Contraception Resources

Transcription

1 Contraception Resources Unity Health Care s Stanton Road Health Center (202) The Stanton Road Health Center provides OB/GYN, family planning, and pediatric services. The Center also provides HIV/AIDS services, WIC appointments, and services related to case management. Unity Health Care s Anacostia Health Center (202) The Anacostia Health Center provides OB/GYN, dental, pharmacy, pediatric and behavioral medicine services. The Center also provides HIV/AIDS services as well as services nutritional education. Unity Health Care s Parkside Health Center (202) The Hunt Place Neighborhood Health Center provides pediatric, ophthalmology, OB/GYN services, and social services. The Center also provides HIV/AIDS services as well as dental services. Planned Parenthood (202) Planned Parenthood provides gynecological examinations, emergency contraception, birth control, pregnancy testing and counseling, STD testing and treatment, HIV testing and counseling, and family medical care. Planned Parenthood s website contains detailed information on all forms of birth control and provides an interactive questionnaire to aid women in identifying birth control methods that are right for her (

2 Tips for Talking with Sexually Active Teens about Contraception Parents Sex Ed Center According to the Centers for Diseases Control and Prevention, each year in the United States nearly 850,000 teens experience pregnancy, mostly unintentionally. 1 U.S. teens also experience about three million sexually transmitted infections (STIs) each year. 2 A critical issue in reducing these numbers is encouraging teens to use contraception consistently and correctly. Parents can play an important role in helping young people to utilize their own values, aspirations, and expectations in deciding the appropriate time in life for initiating sexual intercourse. Parents can also provide teens with important information about contraception and encourage them to use contraception correctly and consistently. The following tips can help parents to talk with young people about contraception and to support youth in using contraceptives effectively and consistently. Educate yourself about the specifics of contraception and STIs. Learn about contraception, including emergency contraception, and about condoms. Learn how contraceptives work, the cost of various methods, side effects, pros and cons of each method, and where teens can go for information and services. Learn also about STIs gonorrhea, syphilis, herpes, genital warts, and HIV including ways they are transmitted, symptoms, risks, and treatment options. Carefully explain your own feelings and values about sexual intercourse and contraceptive use. Include personal memories and values. Values that are related to contraceptive and condom use include respect for self and partner, responsibility, and trust. Other values pertinent to discussing contraception may include, but are not limited to, those related to life, children, and future aspirations. Listen carefully. Only by listening to your teen s feelings and values will you understand how he/she approaches decisions, including sexual decisions. When you understand your teen s values, you can ask questions that help the teen clarify how to act consistently with those values. For example, a teen might say, I believe that too many children need homes and there are too many people in the world. This is an opportunity to ask what actions related to preventing pregnancy would be consistent with that value. Avoid assumptions. Do not assume that your teen knows everything he/she needs to know about contraception and condoms. Assure your teen that knowledge is power and that you want him/her to have the power that comes from knowledge. Assure your teen that you will not make assumptions based on the teen s questions or concerns. Do not make assumptions about the teen s sexual orientation or about his/her sexual behavior based on that orientation. Do not assume that there is only one kind of sexual intercourse. Many teens are having oral and/or anal intercourse, believing that this is not sex. Be clear with your teen that all these types of intercourse are sexual intercourse and are behaviors that necessitate protection. Arm your teen with information. Talk with your teen about what you have learned about contraception, including condoms and emergency contraception (EC). Encourage your teen to seek out further information and to decide what method would be right for him/her. Say that being prepared in advance is always the intelligent, mature choice. Make sure your teen knows where he/she can go for confidential sexual health services, including contraception and STI testing and treatment.

3 Be sure that your teen has information about contraception and condoms regardless of his/her sexual orientation. Gay and lesbian teens sometimes have sexual intercourse with members of the opposite gender in order to hide their sexual orientation. Any young person may experiment. Regardless of sexual orientation, all youth need to know how to prevent pregnancy as well as STIs. Discuss using condoms as well birth control. Teens need to know that contraceptive methods, such as birth control pills, Depo-Provera, and the IUD, don t protect against STIs. Teens need to know that they can contract STIs, including HIV, from unprotected vaginal, anal, or oral intercourse. For best protection, a teen and his/her partner need to use both condoms and another form of birth control. Consider making condoms available in your home. Make sure your teens knows know about emergency contraception which can be taken to prevent pregnancy up to 120 hours (five days) after unprotected intercourse or when a contraceptive method fails. Encourage your teen to take equal responsibility with a partner for using condoms and birth control. Just as a male should not be the only one responsible for providing condoms, so a female should not be the only one responsible for providing for other forms of contraception. Protection is a mutual responsibility within a caring relationship. Discuss being swept away. Many teens say they did not use condoms or contraception because they just got swept away. Be clear that this is not okay. Anyone who is mature enough to have sexual intercourse is mature enough to use protection. Discuss sexual coercion and dating violence with your teen. Make sure that your teen knows she/he has the right to say no and the right to be safe. Make sure your teen knows that he/she can come to you or another trusted adult if a relationship involves or threatens to involve coercion or violence. Make sure your teen knows that it is both illegal and contrary to your family s values to use coercion or violence against anyone else. Help teens identify ways to avoid/get away from sexual situations that feel uncomfortable or dangerous. Identify with your teen the names of other adults to whom he/she can go if unable or unwilling to come to you. This could be a relative, clergy member, health care provider, or friend, but identify the person as someone your teen can trust for confidential guidance and support. Give your teen permission to confide in someone else and say that these conversations will remain confidential although the other adult may encourage the teen to involve you. Consider incorporating the Rights. Respect. Responsibility. philosophy into your value system, especially in relation to talking about sexual health and contraception with your teen. RESPECT your young person s RIGHT to confidential sexual and reproductive health services. Share with your teen what to expect at his/her first visit for sexual health services. Then, ensure that your teen has private sessions with the health care provider. Private sessions empower teens to discuss issues honestly with the provider and to go for care when they need it. Encourage your teen to take RESPONSIBILITY for her/his personal sexual and reproductive health needs. Provide support so teens can make and keep appointments for annual medical exams and other needed health care. References 1. Centers for Disease Control and Prevention. Teen Pregnancy. [Fact Sheet]. Atlanta, GA: The Centers, Alan Guttmacher Institute. Facts in Brief: Teen Sex and Pregnancy. New York, NY: The Institute, Compiled by Barbara Huberman, RN, MEd, Director of Education and Outreach October 2002 Advocates for Youth 1025 Vermont Avenue, N.W. Suite 200 Washington, D.C USA Phone: Fax:

4 Careful, Current, and Consistent: Tips to Improve Contraceptive Use by James Jaccard, Ph.D.

5 board of directors chairman The Hononorable Thomas H. Kean Chairman, The Robert Wood Johnson Foundation CEO, THK Consulting Chairman, The Carnegie Corporation of New York former Governor of New Jersey president Isabel V. Sawhill, Ph.D. Senior Fellow, Economic Studies The Brookings Institution ceo & treasurer Sarah S. Brown members Robert Wm. Blum, M.D., Ph.D. William H. Gates Sr. Professor and Chair Department of Population and Family Health Sciences Johns Hopkins University Thomas S. Chappell Senior Manager Goodman & Company, LLP. Linda Chavez Chairman Center for Equal Opportunity Vanessa Cullins, M.D., M.P.H., M.B.A. Vice President for Medical Affairs Planned Parenthood Federation of America, Inc. Susanne Daniels Media Consultant Maria Echaveste Senior Fellow Center for American Progress Daisy Expósito-Ulla Chairman and CEO d expósito & partners William Galston, Ph.D. Senior Fellow, Governance Studies The Brookings Institution Ron Haskins, Ph.D. Senior Fellow, Economic Studies Co-Director, Center for Children and Families The Brookings Insitution Senior Consultant, The Annie E. Casey Foundation Nancy L. Johnson Senior Public Policy Advisor Federal Public Policy and Healthcare Group Baker, Donelson, Bearman, Caldwell & Berkowitz, PC Judith E. Jones Clinical Professor Mailman School of Public Health Columbia University Jody Greenstone Miller President and CEO The Business Talent Group Reverend Father Michael D. Place, STD Senior Vice President Social Mission & Ministerial Development Resurrection Health Care 2

