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Water Fluoridation: A Problem in Ethics

Sixty-eight years ago, the beautiful city of Grand Rapids, MI, added fluoride to its municipal water system - and hence, America introduced the world to community water fluoridation.[*][*]


However, in a fascinating twist, individuals and communities all over the world continue an active effort in removing/rejecting the fluoridation of their local water supply.[*]

The most recent efforts here in the US were among voters in Portland who emphasized that adding fluoride would violate an individual’s right to consent to ‘medication.’[*] 

This rejection of the proposal continues to maintain Portland as the largest U.S. city without fluoride in their water.[*]


Quicky - History of Rejection

Between 1950 and 1967 there were over 1,000 fluoridation referendums (according to the CDC). Of those, 41 % fluoride proposals were adopted with 59 % rejected.[*]

From 1980 to 1988, there were fewer fluoridation votes, 150 in total, with a 36 % success rate.[*]

In spite of this, fluoridation rates have steadily increased in recent years. Americans living in areas with fluoridated water has increased from 62 % (1992) to 72.5% (2013).[*]

 



The Elephant in the Room – An Ethics Lesson


Fluoridation is the only water treatment process that does not treat the water itself, but the person consuming it.

Fluoridation is the practice of adding chemicals (fluorosilicic acid, sodium fluorosilicate) to drinking water to raise the naturally occurring level of the fluoride ion to approximately 1 mg/L in the belief that this can reduce the frequency of dental caries.[*][*]


Currently, the Department of Health and Human Services and the Environmental Protection Agency recommended that cities maintain 0.7 milligrams per litter of fluoride in the water supply. (This was recently lowered in 2011 from the original recommendation of 1.2 milligrams.)[*]

Nearly 75% of municipalities follow this recommendation (with many reaching levels beyond the 0.7 ml/L  recommendation…personally, my own municipal water supply is included in this elevated bunch).

Given this, there are several ethical issues that fluoridation neglects:


Unlicensed medicinal substance


medicinal substance(noun): any chemical compound used in the diagnosis, treatment, or prevention of disease or other abnormal condition.[*]



To put it plainly, fluoride, when used in the diagnosis, cure or prevention of disease in man (or animal), is a drug that is subject to Food and Drug Administration (FDA) regulation.[*]

Originally, fluoridation involved the sole use of sodium fluoride, however this process is now accomplished mainly (90%) by the use of silicofluorides obtained from the manufacturing process (effluent scrubbers) of the phosphate fertilizer.[*][*][*][*]

While most commercially available formulations of toothpaste that contain fluoride are formally registered as ingestible drugs, neither sodium fluoride or silicofluorides has been licensed as such in the United States.[*]

This is in strak contrast to pharmaceutical products that require strict formal licensing, quality control (in the manufacturing process), and safety testing. Yet, these particular chemicals (silicofluorides) are given to adults and children as unlicensed medicines - without any such safety testing, pharmaceutical-level quality control in manufacture,
or medical monitoring in administration.[*][*]

In my opinion, fluoridation should be reclassified as medical research. At least in this classification, there are strict ethical procedures and sanctions intended for protection the public.


Voluntary and informed consent

The ethical issues raised by fluoridation can ultimately be referenced in the Nuremberg Code. [*][*]

Research, medical experimentation or even routine medical procedures, must be completed with the voluntary cooperation of the individual, who must be fully informed of the risks and benefits of the medical procedures in which they are involved.[*]


 
In the case of fluoridation there is no such actions taken (or are planned) at attaining informed consent of the public at hand. The State has taken the power upon itself to assume the rights of the individual.

Obviously, a State’s interest may legitimately override an individual’s consent in the event of a potentially life-threatening and/or contagious disease. However, unless there is a valid public health concern, the request of the individual must take precedence over actions imposed by the state.

In the data and research I’ve completed, tooth decay does not qualify as such a disease requiring the State to assume individual rights. Clearly, because tooth decay is not a life-threatening or contagious disease, the use of fluoridation as a prophylactic medical intervention (without the fully informed consent of the public) violates civil liberties.



Safety
There are many health concerns that are debated currently with fluoride ingestion, fluoridation and toxicity – however, I am not going to go into detail here in this post. Rather – this post is dedicated to the ethical issue at hand so I will only address this briefly.

At the heart of any medical ethics debate is the nature of the substance being administered: fluoride chemical compounds added to drinking water.

The National Sanitation Foundation (NSF) standard requires that the chemicals added to drinking water be supported by toxicological evaluation.

However, no randomized, controlled human trials (RCTs) have been completed on the products (hydrofluosilicic acid and sodium fluorosilicate) used in water fluoridation – which makes this section of the post rather short.[*][*]

Nonetheless, there are particular risks when these chemicals are being purchased and added by your municipality that I do want to address.

