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Latest revision as of 02:01, 23 July 2017

This is an archive of past discussions about Birth control. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

Discipline "from both partners"

I plan to delete the words "from both partners" from the sentence "However, with this method, discipline is required from both partners to prevent the progression to intercourse." in the "Avoiding vaginal intercourse" section, on the grounds that I believe the sentence as it stands is false and it is not supported by a citation. I believe that discipline from both partners may not always be required. In some cases, discipline may only be required by the physically stronger person or by the one in a stronger position (e.g. on top). In some cases, discipline may only be required by the more passionate person. No proof has been provided that discipline from both partners is required. Furthermore: if one partner maintains discipline and maintains the intention not to have intercourse and intercourse nevertheless occurs, then that is rape and should be referred to as such. So, it could say something about "the risk of progressing to either consensual sex or rape," if we can find any citation providing any fact about such risk. Even if the sentence were true I object to the current wording as trivializing rape. --Coppertwig 17:09, 1 January 2007 (UTC)

I went ahead and made the change described above. --Coppertwig 03:10, 6 January 2007 (UTC)

"pregnancy rate" rather than "failure rate"

I plan to edit the article to say "pregnancy rate" rather than "failure rate" throughout. "Pregancy rate" is more courteous to people whose lives happened to begin while their parents were trying to prevent pregnancy; it's more neutral, less negative. I'm giving an opportunity for discussion here first before making the change. --Coppertwig 22:06, 7 January 2007 (UTC)

"Pregnancy rate" is more clear, also. "Failure rate" with respect to barrier methods doesn't necessarily mean the woman got pregnant - a "lost" condom or a diaphragm that came out in the middle of coitus would be described as "failures" regardless of pregnancy outcome. Lyrl _C 22:13, 7 January 2007 (UTC)

Coppertwig please do not open identical debates on multiple pages at once. I'll copy over your additonal points from Template talk:Infobox Birth control and my responses:

I would like to edit this infobox to change "failure rate" to "pregnancy rate". This is the usage in some birth control literature e.g. and I believe this usage is growing and that it will become standard. The phrase "pregnancy rate" is much more courteous towards those people whose lives happened to begin while their parents were trying to prevent pregnancy. "Failure rate" can be perceived as very negative towards those people; "pregnancy rate" is neutral and its meaning is quite clear -- even slightly clearer than "failure rate", perhaps, which could possibly be misinterpreted in some contexts as a failure to achieve pregnancy. I'm also planning to similarly edit the wording on the birth control and natural family planning pages and perhaps other pages. I'm leaving an opportunity for discussion before making the change. --Coppertwig 22:27, 7 January 2007 (UTC)

I disagree: "which could possibly be misinterpreted in some contexts as a failure to achieve pregnancy" – but the whole point of contraception is NOT to "achieve pregnancy". A pregnancy despite use of contraception is therefore not what is being sought and not a "success" as far as the method goes, indeed it is a negative reflection on the particular method. Terminology usage in the UK is still to describe failure rates. The view that "usage in some birth control literature ... and I believe this usage is growing and that it will become standard" is a personal opinion and thus excluded from article space by WP:NOR, unless you can cite an authorative source explaining that the terminology is to change. The reference given is for a US webpage in 1997, which is hardly indicative of a changing use of terminology (just that this one paper in 1997 so phrased).

Of course I agree none of this implies any judgement on those people so borne, but we do use terms such as "planned pregnancy" or "unplanned pregnancy" when making antenatal referals or supporting people in making a decission on how they wish to proceed (continue with pregnancy or not to) - see current UK FPA's Information about unplanned pregnancy in Northern Ireland. David Ruben 02:32, 8 January 2007 (UTC)

Further, and from 2006, example of terminology usage comes from Family Health International, Using Pills Correctly which describes "Typical failure rates among pill users are as high as 12% to 20% in some surveys." So I am not convinced of a changing international use of terms. David Ruben 02:45, 8 January 2007 (UTC)

I like your enthusiasm, but calling it the "pregnancy rate" is just inaccurate. It's not duplicated anywhere else of which I'm aware. Like Lyrl said, a failure of a method does not necessarily mean pregnancy, it could just mean that the condom broke, etc. A method can fail without a pregnancy occurring. Also, I don't see this usage as any more "courteous" - what about women who chose abortion? Would they appreciate being included in the "pregnancy rate"? This, of course, isn't as relevant as what I mentioned initially. Joie de Vivre 03:11, 8 January 2007 (UTC)

While some people might inaccurately believe that every time birth control fails they'd get pregnant (really the fault of the pro-birth control crowd in the first place) I don't think that we should change every single article from failure rate to pregnancy rate. It seems impractical, especially since, if the original source doesn't include the pregnancy rate, it would make it more difficult to compare findings. Or at least that is what I believe. What would we do in those cases where a study simply lists the failure rate? Use a conversion method devised by another study? Chooserr 04:30, 8 January 2007 (UTC)

In the context of Vasectomies (where this debate is linked), the term failure rate is an applicable term - as the procedure is a surgical sterilization of the male reproductive system, therefore any conception that results is due to a failure in this procedure. To state POV/NPOV in either direction for this sepcific discussion could lead to a long and complex argument, with little gained by any but in the case vasectomies specifically, then it's innaccurate to not descibe it as such. --RedHillian 04:35, 8 January 2007 (UTC)

I apologize for opening the same discussion in different places. Thanks, David Ruben, for helping straighten this out. I've just now put notes on multiple other birth control pages alerting people to this discussion, indicating a desire to make the same change on those pages too, and directing them to comment here; I hope I did that right this time.

In reply to David Ruben: I agree that the point of contraception is to avoid pregnancy, but I fail to see how this fact prevents misunderstandings occurring. The writer could be talking about contraceptive methods and the reader could wrongly think that methods to achieve pregnancy were being discussed -- especially on a page such as Natural Family Planning where both types of technique are likely to be discussed on the same page, but also on other pages where a reader might for some reason think both types of technique were being discussed. I don't think we're necessarily constrained to stay with any particular terminology for example the terminology of a particular country; I think we're free to choose another terminology, for example if some of us find it to be more courteous and/or less ambiguous and if others have no strong objections. The view that "usage in some birth control literature ..." True, this is a personal opinion; but since I'm not proposing to make such a statement in the article, it's irrelevant whether it's excluded from article space. It's not excluded here, where the goal is to find a consensus among Wikipedian editors as to what the article should say.

I did Google searches for "failure rate" "birth control" and for "pregnancy rate" "birth control" and got a larger number of pages for the latter. I've also given an example above of a web page using the "pregnancy rate" usage; I've also seen it other places, as well as seen the idea expressed that it's more respectful of people who were born under such circumstances.

"Of course I agree none of this implies any judgement on those people so borne..." Maybe you're missing my point. I think that if someone has been born in spite of birth control (as many people have been), and knows or suspects it, and if that person is depressed, (as many people are), and if that person reads these articles, it may be very difficult for that person to avoid thinking that there is an implication here of a negative judgement on them, such as the idea that that person is a failure. So I'm saying it does imply judgement (at least in the minds of some such people). So, I'm not sure who you're agreeing with here.

I'm OK with the terms "planned pregnancy" and "unplanned pregnancy"; they don't seem too negative to me. It's the term "failure rate" that I would like to eliminate as much as possible in this context.

In reply to Joie de Vivre: So, is it your understanding that when it says in the birth control infobox, for example on the page about the Diaphragm, "failure rates (per year, with spermicide)/Perfect use: 6%/Typical use 10-39%" is it your understanding that this does not mean that there is a pregnancy rate of 6% and of 10-39%, but that those include a rate of something else happening (e.g. diaphragm falling out or something)? I think you've misinterpreted the phrase "failure rate" in the birth control infobox, and that changing it from "failure rate" to "pregnancy rate" will help prevent people misunderstanding it just as you have just misunderstood it. What do other people think? Does it actually mean a pregnancy rate of 6% or is it talking about some other definition of "failure"? This phrase "failure rate" occurs in the birth control infobox which is on many birth control pages; it would be good if the term were clearly defined and understood by everyone.

In reply to Joie de Vivre saying Also, I don't see this usage as any more "courteous" - what about women who chose abortion? Would they appreciate being included in the "pregnancy rate"? I think I don't follow your point here. Maybe you could explain more fully what you're getting at. I suppose different people who have chosen abortions will have different opinions. I think some people may feel a little depressed or belittled or offended on reading "failure rate"; I don't see any reason why anyone would feel particularly bad on reading "pregnancy rate". I think a woman who has chosen an abortion and who herself was born when her parents were using birth control may feel depressed or belittled or offended on reading "failure rate", just as someone who has not had an abortion may also feel on reading that. Actually, I think having had an abortion would tend to make the feeling even worse, even stronger -- the depressed thought that might tend to intrude might be "I'm a failure; I'm worthless, just like the fetus I aborted." It can be difficult or impossible to push such negative thoughts out of one's mind if one is depressed. --Coppertwig 05:30, 8 January 2007 (UTC)

In reply to RedHillian: I don't quite follow. I agree that the term "failure rate" is logically applicable and accurate. However, the term "pregnancy rate" is also logically applicable and accurate (and clearer, less ambiguous, and more respectful). Do you agree that the term "pregnancy rate" is also applicable? If not, why not? Why do you say it would be inaccurate not to say "failure rate"? I don't see how not saying something can be inaccurate.

