Nancy Gettman and Deborah L. Vosler
1992 Woodrow Wilson Biology Institute
To introduce the uses, effectiveness, cost, advantages, disadvantages or contradictions, and ethical issues concerning birth control devices. RU-486, known as the French Abortion Pill, will be featured in this activity.
Condoms (male & female), Birth Control Pill, IntraUterine Device (IUD), Spermicides (Foam, Gel, Film, Suppositories, Cream), Diaphragm, Sponge, Scalpel to portray sterilization, Cervical Cap, Hormone Releasing Capsule, Latex Plug, Douche, Syringe to indicate long-term Injectable Hormone, Calendar to portray the Rhythm Method, 1/2 inch Plastic Tubing to signify an Induced Abortion, Empty Gelcap to represent RU-486
1 Paper lunch sack for each contraceptive type
Empty paper lunch sack to depict Abstinence
*Suggested areas of student research include:
A) How does this birth control device work?
B) What is the effectiveness of the birth control device?
C) Determine the cost of each birth control device for one month, one year, a reproductive life cycle.
D) Describe advantages and disadvantages/contradictions for the birth control device.
E) What impact has this birth control device had on society con-cerning ethical issues?
A. Discussion with the entire class.
B. Dividing the class into cooperative learning groups.
C. Having students work alone.
D. Using role playing techniques.
E. A panel presentation having students determine the role that each will take.
F. A panel presentation having students take an opposing viewpoint.
G. Videotaping the class for further discussions.
H. Setting up a debate.
I. Being creative!
|Method of Birth Control||Preg/100|
|Mode of Action||Advantages||Disadvantages|
(estrogens and progesterone)
|3 - 6||Inhibits secretion of FSH, LH: prevents follicle maturation and ovulation||Decreases menstrual pain and blood flow, lowers risk of PIDs & allows for sexual spontaneity||Weight gain, moodiness, water retention, breast tenderness, prescription required|
|Diaphragm with Spermicide||2 - 25||Blocks and kills sperm||Protects against STD, viable for 6 hours||Lack of spontaneity, MD administration|
|Intrauterine Device - IUD||1 - 6||Prevents or terminates implantation||Allows sexual spon-taneity, effective up to six years||Pelvic infection, excessive bleeding, physician placement|
|Condom - Male and Female||3 - 36|
2 - 15
|Blocks sperm||Inexpensive, protects against STD||Some loss of sensation|
Male & Female
|<1||Fertilization prevention||"Safe, " allows for sexual spontaneity||Surgical risks, irreversibility|
|Hormone Releasing Capsule||<1||Inhibits secretion of FSH, LH: prevents follicle maturation and ovulation||Protection lasts 2-5 years, fertility return next cycle, may reduce endometrial cancer||Surgical risks, weight gain, menstrual irregularities, mood changes|
|Sponge with Spermicide||6 - 20||Blocks and kills sperm||24 hour protection, reduces risk of STD||Irritation, yeast infection|
|Rhythm||10 - 47||Abstinence during time of ovulation||Knowledge of cycle changes||Requires motivation|
|Douche||? - 85||Washes out sperm in the vagina||Restores pH, acts as a cleansing agent||May force sperm into uterus|
|Foam/ Film/ Gels/ Suppositories/ Creams||3 - 30||Kills sperm and may act as a barrier||Protects against STD, inexpensive, effective with barrier methods||Irritation, waiting period up to 4 hours, needs reapplication|
|Cervical Cap with Spermicide||4 - ?||Blocks and kills sperm||48 hour protection, reduces risk of STD||Irritation, lack of spontaneity, MD|
|RU-486: "The French Abortion Pill"|
|20 - 35|
4 - 10
|Blocks action of progesterone and provokes uterine lining to slough off the embryo||Effective up to 7 wks after egg is fertilized, may be used to treat a number of different cancers and/or diseases||Small risk of excessive bleeding, physician administered in three office visits|
|Induced Abortion||0Abortifacient: removal of embryo||100% effective||Surgical risks, excessive bleeding|
|Total abstinence||0Refraining from sexual activity||Totally safe||None|
|Latex plugs||0 - ?||Temporary physical blockage of fallopian tubes||Allows for sexual spontaneity, highly effective||Accidental removal, irritation, physician administration|
|Injection Hormone: Depo-Provera||<1||Inhibits secretion of FSH, LH: prevents follicle maturation and ovulation||Lasts 1-3 months, fertility return by next cycle||Physician administered, moodiness, weight gain|
To develop, test, and evaluate the safety of a new contraceptive, it generally takes 15 or more years and at least $50 million. Despite the importance of population control, annual worldwide expenditures on reproductive research and contraceptive development have declined from a high of $250 million a year to $200 million a year today Ñ an average of only 25 cents per person (Hanna 47).
At the present, the four most widely used methods for preventing pregnancy include sterilization, IUDs, oral contraceptives, and condoms. Injectable contraceptives and hormonal implants are also being used in some countries.
