Absenteeism
Chronic absence from work; herein we refer to absenteeism as a chronic absence from work as a result of a birth, pregnancy, or a pregnancy-related condition.
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Cervical Caps, Diaphragms and Shields
These methods, all used with spermicide, are soft latex or silicone barriers that cover the cervix and prevent sperm from reaching the egg, thus preventing conception. These products must be individually fitted prior to use. The number of unintended pregnancies expected to occur per 100 women while using these products is between 15-23 per year.

Women should not use these products if they have allergies to latex, silicone or spermicide, frequent urinary tract or reproductive tract infections or poor vaginal muscle tone. The products may cause irritation and there is a risk of toxic shock syndrome with their usage. This syndrome is a rare but serious infection that occurs when the products are left in longer than recommended.

Cervical caps, diaphragms and shields can be used while breastfeeding and are immediately effective and reversible.
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Ectopic Pregnancy
A potentially life-threatening condition caused by the implantation of a fertilized egg outside of the uterus, typically in the fallopian tubes. Some forms of sterilization increase the risk of ectopic pregnancy. Ectopic pregnancy is the leading cause of pregnancy-related death in the first trimester and accounts for 9% of all maternal mortality.
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Emergency Contraception
Emergency Contraception (EC) is a method of preventing unintended pregnancy after unprotected sex has occurred. There are two types of emergency contraceptive pills. One type uses the hormones estrogen and progestin in similar doses to those in ordinary birth control pills. Approximately half of women who use this type of EC experience nausea. Use of this pill cuts the chance of pregnancy by 75%. The other type of emergency contraceptive pill contains only the hormone progestin and is commonly known as Plan B in the United States. It is more effective than combination pills, and the risk of nausea is lower. Plan B reduces a women’s risk of pregnancy by 89%. EC pills should be taken within 5 days of unprotected intercourse and are most effective the earlier they are initiated.

A copper-T intrauterine device (IUD) can also be inserted up to five days after unprotected intercourse to prevent pregnancy. The Copper-T reduced the risk of unintended pregnancy by more the 99%. IUDS may not be appropriate for women at risk for sexually transmitted diseases, who have multiple sex partners, because insertion of the device can cause pelvic inflammation, which left untreated may lead to infertility.
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Injectables
This method of contraception requires that a woman receive hormone shots from her health care provider. Lunelle and Depo-Provera are two brand name injectables. To prevent pregnancy, Lunelle must be administered monthly and Depo-Provera should be given every three months. Shots can be progestin only or both progestin and estrogen. Injectables prevent the ovaries from releasing an egg and thicken cervical mucus to prevent sperm from joining an egg. This method is highly effective with a failure rate of less than 1 pregnancy per 100 women per year. The method requires no user intervention before, during, or after sex.

Some side effects include irregular periods, weight gain, and headaches. There are also less common side effects including a change in sex drive, depression, nausea, and nervousness or dizziness. Women who are at risk of heart disease, have blood clotting conditions, high blood pressure, a history of severe depression, and liver disease need special medical supervision. Injectable contraceptive use may result in significant loss of bone mineral density. Bone loss is greater with longer duration of use and may not be completely reversible. Therefore, injectables should only be used as a long-term method of contraception when other methods are inadequate.
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Intended Pregnancy
This term describes a pregnancy that is wanted at the time of conception or sooner, regardless of contraception usage.⁷⁶
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Intrauterine Devices and Systems (IUDs/IUSs)
These methods of contraception require a health care provider to insert a small plastic T-shaped device, which contains copper or hormones, into the uterus. The devices are thought to prevent fertilization by affecting the way sperm moves, although the mechanism for this is not entirely understood. In addition, the copper in IUDs affects the lining of the uterus, which prevents implantation of an egg. Hormone IUSs thicken cervical mucus, reducing the sperm’s ability to enter the uterus.

This method is highly effective with a failure rate of less than 1 pregnancy per 100 women per year. These methods require no user intervention before, during or after sex and are effective for 5 to 10 years, depending on the method. The copper IUD can also be used while breastfeeding.