I'll rephrase - the single purpose of a vasectomy is to prevent pregnancy. It is a complex procedure requiring work that is only entrusted to a few highly trained and skilled professionals. Barring surgical reversal (where conception is the specific desired result), there is the intention of creating a sterile male, unable to reproduce, therefore any pregnancy resulting afterwards is as a result of the operations failure rather than any other choice. Regardless of personal feelings (which require a Point of view), the terming of this (at least withing the page vasectomy as anything other than failure is Un-encyclopedic. As has also been noted elsewhere in this thread, failure does not always mean conception either, failure in the case of a vasectomy could mean that viable spermatoza were detected in a semen sample from a patient, well after the sample should have been clear, a clear failure but no pregnancy. --RedHillian 06:11, 8 January 2007 (UTC)

In reply to Chooserr: Please see my reply to Joie de Vivre. --Coppertwig 05:37, 8 January 2007 (UTC)

Please read WP:NOR before any wholesale changes are made to multiple articles. Understanding of the studies and terminology is paramount before any change is made. Personal feelings aside when one reads failure rate, this is an encyclopaedic project, not personal opinion portrayed as fact. Unless you can find citations from reputable studies that state pregnancy rate, any change from failure rate would be POV and original research. We should not be going down that path, no matter how we feel. --Bob 06:26, 8 January 2007 (UTC)

I think regardless how good our personal arguments are for or against the usage of these terms, what matters most is WP:V. What term do our sources use? A quick google search finds that the FDA and the ACOG use the term 'failure rate'. Who exactly uses the other term in regards to birth control? --Andrew c 21:59, 8 January 2007 (UTC)

Here are a few examples of "pregnancy rate" in the literature (there are more):

• Cumulative pregnancy rates during lactational amenorrhoea were 2.9 and 5.9 per 100 women at 6 and 12 months, compared with 0.7 at 6 months for the LAM.

  1: Lancet. 1992 Jan 25;339(8787):227-30. Links Contraceptive efficacy of lactational amenorrhoea. Kennedy KI, Visness CM.

• Breakage and slippage rates were determined, and typical-use and consistent-use pregnancy rates were calculated using life-table analysis, adjusted for use of emergency contraception.

  Evaluation of the Efficacy of a Polyurethane Condom: Results from a Randomized, Controlled Clinical Trial. Ron G. Frezieres, Terri L. Walsh, Anita L. Nelson, Virginia A. Clark, Anne H. Coulson Family Planning Perspectives, Vol. 31, No. 2(Mar. - Apr., 1999), pp. 81-87

• Progestogen-only contraceptive implants are highly effective. In most studies, 5-year cumulative pregnancy rates are less than 1.5/100 women for Norplant and Norplant II.

  Contraception. 2002 Jan;65(1):29-37. Implantable contraceptives for women: effectiveness, discontinuation rates, return of fertility, and outcome of pregnancies. Glasier A.

"Pregnancy rate" and "failure rate" do not always refer to the same quantity. Where they refer to the same quantity, I prefer the term "pregnancy rate" for reasons I've mentioned above. Where they refer to different quantities, a distinction needs to be made. Another alternative is to cite the "effectiveness rate" -- this term is also frequently used outside Misplaced Pages; for example a method may have a pregnancy rate of 1% which means an effectiveness rate of 99%.

Maybe the Birth Control infobox does not report pregnancy rates. I consider the method and use pregnancy rates to be important quantities that people want to know and that should be in the infobox. Here's another idea: modify the Birth Control Infobox so that editors can easily list either "pregnancy rate", "failure rate" or "effectiveness rate", (or more than one of these), depending on which is most appropriate to the given method. Also, modify the infobox so that "pregnancy rate" (or "failure rate") becomes a link which goes to a definition of the term, a different definition for each method if necessary, (usually in a subsection of one of the birth control method pages or this page), or to say for example on the Condom page "pregnancy rate (per year, latex; definition)" with "definition" being a link to the definition. (Or similarly for "effectiveness" or "failure" rate.) Clearly (based on this discussion) it is not adequate to simply say "failure rate" and assume that everybody understands what it means.

I think the meaning is clearer if "pregnancy rate" is stated. Everybody knows what a pregnancy is. But who knows what a writer or editor meant to include in "failure rate", unless the definition is stated? For example, if a vasectomy does not reduce the fertility of a man but he does not get anyone pregnant because he knows he's still fertile and continues to use other methods of contraception, is that a "failure" or not? It could easily be considered a "failure" by some people but not by others. Perhaps the man considers it a "success" because his primary objective of not getting anyone pregnant was achieved. So, if we say "failure rate" some readers may think they know what we mean but be wrong. This is to be avoided.

Some of the citations used in these Misplaced Pages articles say "failure rate," but they generally define what they mean, which can vary from one article to another. Here on Misplaced Pages we're supposed to be writing concise summaries, not copying the literature word-for-word. If they give a long, complex definition that includes a description of which cases they excluded and why, we don't have to copy the entire definition. But we do have to provide accurate reporting. Just saying "failure rate" because the original article did, without providing a summary of their definition, may be very misleading. Saying "pregnancy rate" or "percent who continue to be fertile 12 months after a vasectomy" has a clear meaning in English. Just saying "failure rate" without supplying a definition does not. --Coppertwig 00:34, 9 January 2007 (UTC)

If one takes a driving test, and does not meet the required standard of competence then it is not termed as continued pedestrian activities, but as a failure. By your own arguments, we are supposed to be writing a conscie summary for an encyclopedic article, hence WP:NPOV. In your hypothectical question of the gentleman with then non successful vasectomy; then yes, it is still a failure as he has not become permanantly sterilised despite the cost and discomfort of the operation. --RedHillian 01:31, 9 January 2007 (UTC)

In the case of vasectomies, then, failure rate can mean either 1)the portion of men whose semen analysis comes back "fertile" after the vasectomy or 2)the portion of men whose semen analysis comes back "infertile" after the vasectomy but go on to impregnate their partner anyway (perfect-use failure rate). The meaning is not clear. Changing the term to "pregnancy rate" would specify that 2) was meant.

I'm not enthusiastic about the term "effectiveness rate" because nothing/no birth control has an "effectiveness" of 10-15% per year in preventing pregnancy. The infertility rate (at 10-15% of the population) has an impact on the number of pregnancies, and just subtracting the pregnancy rate from 100 does not take that into account.

As far as what the term in the infobox currently refers to, on the pages on which I've been involved (a large majority) it currently refers to "pregnancy rate". I don't think I've seen anyone so far argue that that field should be used to refer to something else. Lyrl _C 02:20, 9 January 2007 (UTC)

I remembered, though, for emergency contraception, the failure rate has a rather complex definition that does not lend itself to expression as a pregnancy rate. If a change to "pregnancy rate" were accepted, there would have to be an opt-out option for EC. Lyrl _C 02:32, 9 January 2007 (UTC)

If the infobox means "pregnancy rate", then I submit that it would be a good idea to edit it to say "pregnancy rate". Two people in this discussion (Joie de Vivre and Chooserr, see above) have claimed that it does not mean "pregnancy rate" but means something else. If they have misunderstood it, then I guess many other readers of the pages have also misunderstood. This is a serious problem.

Look at the Condom page, for example. It already uses all of the terms "pregnancy rate", "failure rate" and "effectiveness". In some cases, the meaning is clear, and in some cases it is not. It says The method failure rate of condoms is 2% per year. The actual pregnancy rates among condoms users vary depending on the population being studied, with rates of 10-18% per year being reported. (Note that the phrase "pregnancy rate" was already being used here before I came along.) Without actually going and looking at the citation it is not 100% clear whether "method failure rate" could mean that there was a certain rate of condoms breaking (but not usually leading to pregnancy). Note that the citation for the 2% "failure rate" gives a URL to a page which does not use the word "failure" anywhere on it. Therefore, this instance of the word "failure" should be changed. The citation says Percentage of women experiencing an unintended pregnancy during the first year of typical use and the first year of perfect use of contraception and the percentage continuing use at the end of the first year. To my mind, "pregnancy rate" is a much better concise summary of this long phrase than is "failure rate".

I hereby clarify or modify my original intention: I don't intend to change the phrase "failure rate" everywhere it appears. I only wish to change it when another phrase such as "pregnancy rate" is equally clear and accurate (but more courteous) or more clear and accurate in the context. For example, in the section "causes of failure" on the condom page, I might not edit "fail", "failure" or "failure rate" because it seems to be talking about condoms breaking, not pregnancy. (Or is it?) But the Condom page gives a use "pregnancy rate" in the main text and a similar number for "failure rate" in the infobox; I would like to change the infobox to say "pregnancy rate" at least in this instance, which would only be making it agree with the text. --Coppertwig 02:55, 9 January 2007 (UTC)

In reply to RedHillian re driving test etc.: I don't disagree with your first two sentences but by themselves they don't disprove anything I've said; you might want to try explaining your arguments more fully. Re vasectomy, I see that in your opinion it (what precisely? see below) would be a failure; this confirms my opinion that to some people it would be a failure, and doesn't change the idea that there are likely also people who would not consider it a "failure". Personally, I would look at it like this: The overall goal is to prevent pregnancy. As a step towards this goal, sterilization is attempted. The attempted sterilization doesn't work and can therefore be referred to as "an attempted sterilization that didn't work" or as "a failure" or as "continuing fertility after vasectomy" or by any of a number of other phrases (it is not necessary to use the word "failure"). In the example I give, the attempt to prevent pregnancy did nevertheless work, so the attempt to prevent pregnancy can be referred to as "an attempt to prevent pregnancy, which worked" or as "a success" or as "managing to avoid pregnancy" or by any of a number of other phrases. So if we ask, "was it a failure?" I would say the answer to this question depends on what exactly is referred to as "it". In the Birth Control infobox, "it" is not defined so the meaning is not clear. --Coppertwig 03:23, 9 January 2007 (UTC)

OK, summing up - are you agreed with me that in the specific case of page Vasectomy, the term failure rate is applicable as an encycolpedic and neutral entry? I fully appreciate that in the case of some of the other pages on this topic, the termong may not be so clear? If so, I'm quite happy to get back in my box and leave this discussion before it gets too messy! --RedHillian 04:36, 9 January 2007 (UTC)

Other issues that have been discussed above and are not yet resolved: The proposal to change many instances of "failure rate" in many birth control articles with "pregnancy rate"; the proposal to modify the Birth Control infobox to allow "pregnancy rate" to be displayed (instead of or in addition to "failure rate" and perhaps "effectiveness"); and specificially the proposal to change this sentence on the Condom page: "The method failure rate of condoms is 2% per year" to say "pregnancy" rather than "failure" on the grounds that the citation given for this statement says "pregancy" and does not say "failure". (The pages on which I put notes directing people to this discussion are this page, the Birth Control infobox, and many but not all of the articles that can be reached by the Birth Control navigation template. I didn't put such notices on pages that don't use the word "failure" or that use the word "failure" but where it was apparent to me at the time that it likely didn't mean "pregnancy rate" in that context.)

