medical boards have come out against office procedures for obvious financial reasons. (Costs which vary from $100 to $400 for the abortion itself are increased to $600 to $800 by hospital char Statistics Statistics for illegal abortion are developed on the basis of population, hospital records, total number of births, death from post-abortive complications, questionnaires etc. Some of the most carefully developed and most widely accepted figures are listed below. Statistics for legal abortion, such as performed in Communist countries and in Japan are from hospital records. General: In the world: at least 30,000,000 abortions every year. At least 4/5 of all abortions are performed on married women. Canada: At least 100,000 illegal abortions every year. At least 20,000 admissions to hospital for post abortive complications - at least 1,000 of these cases result in severe disability or death. United States: At least 1,000,000 illegal abortions every year. Four out of five legal abortions are performed on private patients, not clinic patients. Nine out of ten legal abortions are performed on whites, not Blacks. Where abortion is legal: Bulgaria: between 1962 and 1964, 67,000 legal abortions without a single death. Czechoslovakia: between 1962 and 1964, 140,000 legal abortions without a single death. Hungary: between 1962 and 1964, 358,000 legal abortions with 2 deaths. Japan: 1,500,000 legal abortions every year performed by more than 20,000 specially licensed technicians. ges). These boards have also recommended an earlier cut-off point than is provided in the law after which abortions will not be performed. Due to the shortage of adequate medical facilities in New York, the backlog for abortion has become critical. Many women are forced to wait until they are more than 3 months pregnant, and therefore must undergo the more complicated and expensive procedures for advanced pregnancies. None of these problems is accidental, nor can we expect them to be solved without a radical restructuring of the entire medical profession, indeed, of the whole society. The number of doctors trained each year is controlled by the American Medical Association; thus a shortage of doctors maintains the high income of the members of the profession. Para-medical staff who could easily be trained to do abortions and many other routine medical procedures would tend to demystify the godlike image of the doctor. To date, there is no program for the training of para-medical staff in the numbers required to meet the needs of the people. The prohibitive costs of all medical procedures determine the quality and amount of medical attention a person will receive, regardless of that person’s needs. The emphasis on curative rather than pr ventative medicine ensures business for the medical profession but does little to improve the quality of life for all people. Abortion as a medical problem is complicated by the chauvinism expressed and perpetuated by the medical profession. So long as male doctors see women as breeders with no other useful function within society, women will continue to be denied control of their own bodies. The fact that a husband or parent (depending on the woman’s age and marital status) must grant permission for abortion and many other medical procedures is merely a reflection of the ownership of women’s minds and bodies by men. Poor women, especially black women, suffer the worst humiliation at the hands of male doctors and their hospital boards. These woman are commonly ‘offered’ abortion with the stipulation that they must accept sterilization as well. The rationale that such measures are necessary to alleviate the population crisis is merely a cover for racist genocide. The children of the rich exploit and pollute the resources of the earth, not the children of the poor. The struggle for justice on the abortion issue will not be complete until abortion becomes just another medical procedure available free to all women whenever necessary. venereal qisease Syphilis Syphilis, the most dangerous form of venereal disease, is an acutely infectious disease, invading every system of the body. If treated it can be cured; if not, it can be disabling and fatal. The treponema pallidum is a spirochaete (coil-shaped organism) which initiates the syphilitic condition. It is extremely sensitive to drying, heat, mild antiseptics, and soap and water. Moisture is essential to its survival and therefore it flourishes in areas such as the mouth, genitals and anus. SYPHILIS IS ONLY TRANSMITTED THROUGH INTIMATE SEXUAL OR PHYSICAL CONTACT. SYPHILIS IS VERY RARELY TRANSMITTED BY OBJECTS SUCH AS TOILETS, TOWELS, CUPS, CUTLERY, ETC. Symptoms The primary stage of syphilis usually shows itself about three weeks after exposure to infection; however a range of up to 90 days is recognized. It is characterized by a chancre or sore on either the genital organs, the anus, or in some women on the cervix. The treponemes penetrate microscopic breaks in the skin. The sore develops where white blood corpuscles pack the infected areas so tightly that by cutting off the blood supply, they kill the local tissue. Chancres which appear in the mouth are usually acquired by kissing a person with secondary sores. The sore is neither painful nor itchy, and often goes unnoticed. It may disappear after several days whether or not the disease is treated. The early disappearance of such sores deludes many infected individuals about the serious nature of their condition. A person with primary syphilis, is highly infectious to other people. If untreated, syphilis progresses to its second stage. The numerous symptoms of this stage often imitate those of other common diseases, and therefore they are often misinterpreted or unnoticed. They include: sores in the mouth; sore throat; skin rash: enlarged glands, particularly about the genitals; swollen joints; fever; headache; pain in bones and joints; and patchy balding. If left untreated, secondary symptoms tend to come and go for about four years. As in the primary stage, the disappearance of such symptoms is no indication of cure, and the individual is still highly infectious. If the patient is not treated, the disease enters a latent (hidden) state giving no visible symptoms of its presence. During the early part of this stage the patient may suffer an infectious relapse with the reappearance of sore and rash. However, the latent state may last anywhere from five to fifty years. As the disease progresses, the patient loses his infectiousness to others as the disease “‘goes underground . �related information Late syphilis, the fourth stage may manifest itself in any body system, however the cardio-vascular and nervous systems are the most common targets. Syphilis attacks the heart in many ways: the treponemes destroy the elastic fibers of the wall of the aorta causing aneurysms (stretched sacs) to develop: the valve between the left ventricle and the aorta may be destroyed, causing the heart to enlarge in muscle power and capacity to compensate for its inefficiency; and inflammation of the mouths of the coronary arteries can diminish the blood supply to the heart muscles. Any one of these conditions may prove fatal. Syphilis of the nervous system also takes one of many forms: when the coverings of the brain and the blood vessels are involved, paralysis may develop in varying degrees, from one eye muscle to half the body. If the substance of the brain or spinal cord is involved, a type of paralysis of the legs called tabes dorsalis may develop with complications such as impotence and urinary difficulties. When the effects of syphilis are concentrated on the brain substance, general paralysis of the insane may follow. Symptoms may develop slowly or suddenly, and may lead to extreme mental and physical deterioration, and death. Blood donors are always tested for venereal disease. Diagnosis Diagnosis of syphilis is a very difficult process. The treponema pallidum do not lend themselves to staining for microscopic observation, nor can they be grown on a biochemical media in the laboratory. At the primary stage of syphilis, the blood tests are negative, that is, they show a normal condition. For these reasons knowledge of the social background (whether or not the individual has engaged in casual sexual relations with someone who is likely to be or possibly may be infected, and whether or not there is a family history of the disease) is of utmost importance to the doctor. If the primary sores are still present, fluid from them may be examined by special microscopic techniques, in order to establish a diagnosis. During the second stage, blood tests designed to determine whether a person has developed reactions characteristic of the disease, become more effective. However one negative blood test is not enough assurance that the individual is not infected. A second should be taken within a few weeks whether or not any symptoms remain. Microscopic examination of fluid from swollen glands may yield some information also. During latency, only repeated positive blood tests will confirm the disease. Infection may be masked (resulting in a negative test) if the person is undergoing anti-biotic treatment for some other reason. A second test is always necessary. In the fourth stage, both tests of blood and cerebrospinai fluid and microscopic examination of tumor tissue are effective. Syphilis may be contracted congenitally (from birth). For this reason all pregnant women are tested for syphilis. If treated early in pregnancy, the mother can be cured and the baby will be born normal. Otherwise, the baby may be born dead or diseased. Much depends on the extent of the mother’s infection. Gonorrhea Gonorrhea is essentially a disease of the linings of the genito-urinary organs. The gonococcus organism spreads immediately below the surface of these linings. It is highly sensitive to drying, change in temperature, and weak antiseptics. Like syphilis, GONORRHEA IS TRANSMITTED THROUGH INTIMATE SEXUAL CONTACT. IN ADULTS IT IS NOT TRANSMITTED BY CLOTHING, TOWELS, TOILETS, ETC. On