6 Diane Rowland, Sc.D. Executive Director Kaiser Commission on Medicaid and the Uninsured Victoria P. Sant President The Summit Foundation Sara Seims, Ph.D. Director, Population Program The William and Flora Hewlett Foundation Matthew Stagner, Ph.D. Executive Director Chapin Hall Center for Children University of Chicago Mary C. Tydings Managing Director Russell Reynolds Associates Roland C. Warren President National Fatherhood Initiative Stephen A. Weiswasser Partner Covington & Burling Gail R. Wilensky, Ph.D. Senior Fellow Project HOPE Kimberlydawn Wisdom, M.D. Surgeon General, State of Michigan Vice President, Community Health, Education & Wellness Henry Ford Health System Judy Woodruff Senior Correspondent The News Hour with Jim Lehrer 3

7 blog.thenc.org ISBN #: Suggested Citation: Jaccard, J (2010). Careful, Current, and Consistent: Tips to Improve Contraceptive Use. Washington, DC: National Campaign to Prevent Teen and Unplanned Pregnancy. The National Campaign to Prevent Teen and Unplanned Pregnancy. All rights reserved. 4

8 Careful, Current, and Consistent: Tips to Improve Contraceptive Use by James Jaccard, Ph.D. 5

9 Many practitioners and researchers recognize the value of effective client-centered communication about contraception, and the potential impact that this interchange can have on a client s use of contraception. Clients also often report that they want information about contraception from their healthcare providers. The tips below provide suggestions on improving current contraceptive counseling particularly for younger clients and offer specific ways to help these clients reduce their risk of unplanned pregnancy. Although it is not usually possible to incorporate all of the tips suggested below into a single counseling session especially given limited time with clients we would encourage providers to at least address those that are of greatest priority for their clients. These tips are based on an extensive synthesis of literature on contraceptive behavior by Dr. James Jaccard. The full report is available online at: pubs/unlocking_contraceptive.pdf 6

10 Quick Guide for Using These Tips: If you don t have much time, be sure to address issues of most concern to the client and consider focusing on the tips below. Every time with every client: > Cover tips 1, 5, 6, 8, 10, and 12 If the client is interested in a new method: > Cover tips 2, 3, 4, and 9 If the client chooses a user-dependent method: > Cover tips 7 and 11 Note: the order in which these tips are taken up might vary depending on the client s circumstances and history as well as your own personal style. 7

11 Tip 1 Demonstrate the key three attributes of effective counselors expertise, trustworthiness, and accessibility. Why You Need to Do It. Research shows that clients who see their provider as accessible are more likely to contact that provider and are less likely to experience gaps in protection when switching methods. Research also shows that clients do not automatically think that counselors have expertise or are looking out for their client s best interests. Counselors are more effective if they are seen as expert, trustworthy, and accessible. How You Might Do It. Simple, informal comments to the client to underscore your expertise ( I have dealt with these issues a great deal ), trustworthiness ( let s make sure we get this worked out in the best possible way for you ), and accessibility ( if something comes up, you can always call and I promise I will get back to you. I mean it. ) can make a difference. Tip 2 Use skills-based strategies to actively engage the client in learning and remembering important points such as how to use their method accurately. Why You Need to Do It. People are more likely to remember important information when they actively process it as opposed to passively listen to it. For example, remembering how to accurately use the particular method a client has chosen is critically important (inaccurate use is a major source of disparity between perfect use and typical use failure rates, which can be considerable). Thus, active processing of information about how to use a method accurately is important. How You Might Do It. Have clients repeat back to you in their own words the information you think is most critical for them to know. Make it informal and non-threatening. You might tell the client that 8

12 the topic at hand is so important (e.g., how to use the method correctly), that you would like the client to repeat in her own words her understanding of the topic. Consider all aspects of the topic that the client needs to remember, including how to use the method, how to refill the method, etc. Assume that your clients will not read package inserts or brochures you give them to take home. Tip 3 Address all four facets of contraception method choice, correct use, consistent use, and method switching. Why You Need to Do It. Using ineffective methods, using a method inaccurately or inconsistently, and gaps in protection that typically accompany a method switch all increase the risk of unplanned pregnancy. Unless you explicitly talk about these matters, women may choose less effective methods, use those methods inaccurately, use them inconsistently, or switch from a method often with a significant gap in protection without telling you. You should always think about the four facets of contraceptive behavior (choice, accuracy, consistency, and switching) and whether they need to be addressed with your client. How You Might Do It. Whether a client is seeing you to choose an initial method, to switch to a new method, or to discuss medical issues or side effects with a current method, discuss the accurate and consistent use of the method she settles on and develop a specific action plan (see Tips #7 and #9 for more on action plans) for what to do if she becomes dissatisfied with that method. Tip 4 Make choosing a method manageable, and give priority to more effective methods. Why You Need to Do It. There are more than a dozen methods of birth control, and each method differs on about a dozen different dimensions. Therefore, in theory, clients must wade through at 9

13 least 150 pieces of information to make a choice, which is overwhelming. Research shows that when people are faced with information overload, they may use poor strategies to make choices or reach decisions. For example, they may jump around from one piece of information to another and make decisions based on what comes to mind at that particular moment, not on what is important. This means that when clients make a bad contraceptive choice, they may quickly become dissatisfied with the method and then either stop using it or switch to another method, substantially increasing the risk of a gap in protection. How You Might Do It. Help clients simplify the process of choosing a method by first assessing medical conditions that will allow you to eliminate methods based on medical considerations (e.g., high blood pressure, smoking). Second, discuss client perceptions and reactions to individual methods sequentially using the three category method-effectiveness chart below (note: the percents in the table are typical use failure rates for each method). Start with Category A methods, then go to Category B methods, and then to Category C methods until you find what seems to be a good match (you will need to use some judgment here as not all methods will be applicable to every client). Note your purpose is not to recite every fact you know about each method. Rather, your purpose is to hone in on features the client wants and couple that information with the importance of using very effective methods. Once she has selected a method, see Tip #5. Category A highly effective and less dependent on adherence to a protocol to be effective; Category B highly effective but more dependent on adherence to a protocol to be effective; Category C less effective and highly dependent on adherence to a protocol to be effective. 10

14 Category Category Category A B C > IUD (<1%) > Implants (<1%) > Depo-Provera (3%) > Sterilization (<1%) > Pill (8%) > Patch (8%) > Vaginal Ring (8%) > Male Condom (15%) > Diaphragm (16%) > Sponge (nulliparous only 16%) > Cervical Cap (including FemCap, 16%) > Female Condom (21%) > Fertility Awareness (25%) > Withdrawal (27%) > Spermicides (29%) Source: More detailed information about these methods is available in Hatcher RA, Trussell J, Nelson AL, Cates W, Stewart FH, and Kowal D (2007). Contraceptive Technology, Nineteenth Revised Edition. New York, NY: Ardent Media. It is not uncommon for a client to come to a clinic with a clear cut preference of which method(s) she wants or is considering. This raises the issue of whether you should just give the woman what she initially wants or discuss only those methods she initially indicates she is considering. As a general matter, the answer is no, because the client might be misinformed or uninformed. You should try to give a woman what she wants, but only after she is fully informed. Don t overwhelm her by telling her about every technicality about every method. A good compromise is to discuss methods sequentially until a good match is found, starting with Category A methods, then Category B methods, and then Category C methods. Think of the two of you as being a team sharing information with one another about lifestyles, wants, and methods. The final decision, of course, should be made by the client; just make sure it is an informed one. 11

