Pregnancy can be a beautiful thing. But it can also be an inconvenient thing, a financially burdensome thing, a physically dangerous thing, an emotionally AND politically charged thing, and at times a scandalous thing. This is why most women prefer to control their fertility: when pregnancy happens to them, they want it to be at its most beautiful. There are many ways to deal with an unwanted pregnancy, but they fall into just three basic categories: prevent it, terminate it, or follow through with it. If you choose to carry an unplanned pregnancy to term, you have the additional option of giving the child to another family through the process of adoption. We will go over all these options, starting with prevention, since it is the easiest and least traumatic way to control fertility. If already faced with an unexpected pregnancy, you will want to skip to the bottom of the page, where we discuss adoption and abortion.
Whatever your situation or your preference for handling it, bear in mind that I am not an expert or medical professional, just a good researcher. The purpose of this page is to provide a brief overview of all your options. If an option interests you, I encourage you to do further research and definitely talk to a counselor or doctor before making a final decision.
Hormonal birth control works by delivering a regular dose of synthetic estrogen and/or progesterone that prevents ovulation, makes cervical mucus thicker (and therefore harder for sperm to navigate through), and thins the uterine lining so any egg that manages to become fertilized will be less likely to implant in the uterus and continue growing. Hormonal contraception is available in the form of a daily pill, a patch, an injection, and a vaginal ring. Side effects (the most common of which are breast tenderness, weight gain, irregular vaginal bleeding, fatigue, and mood changes) are often more intense with the last three options, but those are also more effective than pills, which may be misused or forgotten. The way they are typically used, birth control pills are 93-97% effective, but when used perfectly, they are about 99% effective, just like both the patch and the vaginal ring. An injection of Lunelle or Depo-Provera is so effective that only a few of every 1,000 women get pregnant while on it.
Emergency contraception, or the morning after pill, is two higher doses, taken 12 hours apart, of the same stuff that’s in regular hormonal contraception. It works in the same way, too—by preventing ovulation, thickening the mucus in the vagina, and changing the lining of the uterus. Most pharmacies make emergency contraception available to women over 18 without a prescription. It really should only be used as a back-up plan, though, since it isn’t as effective as most other forms of birth control: it only works 75-89% of the time, and its effectiveness changes depending on how soon it’s taken after unprotected sex. If the morning after pill isn’t taken within 72 hours of intercourse, it just won’t work.
Barrier methods of birth control work by blocking the passage of sperm into the uterus and fallopian tubes, where they could fertilize an ovum. The best-known and most common barrier is the male condom (Amazon has a wide variety of them), which is also the most effective barrier method—it works 85% of the time when used alone and 95% when combined with a spermicide (foam, jelly, or cream that kills sperm). Spermicide considerably increases the effectiveness of other barriers, too, although it’s only about 75% effective if used on its own. In addition to blocking the passage of sperm into the uterus, the contraceptive sponge actually contains spermicide and is 84-91% effective, depending on how carefully it’s used. This and other female barriers have the benefit of giving contraceptive control to the woman, instead of leaving it in the hands of the man. They can also be inserted before things get hot and heavy, so you don’t have to worry about pausing the action to put them in—or worse, forgetting to use them. Like the contraceptive sponge, the diaphragm, cervical cap, and female condom all fit inside the vagina, but with these it’s necessary to apply separate spermicidal chemicals to the vagina shortly before intercourse. Without an added spermicide, these forms of birth control are only about 80% effective. With spermicide, they’re over 90% effective. It’s important to remember that the only barrier methods that also provide protection from sexually transmitted diseases are the male and female condom. Spermicide kills sperm, but not the germs that cause STDs.
An intrauterine device (IUD) is a small T-shaped plastic object that a doctor can insert into the uterus. There are two basic kinds of IUD: the first kind has a copper sleeve or is wrapped with copper wire, and the other kind releases the hormone progesterone. The uterine lining responds to the presence of a foreign object inside the uterus by releasing prostaglandins and leukocytes, which attack and kill both eggs and sperm as they enter the uterus. Copper acts as an additional spermicide, and progesterone from an IUD prevents ovulation, thickens cervical mucus, and thins the uterine lining, just like other forms of hormonal birth control. There are some serious risks associated with IUDs, but these are very rare, and the main drawback of an IUD is that it can cause longer, heavier, more painful periods. (Adding progesterone to the IUD usually lessens this side effect.) On the plus side, a single IUD usually stays about 99% effective for 5-10 years, and once it’s in, you rarely have to even think about it.