The more I began to read about how fluoride is added to our drinking supply, it made me wonder - who the hell is responsible to maintain the safety (particularly the processes) of public water fluoridation?

(Unfortunately, I was unable to find the exact answer to this – however, here are three recent lawsuits in the US pertaining to water fluoridation which may add to the confusion of who is wholly responsible.)

To the best of my understanding the State is responsible for monitoring the safety of water fluoridation (please correct me if I’m incorrect). However, not one state’s public health department requires monitoring results of any water system’s fluoridation program; this information is purely on a voluntary basis from each water municipality. 

How exactly is safety (principally the level of fluoride) being monitored if it is not required to declare/report it?

75% of drinking water in this nation is being treated with chemicals by corporate workers and engineers with no medical qualification or clinical experience. The training recommendation (mind you -not required, just recommended) by the CDC is that managers working in fluoridated public water systems should have 6 hours of fluoridation training – that is the end of it.[*]

This is disheartening to say the least, you see, when a community fluoridates its drinking water, a potential exists for a fluoride overfeed (this is per the CDC). The CDC also  confirms that some fluoride levels in fluoridated municipalities can be high enough to cause immediate health problems. Of course, it is instructed that all overfeeds should be corrected immediately because some “have the potential to cause serious long-term health effects”.[*]

And what if they do? Who is responsible – and what about the case that the public are NOT required to be notified of fluoride overfeeds occurring – ?!



One size-fits all approach

In pharmacology, it is understood that individuals respond differently (sometimes very differently) to the same dose of a given drug/medication.

Consequently, the dose of a medication that is considered safe for one person may be harmful for someone else – in some cases dangerous.

The data and understanding on this particular issue is still developing, nearly 70 years after the initiation of fluoridation. However, the premise that fluoridation is safe at the same dose for everyone (irrespective of age, health, and nutritional status) is not well held by scientific evidence – in fact, data point to the contrary.

Some examples:

Formula fed infants (younger then 12 months)
Not only do infants receive a larger dose then their adult counterparts, they have an impaired ability to excrete fluoride through their kidneys.[*]

Current studies have discuss the possibility that infants in this age group (0-12 months) may be consuming more fluoride than necessary. In March 2006, the National Research Council (NRC) cautioned that infants can fluoride-overdose via reconstituted baby formula.[*]


            Individuals with poor kidney function (particularly dialysis patients)
A 2006 National Research Council report indicates people with kidney disease are more susceptible to fluoride’s bone and teeth damaging effects. Particularly, dialysis machines cannot use fluoridated water because it is understood to be potentially dangerous to patients. An NKF statement indicates some people receiving dialysis treatments died or were poisoned from fluoride after it leeched through machine filters.[*]


            Individuals with iodine deficiency
Research has shown that fluoride exposure worsens the impact of an already occurring iodine deficiency. When iodine intake is inadequate during early childhood, the brain can suffer permanent damage. An iodine deficiency coupled with fluoride exposure produces a significantly more damaging effect on neurological development than iodine deficiency alone.[*][*][*][*][*][*][*]


            Children with Polydipsia
Children with medical conditions that induce polydipsia (excessive thirst) are at particular risk of developing severe fluorosis (marked by brown and black staining of the teeth, often with extensive pitting, chipping, and crumbling of the enamel).

Diabetes insipidus is one such medical condition that produces polydipsa and has been confirm by research to be adversely affected by fluoridation.[*][*][*][*]



Fluorosilicic acid and sodium fluorosilicate is delivered to everyone regardless of age, health or nutritional status – this is done without individual oversight by a medical professional and without control of dose.

The underlying point here is that there are members of the population that are more susceptible to adverse reaction when fluoride is added to their water source. Water fluoridation does not allow medical personnel to monitor reactions.

In general, any professional that participates in a medical act (even preventative) are subject to legal and ethical imperatives – with careful attention to the needs of each patient. This is simply not done with regards to water fluoridation.  



Conclusion

The Centers for Disease Control and Prevention list water fluoridation as one of the top 10 public-health achievements of the 20th century.[*]

Whether adding fluorine compounds to municipality water sources carries benefits or risks – the underlying issue is one of ethical allowance.

To put it plainly, silicofluorides are widely used in public water fluoridation are unlicensed medicinal substances administered without informed consent by an unqualified medical practitioner.  