the other hand, the eyes of newborn babies and the immature sexual organs of small girls are terribly susceptible. Gonorrhea can spread through a nursery faster than measles. Treatment Treatment for all stages of syphilis involves an injection of various dosages of penicillin. Sometimes a single injection is sufficient: however a series of two injections may be advised. It is important that the treatment be followed by at least two negative blood tests in order to make sure that the treatment is complete. THE EARLY STAGES OF SYPHILIS CAN BE COMPLETELY CURED. Even in late syphilis, the destructive processes can be stopped, and some improvement may be made in the individual’s condition. Free clinics for the treatment of venereal disease are maintained in all cities in Canada. It is important that people cooperate with the medical staff in naming sexual contacts if necessary. Strict confidence is usually maintained. SYPHILIS IS A HIGHLY INFECTIOUS, DANGEROUS DISEASE. IT IS IMPORTANT THAT ALL SEXUAL CONTACTS OF AN INFECTIOUS INDIVIDUAL BE REACHED FOR MEDICAL ASSISTANCE. Female Symptoms The incubation period (time after contact until the disease can be detected) for gonorrhea is from two days to three weeks. In women, the urethra and cervical canal are first infected. Most women are unaware of these symptoms, however some experience discomfort when urinating or have a slight vaginal discharge. If the woman is not treated, various complications may arise. The glands in the genital area may become very swollen and painful. The infection may spread up the urethra to the bladder causing cystitis, a condition where urination becomes more frequent and painful. Inflammation of the rectum, called proctitis, is not uncommon. The most serious complication however, is inflammation of the Fallopian tubes, called salpingitis. In the acute form, the woman may have no prior symptoms before becoming acutely ill with low abdominal pain on one or both sides, perhaps vomiting and fever. Subacute forms involve similar but milder attacks over several months. Menstruation may be erratic in length of cycle and amount of flow. If not treated a chronic state develops in which the Fallopian tubes become twisted with scar tissue. If both tubes are affected, complete sterility may result. Male Symptoms The symptoms of gonorrhea in the male are more annoyingly obvious. At first a burning sensation may be felt when urinating, and then a discharge of yellow pus from the urethra is noticed. This discharge is highly infectious, and bacteria may be carelessly transferred to the eyes. If untreated, the infection spreads to the bladder causing cystitis, to the semlnal vesicles, or to the epididymis. (Refer to male anatomy). Infection of the epididymis can be very serious, Causing a hard tender swelling in the scrotum. When healing takes places, the scar tissue may block the passage of sperm from the testicles, rendering the man sterile. In both male and female, the gonococci may reach the blood stream and cause a form of arthritis or inflammation of the joints. Babies born to women with gonorrhea may develop serious eye infections. In past, such infection was a common cause of child blindness. Therefore as a preventive measure, the eyes of every new born baby are treated with silver nitrate solution or penicillin drops. Early therapy saves the child’s eyesight. Diagnosis Gonorrhea can be diagnosed in three ways: microscopic examination of discharge from potentially infected organs; use of laboratory cultures of the bacteria taken from a discharge; and a blood test. It is important that more than one test be taken whether or not the first has been negative. Blood tests for gonorrhea are almost useless: however the more accurate blood test for syphilis is often given at the same time in case the patient may be infected with: both diseases at once. Treatment Treatment of gonorrhea usually involves one or two injections of penicillin. The dosage of penicillin has increased over the years as various strains of the bacteria develop a level of resistance to the drug. An example of this, a strain of gonorrhea called Vietnam Rose, has developed this resistance when prostitutes near military bases attempt to protect themselves from the disease by taking low doses of antibiotics. These drugs may not be strong enough to kill the bacteria, and an environment is provided in which the bacteria can adapt to varying levels of chemical presences. Different antibiotics are constantly being tested and tried to keep in check this ancient scourge of mankind. VD is just a disease. If you need treatment, go to a doctor. You have the right to proper medical atten- tion, for syphilis, gonorrhea, or any other health problem. bibliography The following is a highly selected bibliography of recent medical articles. For a complete list of scientific articles and publications referred to by this publication, please contact the editors. Abstracts of all medical articles included in complete list is available to groups doing research on the Pill or IUD. General books & publications Breen, J. L. ‘‘Venereal Disease”, Symposium of Sex Education of the College Student, Florida 1966. Calderone, M. S. ed., Manual of Contraceptive Practice, a The Williams & Wilkins Co., Baltimore, 1964. Charbonneau, H. & Mongeau, S., Naissance Planifiees, Les Editions du Jour, Ottawa; 1966. Eastman, N. & Hellman, L., William’s Obstetrics, Appleton Century Crofts, N.Y., 1966. Green, T. H., Gynecology: Essentials of Clinical Practice, Little, Brown & Co., Boston 1965. Greenblatt, B. R. A Doctor’s Marital Guide for Patients. Budlong Press Co., Chicago, 1964. Guttmacher, A., Birth Control and Love, MacMillan Co., revised 1969. Guttmacher, A., Pregnancy and Birth, Signer Books, N.Y. revised 1962. Havemann, E. Birth Control, Time-Life Books, N.Y. 1967. King, A. & Nicol, E., Venereal Disease, Cassell, London, 1964. Kinsey, A. C. et al. eds., Sexual Behavior in the Human Female, Pocket Books of Simon & Shuster, Inc. N.Y. 1953. Kistner, R., The Pill, Delacorte Press, N.Y 1968. Kleinman, R. ed., Medical Handbook, International Planned Parenthood Fed., London 1968. Lowe, D. Abortion and the Law, Simon and Shuster, N.Y., 1966. Masters, W. H., & Johnson, V. E., Human Sexual Response, Little, Brown & Co., Boston 1966. Mongeau, S., Cours de Sexologie, Editions du Jour, Ottawa 1968, vols. I-IV. Morton, R. S., Venereal Disease, Penguin Books, Great Britain, 1966. Neubardt, S., A Concept of Contraception, Trident Press, N.Y. 1967. Potts, M. ed., A Guide to the Abortion Act 1967, Alra Inc. London 1968. Stone, A. & Himes, N., (revised by Rovinsky, J.) Planned Parenthood, Collier Books, N.Y. 1960. Swartz, D.P. & Vande Wiele, R. L., Methods of Conception Control, Ortho Pharmaceutical Corp., N.J. 1966. Williams, H., The Pill in New Perspective - Pregnant or Dead? New Perspectives Publications, San Francisco, 1969. Wood, C.; Sex and Fertility, Thames & Hudson, London, 1969 Abortion Buckle, A., Anderson, M., & Loung, K., “Vacuum Aspiration of the Uterus in Therapeutic Abortion’, Brit. Med. J., 2:456, 1970. Cisler, Lucinda, “Abortion Reform: The New Tokenism’’, Ramparts, vol. 9. no. 2, Aug. 1970. Eaton, C. J. “Uterine Aspiration for Evacuation of the Pregnant Uterus’, JAMA 207:1887, 1969. Embrey, M., Induction of Abortion by Prostaglandins EK] and Brit. Med. J., 2:258, 1970. Ingram, J. “Changing Aspects of Abortion Law’, Am. J. Obst. & Gynec., 101:35, 1970. �Population control and genocide Ridgeway, J., ““Anti-Personnel Bomb’’. Hard Times, no. 37. June 23, 1969. Weissman, S., “Why the population bomb is a Rockefeller: baby’. Ramparts, vol. 8, no. 11, May 1970. Oral contraceptives Abraham, G.E., et. al., “Effect of a combination of norethyhodrel and mestranol on plasma luteinizing hormone in hormal women’’. Am. J. Obstet. Gynec., 104:1038, 1969. Ambrus, J.L., ““Progestational agents and blood coagulation’’, Am.J. Obstet. Gynec., 103:994, 1969. Atkinson, E.A., et al., “Intracranial: venous thrombosis as complication of oral contraception’. Lancet, 1:914, 1970. Baumblatt, M.J. and Winston, F., “Pyridoxine and the Pill”. Lancet, 1:832, 1970. Bowman, J.A., “The effect of norethindrone-mestranol on rvical mucous’. Am. J. Obstet. Gynec., 102:1039, 1968. Brakman, P., et. al. “Effects of different systemic contraceptives on blood fibrinolysis’. Am. J. Obster. Gynec. 106:187, 1970. Carbia, E., et. al., ““Colposcopic study of the uterine cervix during administration of ethynodiol diacetate with mestranol’ Am. J. Obster. Gynec., 102:1023, 1968. Coburn, J., “Off the Pill?”. Ramparts, vol. 8, no. 12, June 1970. Connell, E.B. and Kelman, C.D., “Eye examinations in patients taking oral contraceptives’’. Fertil. Steril. 20:67, 1969. Daniel, G.R., “Chlormadinone contraceptive withdrawn’’. Bnt. Med. J., 1:303, 1970. Diczfalusy, E., “Mode of action of contraceptive drugs”. Am. J. Obstet. Gynec., 100:136, 1968. Dickey, R.P. and Dorr, C.H., “Oral contraceptives: selection of the proper pill’. Obstet. Gynec., 33:273, 1969. Diddle, A.W., et al., “Oral contraceptive medications and vulvovaginal candidiasis’. Obstet. Gynec., 34:373, 1967. Diddle, A.W., et. al., “Oral contraceptive medications and headache”’. Am. J. Obstet. Gynec., 105:507, 1969. Di Paola, G., et. al., “Estrogen therapy and glucose tolerance test”. Am. J. Obstet. Gynec., 107-124, 1970. Djerassi, C., “Prognosis for the development of new chemical birth-control agents’’, Science, 166:468, 1969. 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Melamed, M.R., et al., “Prevalence reates of uterine cervical carcinoma in situ for women using the diaphragm or contraceptive oral steroids’. Brit. Med. J., 3:195, 1969. “Metabolic effects of oral contraceptives”. Lancet, 2:783. 