15 Tip 5 Consider how the method fits the lifestyle of the client by raising other key socialbehavioral factors. Why You Need to Do It. In addition to discussing the attributes of a given contraceptive method with a client, you also need to make sure that the chosen method fits with the lifestyle and life circumstances of the client more generally, including the nature of her relationship with her partner. In other words, it is not enough to just talk about effectiveness, side effects, and other method characteristics. A good choice considers broader considerations as well. How You Might Do It. Once a method is tentatively chosen, review it with the client on each of the following criteria that decision theories suggest are relevant to the choices we make in life: Perceived advantages and disadvantages: Explore what the client sees as the advantages and disadvantages of the chosen method and make sure there are no significant perceived disadvantages that might undermine her using the method succesfully. Emotional and affective reactions: Make sure there are no strong negative emotions that could undermine successful use of the chosen method. For example, some women have a visceral dislike of touching their genitals a feeling that could undermine their use of such methods as the diaphragm, ring, or female condom. Intermenstrual bleeding and spotting or amenorrhea caused by some progestin-only contraceptives also elicits negative emotions in some women. Other women have a negative reaction to having a foreign object in their body a feeling that could undermine their use of an IUD or implant. Normative considerations: Client satisfaction with her chosen method may depend on how others view her choice. Will the client s partner(s) be on board with the choice? Will the 12

16 client tell any of her friends about what she is using and how will they react? Who else s opinions might matter? Assure the client that many other women also use the method, and find out if a partner or other person of significance might object. Make sure this will not undermine the choice and successful use of the method. Image implications: Sometimes a method does not fit the image a client has of herself. For example, a client may see herself as natural/organic and the thought of putting hormones into her body just does not fit with her self-image. Make sure the chosen method is consonant with a woman s image of herself. Self efficacy: Sometimes women are unsure of their ability to use a method correctly and consistently. Ascertain if they have confidence in their abilities to use the method and offer specific encouragement and support if needed. Tip 6 If the client is at risk of contracting a sexually transmitted infection (STI), recommend dual protection condoms plus a more effective contraceptive method. Why You Need to Do It. Some STIs (e.g., herpes) are untreatable, incurable, and very easily transmitted, and others, like HIV, can be deadly. It is important to remind women of ways to protect themselves from STIs since methods other than condoms do not provide protection from STIs. How You Might Do It. Ask the client about the number of different sexual partners she has over the last three- to six-months, if she tends to engage in sex without condoms, if she has ever had an STI, if any of her partners have ever had an STI, or if they are likely to have an STI. Because clients may be reluctant to disclose such sensitive information, listen for any clues that suggest a need for condom use. For example, if she has 13

17 multiple partners and any of them has a history of an STI, or if she has had an STI in the past few years, encourage dual protection/use. Stress the importance of dual (preventing both unplanned pregnancy and STIs) in dual use. Tip 7 Give the client practical strategies to ensure accurate and consistent use of the chosen method of contraception. Why You Need to Do It. A common reason for not using a method accurately or consistently is that the client thinks she can get away without doing so just this once. The problem is that the just this once phenomenon often occurs many times, and multiple instances of inaccurate or inconsistent use can dramatically increase the chances of becoming pregnant. This just this once logic, for example, contributes to the pill being eight times less effective than it would be if it were used accurately. Research shows that if people have made a plan ahead of time and thought about what to do when encountering obstacles they are more likely to overcome those obstacles. Also if you effectively address reasons people give for not using birth control, they will be less likely to fall back on those reasons for not using contraception consistently and carefully. How You Might Do It. Help clients develop action plans for what to do if they encounter a problem or an obstacle to using their method correctly and consistently. For example, tell your client what specific steps she should take if she misses one pill or two or more pills in a row. Help clients anticipate reasons why they might not use a method accurately or consistently and develop strategies to deal with these reasons. For users of coital-dependent methods, like male and female condoms, review with clients basic information about the withdrawal method and avoiding intercourse around the time of ovulation, as these techniques might be used if a barrier method is not 14

18 available at a given instance of sexual intercourse. If appropriate, also tell them about emergency contraception; make sure they know how to obtain it and/or provide them with at least one dose. As an example, Box 1 presents the most common reasons that pill users report for missing a birth control pill. If a client chooses to use the pill, review the reasons users often give for missing a pill and talk with the client about those situations that are most relevant for her. For example, to overcome forgetting to take the pill, you can encourage the client to consciously link taking the pill with a routine activity that she does everyday (brushing one s hair in the morning when getting dressed, for example). The appendix to this report gives reasons commonly given for inaccurate and inconsistent use for other commonly used contraceptive methods. Box 1: Reasons for Missing a Pill Reason Percent Giving Reason Away from home without pills 13 Forgot 13 Didn t re-fill prescription 11 Was doing something else 10 Travel 9 Work pressures (job transition; 8 irregular schedule) Other disruptions to routine 5 (family crisis, etc.) School pressures (final exams 4 got in the way) Sleep disturbances (exhausted; 4 fell asleep and forgot) Health issues (had the flu; 2 throwing up) Side effects (had bleeding, 1 so waited) 15

19 Tip 8 Address the issue of side effects ahead of time. Why You Need to Do It. Concerns about side effects are one of the most common reasons clients give for being dissatisfied with a particular method and switching to less effective methods. And switching methods is often associated with gaps in protection or switches to less effective methods. How You Might Do It. Help ensure that clients are not caught off guard by side effects. Enable them to anticipate what side effects might occur and how they might respond. Discuss what the specific side effects might be for the chosen method and explain, as appropriate, that these side effects are not necessarily unusual. Also, help them appreciate, as appropriate, that some side effects dissipate or disappear with time and that sometimes small changes in their lives can help offset side-effects. For example, the bleeding and spotting that tends to accompany progestin-only methods or implants often go away with time. Try to give clients specific examples and discuss the use of social support. Encourage the woman to weigh the costs of coping with minor side effects against the costs of a significant increased risk of an unplanned pregnancy. If possible, identify what side effects would make the method unacceptable to her and encourage her to call you or your staff right away if she experiences these. Be prepared to discuss myths about side effects there are quite a few and don t be afraid to mention positive side effects of some methods (e.g., levonorgestrel IUDs protecting against endometrial cancer). 16

20 Tip 9 If a client decides to change her method of birth control, encourage her to switch to an equally or more effective method and try to ensure that there are no gaps in protection. Why You Need to Do It. Switching to a less effective method increases the risk of an unplanned pregnancy, sometimes substantially so. As noted previously, research shows that if people have action plans ahead of time for what to do when encountering unexpected and difficult situations (such as an unanticipated side effect), they are more likely to cope with and resolve those situations effectively in this case, by not having a gap in protection. How You Might Do It. Plan with a client a specific set of steps she should pursue as part of a contingency plan if she decides to switch. This might involve speaking with you or another staff member over the phone/via about other potential methods. Help her understand the relative effectiveness of various methods, and encourage switching to a method that is at least as or more effective than her current pregnancy prevention method. When you help the client select a new method she will switch to, begin sequentially with consideration of Category A methods first, then Category B methods, then Category C methods, as needed and appropriate. For example, if the client is dissatisfied with the pill, ask her to consider either a Category A method or another variant of the pill such as the patch or ring. For users of coital-dependent methods, review basic information about the withdrawal method and avoiding intercourse when ovulation is likely, as these techniques might be used if protection is not available; and, again encourage her to switch to a better method. Also, make sure your client knows about emergency contraception if she does experience a gap in use before selecting a new method. Make sure that she knows how to obtain it and/or provide her with at least one dose. 17

21 Tip 10 Be sure you or a staff member followsup with the client to see how things are going. Why You Need to Do It. A follow-up call can be used to inquire about initial difficulties the client is having during the time she is learning to use the new method of birth control. It also will reinforce the perceived trustworthiness and accessibility of the counselor. Follow-up is particularly important with young clients. How You Might Do It. Mention during the visit that you ll be checking to see how things are going and ask for the best way to contact the client. Then make a follow-up call or send a follow-up (containing no personal or confidential information) to make sure there are no unanticipated issues during the learning period. If you do not have the time to do this, consider having support staff help you with it. The call can be at the end of the day and can be quick and to the point. Tip 11 Use quick start options for any method that has such an option. Why You Need to Do It. Research suggests that for some birth control methods, women who start a method on the day of the clinic visit instead of waiting for the next menstrual cycle are more likely to start the method, and may be more likely to use it correctly and continue to use the method. For the pill, a quick start method can prevent unplanned pregnancy during what would normally be the waiting period, when women might be using a less effective method or no method at all. A common reason for waiting until menses to start some forms of birth control is to ensure that the woman is not pregnant. But research shows that there is no known harm to the woman, the course of her pregnancy, or the fetus if combined oral contraceptives, Depo-Provera, the contraceptive patch, or ring are accidentally used 18