In reply to RedHillian re the vasectomy page: I am not happy with the vasectomy page and I think it definitely needs to be modified. The problem, which IMO is much more serious than the courtesy issue I originally raised here, is that it provides a summary "infobox" which displays a "failure rate" with no link to any definition of "failure rate", and also mentions "failure rate" in the text without defining it. It's clear from the above discussion that some people (e.g. myself and Lyrl, apparently), on first encountering this wording in the article, assume that "failure rate" obviously and certainly means the rate of pregnancies, while other people (e.g. Joie de Vivre and Chooserr), encountering the same wording, assume that it obviously and certainly refers to a quantity which can be quite different both numerically and semantically from the rate of pregnancies. Assuming that the general readership of the page also contains many people who react similarly, this is a dangerous situation which can easily lead to people believing they have received certain information when in fact the information they have is false and is based on a misunderstanding of the intent of what was written. (Of course, it's not possible to avoid all misunderstandings, but when it seems likely that large numbers of people are going to misunderstand, as in this case, the article needs to be edited.) Because of the profound effects of birth control on individual peoples' lives, it's urgent that such major ambiguities be corrected.

One thing that would help: Note that on the Condom page, after "failure rate" in the infobox it says "(per year, latex)". So obviously it's possible to add information to this line in the infobox. On each page that uses this infobox, a couple of words can therefore be added clarifying what "failure rate" means in each case. For example, for Condom, it can be edited to say in the infobox "failure rate (pregnancies per year, latex)". For Vasectomy, it can say "failure rate (return of fertility, per year)" if that is what it means, or "failure rate (pregnancies per year)" if that is what it means. (This would clarify it, which is the more urgent and important thing; later I would also like to change "failure rate (pregnancies per year)" to "pregnancy rate (per year)" for reasons of courtesy and conciseness.) --Coppertwig 13:07, 9 January 2007 (UTC)

I think we may be beginning to head towards a consensus here. David Ruben, you said "I disagree" above, but it's not clear to me exactly what you disagree with. If you disagree with any of the edits that have been proposed in this discussion, and if you still disagree with them in light of the rest of the discussion, please state clearly which proposed edits exactly you disagree with.

If I don't see any objections to this specifically, I'll edit the Condom page to change the sentence I mentioned above to say "pregnancy" rather than "failure" as its citation does. Many other similar edits are also still under discussion.

I've made two test versions of the Template:Infobox Birth control. I have a version with a bugfix (User:Coppertwig/Infobox Birth control1) and a version which also has a default of "Pregnancy rates" and option to fill in "Failure" or other word as a "rate_type" parameter value to give "Failure rates" (User:Coppertwig/Infobox Birth control2). The bugfix allows the default values (usually question marks) to be displayed as they should when blank or null parameter values are set. I can put "rate_type = Failure" into the infobox call on most pages and then install the new version of the infobox, and "Failure rates" will still appear the same as it does now on those pages with "rate_type = Failure". I propose to have "Pregnancy rates" appear on the Condom page, though, on the grounds that the numbers displayed apparently come from a citation that does not use the word "failure" and for reasons discussed above. Later I intend to look more closely at some of the other pages and comment on which words are most appropriate on those pages.

RedHillian: to answer your question slightly more directly: I don't believe we're restricted to any list of "encyclopedic" terms. We're free to use the English language including occasional words from other languages if appropriate, and in each specific context we can choose words based on clarity, style and other considerations within a consensus-building process. Because I don't think in terms of a restricted list of allowed words here (as opposed to the Simple English projects) I don't see how I can give a yes or no answer to your question. However, I hope the paragraph directed to you about the vasectomy page above is a sufficient answer. --Coppertwig 04:43, 10 January 2007 (UTC)

- Coppertwig I do not see consensus in the above for this change (either for all BC articles or various rephrasing in specific articles). This edit to Essure therefore seemed a little premature. Absence of people responding back to your replies is not evidence of their change of view & agreement; although I agree you do discuss well :-) We could perhaps do with some additional editor views, but before perhaps adding a request at Misplaced Pages talk:WikiProject Clinical medicine, are there any points/issues/framework for further discussion that we wish to agree upon first (eg set up outline for a straw poll on various aspects of the above discussions) ? David Ruben 02:07, 4 February 2007 (UTC)

First, let me clarify what I'm doing here. Note that the first three changes listed below make little or no difference to how any of the articles display and do not in themselves change "failure rate" to "pregnancy rate" anywhere.

• Default values: the current version of the template Infobox Birth control has one behaviour if a parameter is not specified at all (usually displaying a question mark), and a different behaviour if a parameter is assigned a blank value. The version User:Coppertwig/Infobox Birth control1 modifies this so that the default value (usually a question mark) is displayed whether the calling page does not mention the parameter or assigns it a blank value. I think that most or all pages using this template do assign values, so it will make little or no difference now, but will I hope be a convenience for future users and maintainers of the template. This modification has nothing to do with whether the infobox says "Failure" or "Pregnancy" and perhaps should be in a separate discussion; I mention it here because I propose to make both changes to the infobox simultaneously.
• Adding "rate_type = Failure" to various pages: This change by itself, which I did a few hours ago, makes no difference to how the articles look. As long as this line is left as-is, then going from version infobox1 to version infobox2 will make no difference to how the articles look. However, if this line is deleted or changed, then the articles can be modified to say something else instead of Failure: perhaps Pregnancy as in "Pregnancy rate", or Failure with a footnote attached and the footnote can explain the definition of Failure, or some other text.
• Installing version User:Coppertwig/Infobox Birth control2 at Template:Infobox Birth control: I haven't done this yet but am proposing to if there is no objection. As explained above, this change should have no effect on the phrase "Failure rate" in the infobox as long as the rate_type line is left as-is. I plan to modify the documentation for the infobox too, so that people using it on new pages would tend to copy in a rate_type line. This modification is not intended to have any immediate effect on how the articles look, but it adds flexibility allowing the following changes to be made. I propose to skip version infobox1 and just install version infobox2.
• Changing "Failure rate" to "Pregnancy rate" in the infobox on the Condom page: I propose to make this change, which as I pointed out above will make the wording of the infobox conform more closely to the citation its information is based on, since the citation says "pregnancy" but does not say "failure". I put a note some time ago on the Condom talk page about this, directing discussion to take place here. The above changes, which do not in themselves change the way the pages look, allow this change to be made.
• On the Vasectomy page, I think it would be good to attach a footnote to the word "Failure" in the infobox, with an explanation of what is meant by "Failure". I would have to read the references to see what is meant (pregnancy rate? rate of continuing fertility?). Again, the version infobox2 allows such a footnote to be added. For an example of what this looks like, see User:Coppertwig/Sandbox4.

The change I made, adding "rate_type = Failure" does not in itself change the way the articles look. The next change, installing the version infobox2, should make no change to how the "Failure rate" header displays. The change from "Failure rate" to "Pregancy rate" in the infobox on the Condom page has already been discussed above and I don't see any objection to it after I pointed out that this brings the wording closer to what is in the citation. Related changes on the Vasectomy page and other pages may require further discussion. People are welcome to comment here on any of these changes. --Coppertwig 13:39, 4 February 2007 (UTC)

If you want to ask for more opinions from Misplaced Pages talk:WikiProject Clinical medicine that's fine. What question were you thinking of asking? The question could be whether to change the heading in the birth control infobox specificially on the Condom page from "Failure rate" to "Pregnancy rate". It seems unnecesary to me to seek a lot of opinions about internal changes to the template that won't affect the display, but you can if you want.

I oppose having a vote covering wording in multiple pages at the same time. I think each page needs to be considered individually, without having to deal with constraints imposed by people who were voting about birth control in general, possibly without having considered the specifics of particular pages: for example, some methods are single-use; some might have purposes other than just avoiding pregnancy, such as the vasectomy page where the purpose may also be avoiding having to use other forms of birth control, some might have specific wording used in the citations, etc. There may be other things one would discover one has to consider when editing a particular page. I don't think the editors of each page should be constrained by an overall vote. --Coppertwig 17:18, 4 February 2007 (UTC)

Re the vasectomy page: In the infobox I see failure rates of 0.1% and 0.15%, but I don't see any supporting citation anywhere on the page. We need (a) a supporting citation, and (b) the definition of "failure", which will depend on what definition is used in the citation (which could be pregnancy rate, or rate of continuing fertility, or something else.) --Coppertwig 17:25, 4 February 2007 (UTC)

Here's a citation re vasectomy: The risk of pregnancy after vasectomy Here's another one: " How reliable is a vasectomy? Long-term follow-up of vasectomised men. The Lancet, Volume 356, Issue 9223, Pages 43-44 N. Haldar, D. Cranston, E. Turner, I. MacKenzie, J. Guillebaud" --Coppertwig 17:50, 4 February 2007 (UTC)

And I also propose to make the following change, as I suggested earlier and I don't think anyone has objected: on the Condom page, changing "failure" to "pregnancy" in "The method failure rate of condoms is 2% per year. The actual pregnancy rates..." (near the end of the section on effectiveness in preventing pregnancy), which will also make this part conform more closely to the citation, which as I mention above says "pregnancy" and does not say "failure". --Coppertwig 21:37, 4 February 2007 (UTC)

I don't have immediate easy access to the text of the vasectomy studies I mentioned above, so I'm hoping maybe someone else will pull the relevant information out of them. (Or find other citations.) The abstract of the first one is available online but I don't think the full text is -- I could be wrong. --Coppertwig 01:51, 7 February 2007 (UTC)

David, I do not see opposition to the changes I propose in the list immediately after "First, let me clarify what I'm doing" above. Someone may hold a vote if they wish provided case-by-case editing of each page is one of the options. Someone may seek to involve more people in this discussion if they wish. I've already made edits on many pages with a link to here in the edit summary, and put two notes each on the Condom and Vasectomy talk pages as well as the original notes on a number of other talk pages, directing discussion here. If someone thinks I should follow some procedure before proceeding, that one will need to tell me specifically what that one thinks I should do. Anyone is welcome to comment here on the proposed changes, stating reasons for any opposition. II don't think I've assumed that anyone has changed their views; I think the proposed edits are consistent with most or all of the views that have been expressed in this discussion. In particular, David, although you've asked me to wait, it isn't at all clear to me that you've expressed opposition to any of the proposed edits; if you do oppose them, please clarify that and give reasons. --Coppertwig 01:56, 10 February 2007 (UTC)