1969. Mishell dr., D.R., et al., “The effect of an oral contraceptive on thyroid function’’. Fertil. Steril., 20:335, 1969. Oakley, C. and Somerville, J., “Oral contraceptives and progressive pulmonary vascular disease’’. Lancet, 1:890, 1968. O'Leary, J.A. and Spellacy, W.N., “Zinc and copper levels in pregnant women and those taking oral contraceptives’. Am. J. Obstet. Gynec., 103:131, 1969. “Oral contraceptives and thromboembolism”. Lancet, 1:962. “Oral contraceptives and hypertension”. Brit. Med. J.. 2:378, 1970. “Oral contraceptives and alopecia’. Brit. Med. J., 1:593, 1968. “Oral contraceptives and depression”. Brit. Med. J., 4:380, 1969. Oral contraceptives and gestational diabetes’. Brit. Med. J., 1:190, 1970. “Oral contraceptives and thromboembolism”. Brit. Med. J., 2:187, 1968. “Oral contraceptives - choice of product”. Brit. Med. J.. 1:690, 1968. Paola, G., et. al., “Oral contraceptives and carbohydrate metabolism’’. An. J. Obstet. Gynec., 101:206, 1968. ‘Plasma proteins and oral contraceptives’’. ‘Lancet, 1:72. Poland, B.J., “Conception control and embryonic development’. Am. J. Obstet. Gynec., 106:365, 1970. Poller, L., et al., “Effects of low-dose oral contraceptives on blood coagulation’’. Brit. Med. J., 3:218, 1968. Potts, D.M., “Thromboembolism and the pill - new data’. PPE Med. Bull., vol 2, no. 4, p. 2, 1968. “Progesterone oral contraception and blood coagulation”. Brit. Med. J., 1:554, 1969. Report on the Oral Contraceptives, Advisory Committee on Obstetrics and Gynecology, FDA, 1966. Roland, M.., et al., “Sequential endometrial alterations during one cycle of treatment with synthetic progestagen-estrogen compounds’. Fertil. Steril., 17:338, 1966. Rose, D.P. and Braidman, .I.P., “Oral contraceptives, depression, and aminoacid metabolism’’. Lancet, 1:117, 1970 Schrogie, J.J., “Oral contraceptives: a status report’. FDA Papers, vol. 4, no. 4, 1970. Second Report on the Oral Contraceptives, Advisory Committee on Obstetrics and Gynecology, FDA, 1969. Shearman, R.P., “Investigation and treatment of amenorrhoea developing after treatment with oral contraceptives . Lancet, 1:325, 1968. Song, C.S., “Hormones and the liver’. The effect of estrogens, progestine, and pregnancy on hepatile function’. Am. J. Obstet. Gynec., 105:813, 1969. Song, J., et. al., “Endometrial changes in women recelving oral contraceptives”. Am. J. Obstet.” Gynec., 107:717, 1970. Spellacy, W.N., ‘“‘Glucose, insulin, and growth hormone stuides in long-term users of oral contraceptives’. Am. J. Obstet. Gynec. 106:173, 1970. Thompson, D.W., “Oral contraceptives and cervical! atypia: A plea for objective appraisal”. Canad. Med. Ass. J., 101: 285, 1969. Vessey, M.P. and Doll, R., “Investigation of relation between use of oral contraceptives and thromboembolic d1sease’’. Brit. Med. J., 2:199, 1968. Vessey, M.P. and Doll, R., “Investigation of relation between use of oral contraceptives and thromboembolic dlsease. A further report’’. Brit. Med. J., 2:651, 1969. Vessey, M.P. and Weatherall, J.A.C., “Venous thromboembolic disease and the use of oral contraceptives. A review of mortality statistics in England and Wales’. Lancet, 2:94, 1968. Vessey, M.P. et. al., ‘““Postoperative thromboembolism and the use of oral contraceptives’. Brit. Med. J., 3:123, 1970. Wynn, V. and Doar, J.W.H., “Some effects of oral contraceptives on carbohydrate metabolism’. Lancet, 2:761, 1969. Wynn, V., et al., “Fasting serum triglyceride, cholesterol, and lipoprotein levels during oral contraceptive therapy”’. Lancet, 2:756, 1969. Intrauterine Contraceptive Devices Davis, H. J. , “The shield intrauterine device’. Am. J. Obstet. Gynec., 106:455, 1970. Engineer, A. D. et al., ““Chemical composition of the deposit formed on the Lippes loop after prolonged use’’, Am. J. Obstet. Gynec., 106:315, 1970. Hall, R.E., “A four-year report on loop D”. Int. J. Fertil. 13:309, 1963. Hall, R.E., “A reappraisal of intrauterine contraceptive devices prompted by the delayed discovery of uterine perforations . Am. J. Obstet. Gynec., 99:808, 1967. Kar, A.B., et. al., “Effect of an intrauterine contraceptive device on biochemical composition of uterine fluid’. Am J. Obstet. Gynec., 101:966, 1968. Kar, A.B., rt. al., “Effect of an intrauterine contraceptiv devite on urea content of uterine fluid’. Am. J. .Obstet Gynic., 104:607, 1969. Mateos-Candano, M., et. al., “Comparative study on the use of the IUD in different socio-economic groups’. Am. J Obstet. Gynec., 99:291, 1967. Mishell, Jr., D.R. et. al., ‘““The intrauterine device: a bacterialogic study of the endometrial cavity’. Am. J. Obstet Gynec., 96:119, 1966. Morgenstern, L.L., et. al., “Observations on spermatozoa ‘n the human uterus and oviducts in the chronic presence of intrauterine devices’: Am. J. Obstet. Gynec., 96:114, 1966. Ping Yen Wei, “Occurence of ectopic pregnancy In women with IUDs and consideration of the contraceptive mechanism of the JUD’’. Am. J. Obstet. Gynec., 102:776, 1968. Sagiroglu, N. and Sagiroglu, E., “Biologic mode of action of the Lippes loop in intrauterine contraception’. Am. J. Obstet. Gynec., 106:506, 1970. Scott, R.B., “Critical illnesses and deaths associated with intrauterine devices’. Obstet. Gynec., 31:322, 1968. Serr, D.M., et al., “Electrical activity of the human uterus in the presence of intrauterine contraceptive device’. Obstet. Gynec. 35:216, 1970. Statham, R. and Morton, R.S., “Gonorrhoea and the intrauterine device’. Brit. Med. J., 4:623, 1968. Tietze, C., ““Contraception with intrauterine devices’. Am. J. Obstet. Gynec., 96:1043, 1966. Tietze C., and Lewit, 8S., (eds), Intra-Uterine Contraceptive Devices, Int. Congress Series no. 54, Excerpta Medica, 1962. Willson, Jr., et. al., “The effect of an intrauterine contraceptive device on the histologic pattern of the endometrium’’. Am. J. Obstet. Gynec., 93:803, 1965. Wynn, R.M., “Fine structural effects of intrauterine contraceptives on the human endometrium’. Fertil. Steril, 19:867, 1968. �� Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Other publications Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Original Format The type of object, such as painting, sculpture, paper, photo, and additional data Paper Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Birth Control Handbook: 4th edition (revised) Description An account of the resource The Birth Control Handbook was first published in 1968 as an initiative of the Students’ Society of McGill University to disseminate information about birth control, sexual education, and reproductive justice. At the time, publishing and distributing such information was illegal under Canadian anti-obscenity law. This is the 4th edition (revised), published in August 1970 after the 1969 Omnibus Bill was passed, legalizing birth control and decriminalizing abortion. Creator An entity primarily responsible for making the resource Donna Cherniak, Allan Feingold, and the Students’ Society of McGill University (SSMU) Publisher An entity responsible for making the resource available The Arts and Science Undergraduate Society of McGill University Date A point or period of time associated with an event in the lifecycle of the resource 1970 Format The file format, physical medium, or dimensions of the resource PDF birth control reproductive health reproductive justice sexual health https://d1y502jg6fpugt.cloudfront.net/62030/archive/files/52ac03182fc29c26fa820bda1eaa4224.pdf?Expires=1792022400&Signature=av2PulJYOhkhmXRayUI64PreOZCbRkCBY-HIhlIgOUIQVVe9y3BC87PCVQDxpmjEESb8hPmb925AHgBShmROOHWyL2hjhiwOgkNquQkNc%7E7L8Yutd%7ELRtoUbthHJE8mo989qYqUKH35svdhKx2c7kcgv5DrbHyuCl5A3id0aovMuZKLcmnjx9mwVrBmLM3ayvzgL0C8K0wmZWjTcM2O03EgtgR946LEfA6S4YPoGJ52kRzFs6WSeSzAZ1QBXO29Tr0NMQIPvQ3bhizPsUh2FqyNwx-RyZsvInnf16%7EP65%7EmaEUrIfAm7pduqDnY521Q8NeICSWmeOSRUn1P2lpWuGg__&Key-Pair-Id=K6UGZS9ZTDSZM 5b0f1ce848034deb394a0e8b5631bd76 PDF Text Text February 10, 2020 mcgilldaily.com | The McGill Daily features 11 Accessing Emergency Contraception An International Student’s Experience Anonymous content warning: mention of OCD and skin-picking disorder I n the span of 36 hours, I found out that my anti-anxiety medication had interfered with my hormonal birth control, that there was a possibility that I could be pregnant, and that I immediately needed to get a copper intrauterine device (IUD) inserted in my uterus in order to prevent pregnancy. To say that I was overwhelmed would be an understatement – nothing could have prepared me for the leaps and hurdles I would encounter while trying to get a copper IUD inserted in the next 36 hours with McGill international student health insurance offered with International Student Services (ISS). I write this guide hoping that no one else finds themselves in a similar situation without any knowledge of what to expect. (The $20 probiotics that I decided to buy were not prescribed by a doctor, and therefore not under the purview of Blue Cross.) A portion of this is reimbursable with Medavie Blue Cross international student insurance, but I had to pay the full amount up front. For many, I know this is not possible, and the fact that our health insurance is shit (more on that later) is unacceptable. How it started. Those who have been medicated for a mental illness understand the absolute shit show that is tapering off medications. Antidepressants, which I’d been on since the fall of 2019, never fully worked for me. Yes, they reduced the chance of me having an anxiety attack, but they never addressed the all-consuming compulsions that have characterized my OCD since I was in middle school (or my skin-peeled thumbs – another common characteristic of the illness). So, when my psychiatrist Nothing could have prepared me for the leaps and hurdles I would encounter while trying to get a copper IUD inserted in the next 36 hours with McGill international student health insurance offered with International Student Services (ISS). I was, and am, immensely privileged in that I had the funds necessary to pursue this route, as well as a good support network around me. Between the doctor consultation, the IUD itself, antibiotics, probiotics, and the gynecologist visit: it cost $435, $300 of which had to be provided in cash. in the United States prescribed me a mood stabilizer that she thought would improve my condition – without the side effects I dealt with on antidepressants – I was hopeful. I followed her instructions, lowering my dosage