22 during pregnancy. IUDs, however, should never be inserted into a pregnant woman. Pregnancy tests can help to rule out pregnancy, and Family Health International ( publishes a pregnancy checklist of six questions to help determine if a woman is likely to be pregnant without giving a pregnancy test. How You Might Do It. Depending on the method they have chosen, instruct clients to start their method the day of the clinic visit. Tip 12 Address issues of pregnancy ambivalence with clients. Why You Need to Do It. Research shows that pregnancy ambivalence including but not limited to those who want to leave the prospect of having a baby to chance is associated with gaps in protection, less accurate and consistent use of birth control, more method switching, and extended periods without using contraception. How You Might Do It. Many clients in their twenties have ambivalent feelings about becoming pregnant and having a child; for example, some say that they do not wish to be pregnant now but also say they would be at least somewhat happy if they found out they were pregnant. Explore with the client how these feelings affect contraceptive behavior. You do not need to turn this into an extended counseling session on childbearing, but you should inform clients that research shows that doubts about not having a child at this time in one s life creates lapses in the use of contraception. During these lapses, women use birth control less consistently, less accurately, and are more apt to have gaps in protection. The result can be an ill-timed or unplanned pregnancy that the woman is not clearly and unambiguously seeking. 19

23 Enhancing the Clinic Experience In addition to the tips presented above, consider the following suggestions for improving the overall clinic experience of your clients. > Streamline the process of getting contraception including emergency contraception as much as possible. Try to make it standard practice to explore with clients obstacles to acquisition (note that this will vary by insurer). The process of refilling prescriptions should also be streamlined when possible. Consider on-line options and other convenient, time saving alternatives. If possible, provide refill reminders. Call women who miss appointments or who do not obtain a refill, if this can be done. Consider dispensing starter kits with initial pill prescriptions that include reminder devices such as a timer or a calendar. > Convenient clinic hours, accessible locations, and flexibility about appointments can all contribute to greater access to contraception for young adults. Similarly, low cost or free contraception, available as part of a single visit, increases access. > If possible, use modern communication strategies to reach clients, especially teens and young adults. Texting, , and/or cell phones are low cost ways that service providers can reach clients. > Distribute condoms in both open (e.g., in a basket on the reception desk) and discreet ways (e.g., in a basket on the sink in the bathroom). > Have posters and reminders visible for choosing and using effective methods of birth control in your office. These function as cues-to-action. 20

24 > Provide materials which supplement package inserts and may better address the needs of your clientele. Avoid jargon. > Use standard approaches identified in the medical literature for gaining patient compliance, including: a. emphasizing important instructions b. pacing the flow of information so as to avoid information overload c. using simple, understandable language without jargon d. reinforcing essential points through review or summary e. asking clients to repeat essential elements of the message f. providing written instructions for reinforcement and home practice g. ensuring that information is consistent across practitioners (where teams of practitioners are involved) h. asking the client questions about any dissatisfaction with the treatment regimen and the reasons why the client is dissatisfied i. explaining the rationale for recommendations j. discussing the costs and benefits of alternative treatment regimens k. adopting a friendly and relaxed yet professional manner l. linking medication consumption to habitual events in the client s life where possible 21

25 Appendix Inaccurate condom use common mistakes and problems Using a sharp instrument to open condom packages (could put a hole in the condom) Storing condoms in a wallet for more than one month (some condoms deteriorate) Completely unrolling the condom before putting it on Putting the condom on inside out, then flipping it over to use correctly Failing to hold onto the base of condom when pulling out (condom fell off) Re-using a condom (e.g., for a second orgasm or if one does not have an orgasm) Losing an erection and having the condom fall off Note: Whether men or women put a condom on the man, they both are about as likely to make the above errors. Inconsistent condom use common reasons Didn t have a condom available Didn t want to interrupt the heat of the moment to put a condom on Couldn t put it on correctly so didn t bother to use it Was under the influence didn t want to bother with a condom or did not think of it Wishful thinking thought they could get away with it just this once Lack of refusal/communication skills to insist on condom use or refuse having sex Losing an erection and having the condom fall off 22 Note: many of the reasons listed above apply to other barrier methods as well (e.g., diaphragm, female condom). Design: Nancy Bratton Design

26 research advisory panel chairman Matthew Stagner, Ph.D. Executive Director Chapin Hall Center for Children University of Chicago members Joyce Abma, Ph.D. Social Scientist Reproductive Statistics Branch Division of Vital Statistics National Center for Health Statistics Jane Brown, Ph.D. James L. Knight Professor School of Journalism and Mass Communication University of North Carolina Marcia Carlson, Ph.D. Associate Professor of Sociology Department of Sociology University of Wisconsin- Madison Randal Day, Ph.D. Professor, School of Family Life Brigham Young University Lawrence B. Finer, Ph.D. Director of Domestic Research The Guttmacher Institute Saul D. Hoffman, Ph.D. Professor, Department of Economics University of Delaware Carol Hogue, Ph.D., M.P.H. Director of the Women and Children s Center and Jules and Deen Terry Professor of Maternal and Child Health Emory University Jim Jaccard, Ph.D. Professor, Department of Psychology Florida International University Melissa S. Kearney, Ph.D. Assistant Professor of Economics University of Maryland Daniel T. Lichter, Ph.D. Professor, Department of Policy Analysis & Management Cornell University Susan Newcomer, Ph.D. National Institute of Child Health and Human Development Demographic and Behavioral Science Branch National Institutes of Health Nadine Peacock, Ph.D. Associate Professor School of Public Health University of Illinois at Chicago Susan Philliber, Ph.D. Senior Partner Philliber Research Associates John Santelli, M.D., M.P.H. Heilbrunn Department of Population and Family Health Mailman School of Public Health Columbia University Jeff Spieler, Ph.D. Senior Technical Advisor for Science and Technology Office of Population and Reproductive Health Bureau for Global Health Laurence Steinberg, Ph.D. Distinguished University Professor Laura H. Carnell Professor of Psychology Department of Psychology Temple University W. Bradford Wilcox, Ph.D. Assistant Professor of Sociology University of Virginia 23

27 blog.thenc.org For more information, contact The National Campaign at: 1776 Massachusetts Avenue, NW #200 Washington, DC phone fax

28 Emergency Contraception THE FACTS

29 Emergency Contraception THE FACTS Quick Facts What is it? Emergency contraception is birth control that you use after you have had unprotected sex--if you didn t use birth control or your regular birth control failed. Depending on the type of emergency contraception, you can use emergency contraception within 3 days or within 5 days after unprotected sex to prevent pregnancy. There are two types of emergency contraception (EC): Emergency contraceptive pills (ECPs) a. Plan B One-Step, Next Choice One Dose, and My Way consist of one pill that the instructions state must be taken with 3 days (72 hours). b. Levonorgestrel Tablets consist of two pills. Although the instructions state that the first one must be taken within 3 days (72 hours) and another must be taken 12 hours later, both pills can be taken at the same time within four days (96 hours) after unprotected sex. c. ella consists of one pill that must be taken within 5 days (120 hours). Research has shown that the pills in a and b above are equally effective when taken on the first-fourth days after unprotected sex and are ineffective thereafter. ella is equally effective when on the first-fifth days. Emergency insertion of a copper T intrauterine device (IUD) within 5 days (120 hours) 1. How do I get emergency contraceptive pills? ECPs are available at some pharmacies. Women (and men) of all ages can get emergency contraceptive pills besides ella without a prescription. You may want to check that your local pharmacy carries ECPs before making a trip there. Women of all ages need a prescription for ella. Contact your health care provider to get a prescription. Many family planning clinics dispense emergency contraceptive pills and offer IUDs as a birth control option. Check the clinic locator on OPA s home page for a clinic near you.