Abstinence is, of course, the only 100% effective form of birth control—that is, if you can handle not having any sex at all, ever. Lots of people can’t, or don’t want to. If abstinence works for you, use it. And if it doesn’t . . . well, people are animals. Animals have sex. Use one of the other forms of birth control.
If You’re Already Pregnant
Before you start weighing your options for getting rid of an unwanted pregnancy, make absolutely sure you are in fact pregnant. All of the common symptoms of early pregnancy—including nausea, vomiting, swollen or painful breasts, fatigue, headaches, mood swings, and even a light or missed period—can also be caused by other things that have nothing to do with pregnancy. If you use a home pregnancy test, be aware that they can give inaccurate results during the earliest stage of pregnancy. The best way to find out for sure whether you are pregnant is to go to a doctor or a center like Planned Parenthood for a blood test.
If you are definitely pregnant and decide you don’t want to carry the pregnancy to term because of social, lifestyle, or health factors, you are choosing abortion. If you’re still very early in the pregnancy, you may have the option of medical abortion—that is, an abortion brought on by medication. If your pregnancy has progressed past nine weeks, you will need to have a surgical abortion. A doctor can help you determine how long you have been pregnant and advise you on the most suitable form of abortion for you.
Three methods of surgical abortion are commonly performed in the United States. The first of these is called vacuum aspiration, which can be done in the first trimester (12 weeks) of pregnancy and involves passing a tube into the uterus through the cervix. Any tissue inside the uterus is sucked out using either a handheld syringe or an electric pump connected to the tube. The second type of abortion, dilation and curettage (D & C), is usually used either to remove tissue that was missed in a previous vacuum aspiration procedure or as part of the third type of abortion, dilation and evacuation (D & E). D & E is usually used in the second trimester (12-24 weeks) of pregnancy. The first step, dilation, is a process of widening the opening of the cervix using a drug called misoprostol and an instrument called an osmotic dilator, which is placed in the cervix and then expands, enlarging the cervical opening as it does so. Once the cervix is dilated, the doctor uses a curved instrument with a sharp edge called a curette to scrape the inside of the uterus, then removes the tissue that’s been scraped away using vacuum aspiration and/or forceps, which are kind of like medical tongs. Because this can be painful, many doctors recommend general anesthesia so the patient is asleep during the procedure.
Of the three types of abortion, vacuum aspiration is the safest and least invasive, so the earlier in your pregnancy you have an abortion, the better. In general, though, serious complications from an abortion done legally by a medical professional are very rare, and unless you have more than one D & C or D & E, abortion is unlikely to affect your future fertility. A surgical abortion is usually completed in 15 to 30 minutes, depending on the type of procedure, and most patients get to go home the same day.
If you prefer not to have an abortion, but you can’t or don’t want to take on the responsibility of raising a child yourself, you may choose to place the baby for adoption. While confidential or “closed” adoption is still possible, it has become uncommon in the United States. A birthmother usually works with an adoption agency to choose a family for her baby, based on photos and family profiles. It’s usually even possible to meet prospective parents before making a decision, and many adoptive families are willing to provide the birthmother contact with the child after the adoption, through letters and photographs or actual visits. The process of adoption should be started during pregnancy, but in most places it isn’t legally complete until well after birth, so the birthmother isn’t stuck with her decision before she even meets the baby. If you’re considering adoption, you should take advantage of all the support available to you, from your family and friends and in the form of counseling and support groups that can help you both before and after the adoption.
The Abortion Pill
Medical abortion is an alternative to surgical abortion (see “If You’re Already Pregnant”) in which a doctor prescribes a drug that usually causes abortion during the first nine weeks of pregnancy. The drug most commonly used for this purpose is mifepristone, sold in the United States under the brand name Mifeprex and sometimes referred to as RU-486 or the “abortion pill.” It is prescribed along with misopristol to dilate the cervix so dead tissue can easily leave the uterus. Mifepristone works by preventing a fetus from getting the hormone progesterone, without which it can’t continue to develop and will be shed from the uterus along with the uterine lining. The drug causes uterine cramping and bleeding, and results in abortion about 90% of the time. A few days after a medical abortion, a woman goes back to the doctor to confirm that she isn’t still pregnant. If the medical abortion has failed, the doctor will perform a surgical abortion.
The abortion pill should not be confused with the morning after pill, which prevents pregnancy in the first 72 hours after unprotected sex.