of the antidepressant fluvoxamine. I began taking the mood stabilizer IUD Receipt oxcarbazepine late Friday night. I took it again Saturday night. On Sunday morning, when I decided to search up the medication online, just for the heck of it, my heart fucking flipped – oxcarbazepine was known to interfere with hormonal birth control pills. For many reasons, the burden of preventing pregnancy usually falls on the person with a uterus in sexual relationships where semen is also involved. Yes, people with penises can wear condoms, but they aren’t completely foolproof. And while clinical trials for hormonal contraceptives made for people with penises are ongoing, they are not yet available to the public. So, many people with uteruses take on the responsibility of using a form of hormonal birth control, all of which come with numerous side effects. The pill can cause depression, migraines, and increase your risk of blood clotting (while the pill was in its early stages of development, the dosage of estrogen within the pills was much too high, and 11 people taking it died from blood clots). The implant can cause users to experience long-term bleeding; the shot can also cause long-term bleeding, as well as depression and nausea; and the IUD, though extremely effective, is fucking painful to insert. The best type of birth control for me had been the pill – I hadn’t experienced the worst of its side effects, and I was good at taking it on time every day. In the past, I had thought about getting a hormonal IUD but decided against it, as I was scared and uncomfortable at the thought of the insertion procedure. But once I found out that there was a possibility I could be pregnant, my comfort was the least of my worries. I was willing to sacrifice anything to ensure I wasn’t pregnant, and honestly, I’ve always been pretty open about the fact that I would definitely get an abortion if I found out I was. Making a next-day appointment. I spent that Sunday talking to pharmacists, first at the Jean Coutu on Parc Ave. at 8 a.m. to make sure there definitely was an interaction (there was), then calling the CVS back home to confirm at 9 a.m., and finally at the Jean Coutu on Saint Catherine Street West around 10 a.m. where I tried to buy Plan B. The pharmacist there recommended I didn’t buy an emergency contraceptive pill, and I think they were right to do so. I Phone records had had sex twice in the past seven days, once on the Monday prior, and once that Wednesday. Although I had been absolutely protected by the pill at that time, it was unclear if it would still protect me, given the fact I’d taken interfering medication twice in the past 48 hours, and that condoms are not always effective. To be completely sure I had not conceived, they recommended that I get the copper IUD. Some may not know that the copper IUD is the most effective method of emergency contraception out there, lowering one’s chances of getting pregnant by 99.9 per cent if inserted within five days of unprotected sex. While oral emergency contraceptives may be preferable due to their non-invasive nature, they only work well up to three or five days after unprotected sex, depending on whether you take the pill with levonorgestrel, also known as “Plan B,” “the morning after pill,” etc., or the one with ulipristal acetate, also known as “ella,” respectively. Meanwhile, a copper IUD can prevent pregnancy up to seven days after unprotected sex (though Planned Parenthood’s website says up to five days). However, a barrier against getting the copper IUD is that it’s more expensive than oral emergency contraceptives, which cost around $20-$30 (at least in Quebec) when your insurance doesn’t cover them. And it’s important to note that emergency oral contraceptives are not covered under ISS, while IUDs A barrier against getting the copper IUD is that it’s more expensive than oral emergency contraceptives, which cost around $20-$30 [...] when your insurance doesn’t cover them. �12 features February 10, 2020 mcgilldaily.com | The McGill Daily are – albeit only up to $50. Once I get reimbursed from Blue Cross, I will have, in effect, paid $35 for the IUD, as it cost $85 upfront, which is still more expensive than Plan B, but only by $5-$15. The copper IUD can then be used as contraception for up to five years, which can save you money in the long run – Blue Cross only covered 80 per cent of my roughly $25 monthly pack of pills. I was undoubtedly scared of getting an IUD. But the idea of being pregnant was scarier. Trying to find a place that could insert it on Monday, the next day, I made calls to at least 10 different clinics. I was on hold with 811, trying to talk to an Englishspeaking nurse, for more than 45 minutes. I spent almost an hour and a half in total on the phone, trying to find a clinic that could schedule me in for a same-day appointment. Initial Costs: octor consultation IUD insertion: $100 IUD: $85 nti iotics ro iotic otal cost u ront not an option – I had had sex the Monday night prior. Although the first place I called was full, I asked for a recommendation for another clinic offering same-day insertion, [Clinique Médicale MaisonneuveRosemont] – as well as many other clinics shown online through the Quebec government’s website – do not display a great deal of information regarding their services online, and callin the to con r what the offer is o ten necessar When I finally did get off hold and talk to a nurse at 811, they were actually pretty helpful. I was given a list of clinics nearby that offered same- or next-day copper IUD insertion, and I called one asking for an appointment on Monday morning. Tuesday was and I was able to schedule an appointment at Clinique Médicale Maisonneuve-Rosemont for Monday morning at 9 a.m. I could finally breathe. Clinique Médicale MaisonneuveRosemont is an interesting place. Located in a building with multiple Doctor’s Appointment Receipt medical offices and a Familiprix, the clinic takes requests for sameday and next-day appointments both online and via phone. Since I did not have a RAMQ (Quebec health insurance card), I could not register for a walk-in appointment online, but I was able to book an appointment by calling the front desk at 514-257-7000. This clinic – as well as many other clinics shown online through the Quebec government’s website – do not display a great deal of information regarding their services online, and calling them to confirm what they offer is often necessary. The clinics shown online via the Quebec government’s website are in French, and Google Translate is, of course, not always the best. I made do with Google and my (limited) French, but if there is someone you trust who knows French well, ask them for help. It will make the whole process so much easier. Other clinics I was recommended in Montreal include Clinique angus (they take calls for walkin appointments the next day beginning at 5 p.m., but if you’re an international student like me, call their regular number at 514807-2333); Clinique en route - gare centrale (the nurse informed me that they would take calls for walk-ins beginning at 7 a.m. on Monday, 514954-1444); and Clinique médicale des 2 tours (which you can call for a walk-in appointment the next day beginning at 6 p.m., 514-954-4444). The insertion procedure. I woke up early Monday morning, nerves racing in anticipation of the procedure (It was probably also a result of not having taken any medication for my anxiety the night before). Unmedicated and scared, my boyfriend drove me 25 minutes from the McGill area to the clinic, located near the Olympic stadium. We parked, he held my hand, and we found the clinic inside the medical complex. Like the receptionist had said, it was located at the end of the hallway, on the right – bureau 60. Reimbursements: octor consultation IUD insertion:$100 IUD: $50 nti iotics Probotic: $0 Cost post-reimbursement: I brought with me everything I could possibly think of needing – Advil, a water bottle, my passport and IDs, a printed out copy of my insurance card, my debit card, and $200. Because of the type of insurance I had, the receptionist told me on the phone earlier that I’d need to pay upfront in cash, and get reimbursed by Blue Cross later. I stumbled in at the front desk, speaking a mix of English and (extremely) limited French. Sitting with my boyfriend in the clinic, we waited about 10 minutes until a nurse called us in. I made calls to at least different clinics was on hold with 811, trying to talk to an English-speaking nurse, for more than inutes I spent almost an hour and a half in total on the hone This was probably the most confusing part – although the clinic says online that they offer services in both French and English, some who work there do not speak the latter. With the help of my boyfriend (who knows more French than I do), and another nurse, we were fortunately able to convey the reason I was there and the situation I was in, and they sent me to a different room in the clinic where we waited for a doctor. After relaying the days I had had sex and when I began oxcarbazepine, the doctor agreed that a copper IUD would work for me as emergency contraception. I was lucky, they said, because the gynecologist that performed insertions was in today. After giving me a prescription for the Mona Lisa copper IUD, a receipt for my insurance company, and a card displaying the location of the gynecologist’s office – just upstairs in the same medical complex – they sent me along to Familiprix to buy the contraceptive itself (which was about $85). This hadn’t been a part of my initial calculations, and when I used my Canadian debit card to pay for it, I couldn’t purchase it – most likely due to the daily purchase limit on my account. (So if you’re ever in my position, it’d be a good idea to check your account limits – I ended up needing to use my American card.) We took the elevator to the third floor, and I explained my situation, once again, to the receptionist. They had to confirm with the clinic downstairs, but after they did, they penciled me in