30 Emergency Contraception THE FACTS What is Emergency Contraception? Emergency contraception is birth control that you use after you have had unprotected sex--if you didn t use birth control or your regular birth control failed. Depending on the type of emergency contraception, you can use emergency contraception within 3 days or within 5 days after unprotected sex to prevent pregnancy. There are two types of emergency contraception (EC): Emergency contraceptive pills (ECPs) a. Plan B One-Step, Next Choice One Dose, and My Way consist of one pill that the instructions state must be taken with 3 days (72 hours). b. Levonorgestrel Tablets consists of two pills. Although the instructions state that the first one must be taken within 3 days (72 hours) and another must be taken 12 hours later, both pills can be taken at the same time within four days (96 hours) after unprotected sex. c. ella consists of one pill that must be taken within 5 days (120 hours). Research has shown that the pills in a and b above are equally effective when taken on the first-fourth days after unprotected sex and are ineffective thereafter. ella is equally effective when taken on the first-fifth days. Emergency insertion of a copper T intrauterine device (IUD) within 5 days (120 hours) 1. How do the different emergency contraceptive pills work? Plan B One-Step, Next Choice One Dose, My Way and Levonorgestrel Tablets are pills containing the hormone progestin (levonorgestrel). Progestins are hormones found in some commonly-used birth control pills. These pills work mainly by stopping the release of an egg from the ovary. ella is another type of emergency contraceptive pill; its active ingredient is ulipristal acetate. ella works mainly by stopping or delaying the ovaries from releasing an egg. ella is the most effective of the pills. 1 Cleland K, Zhu H, Goldstuck N, Cheng L, Trussell J. The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience. Hum Reprod Jul;27(7):

31 Emergency Contraception THE FACTS How do I get emergency contraceptive pills (ECPs)? ECPs are available at some pharmacies. Women (and men) of all ages can get emergency contraceptive pills besides ella without a prescription. Next Choice One Dose, My Way and Levonorgestrel Tablets are available without a prescription to women (and men) aged 17 or over. Females 16 and under need a prescription. You may want to check that your local pharmacy carries ECPs before making a trip there. Women of all ages need a prescription for ella. Contact your health care provider to get a prescription. Many family planning clinics dispense emergency contraceptive pills and offer IUDs as a birth control option. Check the clinic locator on the OPA s home page for a clinic near you. How effective are ECPs? Plan B One-Step, Next Choice One Dose, My Way and Levonorgestrel Tablets: 7 out of 8 women who would have gotten pregnant will not become pregnant after taking these pills. ella: 6 or 7 out of every 100 women who would have gotten pregnant will not become pregnant after taking ella. What are the side effects of ECPs? Some women taking ECPs experience: headache nausea abdominal pain menstrual pain tiredness dizziness

32 Emergency Contraception THE FACTS Advantages of ECPs Don t require consent from the male partner Safe and effective in preventing pregnancy after unprotected sex Some are available over-the-counter Drawbacks of ECPs Not as effective as some other types of birth control Require a clinic visit and a prescription in some cases Do not work if you are already pregnant May cause side effects like nausea (anti-nausea medication might help with this), vomiting, stomach pain and headaches Do not protect against sexually transmitted infections Can I use ECPs if I am pregnant? Women who are pregnant or suspect they are pregnant should not use ECPs. This is because they are ineffective; ECPs will not cause any adverse effects on an existing pregnancy. Emergency contraceptive pills prevent pregnancy and are different from medications which cause abortions. How does the copper T IUD work as emergency contraception? The copper T IUD is a method of emergency contraception when it is inserted within five days of unprotected intercourse. The copper T IUD is a T-shaped device that is put into the uterus by a health care provider. It prevents sperm from reaching the egg, from fertilizing the egg, and may prevent the egg from attaching in the uterus. It does not stop the ovaries from making an egg each month. One advantage is that it can remain in place for up to ten years as a women s regular contraception. After the IUD is taken out, you can get pregnant.

33 Emergency Contraception THE FACTS How effective is it? The copper T IUD is the most effect emergency contraceptive method. Out of one thousand (1000) women who use this method, only one will get pregnant. What are the side effects and possible risks? Some women experience cramps and/or irregular bleeding. Uncommon risks are pelvic inflammatory disease and infertility. Does any form of emergency contraception protect me from STIs? No. A condom must be used for STI protection. Sources U. S. Food and Drug Administration, Birth Control: Medicines to Help You, Accessed 2/19/14 at Office on Women s Health, Emergency contraception (emergency birth control) fact sheet, Accessed 2/19/14 at women s health.gov The Emergency Contraception Website, accessed 3/12/14 at Robert A. Hatcher, et.al., Contraceptive Technology, 20 th revised edition, Ardent Media, Inc., Cleland K, Zhu H, Goldstuck N, Cheng L, Trussell J. The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience. Hum Reprod Jul;27(7): Reviewed: June 2014 Reviewed by: James Trussell, PhD All material contained in this fact sheet is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office of Population Affairs in the Department of Health and Human Services. Citation of the source is appreciated.

34 Medicines To Help You BIRTH CONTROL GUIDE Most Effective Methods Sterilization Surgery for Women Number of pregnancies expected per 100 women* less than 1 Use Onetime procedure Permanent Some Risks Pain Bleeding Infection or other complications after surgery Ectopic (tubal) pregnancy Surgical Sterilization Implant for Women less than 1 Onetime procedure Waiting period before it works Permanent Mild to moderate pain after insertion Ectopic (tubal) pregnancy Sterilization Surgery for Men less than 1 Onetime procedure Waiting period before it works Permanent Pain Bleeding Infection Implantable Rod less than 1 Inserted by a healthcare provider Lasts up to 3 years Changes in bleeding patterns Weight gain Breast and abdominal pain IUD Copper less than 1 Inserted by a healthcare provider Lasts up to 10 years Cramps Bleeding Pelvic inflammatory disease Infertility Tear or hole in the uterus IUD w/ Progestin less than 1 Irregular bleeding No periods Abdominal/pelvic pain Ovarian cysts Shot/Injection 6 Need a shot every 3 months Bone loss Bleeding between periods Weight gain Nervousness Abdominal discomfort Headaches Oral Contraceptives (Combined Pill) The Pill 9 Must swallow a pill every day Nausea Breast Tenderness Headache Rare: high blood pressure, blood clots, heart attack, stroke Oral Contraceptives (Progestin only) The MiniPill 9 Must swallow a pill every day Irregular bleeding Headache Breast tenderness Nausea Dizziness Oral Contraceptives Extended/Continuous Use The Pill 9 Must swallow a pill every day. Risks are similar to other oral contraceptives (combined) LIght bleeding or spotting between periods Patch 9 Put on a new patch each week for 3 weeks (21 total days). Don t put on a patch during the fourth week. Exposure to higher average levels of estrogen than most oral contraceptives Vaginal Contraceptive Ring 9 Put the ring into the vagina yourself. Keep the ring in your vagina for 3 weeks and then take it out for one week. Vaginal discharge Discomfort in the vagina Mild irritation Risks are similar to oral contraceptives (combined) Diaphragm with Spermicide 12 Must use every time you have sex. Irritation Allergic reactions Urinary tract infection Toxic shock Sponge with Spermicide Must use every time you have sex. Irritation Allergic reactions Hard time removing Toxic shock Cervical Cap with Spermicide Must use every time you have sex. Irritation Allergic reactions Abnormal Pap test Toxic shock Male Condom 18 Must use every time you have sex. Except for abstinence, latex condoms are the best protection against HIV/AIDS and other STIs. Allergic reactions Female Condom 21 Must use every time you have sex. May give some protection against STIs. Irritation Allergic reactions Least Effective Spermicide Alone 28 Must use every time you have sex. Emergency Contraception If your primary method of birth control fails Irritation Allergic reactions Urinary tract infection Plan B Plan B One Step Next Choice 7 out of every 8 women who would have gotten pregnant will not become pregnant after taking Plan B, Plan B One-Step, or Next Choice Swallow the pills within 3 days after having unprotected sex. Nausea Vomiting Abdominal pain Fatigue Headache Ella 6 or 7 out of every 10 women who would have gotten pregnant will not become pregnant after taking Ella. Swallow the pill within 5 days after having unprotected sex. Headache Nausea Abdominal pain Menstrual pain Tiredness Dizziness *effectiveness of the different methods during typical/actual use (including sometimes using a method in a way that is not correct or not consistent)

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36 A Few Things Before We Start If you re having sex and not using any kind of birth control, you re actually planning on getting pregnant or causing a pregnancy. It s as simple as that. If you are having sex, how do you avoid an unplanned pregnancy? Read on Not having sex is the most effective birth control of all. Bottom line: No sex, no pregnancy. Something else to think about even though it may seem like everyone s doing it, that s not the case. Some are. Some aren t. And some are just lying. Only about half of high school teens have had sex, and 2 of about every 3 teens who have had sex say they wish they had waited. Something to think about.