RU-486 is a drug with substantial market potential that is not likely to be available in the United States in the near future. This delay in access to what many consider a proven drug is primarily due to the boycott threats and effective private and public sector lobbying of United States anti-abortion organizations (Hanna 43). Like the birth control pill, RU-486 has encountered strong resistance from moralists who fear it will trivialize sex, life, and human relations by "bolster[ing] the comparison between taking the drug and swallowing aspirin" (Glasow 7). Although there are many sectors against the use of RU-486, the Feminist Majority Foundation is funding efforts to bring the "French birth control pill," RU-486, into the United States. Individuals are making donations as high as $10 million to promote the use of this drug for research and as an abortifacient (Zeman 8).
RU-486 is not the only contraceptive drug held hostage to the abortion debate. The most advanced contraceptive, Human Chorionic Gonadotrophin (HCG) vaccine, has been tested by the World Health Organization (WHO) in Australia, the Dominican Republic, Finland, and India. It has not been tested in the United States because it acts by stimulating the immune system to attack the outer cells of the pre-embryo. Thus, abortion opponents classify it as an abortifacient rather than a contraceptive, although it works on embryos prior to implantation (Foreman, 1989).
Besides being safer than aspiration abortions and causing fewer side effects, RU-486 is relatively inexpensive. Tests on 8,000 women have shown that the drug has a very small risk of causing excessive bleeding. An abortion performed by a private physician in the United States costs between $500 and $2,000. Clinics usually charge $200 - $300 for the service. In France, the cost of an abortion using RU-486 is approximately $235. This includes the RU-486, the prostaglandin, and three medical visits (Abrams, 1988).
RU-486 causes an abortion by blocking the action of the hormone progesterone, thus provoking the uterine lining to slough off the embryo. Used alone, it is about 80 percent effective in preventing implantation of a fertilized egg if taken within five weeks after a missed period. If taken with a small dose of prostaglandin, a substance that makes the uterus contract, it is 95 percent effective up to five weeks after a missed period. After seven weeks, it is not very effective. After counseling and at least a one week waiting period, the pregnant woman receives a dose of RU-486 from her physician and must return two days later to insure a complete abortion.
The prospects for RU-486 in the United States are dim. At best, it could be available by 1997. It is unlikely that this drug will be legally available to women in the United States because of intense opposition from pro-life groups fearing that it will make abortions commonplace. Government-funded researchers are not allowed to test RU-486 or to develop other abortion drugs. No company has expressed interest in marketing RU-486 in the United States because of such pressure and fear of possible liability suits.
What are the ethical and legal implications of the following scenarios?
When accompanied with prostoglandin, a progesterone antagonist such as RU-486 stimulates the changing of the endometrial lining of the uterus, thus provoking a rejection of the embryo. A decline in the progesterone level increases the contractibility of the muscles of the uterus and leads to a softening and dilation of the cervix which results in a sloughing off of the embryo.
As a society we have approved the use of other forms of birth control that function in much the same way as RU-486. The intrauterine device (IUD) may act as an abortifacient by irritating the endometrial lining of the uterus. Further, the removal of the embryo by induced abortion is performed by dilation and aspiration in the first trimester.
Abrams, A. "Politics, profits and a new pill." Discovery (1988): 1.
Carey, John and Jonathan B. Levine. "Can the 'Abortion Pill' save lives?" Business Week 17 December, 1990: 56-57.
Findlay, Steven and Muadi Mukenge. "A user's guide to 14 methods. " U.S. News & World Report 108 (1990): 62-63.
Foreman, J. "Abortion: An American Divide" Boston Globe 23 April, 1989: 1.
Glasow, R. "RU-486: The Prostaglandin Connection." National Right to Life News 13 December, 1990: 7.
Green, Mark. "RU-486." The Nation 252 (1991): 836-837.
Hall, Elizabeth. "When Does Life Begin?" Psychology Today Sept (1989) 42-46.
Hanna, Kathi E. Biomedical Politics, Division of Health Sciences Policy Committee to Study Biomedical Decision Making. Washington D.C.: National Academy Press, 1991.
Hilts, Philip. "Thomas Expedites Suit on Abortion Pill." The New York Times 16 July 1992: A18.
Kieffer, George. "Bioethics." Lecture. Academic Director, Woodrow Wilson Institute on High School Biology, Princeton University. 5-31 July, 1992.
Lewin, Tamar. "Woman at Center of Debate: Model of an Ardent Feminist." The New York Times 16 July 1992: A18.
Miller, G. Tyler Jr. Living in the Environment: An Introduction to Environmental Science. California: Wadsworth Publishing Company Inc., 1990.
Seligmann, Jean. "A Condom for Women Moves One Step Closer to Reality. " Newsweek 119 (1992): 45.
Ulmann, Andre', George Teutsch and Daniel Philibert. "RU-486." Scientific American 262 (1990): 42-48.
Zeman, Ned and Lucy Howard. "Help for RU-486." Newsweek 118: (1990).