Coppertwig, thanks for pausing :-) I only requested this as there did not seem a "positive consensus" to so proceed and there had been almost a month since the last posting in this discussion. Whilst I personally would prefer the term "failure rate" to apply across the contraception articles (both for being a better term, in my opinion, and for the consistency), it is equally true that there was no clear "negative consensus" either, and in particular no one has sought to post additional comments this month. So in the best tradition of wikipedia, Coppertwig be bold and tryout your proposed changes on the selected pages you mention above :-) David Ruben 03:53, 10 February 2007 (UTC)

It's hard to sift through the above conversation because there is a lot to read. It seems like almost every editors initial concern was over unanimously changing failure rate to pregnancy rate due to Coppertwig's concerns of the former having negative connotations. Other editors said that we should follow our cited sources, and that one user not likeing the word "failure" is not enough to change medically acceptable language. However, it seems like Coppertwig's proposal has changes. It appears that a handful of articles' cited sources use pregnancy rate instead of failure rate, and that it is more accurate to use one term over the other in specific, case by case, situations. This make a lot more sense than the initial proposal to change the phrasing unanimously. One thing that may help engage other users would be to try and make posts a lot more concise. It's hard to follow a discussion when one user is taking up a lot more space than everyone else. Good luck.-Andrew c 17:18, 10 February 2007 (UTC)

Methods

Absentence is not having sex, that is not a form of birth control anymore than saying Riding a bike is a form of birth control because if you're busy peddling a bike you can't be having intercourse. It should be removed. Absentence is a form of SEX education not birth control.

4.142.90.229 05:38, 25 April 2007 (UTC)nick

The article uses the term sexual abstinence. This is to say that the a person re frames from having any sexual relations. This is not so much a method of contraception but a method restraining from sexual contact. I suggest putting avoiding vaginal intercourse under abstinence (as it can be seen as a sexual abstinence) and calling it Abstinence of Vaginal Intercourse and changing the title "Abstinence" to "Sexual Abstinence Methods".

Rave666 11:36, 4 September 2007 (UTC)

While there are organizations that group abstinence as a similar method to outercourse (Association of Reproductive Health Care Professionals), it seems more common to treat them as completely separate methods (Planned Parenthood, About.com, Campaign For Our Children). All of these sites list abstinence as a birth control option - Misplaced Pages, as an encyclopedia, does not decide on the categorization of methods. It only reports on how methods are categorized by others. A Google search for "sexual abstinence methods" yields 3 hits. This is not an established category of birth control. Absent some compelling reason, I believe Misplaced Pages should follow the most common practice and list "avoiding vaginal intercourse"/"outercourse" under a different heading than "abstinence". Lyrl _C 02:10, 5 September 2007 (UTC)

"Abstinence is not having sex, that is not a form of birth control anymore than saying Riding a bike is a form of birth control because if you're busy peddling a bike you can't be having intercourse... Abstinence is a form of sex education not birth control."

seems to me that it is worth adding this after the word "Abstinence": ("some organizations group abstinence as a similar method to outercourse Association of Reproductive Health Care Professionals). This should satisfy everyone. Basicdesign (talk) 05:21, 6 December 2007 (UTC)

External links

• Stop Terrible Human Over Population Disasters (eCards website to limit human population growth)
• WiseArt Cybernetics (On-line artistic slideshow about limiting human population growth)

Hallo Joyous! I have a question about your message: You ask me not to add inappropriate external links to wikipedia. When I compare the 2 links I added to other existing external links on certain webpages, I see that the 'appropriate' links (i.e the ones you leave alone), are also links to external -third party- organisations, such as our European organisation (STHOPD) is too. Our non-profit organisation works with volunteers and stands for certain principles which are similar to the 'appropriate' organisations on the webpages concerned, such as: Decreasing human overpopulation in an ethical way, having no children, warnings about the worldwide consequences of overpopulation such as the destruction of ecosystems. Please explain to me what would make our links appropriate. Friendly regards, 213.84.166.83 18:28, 21 January 2007 (UTC) MetaMouse.

The other external links provide information about birth control methods. Your external links advocate for birth control to be used in a certain way. I don't feel this is on-topic to the subject of birth control. They might be appropriate in an article on a different topic such as population control or overpopulation. Although they appear to be off-line now so I cannot view the sites, if they solicit for monetary donations or sell items to raise money, that is generally against Misplaced Pages policy for external links. Lyrl _C 22:14, 21 January 2007 (UTC)

US centric?

Many drugs are mentioned in the article as "available" or "withdrawn", but without mention of whether this is international availability or USA only.

Fertility awareness - primary signs and specific methods

This diff made a couple of changes I'm unsure of:

• It changed from three primary signs to two. Weschler's book, the Kippley's book, and Singer's book (the only major FA publications I am aware of) all say there are three primary signs, the third one being cervical position. The Kippley's book even offers rules for using it as the only sign, which can not be done for secondary signs like mittelschmerz. I'm confused about where the statement that there are only two primary signs comes from.
• While there are significant differences between the CM-only methods of Billings and Creighton, there are also many significant differences between the Couple to Couple League's STM rules and Weschler's STM rules.
  • CCL draws two coverlines, Weschler only draws one - in a different spot.
  • CCL allows 'shaving' (a math formula to lower one or more temps that are much higher than the ones around them), Weschler offers the 'rule of thumb' (completely ignore one temp that is much higher than the ones around it).
  • CCL offers six options for pre-o rules; Weschler offers three.
  • CCL offers five options for combinations of temps and CM to determine post-o infertility; Weschler offers one rule for temps and one rule for CM and leaves it completely up to the user whether to follow one, the other, or both.
• So I'm uncomfortable about separating out the two largest CM-only methods, but not separating out the two largest STM methods. I'm also uncomfortable about separating methods out at all outside of the FA article - because of the international scope of (and thus possibly unrepresentative amount of English-language publications) newer methods like Marquette and the Two-Day Method, I'm not confident in judgments of their size. For all I know, they could be just as large as (and thus just as deserving of a mention) Creighton and Billings.

Others' thoughts? Lyrl _C 03:30, 4 March 2007 (UTC)

Billings deserves a mention, in my opinion. Whenever we become aware of something sufficiently well-known or widespread to deserve a mention, let's mention it. If we're not sure whether something deserves a mention, don't worry about it. Don't not mention something just because there *might* be something else equally worthy of mention; if all of Misplaced Pages did that, we would never write any articles about anything. By "separating out" I suppose you mean mentioning (not writing a separate Misplaced Pages article about)? You can address your concerns by mentioning the Weschler and CCL methods. I'm guessing CCL at least is notable. Incidentally, it's my understanding that "shaving" is actually mathematically equivalent to ignoring one (or more) of the numbers, i.e. the same as the "rule of thumb". I could be wrong on that. --Coppertwig 04:17, 4 March 2007 (UTC)

Shaving lowers the temperature by a certain amount. The adjusted temperature is still used in determining the coverline.

I've done some Google searches and found that "couple to couple league", "billings ovulation method", "fertility awareness method" (what Weschler calls her symtpo-thermo system), and "creighton model" all get well over 10,000 hits. "Marquette model" gets slightly over 10,000 hits, but many of them are unrelated to the NFP system. "Two day method" gets less than 1,000 hits. If my search terms were correct, this somewhat reassures me that Billings, Creighton, FAM, and CCL are the big four that should be specified. Though my worries that the newer methods have foreign language or non-web presences that are large still exist.

If there are a small number of method types, it makes sense to list them all out - this article lists both types of condoms (male and female) and all four types of cervical barriers (sponge, cap, shield, diaphragm). If there are a large number of method types, it does not. This article does not list the five different types of cap (Prentif, FemCap, Dumas, Vimule, Oves) - the cervical cap article does that. This article also does not list every formulation of birth control pill. The article oral contraceptive formulations does that.

I'm not sure at what point the number of FA methods become numerous enough to leave the listing to the FA article. Four seems to have precedence (per the cervical barriers example), but five might be too many (per the cervical cap example).

Per Coppertwig's comment, I'm leaning towards just adding the FAM and CCL brands of symptothermo to the article. Lyrl _C 15:13, 4 March 2007 (UTC)

Condom image

The "three colored condoms" image was deleted on Commons as a copyright violation. Commons has some other pictures of condoms, but I'm not sure which one to use to replace the deleted image. Do others have a preference? Or some other source of a GNU-released picture? Lyrl _C 15:30, 4 March 2007 (UTC)

The best one, IMO, on the commons is Image:Préservatif enroulé.jpg. -Andrew c 18:18, 5 March 2007 (UTC)

Wouldn't an unrolled condom be useful? —Preceding unsigned comment added by 70.51.144.184 (talk) 19:32, 24 October 2007 (UTC)

im taking a minipill since january and my period was become abnormal it is possible to mke me pregnant?

im taking a minipill since january and my period was become abnormal? —The preceding unsigned comment was added by 24.255.33.57 (talk) 20:23, 6 March 2007 (UTC).

You should contact your pharmacist or prescribing physician for matters of medical importance. Misplaced Pages should not be the place to go for personal medical advice. If you believe your primary method of birth control (the minipill) is failing and you are concerned about becoming pregnant, the best thing to do is to use a back of method of contraception (or two) to lower your chances of pregnancy (or stop having sex). However, please seek the advice of a medical professional in this matter.-Andrew c 23:24, 6 March 2007 (UTC)

Fertility awareness - specific methods

In the current version of the fertility awareness section, the Weschler symptothermo method is mentioned specifically in the first paragraph. The Billings and Creighton methods are mentioned specifically in the second paragraph. In opposition to the consensus reached in #Fertility awareness - primary signs and specific methods, the mention of Couple to Couple League has been deleted altogether, with the edit summary that CCL does not currently have an article on Misplaced Pages. Per my comments in the previous discussion, I support adding the CCL method as an example of symptothermo alongside Weschler's method.

If the section is going to link to specific methods, I believe it would be better to list them all together. Both Billings and Creighton have significantly sized non-Catholic target audiences (Billings is widely used in China, for example, not exactly a Catholic stronghold) and the Couple to Couple League's method, while it is not targeted to non-Catholics, is certainly picked up and used by non-Catholics: this buddy group provides instruction in both Weschler's and the CCL methods and recommends both books, despite being a thoroughly secular group. I do not understand why these methods have to be segregated away from Weschler's method.