            The Convention on Human Rights and Biomedicine:

No one may in principle be forced to undergo an intervention without his or her consent. Human beings must therefore be able freely to give or refuse their consent to any intervention involving their person.[*]


There are circumstances in which it could be considered acceptable for the State to impose measures on a population as a whole in the interest of public health – however, fluoridation raises an ethical issue because it is an infringement on personal liberty – unless you purchase a whole house RO filter, you are drinking , cooking, bathing and washing your clothes in water that has been enhanced with hydrofluosilicic acid and sodium fluorosilicate for the sole purpose of reducing dental caries.[*]

When I first set out in writing this post I was originally researching the endocrine-disrupting properties of fluoridation and the effect of early on-set puberty, however, I could not completely focus on that topic until I addressed the underlying issue: water fluoridation, in my opinion, is unethical.

The Anti-Vaccine Label

Be cautious of anyone quick to use the term ‘anti-vaccine’.

photo credit: gttorres.deviantart.com


I’ve found, quite often, that there are 3 possibilities to explain why a person will use this label to pigeonhole parents that show concern regarding the current schedule of vaccines used on children in the US:

(1) they mistakenly assume anyone who questions a product’s safety is consequentially against it in absolute terms;

(2) they tend to consider that vaccines are already being used as responsibly as they can be and the current schedule has been stringently tested for safety and efficacy;

(3) lastly, in a last ditch effort, they select a baited label, in this case ‘anti-vaccine’, to manipulate a person.

And, of course, anyone who disagrees with them is an idiot, which is then most likely to be followed by an insult and/or personal attack.

They may also generalize or over-simplify the topic that is being evaluated at that point in time in hopes to advert attention away from what is being addressed. This could be because they simply do not have any valid information to bring to the table.

When using generic labels, it makes it easier to ignore that the underlying motivation a parent has when deciding to vaccinate (either on schedule, delayed or declined completely) can be diverse.

After concerns are addressed, a family may come to a unique schedule with their healthcare provider and that should be respected.

In most cases, it is.

In others, it is not.

Someone who uses the label ‘anti-vaccine’ liberally may imagine themselves to be the gatekeepers of science.

Yet, the days of limited access to information are gone. (Some helpful, science-based sources can be found: CDC Pinkbook, Clinical Trial Search Engine, DOAJ-Directory of Open Access Journals, Science Direct, Vaccine Package Insert PDFs.)


Scientific information is publicly published and is readily available to whoever would like to review it. While this unquestionably this does not qualify anyone who reads it as being a specialist, it does mean that parents have the opportunity to become a critical influence and an active participant in the healthcare choices for their children and themselves.


Whether you decline (or become selective of) vaccination or if you decide to administer them all according to the current recommended schedule, I sincerely hope that we can all agree that there should be some development of responsibility and education on the side of the parent in the participation of their child(ren)’s health.

That should be the underlying principle pressed on parents – NOT slanderous pigeonholing, restrictive labels, and juvenile squabbling.

I like to believe all parents are doing the best they can (am I in the minority?) – choose what works best for your family while doing your best in honoring the rights of others to make that same choice.



This post reflects the research and concern that I have about vaccination.  I am not a medical professional. It does not represent my opinion of people who choose to vaccinate or not.  Please know that, while my family has made the decision to choose an alternative schedule, we respect the rights of all parents to choose to vaccinate if they feel this is best for their child.  I do not have all the answers.  Most of us don’t.  We’re all in this together and we need to make the best decision we can with the information we have.

The Virgin Mary's Birth: A Metaphor for the Conscious Mother

Mary’s virgin birth of Jesus Christ can be regarded as an incredibly meaningful and powerful metaphor.

And although 83% of Americans state that they do, in deed, believe that Mary was in fact an actual virgin during the birth of her first son - I am not here to confirm or deny the merit to this claim.[*]

Although scientists have observed virgin conceptions (known as parthenogenesis) occurring in nature, it has never been observed as occurring in humans, except in unique births as mentioned in various religious (not just Christian) documents.[*] 


A Metaphor

Jesus, himself, preferred to teach his message using a form of metaphor called parables and the virgin birth may be on of the most powerful and universal metaphors to exist.[*][*]


Many current and past scholars have regarded the Virgin Birth is a metaphor for a woman’s process (Mary’s in this case) into motherhood and a spiritual life.

The events that occur within the soul of a woman cause a shift during birth - A birth of compassion; when you begin to live out of compassion rather than from selfish motivation.


“The emotional labor pains of becoming a mother are far greater than the physicals pangs of birth; these are the growing surges of your heart as it pushes out selfishness and fear and makes room for sacrifice and love. It is a private and silent birth of the soul, but it is no less holy then the event of childbirth, perhaps it is even more sacred.” – Joy Kusek LCCE


Although I can not speak for any other person other than myself, motherhood has transformed all that I am.