37 The next best thing to no sex is using protection if you are having sex. And we mean every-single-time protected sex. Using birth control 90% of the time is not good enough. If you re having sex and find the birth control choices overwhelming, you re not alone! This booklet has some of the most popular birth control methods available listed in order of how effective they are. Not all birth control choices are listed. Please visit for more detailed info as well as help with where to get birth control. This is really important. A lot of people have questions about the effectiveness of different methods of birth control. The effectiveness figures used here reflect typical use couples who used a particular method of birth control pretty well but not perfectly. It accounts for human errors and occasional contraceptive failure. Keep in mind though, typical use rates for teens may be a bit worse than what you see here. Also, birth control only works when you use it consistently and carefully every single time you have sex. Got it? OK...

38 Please keep in mind > Pregnancy and STIs. Although all the methods listed here are good at preventing pregnancy when used correctly, not having sex or using condoms is the only protection against sexually transmitted infections (STIs). > Drugs and drink. If you re drunk or high, you re not going to make good decisions about sex and protection. > Two is better than one. One method of birth control is good, two methods are better. Using a hormonal method of birth control and a condom is your best protection. > Pressure. Never, ever let anyone pressure you to do something sexually you don t want to do. You re in charge of your life; you make the decisions and you deal with the consequences!

39 Waiting (not having sex) We ll say it again: The only 100% effective method for avoiding pregnancy is to not have sex. Whether you ve had sex before or not, waiting has lots of advantages including no difficult emotional or physical consequences. effective: 100% You don t need a doctor or to go to a pharmacy.

40 The IUD An IUD (intrauterine device) is a small, flexible T -shaped device that is inserted into the uterus. Three types are available Mirena, ParaGard, and Skyla. Mirena can be left in for up to 5 years, ParaGard for up to 10 years, and Skyla the smallest IUD currently available can be left in for up to 3 years. effective: just over 99% of the time You must see a medical professional to get an IUD and to have it removed.

41 The Implant (Implanon) This is a small rod about the size of a matchstick that is inserted into a woman s arm just below the skin. Once it s in, you can feel it but you can barely see it. Implanon is effective for up to 3 years. effective: just over 99% of the time You must see a medical professional to get Implanon and to have it removed.

42 The Shot (Depo-Provera) The contraceptive shot known also as Depo-Provera or just plain Depo is an injection given to a woman every 3 months. The shot must be given by a medical professional, so you ll need to go back to the clinic or doctor s office regularly. effective: 94% of the time You must see a medical professional to get the shot.

43 Birth Control Pills Sometimes called oral contraception, birth control pills need to be taken at the same time every day. Many versions of the pill are available and they re all a little different, so if you have side effects from one type, talk to a health care professional to figure out another type of pill that works for you. effective: 91% of the time You must see a medical professional to get a prescription for the pill.

44 The Ring (NuvaRing) The ring (NuvaRing) is a thin, flexible ring about 2 inches across. The woman inserts the ring into her vagina; when properly inserted, neither she nor her partner can feel it. It stays in for 3 weeks and comes out for 1 week, then a new ring is inserted; this process is repeated every month. effective: 91% of the time You must see a medical professional to get a prescription for the ring.

45 The Patch (Ortho Evra) The patch (Ortho Evra) is a thin piece of plastic that looks like a square Band-Aid. It s sticky on the back and a woman places it on her skin. Each patch is worn for 1 week and then replaced with a new one; you go patchless on the 4 th week. effective: 91% of the time You must see a medical professional to get a prescription for the patch.

46 Condoms Condoms for guys are thin tubes that are rolled down over the penis and protect against pregnancy and STIs. Condoms for girls kind of look like bigger male condoms turned inside out. They re inserted into the vagina. Male and female condoms should be put on before sex and taken off after sex is over. effective: male 82% of the time female 79% of the time You can buy male condoms in most drugstores and online as well as find them in clinics. Female condoms are available in some drugstores and online as well as in some clinics.

47 Myths There are a whole lot of myths out there about sex and birth control. Here are a few that we hear a lot. Every single one of these is false, so if you hear them, don t believe them! For more myths visit: MYTH: You can t get pregnant the first time you have sex. MYTH: You can t get pregnant if the guy pulls out before he ejaculates. MYTH: You can t get pregnant if the girl is on top. MYTH: You can t get pregnant if the girl douches, takes a bath, or urinates immediately after sex.

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51 Working with Your Health Care Provider (HCP) Your HCP can be a good partner in birth control by: n Answering questions about methods. n Making sure a method is well suited to your health and age. n Teaching you how to use the method you select. There is no one right contraceptive for you. You can change methods or try out new ones to suit your needs any time. The choice is always yours. Talking with your HCP Tell your HCP what matters most to you in a method (for instance, most effective, doesn t get in the way during sex, lessens heavy bleeding). n If you want a method that lets you skip your period sometimes. n About problems you (or your partner) have had with birth control. n If you (or your partner) have more than one sex partner. n About any major health problems or allergies you have. n Your age and if you smoke (women over age 35 and smokers have special health issues with hormonal methods). n If and when you were last pregnant or had an abortion. n If and when you plan to get pregnant in the future. Ask your HCP Which methods will work well for me, given my age, body type, and lifestyle? And for each method: n If I can have a prescription for Emergency Contraception (EC), in case I need it later. n What side effects might I have? n Is this method safe for me? n What will it cost? Will my health plan cover this method? n What must I do to help this method work best? What will you do? n Your own questions and concerns To Find Out More Visit To find out about Emergency Contraception, go to or call the toll-free number not-2-late. (click on health info, then birth control) Clinical Advisors: Writer: NOTE FROM CHILDRENS LAW CENTER: This information from the Association of Reproductive Health Professionals is available at: Linda Dominguez, RN-C, NP, Albuquerque, NM Bryna Harwood, MD, Chicago, IL Sharon Schnare, RN, FNP, CNM, MSN, Olalla, WA Joy Mara, Wheaton, MD A Woman s Guide to Understanding Today s Birth Control Choices Association of Reproductive Health Professionals Your Choice Matters. This Brochure Can Help You Get Started. The purpose of this brochure is to help you think about your choices. The chart that follows reviews today s major birth control methods. Then there s a tool to help you (and your partner) narrow down your choices, based on your unique needs. The brochure ends with some points to discuss with your health care provider (HCP), such as your doctor, nurse, nurse practitioner, physician assistant, or midwife. Choosing a Birth Control Method Today, women and men have more choices for birth control than ever before. With so many safe and effective methods, the choice is yours based on your health, goals, and lifestyle. ARHP 2401 Pennsylvania Ave., NW, Suite 350 Washington, DC Used with permission. Association of Reproductive Health.