Instead of presenting methods in either the first or second paragraph, perhaps they could all be listed at the end of the FA section in their own paragraph? Lyrl _C 21:01, 11 March 2007 (UTC)

Just because something doesn't have a Misplaced Pages article isn't a reason not to mention it. I support mentioning the CCL method. Maybe at a later date there will be a Misplaced Pages article on it. Any of the ways you've suggested of handling it sound OK to me.

By the way, I question the statement that NFP refers specifically to methods approved by the Catholic church. I've used the term and that is not what I meant and it didn't occur to me that anybody might think that. Who uses it like that? I think it might be more accurate to say that NFP refers specifically to practices such as breastfeeding and periodic abstinence, while FA can involve practices some might not think of as "natural" such as using FA to schedule the use of barrier methods. The fact that the RCC approves of certain methods doesn't seem to me to be fundamental to the definition of NFP; if the RCC were to change their mind and start saying that periodic abstinence is sinful, (or less implausibly that certain practices such as using a thermometer for FA purposes is sinful) would the term "NFP" still refer to whatever the RCC then approves of? --Coppertwig 22:52, 11 March 2007 (UTC)

The definition of NFP varies depending on the source. It is very widely used interchangeably with FA. However, Toni Weschler in her book defines NFP as excluding the use of barrier methods, relying only on abstinence during fertile times to avoid pregnancy. The Couple to Couple League specifies that couples who engage in non-intercourse sexual acts are not practicing NFP. The website of the Canadian organization Serena says "Using condoms, diaphragms, spermicides or withdrawal during the fertile time is not natural family planning," and also appears to be strongly pro-life. From an earlier discussion with an editor familiar with the Billings organization, I gather that their position is that non-intercourse sexual acts are "incompatible with correct use" but not strictly prohibited. The founders of the organization, John and Evelyn Billings, are Catholic and developed the method while working for the Catholic Church. Regarding the definition of NFP, I am unaware of the position of Creighton, but it is based from the Pope Paul IV Institute (so strong Catholic connections).

Despite the fact that the term is most commonly used interchangably with FA (Misplaced Pages's normal guideline), I have tended to use this "religiously motivated" definition because of Misplaced Pages's naming conventions "Use the name(s) and terminology that the individual or organization themselves use." Organizations that call their method NFP all appear to be associated with the Catholic Church and to associate religiously-based restrictions on its use. Lyrl _C 23:27, 12 March 2007 (UTC)

Methods that are widely considered "natural" but that the RCC does not approve of (such as withdrawal) are already excluded from the definition of NFP. (Also see natural birth control.) I imagine that if RCC teaching changed, the Church would attempt to drag popular definition of the term NFP along with their change. It might be unsuccessful, but that's another issue. Lyrl _C 23:32, 12 March 2007 (UTC)

It's fine to list various methods, but it is important to state which are taught as NFP/abstinence-only, and which are taught as a standalone method of FA. The simplest way to do that is to list the NFP-taught methods in the NFP paragraph. However I think it is important to draw the line somewhere: if you look at the Natural Family Planning article, there are many, many "methods" being taught by various organizations, and I don't think it's appropriate or necessary to list every single one. I think the ones we have listed as of now are sufficient. Joie de Vivre 20:35, 13 March 2007 (UTC)

I propose that the line be drawn at methods that are used by large numbers of people, preferably internationally. The Couple to Couple League is an international organization (24 countries) and is the largest NFP organization in the United States, teaching their version of the symptothermal method to almost 8,000 couples in 2004 alone . The only other international organization in the NFP article is Family of the Americas, which teaches the Billings method (already listed in this article). So to my understanding, drawing the line at international methods used by large numbers of people does not have a danger of overwhelming the FA section with a list of methods. I propose including Ms. Weschler's system, even though it has limited international scope, because her book has been so overwhelmingly popular. The Marquette and Two-Day Methods are the only other international methods I am aware of - see my analysis at #Fertility awareness - primary signs and specific methods for why I concluded they should not be included in this article.

To me, it seems much more continuous to list all the methods together. I find it awkward to have them in two separate lists. A note along the lines of "some organizations include religious content in their fertility awareness classes" I would be fine with. However, I object to singling out methods as "these methods are only taught as NFP". Firstly, saying Billings and Creighton are taught as abstinence-only systems is like saying Habitat for Humanity only builds houses for people who convert to Christianity. The fact that these organizations have leadership that is devoutly Christian in no way means they enforce that upon the people they train as leaders or the people they provide services to. Secondly, while the organization of the Couple to Couple League does include religious content in their programs (unlike Billings or Creighton), the method itself - that explained by the secular charting group at weddingchannel.com - is just a set of rules that has no religious connotations about abstinence or anything else. The method can be learned without ever encountering religious material, so the method itself should not be identified as NFP-only.Lyrl _C 22:30, 15 March 2007 (UTC)

I think it's good to list the BOM and the CM here, because there is no religious content in the classes. However, someone wants to learn about specifically NFP methods they can click on the NFP article. It's not necessary to include the CCL method here because it includes religious content and is more specifically Catholic NFP. "Including the CCL method" should not be used as a pretext to blur the distinction between those methods developed without any background in Catholicism, those developed by Catholics but taught fairly secularly, and those taught with religious intent. The paragraph does a good job of that, and I think the distinction should be maintained. Joie de Vivre 17:27, 18 March 2007 (UTC)

I prefer working through issues exclusively on Talk pages. Part of our conversation is now only in our edit summaries, so others who would like to express their opinion can't see the full background. I do appreciate Joie de Vivre coming back to the Talk page, though.

I'm not understanding why a large (at least within the FA/NFP community), international organization with a distinct set of symptothermal rules should not be included in a list of prominent FA methods. I am having trouble understanding Joie de Vivre's reason for excluding them. I certainly agree they should not be characterized as a secular organization. But surely we can find a way to acknowledge their religious attitude without discounting their importance? Lyrl _C 19:07, 18 March 2007 (UTC)

I feel compelled to remind you of Misplaced Pages:No personal attacks: "Comment on content, not on the contributor." It should not be included in the list of FA methods because it is not taught as an FA method. BOM, CM, Weschler's methods are taught without religious content and can be categorized as FA. CCL method includes religious content and can only be considered NFP. Wikilink to the NFP article takes care of that. You destroyed the distinction between pure FA methods and the NFP paragraph. See you in 24 hours. Joie de Vivre 19:12, 18 March 2007 (UTC)

I think the source of our disagreement is that I view NFP as a practice — actions done by a specific couple on a day-by-day basis — rather than a method, or rule set. The rule set that a couple uses - Billings, CCL, FAM, etc. - is independent of their decision to follow or not follow the restrictions associated with NFP. Whether or not they follow those restrictions, the fact that they are observing fertility signs and using a rule set to interpret them means they are practicing FA. So a couple can be using FA and NFP - NFP is not a method by itself.

Does that make sense? —The preceding unsigned comment was added by Lyrl (talk • contribs) 21:34, 18 March 2007 (UTC).

Lyrl did not personally attack anyone here. Please review what is considered a personal attack before making such a bold statement. "When there are disagreements about content, referring to other editors is not always a personal attack." Just because they referred to you does not mean they were attacking you. "The appropriate response to such statements is to address the issues of content rather than to accuse the other person of violating this policy." --pIrish 22:34, 18 March 2007 (UTC)

Lyrl and I are discussing this on our own and as far as I can see there is no real conflict. Thanks for the link, I will remember it in the future. Sorry for the reverting disturbance. Joie de Vivre 22:41, 18 March 2007 (UTC)

Since you can't seem to figure out what to do with the article, I requested to get this page fully protected until you stop fighting about what should and should not be on this page. What's worse about this whole thing is that you continue to edit the article in your favor before even coming to a consensus! That doesn't help solve anything and it only infuriates the other side and makes them less likely to change their position on the issue. Please, figure something out here, on this talk page, or take it over to dispute resolution and have a mediator/arbitrator step in and help. Thank you. --pIrish 22:25, 18 March 2007 (UTC)

(Undent) Yes, that makes a lot of sense. Lyrl, that is an excellent observation, one I had not quite discerned. You are absolutely right that the different methods are separate rule sets, and that individuals may incorporate those rule sets into a practice of NFP, or on their own, for birth control or for other reasons such as health monitoring. You are right that NFP is not a "method" of FA, I see it more as a behavioral system informed by religious beliefs. It is true that the different methods are indeed rule sets which may be used either in conjunction with religious beliefs or without them. The problem I see is in the way they are taught. The CCL is taught specifically as a method of NFP, and if you are learning the CCL method, you are being exposed to religious teachings. I feel that in this article, it is important to make it clear which are taught in a religious context and which are not. I feel that this serves two purposes: to empower people to avoid such teaching if they find it offensive, and to maintain a distinction between the meanings of FA and NFP.

I think it would be fine to include mention of the CCL method. It is indeed well-known and used by many people. However I feel it would be best to specify that this particular method includes religious content. I found this easiest to do by creating an FA paragraph and a NFP paragraph, and listing the NFP methods therein. I found that the sections became too bulky and repetetive if they were mixed together. Could we reinstate the previous version, and include a sentence at the end of the second paragraph about the CCL method, perhaps? Joie de Vivre 22:41, 18 March 2007 (UTC)

I support tying CCL in as an NFP organization or otherwise mentioning the religious content of their classes. However, I'm unsure about classifying Billings and Creighton as NFP, because they are promoted to non-Catholics. But I don't want to imply they're secular, either, because of the Catholic leadership. I was trying to find a way to be ambiguous about their religious connections. Would you be willing to work along that line? Lyrl _C 01:43, 19 March 2007 (UTC)

I appreciate the sentiment, but the ambiguity about the religious connections was what prompted me to make the change. The BOM website bills the method as NFP outright. The CM goes further, stating that "it is a system that it firmly based in a respect for... the integrity of marriage", with prominent links to the Pope Paul Institute. The CCL method includes Catholic content and is certainly NFP. My feeling is that it is important to differentiate between those with a Catholic background and those without, particularly since they all have varying levels of religious content. I think the paragraph explaining the term NFP is the best place for these. Joie de Vivre 23:30, 19 March 2007 (UTC)

Regarding "billing the method as NFP", Katie Singer recently published a book Honoring Our Cycles: A Natural Family Planning Workbook , yet Singer is unconnected to the Catholic Church.