Motherhood is an extraordinarily profound gift which I think our society tends to forget and, in some cases, undermine.

The Virgin birth does not refer to the biological condition of Mary, but to events that occur within the soul that every mother holds the potential in experiencing. With this insight, we must do our best to honor every mother.

This renewal of the self which occurs in a woman during the passage from woman to mother is enshrouded in obscurity and wonder.  A woman is born again with discernment existing in the soul that experiences the Divine in a unique way – through her child, through her heart and as an instrument of Love and compassion.

I encourage every mother to do their best never to lose sight of what a magnificent influence they have.

Homemade Shampoo

The two essential ingredients in this recipe are the Bronners soap and water – you can essentially add anything you want after that and personalize it to your specific needs. This is what I use:



Ingredients:

1 Cup             Bronners Soap (baby mild)
1 Cup             Water
1/4 Cup         Aloe Vera Gel
2 Tbsp             Vegtable Glycerin
1 Tbsp             Extra Virgin Olive Oil
1 Squirt           Honey
5-10 drops     Vitamin E

Optional: Various Essential Oils (I like Mango-Peach, Rosemary, Thyme and Peppermint)

For Conditioner: 1 Spray Bottle filled with Apple Cider Vinegar



Why These Ingredients?


Dr. Bronners Soap (Baby Mild)- this soap comes in different fragrances such as peppermint and lavendar, but I choose the baby mild because it’s better for people with sensitive skin and allergies. (Plus I can add my own essential oils to it to make it my very own.) All t he oils and essentials in this soap is certified organic. You can learn more or order this here.


Aloe Vera Gel- I choose to add aloe vera gel because the soap and water by itself can be very drying to the hair shaft and scalp. Aloe vera gel has many benefits to hair; it moisturizes, soothes irritation, and it has restorative benefits.

I ordered mine from Lily of the Desert - just make sure you are getting 100% Aloe Vera gel (many over the counter brands have filler ingredients)


Vegtable Glycerin- Known to be a humectant (meaning that it attracts water), veggie glycerin helps add moisture as well. (You can skip this ingredient if you wish) While using this as a body wash, it is also nice to know that glycerin helps skin cells mature properly and has been known for its healing properties (because it helps tissues and cells repair themselves).


Extra Virgin Olive Oil- I’ve used this as an intense conditioner treatment in the past and it’s amazing. I added a tbsp of this to the mixture because it can improve the strength and elasticity of the hair. It can penetrate the hair shaft and supply moisture to the cortex of the hair. EVOO contains antioxidants such as vitamin E and A.

EVOO is great for severely dry skin - apply oil directly to skin after washing in the shower or tub and you'll reap the intense moisturizing benefits (safe for kids too).


Honey- This is a humectant as well, but honey smoothes the cuticle so the hair feels soft and looks shiny. (plus you most likely have this on hand)


Vitamin E- although EVOO contains vitamin E, I added a few more drops. Vitamin E is wonderful for hair and skin. It protects the cells from free radicals, helps with split ends and keeps color vibrant. From what else Ive read, it can also help your hair from going gray – so maybe use 10 drops instead of 5 if you are over 30 like me.


Essential Oils- these oils promote natural shine and a healthier scalp, especially when used at night to allow several hours for your hair to absorb them. Make sure you purchase 100% pure essential oils. For this first batch, I used rosemary and thyme. Peppermint is also a great choice.


My Experience with Homemade Shampoo


So now that you know why I used the items I did – let me tell you how it worked.

I was a bit leery since I had heard reviews that the Dr Bronners soap can be quite drying, but since I added quite a bit of moisturizing ingredients, I was hopeful.

I was surprised by a few things:


1. It lathered up much more then I expected.

2. It was more liquidy then I was used to. 

3. When I used it on my face to wash my make-up off, it worked better then the stuff I had been using for over 5 years; especially with my mascara!

4. My hair seemed a lot thicker then normal and the texture seemed more substantial-I’m not sure of the wording here, but I guess heartier word be the way to describe the texture.


The first night I did not use the apple cider vinegar spray as a conditioner. I regret this….Instead, I used some coconut oil on the ends and it made my hair very greasy!

The next night I washed my hair again, which is not my normal routine – I normally wash my hair every 3 to 4 days, but since I put that coconut oil in my hair, I had to wash it out because I felt like a grease-ball.

This time I used the apple cider vinegar as a conditioner. One word - amazing!

Using the ACV you are able to restore the PH balance in your hair which is critical. The benefits of ACV is the great ability in adjusting the acid alkaline balance because of its calcium and potassium mineral content. Though I was hesitant on using this as a conditioner, I have truly converted into a apple cider vinegar lover!



