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    Myriad voices in the contraceptive debates.

    Choudhury PA


    4 major contraceptives are being examined by health care professionals throughout the world. They are: injectables, the IUD, condoms and the pill. This article discusses the advantages and disadvantages of all four. Injectable contraceptive are most commonly either Depo-provera or Noristerat. Depo-provera is approved for use as a contraceptive in 90 countries. Noristerat is approved for use in 40 countries. Detractors of Depo-provera say that is produces breast tumors in beagle dogs, possible tetratogenecity upon failure concern that abnormal bleeding might lead to additional estrogen therapy, and that the simple nature of this type of drug might lead to abuse of informed consent. However, World Health Organization studies have shown no cancerous effects of the drug and a failure rate of 1 in 100 women. When failure occurs, tetratogenecity is very low. It must be looked at in the context of risk assessment before judgement is passed on it. In countries where pregnancy can mean a decrease in the quality of life for the mother or the family, this is an easy method of birth control. The IUD has many questions surrounding its use: infection, expulsion, tubal infertility, ectopic pregnancy and uterine laceration. While it is an effective method of birth control, not an abortifacient, it does have certain disadvantages that must be considered. Condoms have the added benefit of preventing the spread of disease as well as preventing pregnancy. However, in many countries there is a cultural bias against using a condom. Men complain about reduced sensitivity. Also, they break with a certain frequency that is unavoidable in a mass produced product (about 1 in 10,000). Their biggest weakness is most users do not use them consistently. This is where injectables, the IUD and the pill have an advantage over the condom. Use patterns also increase their failure rate in terms of contraception. The pill is the most popular and widely used form of hormonal contraception. It has been proven safe at lower doses and is very effective. It is however, incapable of preventing the spread of disease. Also, women who smoke and use the pill run a higher risk of breast cancer.
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