for an appointment. It was a small room, filled with families waiting to see the doctor. About 30 minutes after I sat down, the gynecologist called me in. My boyfriend and I sat in the two chairs in front of their desk. The gynecologist unwrapped the box and explained the different parts of the IUD to me, telling me that before the procedure, I would have to be swabbed and tested for gonorrhea and chlamydia – apparently if you insert an IUD and have those STIs, it’s not good. I would also have to take antibiotics to treat gonorrhea and chlamydia, regardless of what the test results were, just in case. I felt lucky; the gynecologist said they’d never performed an insertion that resulted in infection, and that they’d done this procedure for awhile. Before I knew it, I was lying down on the table, my feet in stirrups, tightly squeezing my boyfriend’s hand. I’m not going to lie, it hurt pretty bad. Apparently if you’ve never �features given birth before it hurts more, and I certainly hadn’t. The worst moment was when they pinched my cervix, which is necessary in order to insert the IUD into my uterus. It felt like an instant, intense period cramp, and I was in pain. I’d told myself I’d try not to scream during the procedure, but it fucking hurt at that point. Because of the type of insurance I had, the receptionist told me on the phone earlier that I’d need to pay [$200] upfront in cash, and get reimbursed by Blue Cross later. Fortunately, it’s a pretty short procedure, all done in about two minutes (though it felt like forever in the moment). I lay on the bed for a minute or two, trying to gather my sense of self. A bit of blood had stained the bed I was laying on. I’ve always had low iron, and for the whole hour after the procedure, I felt extremely nauseous. I ended up sitting outside the office on the ground with my head between my knees while my boyfriend paid the appointment fee – $100 in cash. We then went back to Familiprix to fill a prescription – antibiotics for gonorrhea and chlamydia ($30), and, as my boyfriend recommended, we bought some probiotics ($20). That turned out to be a really good decision; the antibiotics absolutely destroyed my digestive system. I can’t tell you February 10, 2020 mcgilldaily.com | The McGill Daily 13 how much I shit the following days. I don’t want my story to make you think everyone will have a terrible experience getting an IUD. People’s bodies react in different ways; for some it’s easier, for some it’s more difficult. I’ve heard that some can even go back to work right afterwards. Needless to say, that was not the case for me. While my experience wasn’t completely terrible, it was more painful than I expected. I had to stay home for the next two days, and the cramps and shits got intense. I won’t go into detail, but I’m sure you can imagine. What helped me most was the probiotics, taking two Advil every eight hours, and a hot water bottle. If you don’t have one, take an old, clean sock and fill it with rice. Then heat it up in the microwave for 30 seconds; it will feel – and work – the same as the hot water bottle you buy at the pharmacy. The aftermath. I stopped spotting and experiencing cramps roughly a week after the procedure. I’m supposed to take a pregnancy test approximately two to three weeks after the IUD insertion to make sure I didn’t conceive. (If you don’t want to wait until your next scheduled period to take a pregnancy test, you can take one 7-14 days after having sex – but it may not be as accurate as if you wait until the week your period is supposed to start.) And in two months, I have an appointment back at the gynecologist for them to check up on my IUD. The cramps have subsided for the moment, but we’ll see how my first period with a copper IUD goes; many people using this form of birth control report heavy cramps and bleeding, as well as irregular periods. When I tried to have my expenses reimbursed, the Medavie Blue Cross office on McGill chlamydia antibiotics, they were each reimbursed by 80 per cent. Together, they cost approximately $30, and Blue Cross says they will pay $25 for it. All in all, Blue Cross will pay $280 out of the $415 total expenses (excluding the probiotics). According to VP Finance Samuel Haward, both he and the SSMU Mental Health Commissioner have met with the directors of ISS and Student Services to discuss the review of international student health insurance and negotiate a new plan with Blue Cross. Haward stated that student associations have little control over the plan, and that it is under the purview of Senate and Procurement Services. Fortunately, this review may be happening sooner rather than later – it is set to occur in 2020-2021. As international student Antibiotics Receipt insurance is set to be reviewed, College Avenue informed me that alternatives – one hormonal I implore both Senate and Services to they do reimbursements online intrauterine system (IUS) in Procurement and via their mobile app now – not in person. I used to be able to walk to their location next to Dormez-Vous on Sherbrooke and get my birth control prescriptions reimbursed there, but that location closed in November 2019. As it takes five to seven business days for the claim to be processed, I found out five days after I submitted my claim exactly how much I would be reimbursed. The approximately $415 in prescriptions and doctors visits that I submitted to Blue Cross, as I suspected, was not entirely reimbursable. While the visit to the gynecologist ($100) was Quebec costs around $325, consider the extensive barriers completely covered, the initial meaning that an international that international students face doctor consultation was not – I student who purchases one may under this current plan. Upfront especially unexpected paid $200 in cash for it, and Blue still have to pay around $275 for costs, Cross says they will cover $106.20 it after getting reimbursed – it ones paid in times of emergency, of it. As I mentioned earlier, for is still a barrier, and even more disproportionately affect lowerthe copper IUD itself, they only so if one wishes to purchase the income students. If someone who cover $50 in IUD purchases hormonal IUS. (And especially is in my position is not able to pay (meaning I will have paid $35 for considering the fact that these these costs, there is the possibility that they could become pregnant, it). While $35 for a copper IUD is costs had to be paid upfront.) As for the gonorrhea and and that is unacceptable. not as expensive as the hormonal I implore both Senate and Procurement Services to consider the extensive barriers that international students face under this current plan. Upfront costs, especially unexpected ones paid in times of emergency, dis ro ortionatel affect lower-income students. IUD Insertion Reciept � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coverage from The McGill Daily Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Original Format The type of object, such as painting, sculpture, paper, photo, and additional data Paper Volume 109 Issue 17 Page Number(s) 11-13 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Accessing Emergency Contraception Description An account of the resource A feature article describing an international student's experiencing accessing emergency contraception and dealing with McGill's international student health insurance. Creator An entity primarily responsible for making the resource Anonymous Publisher An entity responsible for making the resource available The McGill Daily Date A point or period of time associated with an event in the lifecycle of the resource 2020/02/10 Format The file format, physical medium, or dimensions of the resource PDF birth control reproductive health student health https://d1y502jg6fpugt.cloudfront.net/62030/archive/files/5c55bd21a8508480cdf75c14f8086d72.pdf?Expires=1792022400&Signature=OR3qDulHDFXLUCX85XR23aFQkG%7E92P77iMVbqlmEVDE8qr3ktEpp3gvBQOuRkM5qOENPnHOYvAGhAMgSo8xlvKbOS-IdwK4NH7kVLTeYABbE9tTPCeN23Evd3LnC9aF%7Eyd2dh4l-ggSsB1OmBCo1knbnLccNifmX9ILZIih3eXgqhc9Rf3p76jccD4f6ZrmsMQJk0VUuD1tLvB0euQGMMAufVlMrGU6fZ16jZrc%7EgZwLuF9t77w4qCUsW3k37Z7TjlIjghP1nLxM9UG9dLtfLcPiYLtgFtfas2pLZl%7EkkwJJehfBS921YEVMld6SixKA1PzK9cgbYnnjIaBjXuPNKg__&Key-Pair-Id=K6UGZS9ZTDSZM 4c09939b9a209edd2ad7335f6e598c96 PDF Text Text 14 Features The McGill Daily • Monday, March 17, 2008 15 “ Hormonal birth control is no longer an option, and never will be again in my life. – Laura McMahon, U3 Philosophy and English Ming Lin / The McGill Daily The new pill politics “A lesse made me stop wanting sex.” This is scrawled in black Sharpie on an advertisement for the popular brand of birth control, in a stall of a women’s washroom in Redpath Library. Simple and shocking, it hints at the contradictions that surround women’s attempts to control their fertility. Why does a drug that allows women to have sex without fear of pregnancy also potentially inhibit their desire to do so? Laura McMahon, a U3 Philosophy and English major, has a horror story about Alesse. She credits this pill with what she calls a “completely, all-consuming bout of depression” which lasted for an entire year of high school. “It never occurred to anyone – not my mom, my boyfriend, my friends, or even my therapist – that there was a link between my taking the Pill and my depression,” she says. The malaise temporarily ended McMahon’s relationship, caused problems with her friends, and left her feeling somehow inadequate. Only through a combination of travel, new circumstances, and, most significantly, using a different form of contraception, did McMahon manage to fight the depression and get back on her feet. Today, McMahon resolutely says that “[hormonal] birth control is no longer an option, and never will be again in my life.” Yet McMahon’s story, as well as that of the anonymous bathroom scribe, are just two among many. Birth control is intrinsically linked with the “free love” movement of the sixties, second-wave feminism, and women’s liberation. While some women rely on chemical or hormonal forms of