Conclusion


My hair hasn’t looked or felt this healthy in years! (and it has only been 2 weeks!!) I would suggest trying on making your own shampoo or at least consider a more natural shampoo.

This shampoo wash can replace your body wash and face wash. I use this on my daughters as well and find it very reassuring that I know exactly what the ingredients are and why they are being used.

15 Non-Hormonal Birth Control Methods

Birth control.

Does your mind instinctively imagine a small plastic compact lined with small pills or maybe it’s a patch, injection or flexible ring that incorporates some sort of hormone that miraculously affects the body to regulate fertility? 

Hormonal birth control options are extremely effective and popular – you may even be using one right now – but perhaps you would like to learn about options that don’t include estrogen and/or progestin hormones.

This could be for many reasons. You may be attempting to lower the effects you are currently experiencing with a hormonal method such as weight fluctuation to depression or perhaps more serious effects such as liver damage or blood clots.

Perhaps you are trying to reduce the overall amount of hormone exposure in your life.

Or you may simply want to be aware of the options offered.

You’ll be interested to know that there are many non-hormonal options readily available, inexpensive and highly effective.

****

Before proceeding to list the options – I would like to note that, above all, there is no one-size-fits-all birth control option. I know many women who have chosen a hormonal fertility control method and are very satisfied. That doesn’t mean they are wrong or they are making a terrible choice. I encourage every woman to make the choice that meets their own personal needs and wants.  

No matter what you personally choose, birth control allows women control and choice over their own sexual heath which pretty damn awesome.


IUD
Paragard Copper Intrauterine Device


How it works:
Paragard is a T-shaped non hormonal copper device inserted into the uterus by your doctor. The IUD works by interfering with the movement of the sperm inside the uterus and prevents it from joining an egg.  Sperm die within the uterus before they can fertilize the egg.

RIP sperm.


Success rate:
The copper IUD is more than 99% effective and prevents pregnancy for over a decade.


Pros:
Using a copper IUD is effective, reversible, and won't impact a woman's naturally occurring hormones.

This particular IUD can last up to 12 years before needing replaced. It might also protect against endometrial cancer.

This method is ideal for women who do not desire a pregnancy for an extended period of time. It also lends the convenience of not having to do anything on an ongoing basis.

No component of ParaGard contains latex for those that are concerned with allergies.

It can be used during breastfeeding.

Cons:
Using an IUD can increase the amount of bleeding a woman experiences during her period and may increase menstrual cramping.

Prescription is needed.

The common myth that they can cause infertility has not found merit. However, inserting an IUD while you have an STD could increase your chance of infertility.


The Sponge
The Today Sponge


How it works:
The sole brand available in the U.S. is The Today Sponge which is a plastic foam sponge that contains spermicide. The sponge covers the cervix while continuously releasing spermicide.

The sponge was removed from the U.S. market in 1994 due to manufacturing issues but finally re-introduced in Canada in March 2003 and in the U.S. in September 2005.

There is a polyester loop string located on the outer surface to assist in the removal of the sponge.  The sponge can be left in place for 24 hours, with no limit of how many times you can have sex during that time frame. However, for the spermicide to be effective, the sponge must be left in place for 6 hours after sex before it is removed.


Success rate:
Among women who have never given birth, the sponge is 91% effective and for those who have had children the sponge is about 80% effective.


Pros:
You can buy the sponge over the counter or even online. No prescription need.

You can also have sex as many times as you like during the first 24 hours of wearing it.

It can be used during breastfeeding.


Cons:
The sponge is somewhat costly (compared to condoms at least); a package of three can cost about $15 over the counter.

It can also be challenging to insert. Also women who use contraceptive sponges may have a risk of yeast infection and urinary tract infection if they are more prone to them to begin with.

A woman should be comfortable touching herself in order to insert and remove this barrier method correctly.



Male Condom
Trojan, Durex, Lifestyles, Crown


How it works:
Male condoms prevent sperm from entering the vagina via barrier method to reduce the probability of pregnancy and spreading sexually transmitted diseases.

Condoms are most often made from latex, but some are made from other materials such as polyurethane, polyisoprene, or lamb intestine.


Success rate:
If used correctly, condoms can be up to 98% effective against pregnancy.

As for lambskin condoms, they are generally effective as a contraceptive by blocking sperm, it has been presumed that they are likely less effective than latex in preventing the transmission of agents that cause STDs, because of pores in the material - however, no data exists that either confirms or denies this.


Pros:
Condoms are pretty simple to use, easy to get, and cheap.

They prevent STDs.

Condoms are widely available without a prescription at many drug and grocery stores. They come in different sizes, textures, flavors and colors, and spermicidal condoms are also available.