As far as people seeking FA information, and unexpectedly encountering religious information - I'm not convinced that's a danger. Classes from Billings and Creighton certified teachers are unlikely to contain any religious content - Kerry Hampton, for example, is a Billings teacher, but obviously does not follow Catholic teachings (she fits diaphragms). For the websites, if the name of a Pope, and a statement implying Creighton is marriage-strengthening are the most religious comments to be found, I'm not impressed. Both Toni Weschler and Katie Singer in their books talk about how periodic abstinence can strengthen a relationship; I don't believe the idea is religious in nature. Weschler specifically recommends that FA only be used by couples in a long-term committed relationship; while it's not cutting-edge PC to assume this kind of relationship involves a piece of paper issued by the government, I don't find targeting FA at married couples to be overtly religious, either. I'm also not impressed by a link to a site that contains some religious content - both Weshler's and Singer's books list places like CCL in their "Resources" sections, which are not segregated into FAM vs. NFP lists, but placed in simple alphabetical order by organization name.

As far as I am aware, people looking into Billings and Creighton either through the website or a local teacher are no more likely to come across religious content than people looking into Weschler's FAM. Following from this, I don't understand why these methods should be specifically categorized as NFP. Lyrl _C 02:05, 20 March 2007 (UTC)

They should be categorized as NFP, primarily because that is what they bill themselves as. End of story. Joie de Vivre 18:46, 20 March 2007 (UTC)

They are not using the definition of NFP described in the FA section. If Misplaced Pages is going to go with the "popular use" definition of NFP, and the definition Billings and Creighton (and now, apparently, Katie Singer) use in their outreach efforts, it does not include religious restrictions. In that case (a change of Misplaced Pages's definition of NFP to remove religious restrictions), I would have no objection to calling Billings and Creighton NFP. Lyrl _C 23:00, 20 March 2007 (UTC)

I am so tired of arguing about this with you. Can't we just explain that the term NFP was coined by Catholics, that others have adopted its use, but that the term FA is more frequently used to mean non-religious, condom-OK-unmarried-OK, and NFP more frequently means Catholic, no-condom,-must-be-married,-penile-vaginal-only? Can't we explain that the CM and the CCL methods are religious in background and that the BOM, Weschler and Singer methods are more open? I honestly see a big difference between someone who teaches it as "this is a wonderful way to avoid pregnancy naturally", and someone who teaches it as "God said that everything else is forbidden." Joie de Vivre 14:45, 21 March 2007 (UTC)

There are certainly things we agree on - that NFP is more commonly used by Catholic groups, that FA has no religious connotations, that CCL teaches "God said that everything else is forbidden" and article references to CCL should make that clear. I agree this kind of strung-out debate is onerous, but I'm not sure how else to handle it. I'm open to ideas if others have dispute resolution suggestions.

For me, I see a big difference between an organization that outright states "sexual morality education" and "God's great gift of sexuality" are part of their "ministry" and an organization whose founders apparently believe in Catholic morality, but whose fertility information pages contain no religious content (Billings, Creighton). I can agree to specifying secular organizations as secular, and "morality education" groups as religious. I do not agree with categorizing the "morality education" groups like CCL together with the "no religious commentary" groups like Billings and Creighton. Lyrl _C 01:36, 23 March 2007 (UTC)

Since you still can't seem to come to a mutual decision (though not much dicussion has taken place here recently so I'm not sure if you're talking elsewhere or just not talking at all), I will, once again, bring up the page for dispute resolution. It can help you make your case and have an unbaised third party person help you work through things. --pIrish 20:45, 26 March 2007 (UTC)

I am starting to wonder why the NFP methods need be listed at all. Joie de Vivre 16:35, 28 March 2007 (UTC)

I would support not mentioning any specific methods, just leaving that to the FA article. Lyrl _C 00:29, 29 March 2007 (UTC)

How would not mentioning FA methods in the FA section improve the article? NFP and FA are not conjoined twins. Excluding the methods which are explicitly geared towards married Catholics does not necessitate excluding standalone FA methods that carry no religious or behavioral expectations in their teaching. Joie de Vivre 19:31, 29 March 2007 (UTC)

Teaching a method to atheist Chinese populations without including religious content (as Billings does) is not exactly "geared toward married Catholics".

Not mentioning FA methods would resolve our conflict, and would not affect the article significantly. Lyrl _C 01:52, 30 March 2007 (UTC)

I wouldn't have any problem with including Billings. I also wouldn't have a problem including CCL and CM and the other NFP methods if we were just to briefly note which ones include Catholic messages in their teaching. Why can't we do that? FA in general is so little-known (and so useful) that I think it'd be a real shame to remove their mention from the article. More people will read the Birth control article, and fewer people will bother to click through onto the NFP or FA articles. I think increasing public knowledge of FA could be achieved here by including the most popular systems.

What if it went like this:

Fertility awareness (FA) methods involve a woman's observation and charting of one or more of her body's primary fertility signs, to determine the fertile and infertile phases of her cycle. Unprotected sex is restricted to the least fertile period. During the most fertile period, barrier methods may be availed, or she may abstain from intercourse. Different methods track one or more of the three primary fertility signs: changes in basal body temperature, in cervical mucus, and in cervical position, though cervical position is most frequently used as a cross-reference with one or both of the others. If a woman tracks both basal body temperature and another primary sign, the method is referred to as symptothermal, one such method is taught by Toni Weschler. Other bodily cues such as mittelschmerz are considered secondary indicators. A woman may chart these events on paper or with software.

The term natural family planning (NFP) is sometimes used to refer to any use of FA methods. However, this term specifically refers to the practices which are permitted by the Roman Catholic Church — breastfeeding infertility, and periodic abstinence during fertile times. FA methods may be used by NFP users to identify these fertile times. Various systems are taught as NFP: the Couple to Couple League teaches a symptothermal method, while the Billings Ovulation Method and the Creighton Model are based on mucus observation alone. Some NFP teachers and organizations include religious content in their classes.

Pretty please? Have I misunderstood any of your concerns? Does this address them? I too would love to get this resolved. Joie de Vivre 23:57, 30 March 2007 (UTC)

Subheader for navigation

It's better, because it does not outright say Billings and Creighton include religious content. However, I still object to presenting them separately from Weschler's system. My objections to specifying Billings and Creighton as NFP are twofold: 1)they do not use the definition of NFP that Misplaced Pages is using, and 2)the methods themselves can be (and sometimes are) taught outside of an NFP context.

The term NFP is defined differently by different organizations. Some organizations, such as CCL, include the Catholic behavior restrictions as part of NFP. Other organizations, such as Billings and Creighton, appear to define NFP as the observational method itself, and to consider the behavior restrictions as separate aspects of the Catholic faith not integral to NFP. It is misleading to define NFP with the CCL definition and then say Billings and Creighton are "taught as NFP". It falsely implies they use the same definition that CCL does.

Saying the methods are "taught as NFP" also misleadingly excludes teaching of the methods outside of their original organizations. Examples include the promotion of the CCL method on weddingchannel.com, and Billing's practice of giving official teaching licenses to all comers, resulting in secular teachers of the Billings method. These avenues are certainly not teaching these methods as NFP. Lyrl _C 01:47, 1 April 2007 (UTC)

What about adding to the end of the current section: The Roman Catholic Church has dominated the development of fertility awareness methods. While numbers of secular teachers such as Toni Weschler are increasing, currently even organizations that do not include religious content in their classes may have connections to this Church.Lyrl _C 01:54, 1 April 2007 (UTC)

I like the general idea of identifying the RCC's involvement with the research and development of FA methods. I am not pleased I feel uncomfortable with the wording "has dominated", also "numbers of secular teachers... are increasing" is somewhat speculative. How about this:

Some NFP organizations include religious content in their classes. Those that do not may still be run by practicing Catholics.

The phrase "connections to this Church" is really vague. Can't we be more specific about the nature of those "connections"? Joie de Vivre 15:33, 2 April 2007 (UTC)

Just add that on to the end of the current last paragraph of the FA section (that lists all the methods, including Weschler's)? That would work for me. Lyrl _C 01:32, 3 April 2007 (UTC)

I am fine with adding the sentence but not with including something that is definitely 100% an FA method in with all the NFP methods. Joie de Vivre 15:39, 9 April 2007 (UTC)

Look, I can't talk about this any more. We should just get rid of the last paragraph in the current version and leave it at that. Joie de Vivre 15:40, 9 April 2007 (UTC)

I wish I knew more about what you were talking about so I could help out with this issue more, but, unfortunately, I do not. However, my suggestion would be to not include whatever is trying to be included. If it causes this much controversy, indecision, and argument between established Misplaced Pages editors, it probably doesn't belong or need to belong in this article. This is just my take on things and I hope some sort of consensus can be reached about this issue soon so we can unprotect the article. --pIrish 17:27, 9 April 2007 (UTC)

Getting rid of the last paragraph (that lists the individual methods) is good by me. Lyrl _C 21:35, 9 April 2007 (UTC)

Birth Control equivalent to contraception?

