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For sexually active fertile women who do not use contraception, pregnancy rates approach 90 percent at 1 year. For those who do not desire pregnancy, fertility regulation is now possible, and a variety of effective contraceptive methods are shown in Table 32-1. None is completely without side effects or categorically without danger. One tenet emphasized throughout this chapter is that contraception usually poses less risk than does pregnancy.

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Table 32-1. Contraceptive Methods Currently Used in the United States 
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Nationally representative data concerning contraceptive use are shown in Figure 32-1. With use during the first year, wide variations can be seen between estimated failure rates of perfect and typical use (Table 32-2). Many of these rates can be appreciably reduced with effective motivation and education (Gilliam and co-workers, 2004). The World Health Organization has crafted four evidence-based guides for family planning, which encompass topics of contraceptive selection, patient counseling, and method use. These are available at the World Health Organization website: http://www.who.int/reproductive-health/publications/family_planning.html.

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Figure 32-1
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Contraceptive use in the United States, 2002, for users aged 15 to 44. DMPA = depot medroxyprogesterone acetate; FAB = fertility awareness-based method; IUD = intrauterine device. (Data from Chandra and co-workers, 2005.)

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Table 32-2. Contraceptive Failure Rates during the First Year of Use 
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These are currently available in oral, injectable, transdermal-patch, and transvaginal-ring forms. Oral contraceptive pills are a combination of estrogen and progestin—“the pill”—are or progestin only. Other forms contain progestins alone or a combination of estrogen and progestin. Male hormonal contraceptive options have been evaluated in human trials ...

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