It can be used during breastfeeding.

No prescription need.


Cons:
They might dull sensation and interrupt intercourse. However, lambskin may provide a more "natural" sensation.

Some women or men may be allergic to latex, a material used in some condoms.

Male and female condoms should not be used together because the latex could tear.



Female Condom
Femidom


How it works:
The female condom (or femidom) is placed inside the vagina and collects semen when a man ejaculates via barrier method to reduce the probability of pregnancy and spreading sexually transmitted diseases.


Success rate:
If used correctly, only five out of 100 women will become pregnant (95% effective).


Pros:
This method protects against STDs.

The female condom is a great method for women because it gives them control and choice over their own sexual health; women can protect themselves when their partner does not want to use a male condom; female condoms may provide enhanced sensation for men as compared to male condoms.

They also come pre-lubricated with a non-spermicidal, silicone based lubricant.

No prescription need.


Cons:
It could slip into the vagina during intercourse, reduce feeling slightly, or cause some noise, much like the male condom.

Inserting the female condom is a skill that has to be learned and female condoms can be significantly more expensive than male condoms (upwards of 2 or 3 times the cost).

It can be a turn off to some users because the outer ring remains visible outside the vagina during sex.

A woman should be comfortable touching herself in order to insert and remove this barrier method correctly.




Diaphragm
Koro-Flex, Koromex, Ortho-Diaphragm

How it works:
The diaphragm is a dome shaped, rubber, flexible rimmed cup which is fitted by your doctor.

Before sex, a woman inserts the diaphragm creating a barrier to sperm.  For added protection, about a tablespoon of spermicide is used on the inside of the diaphragm in case an adventurous sperm makes it over the rim.

If a diaphragm is fitter correctly, a woman should not feel the diaphragm and should be able to wear it comfortably.  Your partner may feel the latex of the diaphragm but it should not cause discomfort.  The diaphragm may be inserted up to 6 hours before sex and it may be left in place for 24 hours after sex.

Success rate:
Of women who always use the diaphragm correctly, six out of 100 become pregnant (94%).

Spermicide cream/gel/jelly is recommended to increase effectiveness.


Pros:
It usually cannot be felt by your partner and can be inserted hours before sex which means there is no interruption during foreplay and sex. 

It can be used during breastfeeding, it is immediately effective and reversible.

Cons:
A diaphragm requires a fitting by your doctor (possibly even refitting).

It requires a prescription.

It should not be used during your period and can be difficult to insert-which you have to do each time you have sex.

A diaphragm may be pushed out of place by some penis sizes, heavy thrusting, and certain sexual positions.

A woman should be comfortable touching herself in order to insert and remove this barrier method correctly.


Cervical Cap
FemCap

How it works:
A cervical cap is a silicone cup inserted into the vagina to prevent pregnancy which can last up to two years.

FemCap is the only brand of cervical cap available in the United States today. It comes in 3 sizes and must be fit by a health care provider.



Success rate:
Of women who have never given birth, 14 out of 100 will become pregnant (86% effective). For those who have given vaginal birth, 29 out of 100 will become pregnant (71% effective).

Like the diaphragm, you should use spermicide cream/gel/jelly to increase effectiveness.


Pros:
It works similar to a diaphragm, and for $60-75, a cervical cap will last up to two years.  It usually cannot be felt by your partner and can be inserted before sex which means there is no interruption during sex. 

It can be used during breastfeeding, it is immediately effective and reversible.

Some say it is easier to remove compared to the diaphragm.

Cons:
Similar drawbacks as the diaphragm: it cannot be used during your period, might be a bit challenging to insert and does not protect against STDs.

It requires a prescription.

A woman should be comfortable touching herself in order to insert and remove this barrier method correctly.

The cervical cap must stay in place six hours after sex.



Spermicide
Conceptrol, Encare, Emko, Delfen Foam

How it works:
Spermicides are chemicals that kill sperm or stop them from moving, which you insert deep into the vagina right before sex.

It can be used along with other forms of birth control.

There are many different forms available including creams, film, foams, gels, and suppositories. Instructions on how to use a specific spermicide are provided in the box or can be obtained from your health care provider.

Spermicides are more effective if they are used with another barrier method.

Success rate:
When used alone, studies suggest that six to 26 percent of women will become pregnant (74% effective).

Even if you don't use another method along with spermicide, your chance of getting pregnant is much less than if you use no birth control at all.

Effectiveness generally decreases after one hour.

Pros:
Super easy to get and a rather inexpensive form of birth control that a woman can control.

Available without a prescription.

It can be inserted by a partner as part of foreplay.


Cons:
It is ideal to use spermicide along with another form of contraception.