Why does Contraception redirect to Birth Control? Isn't contraception a specific subset of birth control? --Llewdor 23:47, 19 April 2007 (UTC)

The overlap is fuzzy because of the does-hormonal-contraception-prevent-implantation-and-if-so-is-that-abortion debate. Where to put hormonal methods, and also IUDs, if a contraception article was created would be a mess. Lyrl _C 00:17, 20 April 2007 (UTC)

I think it would be safe to put hormonal methods and IUDs in contraception... Contraception covers the means and methods to prevent conception. Contra - against (i.e. contrary to). Ception - as in "conception"... The hormonal pill acts PRIOR to conception thus it is "contra-conceptive"... Conception does not occur until the zygote has formed and implanted. Birth control includes such things as laws disallowing multiple offspring (such as in many parts of China). I think that is definitely FAR BROADER than the issue of condoms, pills, femidoms and IUDs! Cultural mandates should not come into this... —Preceding unsigned comment added by 81.107.183.201 (talk) 20:27, 11 August 2008 (UTC)

SILCS device

According to the Cervical Barrier Advancement Society, SILCS is a diaphragm. To my understanding, its unique characteristics are that it is one-size-fits-all, and has a hook in the rim for easier removal. If this is correct, I'm uncertain about listing it as a separate kind of birth control. Lyrl _C 03:44, 12 May 2007 (UTC)

I also feel that SILCS intravaginal barrier contraceptive should be merged with Diaphragm_(contraceptive)#Types. The former does not seem foreseeably expandable, and the latter contains specific brands/styles that do not have their own article. That said, I wouldn't mind having a line or two (maybe a little less than what we have now) about this specific brand in development in this article. (I wouldn't mind if it was completely removed, either way works). -Andrew c 03:56, 12 May 2007 (UTC)

Regardless of what it is called, I think its design is different enough to warrant its own mention; just as the Lea's shield has. Joie de Vivre 16:25, 15 May 2007 (UTC)

I think the Lea's shield article should be merged into cervical cap, but that's not something I'm motivated to pursue at this time. A mention of SILCS is fine, in the barriers section with the diaphragm. I oppose SILCS having its very own section. Lyrl _C 00:58, 16 May 2007 (UTC)

I agree that it does not need its very own section. The SILCS diaphragm is mentioned briefly under Barrier methods, with an internal link to its listing in the "Methods in development" section. Joie de Vivre 19:13, 18 May 2007 (UTC)

I question that SILCS should be listed under "methods in development". It is a diaphragm, and diaphragms are not "in development". My current knowledge of the SILCS is that its only unique characteristics are the finger cup (whoop-de-doo) and its marketing as a one-size-fits-most. Distributing only one size of diaphragm has been advocated before, though the first formal study suggested it was a bad idea (PMID 12279800). But with the push for diaphragm use in developing countries, and the barrier posed by the currently-required fitting session, interest in the topic has picked up (PMID 15033398). The effectiveness trials of the SILCS are groundbreaking, certainly, in that good effectiveness studies of a single-size diaphragm have never before been conducted in the over one hundred years the device has been on the market. However, I don't see any reason the results of the study would not be applicable to all arcing-spring diaphragms. Should someone have information on some unique aspect of SILCS I am not aware of, I would be interested. But currently, I believe the SILCS should not be listed as a "method in development" and that its only listing in this article should be in the "barriers" section. Lyrl _C 02:49, 19 May 2007 (UTC)

Your comment about diaphragms not being in development is an association fallacy. The SILCS diaphraghm is still in testing. Your suggestion that the results of the SILCS study should be be applied to all diaphragms is not shared by any medical or statistical authority that I am aware of. There is no onus on me to prove why such associations should not be made. The SILCS device has not been approved by medical authorities. My guess is that if the SILCS device was the same as other diaphragms it would have already been approved on the grounds that it is no different from other diaphragms. Even if the reason the SILCS device is not yet approved is unrelated to any differences from other diaphragms, we can return to the fact that the SILCS diaphragm is still in testing. Thus it is categorized and described appropriately. Joie de Vivre 03:16, 19 May 2007 (UTC)

On the "still in testing" argument: Condoms were studied for effectiveness as recently as 2004 (PMID 15504381). Does that mean they were "in development" until then? On the "medical authority" argument: This pdf article implies that testing of the SILCS is primarily because of its one-size nature: "One randomized, controlled trial now in the late planning stages at Ibis Reproductive Health intends to test the need for fitting the Ortho All-Flex, the diaphragm market leader. If the device performs well without clinician fitting, that diaphragm and perhaps others could be offered in a standard size. Participants at the 2002 meeting also placed priority on evaluating the effectiveness of new one-size or two-size devices such as Lea’s Shield, BufferGel Cup, and the SILCS diaphragm." Lyrl _C 03:43, 19 May 2007 (UTC)

If condoms were not yet on the market, such an argument about continued testing might be relevant. The SILCS diaphragm is not yet available and thus the "still in development" categorization is appropriate. I don't really care to discuss implications regarding the reasons behind the continued testing; I don't see the relevance. The placement of the description of the SILCS device, under "Methods in development", is appropriate. Joie de Vivre 03:50, 19 May 2007 (UTC)

"if the SILCS device was the same as other diaphragms it would have already been approved on the grounds that it is no different from other diaphragms." Its only difference in every document I have read is the lack of sizing. No diaphragm anywhere in the world is approved for use without a clinician fitting. We're not going to agree with each other on this. As a second choice position, I have added other currently researched but so far unapproved methods (like new brands of spermicide, and the new rim type of the Duet diaphragm) so SILCS won't be the only thing in that section. Lyrl _C 11:55, 19 May 2007 (UTC)

The other difference, other than the lack of sizing, is that the device has not been approved. It is still in development; there is nothing that changes the fact. I find your choice, to add a string of other items as a reaction to the inclusion of the SILCS device, to be unsavory. Joie de Vivre 13:47, 19 May 2007 (UTC)

Morality objections mention in lede moved here

The following statements are unsourced. I find it inappropriate to make vague statements about cultural and religious opposition to birth control, especially when such statements are unsourced. I feel that these statements, if sourced, do not belong in the lede. They should be placed under Birth control#Religious and cultural attitudes or perhaps Religious views on birth control.

Here's the content: Joie de Vivre 17:11, 15 May 2007 (UTC)

Contraception differs from abortion in that the former prevents fertilization, while the latter terminates an already established pregnancy. Methods of birth control which may prevent the implantation of an embryo if fertilization occurs are medically considered to be contraception but characterized by some opponents as abortifacients.

Birth control is a controversial political and ethical issue in many cultures and religions, and although it is generally less controversial than abortion specifically, it is still opposed by many. There are various degrees of opposition, including those who oppose all forms of birth control short of sexual abstinence; those who oppose forms of birth control they deem "unnatural", while allowing natural birth control; and those who support most forms of birth control that prevent fertilisation, but oppose any method of birth control which prevents a fertilized embryo from attaching to the uterus and initiating a pregnancy.

New category required for NFP/FA related articles

NOTICE: The old discussion at Category talk:Periodic abstinence is now located at Category talk:Fertility tracking/Periodic abstinence. Joie de Vivre 11:32, 13 June 2007 (UTC)

Note: The centralized location for discussing categorization of NFP/FA articles is at Category talk:Periodic abstinence. Please discuss there, not here. Joie de Vivre 18:33, 29 May 2007 (UTC)

The previous category was Category:Periodic abstinence, however a recent CfD result was "delete". This new category effects the following articles: Rhythm method, Fertility awareness, Natural family planning, Basal body temperature, Billings ovulation method, Creighton Model FertilityCare System. Category:Behavioral methods of birth control is a category that was created earlier this month, and is intended to house these articles, plus Coitus interruptus and Lactational Amenorrhea Method. Should we create a new subcat to house the categories that used to be in periodic abstinence? If so, what should it be called? I'm not sure, for categorization purposes, we need to have such a specific category, especially when we've had difficulty trying to come up with a name that everyone can agree with, however, I feel that we should raise a new consensus for whatever we do before recreating deleted content without going through the undeletion process of deletion review.-Andrew c 13:53, 28 May 2007 (UTC)

The pebble in my shoe here is Rhythm Method. The Rhythm Method involves noting the date that menstruation begins, using an algorithm to estimate the date of ovulation, and bracketing a no-sex zone around that date. All of the other methods involve getting up-close-and-personal with cervical mucus, cervical position (with a speculum), or basal body temperature, which for most women exhibits a noticable shift at ovulation. These methods are called fertility awareness. (They are called natural family planning if used by Catholics for religious reasons.) I would be fine with grouping the fertility awareness methods together and leaving Rhythm out. I don't see how it's grammatically possible to group them together without error. I did try to group them together by suggesting Category:Methods which detect or estimate fertility, but Lyrl argued that all FA methods "estimate" and that we shouldn't differentiate even in the title. I disagree, I think we should make it clear that FA methods involve bodily signals, and Rhythm involves a calendar and a pen.

I still really like Category:Methods which detect or estimate fertility, particularly because then the category can be cross-linked with Category:Fertility, which is good because many women use these methods to help them conceive. Ideas? Joie de Vivre 14:07, 28 May 2007 (UTC)

Of course, then the category is open to things like Hamster test, so maybe we should narrow the scope to Category:Fertility awareness. But then we are back to excluding rhythm, and even Natural family planning. I am having trouble finding a good solution. Joie de Vivre 14:11, 28 May 2007 (UTC)

As explained at Category talk:Periodic abstinence, I believe the recreation was the correct thing to do in accordance with Misplaced Pages policies. Discussion on a renaming had already started there. Lyrl _C 14:40, 28 May 2007 (UTC)

Please disregard my post above, the centralized discussion for this topic is ongoing at Category talk:Periodic abstinence. Sorry.-Andrew c 16:14, 29 May 2007 (UTC)

NOTICE: The old discussion at Category talk:Periodic abstinence is now located at Category talk:Fertility tracking/Periodic abstinence. Joie de Vivre 11:32, 13 June 2007 (UTC)

Population control in fiction

In fiction, population control has appeared in TV-series as Sliders, and movies as Fortress (1993 film).

Brave New World by Aldous Huxley is worth mentioning as all Women are required to take birth control pills and encourageed to engage in sexual play. —Preceding unsigned comment added by 70.51.144.184 (talk) 19:24, 24 October 2007 (UTC)

"Typical use" first-year failure rate for Depo-Provera

The FDA uses a contraceptive efficacy table based on:

James Trussell's "Contraceptive Efficacy" chapter in the 17th edition (1998) of Hatcher et al. (eds.) Contraceptive Technology

not:

James Trussell's "Contraceptive Efficacy" chapter in the 18th edition (2004) of Hatcher et al. (eds.) Contraceptive Technology

for consistency in current FDA-approved labeling for all contraceptives (e.g. Depo-Provera U.S. prescribing information, Lybrel U.S. prescribing information).