52 Darker shaded areas indicate hormonal methods Only the female condom, male condom, and diaphragm protects against sexually transmitted infections (STIs), including HIV. NOTE FROM CHILDRENS LAW CENTER: This information from the Association of Reproductive Health Professionals is available at: Available Birth Control Methods Method The Basics Use Each Sex Act? Note This Most Effective ( 99% or more effective) Sterilization (male and female) Having surgery so you can no longer become pregnant. No Lasts for life. Some may regret this if they want to have children later. Copper T IUD Small device HCP puts in uterus (womb). Protects up to years. No May increase monthly bleeding and cramping in first few months. May protect against endometrial cancer. LNG IUS Very Effective (91%-99% effective) Pills Shots Patch Ring Effective (81%-90% effective) Female Condom Small device (like IUD) with added hormone. HCP puts in uterus. Protects up to 5 years. Swallow 1 pill each day. Protects as long as you take it each day. HCP gives you a birth control shot every 3 months. Protects for 3 months. Apply stick-on patch to skin once a week for 3 weeks. Then, have a patch-free week. Protects for 1 month. Insert ring into vagina. Remove it after 3 weeks. Insert again 1 week later. Protects for 1 month. Insert into vagina up to 8 hours before sex. Protects for 1 sex act. No No No No No Yes Decreases monthly bleeding and cramping. Protects against some cancers. Decreases monthly bleeding and cramping. Protects against some cancers. Can be used for less frequent or shorter periods. Decreases monthly bleeding and cramping. Protects against some cancers. Decreases monthly bleeding and cramping. May protect against some cancers. Can be used for less frequent or shorter periods. Decreases monthly bleeding and cramping. May protect against some cancers. Can be used for less frequent or shorter periods. Protects well against STIs. Male Condom Put over penis right before sex. Protects for 1 sex act. Yes Protects well against STIs. Sponge Insert into vagina less than 24 hours before sex. Protects for 24 hours. During that time, you can repeat sex without changing the sponge. No Contains a substance (spermicide) that stops sperm movement. Must remove by 30 hours after sex. Diaphragm Moderately Effective (80% effective) Fertility Awareness ( natural family planning ) Cervical Cap Spermicide n Hormonal contraception (shaded blocks) works by changing a woman s hormone levels. n Non-hormonal contraception blocks sperm from reaching the uterus (womb) or makes it harder for them to travel. n Self-control methods include not having sex at all and timing menstrual cycles to avoid sex during fertile times. Get from HCP. Insert into vagina less than 8 hours before sex. Protects for 1 sex act. Ask HCP about. Monitor cycle to determine when fertility is likely or unlikely. Get from HCP. Insert into vagina less than 24 hours before sex. Protects for 1 sex act. Foam, jelly, cream. Insert into vagina less than 1 hour before sex. Protects for 1 sex act. Yes N/A Yes Yes Must apply spermicide (see next category) before each vaginal sex act. Decreases risk for some STIs (not HIV). Must carefully monitor monthly menstrual cycle (period). Must use spermicide. Check cap is still in place before repeat vaginal sex. Frequent use can harm vaginal tissue. You can prevent pregnacy up to 120 hours after unprotected sex with Emergency Contraception (EC). To find out about EC, go to or call the toll-free number not-2-late. Which Method Meets Your Needs? The best birth control method is the one that suits your current lifestyle, age, health, and goals. Here is a brief tool to help you sort through your choices. If you want a method that... Is easy to use; requires no daily or pre-sex effort Also may protect you from some STIs Lets you conceive again right after you stop using it (is quickly reversible ) Is highly effective and quickly reversible Is very private; no one knows you re using it Has only local effects, not body-wide Is safe to use while breast feeding Is an over-the-counter product you buy yourself Works long-term for women nearing menopause Prevents pregnancy after sex without birth control You might think about... IUD, IUS, Patch, Ring, Shots, Sterilization Condom, Diaphragm Cap, Condom, Diaphragm, IUD, Spermicide, Sponge IUD IUD, Shots Cap, Condom, Diaphragm, IUD, Spermicide, Sponge Cap, Condom, Diaphragm, IUD, Pills (progestin-only), Spermicide, Sponge, Sterilization Condom, Spermicide, Sponge IUD Emergency Contraception (EC) To find out more about birth control methods, visit Used with permission. Association of Reproductive Health.

53 HIV/AIDS and STD Resources HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA) (202) HAHSTA is the core D.C. governmental agency tasked with working to prevent and reduce the transmission of HIV/AIDS, Hepatitis, STDs, and TB. HAHSTA also works to provide treatment to persons with the diseases. HAHSTA partners with health and community-based organizations to offer testing, counseling, prevention, education, intervention, medical support, housing, nutrition, personal care, emergency services, free medication, and insurance. The HAHSTA website provides information about how to access services in D.C. Moreover, HAHSTA has partnered with D.C. TAKES ON HIV (dctakesonhiv.com) to provide additional HIV-related resources, including testing site locations in the D.C. area. HAHSTA Sexually Transmitted Disease Services (202) or (202) The D.C. Department of Health provides Sexually Transmitted Disease services through the Southeast STD Clinic located at D.C. General Hospital Campus. Services provided by the clinic include comprehensive STD testing for persons over 12 years old, STD diagnosis and treatment, and Hepatitis A & B vaccinations. The clinic further provides free education and counseling as well as access to free condoms. DC s new Health and Wellness Center, located at 77 P Street NE also provides a similar set of services, as well as referrals for conditions that the Center does not treat. Metro TeenAIDS (202) Metroteenaids.org Metro TeenAIDS provides resources to advance the overall health of at-risk and HIV-infected adolescents by providing resources to help teens fight AIDS and support each other. Among other services, Metro TeenAids offers free counseling, testing, and referrals to youth; provides support to adolescents living with HIV; engages in risk-reduction counseling; and provides capacity building assistance to youth-serving organizations in D.C. Through their Stable Families program, Metro TeenAIDS also utilizes a community-based collaborative model to help ensure families affected by HIV are receiving high quality and coordinated service provision.

54 The Conway Health and Resource Center (202) (medical) or (202) (dental) The Conway Health and Resource Center is located in Ward 8 s Bellevue neighborhood and provides primary medical care, including confidential STI and HIV testing and treatment. The Center accepts Medicaid, Medicare, DC Alliance and other private insurance.

55 District of Columbia Department of Health STD Control Program FACT SHEET S.E. STD Clinic DC General Hospital Campus 19th and Massachusetts Avenue, SE Building 8 Phone: (202) Prevention Protects Your Health Chlamydia Chlamydia is a sexually transmitted infection (STI) that is caused by a bacterium called Chlamydia trachomatis. Chlamydia is a common STI that can be spread during vaginal, anal, or oral sex. It can also be transmitted from an infected mother to her baby at birth. Teenagers and young adults are most commonly infected. Symptoms Men Discharge from the penis or rectum Pain or burning sensation when urinating Pain and swelling in the testicles Itching of the tip of the penis Women Pain and itching of the vagina or surrounding area (vulva) Discharge from the vagina Pain when urinating Pain when having sex Approximately 30% of infected men have no symptoms. Approximately 70% of infected women have no symptoms. Serious complications can occur in women who have chlamydia who are not treated: Pelvic inflammatory disease ( a serious pelvic infection in women) Ectopic (tubal) pregnancies Infertility Testing Men If the male client has no symptoms of chlamydia, the clinician may request a urine sample that will be sent to the lab for analysis. If the male client is symptomatic, a urethral examination will be performed. During a urethral exam, the clinician will wipe the opening of the penis with a small swab. The sample is then placed on a glass slide that will be stained with dye and then viewed under a microscope. Women If the female client has no symptoms of chlamydia and declines a pelvic exam, the clinician may request a urine sample that will be sent to the lab for analysis. However, it is recommended at all female clients have a pelvic exam performed during the clinic visit. During the pelvic exam, a speculum will be inserted into the vagina. The clinician will use two small swabs to collect a sample of discharge from the vagina. The sample of discharge is placed on a glass slide and viewed under the microscope. Treatment Chlamydia can be treated with antibiotics. Commonly used medications include Doxycycline (for one week) or Azithromycin (single dose). Since the symptoms of gonorrhea and chlamydia are similar and both diseases can occur at the same time, most people who are treated for gonorrhea are also treated for Chlamydia. It is recommended that individuals be re-screened three months after receiving treatment. Prevention Tips Avoid unprotected sexual contact. Always use a condom during vaginal, anal, and oral sex Have only one sex partner If you are treated for chlamydia, notify your sex partners to avoid re-infection If you have questions or think you may have Chlamydia stop having sex and come to the S.E. STD Clinic for a FREE and CONFIDENTIAL Assessment.