If not used exactly as directed, spermicides may not form a good barrier over the cervix which, of course, may make the spermicide less effective.

Some women tend to complain that spermicides are messy or that they leak from their vaginas.

Spermicide may cause irritation to the penis or vagina.

Most spermicides contain nonoxynol-9 which carry certain risks. If it is used many times a day, or by people at risk for HIV, it may irritate tissue and increase the risk of HIV and other sexually transmitted infections.

The use of spermicide can make oral sex unpleasant for some partners. Additionally, continued use of spermicide can disrupt the vaginal lining.



Surgical Sterilization
Tubal ligation, Essure

How it works:
By sealing the fallopian tubes, surgical sterilization permanently prevents an egg from getting to the uterus.

Closing the tubes can be done in several ways. One way is by tying and cutting the tubes - this is termed tubal ligation. The fallopian tubes also can be sealed using an instrument with an electrical current. They also can be closed with clamps or rings.

In some cases, a small piece of the tube is removed.

In other cases, tiny inserts are put in the tubes. Tissue grows around them and blocks the tubes. The brand name for this type of sterilization is Essure. 

Success rate:
Sterilization is nearly 100 percent effective.

For every 1,000 women who have Essure, fewer than 3 will become pregnant.

For every 1,000 women who have traditional incision methods, about 5 will become pregnant.

Most kinds of sterilization for women are effective right away. But it takes about three months before Essure is effective.


Pros:
It allows a woman to enjoy sex without worrying about pregnancy.

Many women and men report that they have more sexual pleasure because they don't have to think about unwanted pregnancy anymore.

Most women still have normal periods.

Cons:
You might change your mind, plus it requires surgery.

Most women can be sterilized safely. But like any medical procedure, there are risks. One possible risk is that the tubes may reconnect by themselves - but this is rare.

When women get pregnant after being sterilized, about 1 out of 3 has a pregnancy that develops in a fallopian tube (ectopic pregnancy) which is serious and may be life threatening.

You should consider any possible life changes, such as divorce, remarriage, or death of children.



Vasectomy

How it works:
While this is technically birth control for men, if you're in a committed long-term relationship you might consider it.

During a vasectomy, a health care provider closes or blocks the tubes that carry sperm, making it impossible for sperm to travel out of the testes and make a woman pregnant.

To get a bit more technical, a vasectomy blocks each vas deferens and keeps sperm out of the seminal fluid. The sperm are absorbed by the body instead of being ejaculated. Without sperm, the "cum" (ejaculate) cannot cause pregnancy.

Average cost is $350 to $1,000.

Success rate:

Pros:
It lasts for life, and is less intrusive than female sterilization.

It also may be possible to reverse, although men should not count on that.

Cons:
You or he might change your mind.

It is not immediately effective because sperm remains beyond the blocked tubes for about 3 months. A simple test is performed - semen analysis - after 3 months to confirm there are no more sperm remaining.

Very rarely, tubes grow back together again and pregnancy may occur. This happens in about 1 out of 1,000 cases (this happened to a coworker of mine!).

Decreased sexual desire or an inability to have an erection occurs in 4 out of 1,000 cases. The most likely cause is emotional - there is no physical cause for sexual dysfunction associated with vasectomy.


Breastfeeding
Lactational Amenorrhea Method


How it works:
Breastfeeding can be used as birth control when, after giving birth, a woman breastfeeds her baby exclusively. That means the baby does not drink anything besides breast milk. The act of breastfeeding naturally changes a woman's hormones so that she does not become pregnant.

It can be highly effective for six months after delivery or until her period returns.


Success rate:
Effectiveness ranges from 98-99 percent.

Pros:
This method is free and no prescription required.

It reduces bleeding after delivery and is immediately effective.

Breastfeeding has many health advantages for the baby: (1) It decreases the likelihood of infection from germs in water or formula (2) increases body contact and enhances comfort for the child and bonding between mother and child (3) passes on some of the mother's antibodies to protect the baby from certain infections (4) protects against the development of allergies and may protect against the development of asthma (5) provides the best nutrition available

Cons:
Some women find it hard to exclusively breastfeed and not use any formula at all. If formula is given to the baby, the woman has a chance of getting pregnant again.

Breastfeeding may make a woman feel like her breasts are less sexual.


Lea's Shield

How it works:
One of the newer forms of non hormonal birth control, Lea's Shield is an oval device similar to a diaphragm made of silicon rubber and includes a loop which helps in removal.  The shield covers the cervix and is only made in one size so there is no fitting required.

The Lea's Shield is not held in place by the cervix (like the cap) or pubic bone (like the diaphragm) but rather by the vaginal wall. The size of the cervix and the length of the vagina do not play a role, thus the device does not need to be "fitted" by a doctor.