Problems that occur while using these products include irregular bleeding and cramps (during first months of use) and spotting between periods. Risks also include uterine puncture, tubal infection and pelvic inflammatory disease. Women who should not use these methods include women with a history of tubal, cervical or vaginal infections, diabetes, severe anemia, ovarian cancer, HIV/AIDS, and a history of serious blood clots in deep veins or lungs (hormone IUD only).

Some may think IUDs unsafe, recalling the publicity surrounding the Dalkon Shield. The Dalkon Shield IUD was introduced in 1970 and recalled in 1975 due to increased rates of infection and 12 deaths. Today serious problems with the IUD are rare.
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Mistimed Pregnancy
This term describes a pregnancy that was wanted by the woman at some time, but which occurred sooner than she intended.
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Molar Pregnancy
This type of unviable pregnancy occurs when an abnormal fertilization causes the early placenta to develop into a mass of cysts (called a hydatidiform mole). As a result, the embryo either does not form or is malformed and cannot survive. Approximately one in every 1,000 pregnancies is molar. Women who are over age 40 or who have had two or more miscarriages are at increased risk of molar pregnancy. Molar pregnancy can be dangerous to the pregnant women if the mole penetrates into the uterine wall because it can cause heavy bleeding. Occasionally, a mole will turn into a choriocarcinoma, a rare pregnancy-related form of cancer.
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Oral Contraception
Frequently referred to as the “pill,” oral contraceptives come in two basic forms: Combination pills contain estrogen and progestin, which prevent a woman’s ovaries from releasing eggs and thicken the cervical mucus to inhibit sperm from joining with the egg. Progestin-only pills or “Mini pills” typically prevent pregnancy by reducing and thickening the cervical mucus. Both combination pills and progestin-only pills are taken daily for three weeks out of every month regardless of the frequency of intercourse.

The FDA recently approved a new type of oral contraceptive known by the brand name Seasonale. This product contains estrogen and progestin, but unlike a regular combination pill it is taken in three months cycles such that menstruation occurs only four times per year. To prevent pregnancy an active pill must be taken every day for twelve straight weeks, followed by one week of non-active pills, regardless of frequency of intercourse.

The pill is a highly effective means of birth control. With typical use only 8 in 100 women will become pregnant in one year, and with perfect use only 1 in 100 will become pregnant.

The pill is the most common method of contraception in the United States, but it is not appropriate for everyone. Women who smoke, have a history of blood clots and certain forms of cancer should not use the pill. In addition, certain side effects may include dizziness, nausea, weight gain, change in menstrual flow, high blood pressure and increased risk for heart attack, blood clots and stroke. Oral contraceptives come in a variety of dosages that may influence the presence of some side effects
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Presenteeism
Presenteeism occurs when an employee is on the job but not fully functioning. This generally occurs when an employee is ill or has a medical condition, and accounts for productivity losses on the job.
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Reversible Contraception
Any method of contraception that allows normal fertility to be regained within a reasonable amount of time after the method in discontinued. Oral contraceptives, cervical caps, diaphragms, spermicides, injectables, IUDs or IUSs, and condoms are all forms of reversible contraception.
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Spermicide
Any foam, jelly, film, suppository or tablet that melts inside the vagina, blocks the entrance of the uterus, and contains a sperm-immobilizing chemical. Spermicide is typically used in conjunction with another form of removable contraception such as a cervical cap, diaphragm or shield. When spermicide is used alone the number of pregnancies expected in 100 women in one year is between 20 and 50.

Spermicide should be inserted 5 to 90 minutes before intercourse and left in place for at least six hours. Spermicide may cause allergic reactions and urinary tract infections. It does not provide any protection against sexually transmitted diseases. In some cases spermicides containing nonoxynol-9 may increase the transmission of HIV. Spermicide is available without a prescription.
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Sterilization
A non-reversible means of preventing pregnancy. Sterilization in women can be achieved by cutting, tying or implanting a device to block the passage of eggs through the fallopian tubes. For men, sterilization can be achieved by cutting the vas deferens to prevent sperm from reaching the penis.