birth control, such as the Pill or the patch, others rely primarily on barrier methods, namely condoms or diaphragms. Naomi Lightman examines the troubling past and alarming side effects of the contraceptive that changed the world Many women experience only positive benefits from hormonal forms of fertility control. However, a growing minority of women and men are now emphasizing the need for more vigorous debate surrounding the Pill’s safety, distribution, and efficacy. Underlying this is an understandable fear that criticism of the Pill necessarily labels one as anti-sex, anti-feminist, or paternalistic. But this concern only contributes to the lack of critical analysis and discussion. Birth control options must be located within their broader social and political context, where misogyny, heteronormism, and corporate interests often outweigh the needs of individual women. A troubling genesis “The Pill has a really deplorable history in terms of eugenics,” says Jocelyn Porter, who works as a Health Animator at Head and Hands, a not-for-profit organization in NDG that promotes the physical and mental wellbeing of youth. Porter emphasizes that birth control has been tested primarily on marginalized populations, who had very little control over the process. Significantly, most trials for contraception drugs were done in poor, “underdeveloped” nations in the global South. The Pill, for example, was tested most extensively on thousands of poor women in Puerto Rico in 1956 before it was approved for use in the United States in 1960. Norplant, a long-lasting birth control implant (which was discontinued in the U.S. and Canada in 2002) was tested on women in Chile in 1972. Depo-Provera, which uses trimonthly injections of progesterone, was tested for decades on Mexican and Thai women to establish whether it was acceptable for use by North Americans. Native American women, especially those with mental disabilities, were also used as test subjects by Depo-Provera. “Not only were impoverished women in developing nations used as guinea pigs, but if we look at where it’s been given out for free or for really cheap, it’s also tinged with racism,” says Porter, adding that sometimes injections of Norplant were tied to welfare benefits in poor, primarily black areas of the U.S. Margaret Sanger, founder of the American Birth Control League (which eventually became Planned Parenthood), is often considered the original spokesperson for birth control. While Sanger’s goal of introducing a simple, widely accessible, and cost-effective pill form of birth control was admirable, she was also a eugenics proponent. This movement aimed to decrease the fertility rate among genetically “disadvantaged” populations. “Birth control was marketed as a way of controlling the ‘population of the unfit,’ like poor ethnic populations,” Porter says. Sanger fed off white, upper-middle class fears about a “race suicide” of the “fit,” and uncontrollable population growth of the “unfit.” Those who promoted the Pill and other hormonal methods of contraception used them to curtail specific populations. Today, this history is not common knowledge. While it is unlikely to affect women’s present-day fertility choices, it is important to acknowledge the racist and classist origins of birth control drugs. Where are the teachers? Many women recall going to the doctor to discuss birth control for the first time, feeling rushed and uncomfortable, as if taking the Pill was really the only viable option. “You go in there, you’re young, and you’re usually scared because something is wrong,” says Anna Feigenbaum, a McGill graduate student and an instructor in Communication Studies. “They [doctors] think you’re stupid and incapable of using any form of birth control that is non-chemical, and you don’t think to question it unless you start feeling sick.” Feigenbaum herself recalls lasting on the Pill for only six months until she became ill, and says that “the whole time I was on it I was a total nutcase.” Optimally, women would learn in high school – in a relatively neutral, non-judgemental manner – about the array of birth control options and then make informed decisions for themselves. However, according to recent McGill Arts graduate Theresa Howard, sex education in North American schools often falls short. Howard’s undergraduate thesis was entitled “Learning About Birth Control: The Challenges and Opportunities.” In it, she interviewed 12 McGill students about how they had learned about birth control. “A lot of women felt like their doctor and teachers didn’t have enough time, or weren’t willing to give them enough time, to sit down and really go through the different options,” Howard says. As a result, she found that women often value information from their peers over that of medical professionals or educators. Formal sexual health education in Canadian schools began in the early 20th century due to anxieties about venereal disease. In the 1960s, curriculums adjusted to address the rising rates of unplanned pregnancies, while in the 1980s they began to concentrate on the growing AIDS crisis. While many Canadian schools currently do offer comprehensive sexual health education, including instruction on different birth control methods, studies consistently report that these programs are deficient. One study discovered that only 15.5 per cent of Bachelor of Education programs at Canadian universities had mandatory sex-ed training, and 26.2 per cent had optional sex-ed courses. Additionally, due to severe cuts to social programs and education budgets, the quality – as well as the very survival – of sexual health programs is threatened across Canada. In Quebec, sex education was essentially cut from high schools in 2005. This came at a time when the rates of sexually transmitted infections (STIs) were – and remain – alarmingly high among Canadian youth. Overall, Feigenbaum says that, even among university-aged people, there is an information gap concerning non-hormonal birth control options. This is coupled with what she calls a “complaining discourse” surrounding condoms, forcing a heteronormative focus on penetrative sex. “There are limited alternative information sources, particularly ones that have funding and infrastructure,” she laments. “It’s time to expand our definitions of sex.” Medicalizing bodies Despite these misgivings, the Pill remains the most widely-used method of birth control for women under 30. Just the fact that we refer to this hormonal contraceptive as “the Pill,” when there are countless other tablets and capsules, is indicative of its dominance in public discourse about contraception. The known list of hormonal birth control’s potential side effects range from minor to fatal, including depression, weight fluctuations, decreased libido, and a risk of blood clots for smokers. However, as a relatively new drug, long-term side effects of the Pill are dif- ficult to determine. They will only begin to be revealed as the first generation of users develop symptoms. Troublingly, there have been almost no long-term controlled research trials on the Pill. Hormonal oral contraceptives put the entire onus of birth control on women. While this is reassuring for many, it also completely eliminates any male accountability. As a consequence, it becomes women’s sole responsibility to obtain, pay for, and take the Pill – as well as to suffer its physical or emotional side effects. Sam Mackenzie, a researcher at Douglas Hospital and a McGill Neuroscience graduate, says he has “serious reservations” about hormonal forms of birth control. Mackenzie’s concerns began during a course on endocrinology, the study of hormones in the brain. He learned that levels of estrogen naturally fluctuate in a woman’s body, but that hormonal birth control eliminates these fluctuations. “It can lead to really elevated levels of estrogen across the entire cycle,” he says, explaining that estrogen plays a role in the serotonin level and in memory. “So if there’s a natural cycle, it gives me pause to tinker with that.... I’m not convinced that the Pill has no effect on the long-term health of those systems.” However, Howard says she hesitates to use the word “natural” in discussions on birth control. “That word gets thrown around a lot. People will say that something is ‘natural’ and therefore it’s the way it’s supposed to be.” Yet Howard also admits to having doubts about chemically controlling women’s menstrual cycles. “I do think [hormonal birth control] is not the right choice for everyone,” she says. Conflicts of interest For those hoping for better choices in the future, research and development (R&D) on alternative, safer oral contraceptives has been lacking. This is likely because of cost and potential liabilities. Many pharmaceutical companies have completely withdrawn from R&D in pregnancy prevention, focusing instead on marketing. As a result, most recent industry-funded research only focuses on improving existing methods. For example, the patch and the ring both release the same hormones as the Pill into the bloodstream, via the skin, or in the case of the latter, the vaginal wall. “It seems like they’re always coming up with something new, but it’s always a variation on the same thing,” says Porter. She also notes that non-contraceptive benefits of hormonal birth control, such as acne treatment or relief of menstrual cramps, are also often used to lure younger users. Additionally, birth control pamphlets and guides for selecting the right contraception are often sponsored by Pill manufacturers, who have a vested interest in women “choosing” what they sell. These guides also often frame the Pill as “the” contraceptive. “These supposed information pamphlets are actually advertisements,” says Howard. “And birth control pills are also sometimes given free to doctors by pharmaceutical companies as a promotion. This can influence what doctors prescribe, either because the product has been really sold to them by the company, or because that’s just what they happen to have on hand.” Feigenbaum notes