Lea's Shield is inserted much like a tampon. You simply squeeze the shield and push it as far as it will comfortably go. When inserted properly, you should not be able to feel it.

The shield has a flexible ring, which can be used to help with removal.

In the United States, this method is by prescription only.

Lea's Shield is usually used with a spermicide and must be left in place for eight hours after sex.

Success rate:


Pros:
Lea's Shield is composed entirely of medical-grade silicone rubber and thus it is non-allergenic.

The device is one-size-fits-all, washable, and reusable up to 6 months.

You can insert Lea's Shield anytime prior to sex (just place spermicide around the ring of the shield and push it into place). You can leave the shield in place for up to 40 hours after insertion.

It can be used during breastfeeding.

It is among the most inexpensive forms of birth control, costing about $65 per shield.

There is no interruption of foreplay - it can be inserted hours ahead of time.

Cons:
Similar drawbacks as the diaphragm: it cannot be used during your period and does not protect against STDs.

It also requires a prescription.

A woman should be comfortable touching herself in order to insert and remove this barrier method correctly.



Withdrawal
Pull Out Method

How it works:
A man who uses withdrawal will pull himself out of the vagina before ejaculation - the moment when semen spurts out. (skeet-skeet, sorry, I couldn’t help myself here)

This method may be the world's oldest way to practice birth control. About 35 million couples worldwide still rely on the withdrawal method.

Success rate:
With typical use, withdrawal is 73% effective. If used correctly and consistently withdrawal is 96% effective.

Withdrawal is not very effective because it is difficult to perform consistently and the pre-ejaculatory fluid may carry sperm into the vagina.

Withdrawal does not protect against STDs.

Pros:
Anyone can use withdrawal safely - there are no side effects.

No prescription is necessary.

It is free!

Cons:
Even if a man pulls out in time, pregnancy can still happen. Some experts believe that pre-ejaculate can pick up enough sperm left in the urethra from a previous ejaculation to cause pregnancy.

Couples who have great self-control, experience, and trust may use the pull out method more effectively.

This method is not recommended for teens and sexually inexperienced men because it takes lots of experience before a man can be sure to know when he's going to ejaculate



Fertility Awareness
Rhythm Method, Calendar Method, Natural Family Planning 

How it works:
Fertility awareness-based methods (FAMs) are ways to track ovulation (the release of a women’s egg) in order to prevent pregnancy.

FAMs work by keeping sperm out of the vagina in the days near ovulation, when a woman is most fertile and most likely to become pregnant.

There are a variety of ways to determine the days where a woman is most likely to get pregnant from unprotected sex: Temperature Method, Cervical Mucus Method, Calendar Method, Standard Days Method are a few.

To prevent pregnancy, women can abstain from vaginal intercourse on their fertile days or they may enjoy other kinds of foreplay instead of intercourse on their fertile days.

Success rate:
With typical use, Natural Family Planning is 80% effective. If used correctly, consistently, and all of the time, Natural Family Planning can be 98% effective.

Pros:
Cost is relatively small.

These methods are safe and can be stopped easily to plan a pregnancy.

Calendars, thermometers, and charts are easy to get.

Medication or a prescription is not needed.

Can be used during breastfeeding.

Cons:
How well fertility awareness-based methods work depends on both partners. That's why it is important for both to learn about the methods and support each other in their use.

Best for women who have regular twenty eight day cycles and can carefully monitor her fertility on a daily basis.

Fertility awareness-based methods may not work well if you take medicine that may affect reading the signs of these methods.



Abstinence
Just say no


How it works:
Abstinence is refraining from sexual activity.  

Success rate:
Used continuously, this method is 100% effective at preventing pregnancy and STDs.

Pros:
Abstinence is one of the safest ways to prevent pregnancy - there are no side effects.

It is free and prevents STDs

Cons:
People may find it difficult to abstain for long periods of time – becoming quite frisky.

This method will work best for those who choose it for religious or cultural reasons.



Outercourse



How it works:
For some people, outercourse is any sexual interaction without vaginal intercourse. For others, it is foreplay with no penetration at all - oral, anal, or vaginal such as stimulating each other with hands or rubbing.

It allows a couple to be more intimate and even have an orgasm with one another without having sex.


Success rate:
This method is nearly 100% effective at preventing pregnancy and STDs.


Pros:
Outercourse is simple, convenient and free.

It can help people better understand their bodies

This can be used when no other birth control methods are available.

Cons:
Both partners may let outercourse lead to intercourse without being ready to protect themselves against pregnancy.

People may find it difficult to abstain for long periods of time.




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