56 District of Columbia Department of Health STD Control Program FACT SHEET Hepatitis B Hepatitis B is a serious disease caused by the Hepatitis B virus. This infection can be transmitted during vaginal, anal, and oral sex. The infection can also be transmitted by injecting drugs, sharing personal care items (such as a razor or toothbrush), body fluids, and by infected mothers during birth. Symptoms Loss of appetite Tiredness and fatigue Muscular pain Yellow skin and eyes (jaundice) Diarrhea and vomiting How serious is Hepatitis B? S.E. STD Clinic DC General Hospital Campus 19th and Massachusetts Avenue, SE Building 8 Phone: (202) Prevention Protects Your Health After the virus gets into your body, it attacks your liver. The liver helps your body to digest food and to eliminate poisons. Hepatitis B stops your liver from working properly. The virus can cause lifelong infection, scarring of the liver, liver cancer, liver failure, and even death. How is Hepatitis B treated? There is no specific treatment for short term illnesses. Some people remain infectious for life (they become carriers of the virus). How can I avoid getting Hepatitis B? Get vaccinated. Condoms will only partially reduce your exposure to body fluids and your risk of getting the virus. The SE STD Clinic provides Hepatitis B vaccinations free of charge. Who should be vaccinated? Anyone who has recently been treated for a sexually transmitted disease. Anyone who visits a sexually transmitted disease clinic. Injection drug users. Sexually active homosexual and bisexual men. Health care workers. The vaccine is recommended for all infants at birth. If you have questions or think you may have Hepatitis stop having sex and come to the S.E. STD Clinic for a FREE and CONFIDENTIAL Assessment.

57 District of Columbia Department of Health STD Control Program FACT SHEET Genital Herpes Genital herpes is a sexually transmitted disease caused by the herpes virus type II. Herpes virus type I can result in cold sores or fever blisters on the mouth, but can also cause lesions in the genital area. Genital Herpes can be spread from mother to child at the time of delivery. Symptoms Small grouped blisters (clusters) on the genitalia that are often painful. This is referred to as an outbreak. Fever and flu-like symptoms (only with the first outbreak). Many people have no symptoms; however they can still spread the virus to their sexual partners (asymptomatic shedding). *The symptoms usually appear two days to three weeks after infection. *The lesions will go away within 1-3 weeks regardless of treatment. *Herpes is a virus that cannot be cured or eliminated from the body. Testing S.E. STD Clinic DC General Hospital Campus 19th and Massachusetts Avenue, SE Building 8 Phone: (202) Prevention Protects Your Health A blood test can determine if you have herpes type II. Treatment for Herpes The most commonly used medication is Acyclovir (Zovirax). Famciclovir (Famvir) or Valacyclovir (Valtrex) are other medications that can be used. Treatment is given during an outbreak to shorten the duration of the outbreak. However, it is not curative and future outbreaks are common. Prevention Tips Avoid unprotected sex. Always use a condom. However, condoms do not totally prevent the transmission of herpes. Have only one sex partner. If you have questions or think you may have Herpes stop having sex and come to the S.E. STD Clinic for a FREE and CONFIDENTIAL Assessment.

58 Syphilis District of Columbia Department of Health STD Control Program FACT SHEET Syphilis is a sexually transmitted disease that is caused by a bacterium called Treponema pallidum. It can spread from person to person during unprotected vaginal, anal, or oral sex. Syphilis can also be spread from a mother to her unborn baby. Symptoms A painless sore on the penis, scrotum, vagina, cervix, anus or mouth Rashes on the body (especially on the palms of hands and soles of feet) Swollen lymph glands Alopecia (loss of hair form the head or body) In late syphilis, the brain and heart may be affected Symptoms usually appear 1-2 weeks after being exposed to syphilis How would I know if I have syphilis? S.E. STD Clinic DC General Hospital Campus 19th and Massachusetts Avenue, SE Building 8 Phone: (202) Prevention Protects Your Health If you have a sore on your genitals, get an STD examination. A blood test for syphilis is usually performed. You could have syphilis and not know it. Anytime you have tests for other STDs, be sure to ask for a syphilis blood test. How is syphilis treated? Syphilis can be treated with antibiotics. Penicillin shots are usually used. A single shot is often adequate during the early stages of syphilis. Multiple shots are used during later stages of the disease. Other antibiotics may be used in people who have an allergy to penicillin. The Southeast STD Clinic will test, diagnose, and treat Syphilis free of charge. How can I avoid getting syphilis? Avoid unprotected sex. Always use a condom. Avoid infection by having one sexual partner. If you have questions or think you may have Syphilis stop having sex and come to the S.E. STD Clinic for a FREE and CONFIDENTIAL Assessment.

59 District of Columbia Department of Health STD Control Program FACT SHEET Trichomoniasis (Trich) Trichomoniasis is a common sexually transmitted disease that is caused by a single-celled protozoan parasite called, Trichomonas vaginalis. The infection can be transmitted from person to person during unprotected vaginal sex. It can also be transmitted during vulva to vulva contact with an infected partner. Pregnant women who have trichomoniasis may have babies who are born early or with low birth weight. Symptoms Men Most men have no symptoms of the infection Some men may have irritation inside penis, mild discharge, irritation inside of the penis, or a mild burning sensation after urination Women Vaginal discharge that is usually foamy and foul smelling Vaginal itching and irritation Redness and swelling on the outside of vaginal area Painful when having sex S.E. STD Clinic DC General Hospital Campus 19th and Massachusetts Avenue, SE Building 8 Phone: (202) Prevention Protects Your Health Testing Treatment Trichomoniasis can be identified in female patients by viewing the sample of discharge under the microscope. Trichomoniasis is commonly treated by an antibiotic called Flagyl (Metronidazole). This medication interacts with alcohol and can cause unpleasant side effects. Prevention Tips Avoid unprotected sexual contact. Always use condoms. Have only one sex partner If you are treated for trichomoniasis, notify your sex partners to avoid re-infection If you have questions or think you may have Trichomoniasis stop having sex and come to the S.E. STD Clinic for a FREE and CONFIDENTIAL Assessment.

60 DC Department of Health HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA) Fact Sheet HIV/AIDS What is HIV? HIV is the human immunodeficiency virus. It is the virus that can lead to acquired immune deficiency syndrome, or AIDS. CDC estimates that about 56,000 people in the United States contracted HIV in HIV damages a person s body by destroying specific blood cells, called CD4+ T cells, which are crucial to helping the body fight diseases. What is AIDS? AIDS stands for Acquired Immunodeficiency Syndrome. Acquired means that the disease is not hereditary but develops after birth from contact with a diseasecausing agent (in this case, HIV). Immunodeficiency means that the disease is characterized by a weakening of the immune system. Syndrome refers to a group of symptoms that indicate or characterize a disease. In the case of AIDS, this can include the development of certain infections and/or cancers, as well as a decrease in the number of certain specific blood cells, called CD4+ T cells, which are crucial to helping the body fight disease. Before the development of certain medications, people with HIV could progress to AIDS in just a few years. Currently, people can live much longer - even decades - with HIV before they develop AIDS. This is because of highly active combinations of medications that were introduced in the mid-1990s. How does someone get HIV? HIV is spread primarily by: Not using a condom when having sex with a person who has HIV. Having multiple sex partners or the presence of other sexually transmitted diseases (STDs) can increase the risk of infection during sex. Unprotected oral sex can also be a risk for HIV transmission, but it is a much lower risk than anal or vaginal sex. Sharing needles, syringes, rinse water, or other equipment used to prepare illicit drugs for injection. Being born to an infected mother HIV can be passed from mother to child during pregnancy, birth, or breast-feeding. What are the symptoms for HIV? The only way to know if you are infected is to be tested for HIV infection. You cannot rely on symptoms to know whether or not you are infected. Many people who are infected with HIV do not have any symptoms at all for 10 years or more. The following may be warning signs of advanced HIV infection: rapid weight loss, dry cough, recurring fever or profuse night sweats, profound and unexplained fatigue, swollen lymph glands in the armpits, groin, or neck, diarrhea that lasts for more than a week, white spots or unusual blemishes on the tongue, in the mouth, or in the throat, pneumonia, red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids, memory loss, depression, and other neurological disorders For information about HIV/AIDS and how to protect yourself call HAHSTA at (202) or dial 311 for Testing Sites in the District of Columbia.

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