that sometimes doctors who are quoted in these information sources are also on the boards of the pharmaceutical companies that make the product, or in some way connected to their payroll, as a type of conflict-of-interest. “Of course, it won’t say that when you open up your web page,” she says. “It’ll just say, ‘Great new drug for you,’ with doctor recommendations. Then, it turns out – through usually not too many clicks – that the doctor works for the lab.” Overall, critics argue that pharmaceutical companies are consciously drawing attention away from non-medical methods of contraception. “It takes attention away from barrier methods which have the highest efficacy-tosafety ratio, and I think are really fantastic,” says Porter. Healthy skepticism It’s clear that every woman ought to have the option of using oral contraceptives and other hormonal forms of birth control if she so desires, and at reasonable cost. However, the consensus seems to be that a healthy degree of skepticism is warranted concerning safety, and there need to be unbiased information sources readily available about alternative methods. McMahon argues that we can no longer pass the Pill off “as something totally normal and benign.” For herself, she says she has learned over time which condoms work best for her and afford the maximum pleasure and safety. “I’d way rather take real, visible, and exterior precautions on principle,” she says. However, Avital Oretsky, U0 Arts, has been on the Pill for almost two years and has not experienced any negative side effects, besides initial nausea. Oretsky says she is happy with the Pill, and plans to stay on it for the foreseeable future. However, she too admits to a certain degree of uncertainty. “I’m still kind of unsure about how I feel about it,” she says, “even though all doctors reassure you that it’s totally safe and fine for your body.” � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coverage from The McGill Daily Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Original Format The type of object, such as painting, sculpture, paper, photo, and additional data PDF Volume 97 Issue 42 Page Number(s) 14-15 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The new pill politics Description An account of the resource A feature about the history of oral contraception. Creator An entity primarily responsible for making the resource Naomi Lightman Publisher An entity responsible for making the resource available The McGill Daily Date A point or period of time associated with an event in the lifecycle of the resource 2008/03/17 Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English birth control racism reproductive health reproductive justice https://d1y502jg6fpugt.cloudfront.net/62030/archive/files/69e9c81fe202eb88baea8d0f96cb317e.pdf?Expires=1792022400&Signature=cM2bKo4nXA-7ndcdIiiRb9YCIuulDnzThSCxALo5zMhFGqZwW0hEYxwraVv%7EZ4lNKLTjfcNLKGyWTyLOVchSps9D4az-WEu7Q22jWdQ6Mcq8fBy2cS3e2TKlAGngyIm5mn9-mTwJAOrcXdCZDE-j9jygjIeh9ZpZhkf9uPX9HiqAbt9krzMQBY232yJn6w1ZSo48dE5NrPETVaeLsRo-CWZA-1Du1FfTFFQIGr5V2CsDu%7EZpIIo2yiMdE61BVjJWDJaWCOcW%7EDv5xZnx3zD8R5Z5GEyV2wIJPJZgNU3M6U%7EpqZj6C9vffE7JbTsiUD%7EHJFJlETdvtmCACuQQbVThfQ__&Key-Pair-Id=K6UGZS9ZTDSZM 8643d0d1f229a025b3847050e5cfc51d PDF Text Text délit | 29 janvier 2008 02 xle www.delitfrancais.com Nouvelles Des radicaux à McGill La bibliothèque de McGill offre un regard sur les périodiques radicaux des années 1970. campus Louis St-Aimé Le Délit M ercredi soir dernier à la bibliothèque McLennan avait lieu le vernissage de l’exposition Québec Alternative, présentée conjointement par Media@ McGill et la Division des livres rares et des collections spécialisées de la bibliothèque de l’Université McGill. Le matériel exposé provient directement de la collection personnelle de Marc Raboy, professeur d’éthique, média et communication à McGill. «Ce n’est pas de la nostalgie. Ce n’est pas un regard sur un moment qui est disparu et oublié. [...] C’est de l’histoire, mais ça porte avant tout sur le pouvoir de la communication», a-t-il expliqué lors du discours d’ouver- ture, auquel ont assisté plusieurs membres de la presse radicale montréalaise. Le docteur Raboy avait fait don de sa collection privée à la bibliothèque pour en permettre l’accès aux chercheurs contemporains et futurs. «Il y a [des revues] qui reflètent des moments historiques et d’autres qui traitent des enjeux qui sont encore d’actualité», a-t-il précisé lors de son discours. Un point de vue essentiel; un message optimiste «Les médias et les médias alternatifs sont essentiels», a jugé Jonathan Sterne, professeur associé du Département de l’histoire de l’art et des études en communication, au commencement de la soirée. Un propos qui trouve écho chez Marc Raboy: «Il y a là-dedans quelque chose d’universel. [...] L’intérêt est que cela se passe maintenant à l’échelle globale. Le message à retenir est que ‘vous pouvez communiquer’, a-t-il dit au Délit. Et les résultats sont durables». Il a cité en exemple la pièce d’exposition Birth Control Handbook publiée par le groupe Médecine Pour Tous il y a une quarantaine d’années, à l’époque où cette information n’était pas disponible et où les consultations médicales n’étaient pas gratuites: «Aujourd’hui, on ne remet pas en question [la raison d’être de ces publications]. Ce qui a commencé en marge de la société est progressivement devenu normal». Dans les deux présentoirs de verre qui abritent l’exposition étaient aussi mis en évidence des revues périodiques, des calendriers activistes et d’autres publications portant des noms tels que Le temps fou, La vie en rose et Québécoises deboutte!. Rompre avec la tradition? Le Délit a demandé à Allison Flynn, membre du bureau des relations médiatiques de McGill, s’il n’était pas inhabituel dans cette université de réputation conservatrice de Marc Raboy discute avec des invités lors du lancement de l’exposition. Éric Chevalier manifester une telle reconnaissance envers des éléments contestataires de la société. «Tout à fait, a-t-elle répondu en riant. Mais c’est une très bonne initiative visant à présenter les médias d’une autre génération. Même si on n’était pas impliqués dans l’organisation de l’événement, on tenait à le publiciser et à le faire connaître aux gens». La plupart des visiteurs interrogés mercredi soir se sont dits satisfaits de l’exposition. Au moins un curieux, cependant, en est sorti déçu: «Les présentations orales étaient intéressantes, mais l’exposi- tion ‘est morte’. Les présentateurs ont rappelé que les gens doivent s’investir pour faire bouger les choses. Alors c’est plutôt paradoxal de s’extasier sur ces revues radicales enfermées dans de vieux pupitres. C’est bien que [les organisateurs] hiérarchisent ces publications, mais l’exposition est trop pauvre», s’est lamenté au Délit ce visiteur qui a préféré demeurer anonyme. x L’exposition Québec Alternative est présentée jusqu’au 30 mars au 4e étage de la Bibliothèque McLennan. Une formation d’avenir Téléphone : 418 654-2500 Sans frais : 1 877 326-5762 www.inrs.ca � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coverage from Le Délit Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Volume 97 Issue 2 Page Number(s) 2 Original Format The type of object, such as painting, sculpture, paper, photo, and additional data PDF Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Date A point or period of time associated with an event in the lifecycle of the resource 2008-01-29 Title A name given to the resource Des radicaux à McGill Creator An entity primarily responsible for making the resource Louis St-Aimé Format The file format, physical medium, or dimensions of the resource PDF Publisher An entity responsible for making the resource available Le Délit Description An account of the resource Coverage of an exhibit in McLennan Library showcasing radical media from the 1970s. birth control https://d1y502jg6fpugt.cloudfront.net/62030/archive/files/e0e3935df9b36de84b6a95aa47d95dee.pdf?Expires=1792022400&Signature=vP0cv%7EVmwfEUvTatxDwPKN-mPbthkxq3ZV5bO6Dgws5KoeavhaOdSd1MLsofQdPqBcxJWHWb%7EWor3M7RmsHZ4cJcMHm03gM6CbrnYR85hcbwQGd3h1z%7ERdtODx46fiV7bvBIzX5WiCkSS%7EvtlNZzS1UPbFV-JmEZ%7EgNdBNEW7P3nPs4HXRj9MH5D9uX8Y6NBKb0DWQ4nLxtOS6k1hxr8K1EYfJOxgO2jFcbuRp-V0rjssIscYIhlE6jAMueGEU%7E-fTaUh-je0llD04GdG-s7-MWbLi6%7Eqlqm8Yaa82QK0OORkkE2%7EprliAbgFFfDj3Qu3krxvvP4XmI5LIIc8EBN2A__&Key-Pair-Id=K6UGZS9ZTDSZM f1069714b7443de1cb96d74943accb55 PDF Text Text ÉDITORIAL La sexualité chez les jeunes : entre ouverture et abstinence Actualités Société Culture Au féminin Éditoriaux Archives À propos  Contribuer La pilule : cadeau empoisonné ? La prise du moyen de contraception n’est pas anodine et doit être remise en question. Tweeter Dernière édition Édition du 5 avril 2023 Niels Ulrich | Le Délit Moyen de contraception incontestablement populaire, la pilule contraceptive est considérée comme un symbole de l’émancipation des femmes. Or, derrière la contraception hormonale se cache une réalité inquiétante. Le réflexe pilule Peu importe l’âge, la pilule contraceptive est conseillée presque automatiquement aux femmes et jeunes filles qui cherchent un moyen de contraception. En fait, il s’agit du moyen le plus prescrit et compte parmi les médicaments les plus consommés par les Canadiennes selon l’Enquête canadienne sur les mesures de la santé. Au moyen d’hormones comme l’œstrogène et la progestérone, la pilule contraceptive bloque l’ovulation et le cycle menstruel pour empêcher la nidation, soit l’implantation de l’embryon. Si adéquatement utilisée, son taux d’efficacité est évalué à 99%, tout comme le timbre contraceptif, le stérilet hormonal, l’anneau vaginal et l’injection intramusculaire. Aussi, la pilule est couramment prescrite pour atténuer l’acné des jeunes femmes, réduire le syndrome prémenstruel et régulariser les règles. Bien que le·a pharmacien·ne ou le·a médecin doit informer sa patiente des effets secondaires possibles, ces derniers sont caractérisés comme mineurs et sont justifiés par les bénéfices qu’apporte la pilule. Pourtant, rarement, si ce n’est jamais, l’on entend