See glossary entries for trans-abdominal surgical sterilization, sterilization implant and vasectomy.
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Sterilization Implant
This method of permanent birth control is achieved by placing a small metallic implant in the fallopian tubes. The device causes scar tissue to form, which blocks the fallopian tubes and prevents pregnancy. Implant sterilization is highly effective, leading to pregnancy in less than 1 woman in 100. Side effects may include mild to moderate pain after implantation and increased risk of ectopic pregnancy.

The implant is inserted through the vagina using a catheter. Women must rely on an alternative form of contraception for three months after surgery until the placement of the device is confirmed by an x-ray.
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Trans-Abdominal Surgical Sterilization
This permanent method of contraception is achieved by obstructing the fallopian tube to prevent the union of eggs and sperm. During this surgical procedure the fallopian tubes are cut, cauterized or clipped. Pregnancy among women who have been surgically sterilized is less than 1 in 100. The procedure is intended to be permanent although a reversal surgery may be possible in some situations. However, because of the expense and difficulty of reversal surgery, women are strongly encouraged to consider other birth control methods if there is any possibility that they may want to conceive in the future.

Side affects may include pain, bleeding, and other post-surgical complications. Women who undergo surgical sterilization and reversal surgery also have an increased risk of ectopic pregnancy.
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Transdermal Patch
Commonly known by its brand name Ortho Evra, the patch is a reversible method of hormonal birth control that is worn on the skin. Like the pill, the patch contains a combination of estrogen and progestin. It works by preventing ovulation and thickening vaginal mucus to inhibit the passage of sperm.

The patch is a smooth, thin, beige sticker measuring 1 inch on all sides that can be worn on the buttocks, abdomen, outer arm or upper torso but should never be applied to the breasts. The patch is worn on a 28-day cycle such that a new patch is applied once a week for three weeks, with the fourth week “patch-free.” It is important that the patch is replaced on the same day every week.

With perfect use only 1-2 women in 100 will become pregnant in one year of using this method. The patch is most effective in women weighing less than 198 pounds. Side effects of the patch are similar to those associated with the pill. Some women may also develop skin irritation at the site of application. The patch has been shown to remain attached and effective even during bathing, swimming, exercise and humid weather.
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Unintended Pregnancy
This term is defined as a pregnancy that was not wanted at the time conception occurred, regardless of contraception usage. There are two types of unintended pregnancies:
Please see the glossary entries for Mistimed Pregnancies and Unwanted Pregnancies.
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Unwanted Pregnancy
This term is used to define a pregnancy that occurred when a woman did not want to have a(nother) baby ever in her life.

The definition comes from the National Survey of Family Growth, which serves as a comprehensive source of information on pregnancy and contraceptive use among reproductive-age women in the United States. For five decades this federally funded survey has gathered information from women about their intentions at the time they became pregnant.
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Vaginal Ring
The ring is a flexible, vinyl, doughnut-shaped device that is inserted high into the vagina where it releases estrogen and progesterone hormones into the blood stream. The ring measures two inches in diameter and one size fits all women.

The ring is worn for three weeks at a time, followed by a one-week break, after which a new ring is inserted. If the ring is expelled or removed for more than three hours at a time during the “active” three-week period, to prevent pregnancy an additional method of birth control must be used until the ring has been reinserted for seven days. The number of women who will become pregnant in one year using the ring is 1-2 out of 100.

Side effects in women who use the ring are similar to those for the pill but may also include vaginal discharge, infection and irritation. Most women regain their normal fertility two to three months after they stop using the ring.
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Vasectomy
A surgical process that involves sealing, tying or cutting a man’s vas deferens so that sperm cannot travel from the testicles to the penis. The number of women expected to become pregnant after her partner has received a vasectomy is less than 1 in 100.

Side effects of the procedure may include pain, bleeding, infection and other post surgical complications.
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