parler des conséquences dangereuses et parfois même mortelles dues à la prise de ce moyen contraceptif. Celles habituellement mentionnées sont la prise de poids, des changements d’humeur, la baisse de libido, des ballonnements ou encore des étourdissements. En effet, la majorité des femmes ﴾70%, selon l’enquête indépendante menée par la journaliste Sabrina Debusquat﴿ prenant la pilule contraceptive souffrent de ces symptômes. Or, le moyen de contraception le plus populaire au Canada cache une histoire et des répercussions alarmantes ; un silence plane quant aux effets nocifs et étonnamment fréquents que cause la pilule à la gente féminine. Effets plus qu’indésirables En 2015, la famille de Florence Aumont‐Légaré, 28 ans, a découvert les dangers que comporte la pilule sous de tragiques circonstances. Quelques jours après une douleur au mollet qui semblait d’abord anodine, Florence perd connaissance et est rapidement transportée à l’hôpital. Malheureusement, le soir même, Florence décède malgré les soins hospitaliers. Les analyses ont démontré par la suite qu’une embolie pulmonaire était en cause. La première question qui fut posée aux parents de Florence était si elle prenait la pilule contraceptive. La question fut évoquée par tout·e·s les spécialistes interrogeant ses parents qui, eux, n’avaient jamais été informés du danger que courait leur fille par la prise de la contraception orale. Le cas de Florence Aumont‐Légaré n’est pas un cas isolé, bien au contraire. Les chiffres les plus précis proviennent de France, par le rapport de l’Agence Nationale de Sécurité du Médicament ﴾ANSM﴿, qui rapporte une moyenne de 2 529 accidents et 20 décès annuellement dus à la formation de caillots dans le sang provoquée par l’utilisation de la pilule. Pour ce qui est du Canada, entre 2007 et 2008, Santé Canada a relaté la mort de 23 jeunes femmes liée à la pilule anticonceptionnelle de la marque Yaz et Yasmin. Thrombose veineuse, embolie pulmonaire ou encore accident vasculaire cérébral ﴾AVC﴿, le risque de troubles sanguins avec la prise de cette contraception est connu depuis les années 1960 par le corps médical. Pourtant, la formation de caillots sanguins est rarement mentionnée pour prévenir les jeunes femmes des effets possibles de la pilule et de plus, peu d’entre elles ont été formées à reconnaître les signes d’un tel symptôme. Playlist Culture 2021–2022 Et les effets indésirables ne s’arrêtent pas là. La contraception hormonale peut avoir une incidence sur la santé Le Délit 2021-2022 · Le Délit Culture mentale ; on l’associe de plus en plus à la dépression. Cette corrélation est plutôt récente puisque les rares études menées antérieurement démentaient toute association entre l’utilisation de la pilule et le risque de dépression. Cependant, ces études s’étaient penchées sur des femmes plutôt âgées qui prenaient la pilule depuis longtemps. Une étude danoise a quant à elle étudié le cas d’un million de jeunes femmes dans la période suivant leur première utilisation de la contraception hormonale. Les résultats démontraient une hausse significative, allant jusqu’à 80%, de À découvrir l’occurrence de dépression chez les femmes utilisant un contraceptif hormonal. Imaginaire … Le réflexe pilule doit disparaître pour laisser place à la discussion Sexisme chez les scientifiques Si la femme témoigne de symptômes désagréables durant la prise de la pilule, le·a médecin est encouragé·e, sans être toutefois obligé·e, de rapporter ces effets à Santé Canada. Ainsi, il se forme un décalage énorme entre l’expérience qu’ont de nombreuses femmes prenant la pilule et le discours médico‐scientifique dominant. Ce manque d’écoute et de considération face à l’avis des femmes pourrait s’expliquer entre autres par la sous‐représentation du genre féminin en science. Tant dans la recherche en laboratoire que dans la production scientifique, le professeur de l’Université de Montréal Vincent Larivière dénonce depuis une dizaine d’années le manque de femmes dans la production d’articles scientifiques. Plus précisément, moins d’un tiers des auteur·e·s des plus grandes revues scientifiques américaines comme la Public Library of Science et l’American Geophysical Union sont des femmes et ce phénomène se répète à l’échelle mondiale. Cette inégalité dans la hiérarchie scientifique n’est évidemment pas récente ; rappelons‐nous qu’il n’y a pas si longtemps, les femmes n’avaient pas accès aux cours de mathématiques et de sciences puisqu’elles étaient confinées à l’enseignement ménager. Bien que cette mentalité rétrograde ait perdu de sa force avec le temps, elle reste tout de même ancrée dans les perceptions sociales, engendrant une tendance chez les femmes à s’orienter vers des métiers à caractère social. Il n’est ainsi pas surprenant de constater que les études concernant la pilule contraceptive ont été majoritairement guidées par des hommes. L’écosystème affecté En plus de causer préjudice à la santé des femmes, la pilule œstroprogestative apporte des effets dommageables pour l’environnement. Les hormones libérées dans le sang sont évacuées par l’urine dans les nappes d’eau souterraines, les rivières et les lacs. La présence de telles hormones dans l’environnement aquatique perturbe le comportement sexuel des poissons, diminue leur fertilité et crée un phénomène de féminisation des mâles, c’est‐à‐dire la transformation des poissons mâles en femelles. Ces perturbations affectent tout autant les mammifères et les oiseaux aquatiques comme le canard, le goéland et l’oie. Émancipation sexuelle illusoire Alors que la pilule est considérée comme un emblème féministe, il suffit de se pencher sur la genèse de sa commercialisation pour y découvrir une histoire peu glorieuse. C’est d’abord une infirmière et sage‐femme américaine, Margaret Sanger, qui a fait la promotion de la pilule contraceptive et a cherché à convaincre les décideurs américains de financer cette nouvelle découverte scientifique. Elle était certes féministe mais flirtait aussi avec l’idéologie eugéniste et voyait en la contraception orale un moyen de limiter les naissances de certaines minorités ethniques. Dans un contexte de Guerre froide, des milliardaires américains furent charmés par l’idée de contrôler le taux de reproduction des femmes au nom de « l’amélioration du patrimoine génétique » et financèrent le projet de Sanger. Des essais cliniques ont d’abord été menés dans les années 1950 sur des femmes américaines sans toutefois leur mentionner l’effet contraceptif de la pilule. Dû aux effets secondaires insoutenables tels que des changements d’humeurs et des caillots sanguins, un nombre élevé de participantes abandonnèrent l’étude, et l’équipe de recherche se tourna vers Porto Rico où le phénomène de surpopulation commençait à inquiéter. Des Portoricaines furent soumises de force à l’étude malgré les effets secondaires dénoncés. Les résultats furent néanmoins concluants, la pilule contraceptive démontrait un taux d’efficacité de 100%. La quantité d’hormones fut par la suite diminuée pour faciliter sa commercialisation aux États‐Unis. Il faut prendre en considération le fait que la prise d’hormones n’est pas l’unique solution contraceptive. Sans diaboliser la pilule contraceptive, il faut tout de moins prendre conscience de ses conséquences au niveau de la santé physique et mentale ainsi qu’au niveau environnemental. Bien que sa découverte scientifique est considérée comme un point central de l’émancipation sexuelle de la femme, il ne faut pas oublier que cet instrument de libération fut d’abord orchestré par l’homme. Évidemment, grâce à la contraception, la femme a un plus grand contrôle de son corps et il est impératif de ne pas obstruer cette autonomie. C’est pourquoi il faut prendre en considération le fait que la prise d’hormones n’est pas l’unique solution contraceptive. Une méthode au taux d’efficacité similaire à celui de la pilule est le stérilet en cuivre. Ce dispositif intra‐utérin en forme de T est introduit dans la cavité utérine, processus médical qui ne prend qu’une dizaine de minutes. Certaines femmes optent quant à elles pour une méthode naturelle en suivant leur cycle d’ovulation à l’aide d’un calendrier, d’un thermomètre ou d’un moniteur symptothermique. Avec toutes ces alternatives, le réflexe pilule doit disparaître pour laisser place à la discussion. C’est aux professionnel·le·s de la santé, médecins, infirmier·ère·s, pharmacien·ne·s, d’être à l’écoute de leurs patientes, de prendre le temps de répondre à leurs questions et de les mettre en garde sur les conséquences qu’implique leur choix de contraception. Car si l’on prend en considération le bien des femmes et de l’environnement, la pilule devient plus difficile à avaler. À lire aussi : Infographie sur la contraception masculine. Où en est‐on ? Articles en lien Rose Chedid | Le Délit Rose Chedid | Le Délit Mahaut Engérant Mon expérience positive de la Pilule et libido : Pourquoi j’ai Le fardeau de la contraception pilule dit stop ne devrait pas reposer uniquement sur les épaules des femmes À propos Principes Contribuer Publicité DPS – SPD McGill Daily Auteur.e.s Archives Contact Privacy - Terms Created with the free version of PDF Mage � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coverage from Le Délit Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Volume 108 Issue 15 Page Number(s) 8-9 Original Format The type of object, such as painting, sculpture, paper, photo, and additional data Webpage Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Date A point or period of time associated with an event in the lifecycle of the resource 2019-01-29 Title A name given to the resource La pilule: cadeau empoisonné? Creator An entity primarily responsible for making the resource Juliane Chartrand Format The file format, physical medium, or dimensions of the resource PDF Publisher An entity responsible for making the resource available Le Délit Description An account of the resource An article explaining the social, physical, and environmental drawbacks of hormonal birth control methods like the pill. birth control reproductive health