In his 18th edition of Contraceptive Technology contraceptive efficacy table, among other changes, Trussell changed his "typical use" first-year failure rate for Depo-Provera from 0.3% to 3% based on:

Trussell J, Vaughan B (1999). Contraceptive failure, method-related discontinuation and resumption of use: results from the 1995 National Survey of Family Growth. Fam Plann Perspect. 31(2):64-72,93 PMID 10224544

which reported (Table 1) 12-month failure rates from the 1995 NSFG of:

2.3% Implant (Norplant)

3.2% Injectable (Depo-Provera)

3.7% IUD

For his 18th edition of Contraceptive Technology contraceptive efficacy table, Trussell:

• rejected the NSFG failure rate of 2.3% for Norplant as absurd and set his Norplant typical use failure rate equal to its first-year perfect use failure rate of 0.05% derived from clinical trials (which he had used in his 17th edition of Contraceptive Technology contraceptive efficacy table).
• accepted the NSFG failure rate of 3.2% for Depo-Provera instead of using Depo-Provera's first-year perfect use and typical use failure rate of 0.3% from the largest clinical trial of Depo-Provera (which he had used in his 17th edition of Contraceptive Technology contraceptive efficacy table).
• rejected the NSFG failure rate of 3.7% for IUDs as absurd and set his ParaGard typical use failure rate equal to its first-year typical use failure rate of 0.8% in the largest ParaGard clinical trial, and set his Mirena typical use failure rate equal to the average of its first-year perfect use and typical use failure rate of 0.1% in two large clinical trials (which he had used in his 17th edition of Contraceptive Technology contraceptive efficacy table).

The FDA's Draft Guidance on Labeling for Combined Oral Contraceptives published for comment in March 2004 has a simplified contraceptive efficacy table based on clinical trial data reviewed by the FDA—and omits dubious "typical use" failure rates derived from NSFG survey data.

69.208.167.245 03:45, 13 June 2007 (UTC)

The FDA uses the 1997 edition in its labeling because its guidelines were created in 1998. Lacking an actual statement from the FDA that it has rejected the most recent edition of Contraceptive Technology, the most reasonable conclusion is the the FDA is out of date, not that it has actively rejected Trussel's most recent analysis. While the FDA may "omit dubious "typical use" failure rates derived from NSFG survey data" for hormonal contraceptives, they certainly don't have a problem using those rates for fertility awareness. In the "choosing a regular method of birth control" section of this document, the FDA says fertility awareness has a first-year failure rate of 25% - the NSFG number (based on 217 women using calendar-based methods and 33 women using symptoms-based methods). This despite numerous recent clinical studies demonstrating significantly lower typical failure rates (PMID 8478373, PMID 1755469, , PMID 8147240, PMID 9288336). Neither source is "consistent" in using clinical trial data above survey data.

• The current FDA contraceptive labeling guidelines were adopted in 1998 and include a contraceptive efficacy table based on Trussell's table from Contraceptive Technology, 17th ed. (1998).
• The FDA has explicitly rejected use of Trussell's table from Contraceptive Technology, 18th ed. (2004) -- see page 9 of FDA Medical Review - Plan B Rx to OTC switch:

"The Applicant replaced the 18th Edition of the Trussell table with the 17th edition of the Trussell Table as requested by the Division of Reproductive and Urologic Products (DRUP) in order to be consistent with presently approved labeling for Plan B and non-emergency contraceptive products."

• The FDA Draft Guidance on Labeling for Combined Oral Contraceptives (March 2004) does NOT use Trussell's table from any edition of Contraceptive Technology.
  • Aside from the 10X jump in typical use failure rate for Depo-Provera from 0.3% to 3% between the 17th and 18th editions of Trussell's table, the next biggest change has been the 2.67X increase in typical use failure rate for the Pill in Trussell's table from 3% (16th ed. 1994) to 5% (17th ed. 1998) to 8% (18th ed. 2004).
  • Notably, the only significant differences between the 2004 FDA Draft Guidance efficacy table (based on clinical trial data reviewed by the FDA) and the 2004 18th edition Trussell table is:
    • a failure rate of <1% versus 3% for injectables
    • a failure rate of 1% versus 8% for COCPs (and the patch and the vaginal ring)
    • a failure rate of 2% versus 8% for POPs (very-low-dose norethindrone or norgestrel POPs)
    • behavioral methods (withdrawal, periodic abstinence) are not listed in the 2004 FDA Draft Guidance table
    • perfect use failure rates are not listed in the 2004 FDA Draft Guidance table
  • The 2004 FDA Draft Guidance efficacy table IS consistent in using clinical trial data (except for sterilization and spermicide):
    • "The estimates for drugs, condoms, diaphragms, and IUDs are derived from clinical trial data reviewed by the Food and Drug Administration. The estimates for sterilization and spermicides come from the medical literature."
  • "Choosing a regular method of birth control" in this document is a section of a Patient Package Insert proposed by Women's Capital Corporation (owner of Plan B before it was sold to the Duramed Pharmaceuticals subsidiary of Barr Pharmaceuticals) to the FDA and included as Appendix 7 of a briefing document for the 16 December 2003 FDA advisory committee meeting about the proposed Rx-to-OTC switch for Plan B.
    • The FDA did not approve a "Choosing a regular method of birth control" in the OTC patient package insert for Plan B.
    • The FDA did insist, as noted above, that Duramed Pharmaceuticals use the 17th edition instead of the 18th edition of Trussell's table in the physician prescribing information for Plan B.
• Trussell's chapter "Contraceptive Efficacy"" in Contraceptive Technology, 18th ed., page 774 says:
  • "Our estimates of the probability of pregnancy during the first year of typical use of spermicides, withdrawal, periodic abstinence, the diaphragm, the male condom, the pill, and Depo-Provera are taken from the 1995 National Survey of Family Growth (NSFG) corrected for underreporting of abortion."
    • Fu H, Darroch JE, Haas T, Ranjit N (1999). Contraceptive failure rates: new estimates from the 1995 National Survey of Family Growth.] Fam Plann Perspect. Mar-Apr; 31(2):56-63. PMID 10224543
  • "Moreover, women in personal interviews for the NSFG also might overreport use of a contraceptive method at the time of a conception leading to a live birth. Evidence for this suspicion is provided by the uncorrected first-year probabilities of pregnancy of 3.7% for the IUD and 2.3% for Norplant (methods with little or no scope for user error) in the 1995 NSFG; the probabilities are much higher than rates observed in clinical trials of these methods, and for this reason we did not base the typical-use estimates for these two methods on the NSFG."
    • Trussell J, Vaughan B (1999). Contraceptive failure, method-related discontinuation and resumption of use: results from the 1995 National Survey of Family Growth. Fam Plann Perspect. 31(2):64-72,93 PMID 10224544
      • "Overreporting use of a contraceptive method at the time of a conception leading to a live birth" may be a reason for 1995 NSFG failure rates of 2.3% instead of 0.05% for implants and 3.7% instead of 0.8% for IUDs -- so why couldn't that also be a reason for 1995 NSFG failure rates of 3.2% instead of 0.3% for injectables?
      • If "overreporting use of a contraceptive method at the time of a conception leading to a live birth" resulted in a (false) background 1995 NSFG failure rate of 2-3%, this would dramatically affect reported failure rates of methods like implants, IUDs and injectables and significantly affect reported failure rates of pills, but only slightly affect reported less effective methods like spermicide, rhythm, withdrawal, etc.
      • None of the failure rates based on the 1995 NSFG are very precise, but the 95% confidence intervals for implants (0.6% - 8.6%), injectables (0.6% - 14.4%), and IUDs (0.5% - 22.5%) are especially wide, spanning ranges of 14x, 24x, and 45x vs. ranges of ~1.5x for pills or condoms and ~2x for withdrawal or periodic abstinence. Another good reason for Trussell not to use failure rates based on the 1995 NSFG for implants and IUDs (or injectables).

• • Using failure rates based on the 1995 NSFG, instead of an average of 1976, 1982, and 1988 NSFG failure rates, resulted in these changes of typical use failure rates in Trussell's table from the 17th to the 18th edition of Contraceptive Technology:
    • spermicides: 26% -> 29%
    • withdrawal: 19% -> 27%
    • periodic abstinence: 25% -> 25%
    • diaphragm: 20% -> 16%
    • cap (nulliparous): 20% -> 16% (1995 NSFG diaphragm failure rate)
    • sponge (nulliparous): 20% -> 16% (1995 NSFG diaphragm failure rate)
    • male condom: 14% -> 15%
    • pill and minipill: 5% -> 8%
  • Using failure rates based on the 1995 NSFG, instead of the Depo-Provera clinical trial typical use failure rate, resulted in this typical use failure rate change in Trussell's table from the 17th to the 18th edition of Contraceptive Technology:
    • Depo-Provera: 0.3% -> 3% !

69.208.163.127 17:56, 17 June 2007 (UTC)

If I am reading Trussell's 1999 paper correctly, his reasoning for not using the typical failure rate from the clinical trials of Depo-Provera is as follows:

Note that discontinuation among users of the injectable has been measured differently from discontinuation among users of other methods in clinical trials. As in the NSFG, a woman in a clinical trial is usually considered to be a user of a method as long as she considers herself to be using that method. However, in clinical studies of the injectable, a woman is considered to have discontinued use if she does not re-turn for her next shot within 14 weeks (15 weeks in some studies), even though contraceptive protection probably extends well beyond that period, and even if she returns thereafter and receives another injection. This convention of classifying such women as discontinuing but not pregnant at 14 (or 15) weeks leads to an overestimate of the discontinuation rate and to an underestimate of the pregnancy rate if women miss an injection and become pregnant after 14 weeks but still consider themselves to be using the injectable.

The average woman on Depo does not ovulate until ten months after her last shot , so it is not unreasonable for her to still consider herself a "Depo-Provera user" even if she forgets or delays a scheduled shot for several weeks. Rather than rejecting the trial data outright, he seems to have weighed the problems with the survey data against this problem with the clinical trial, and decided the inaccuracies in the NSFG were less problematic. The clinical trials of IUDs and Norplant apparently did not have this issue - the definition of "user" for those products is much more clear-cut.

• "Seems to have weighed the problems with the survey data" = did not discuss the problems with the survey data for Depo-Provera.
• What "problem with the clinical trial"?
  • In a clinical trial of a contraceptive pill, or patch, or ring -- a woman would NOT consider herself to still be using them after stopping for more than two weeks.
  • In a clinical trial of an implant or an IUD -- a woman would NOT consider herself to still be using them after they were removed.

69.208.163.127 17:56, 17 June 2007 (UTC)

Also on the topic of consistency, the 18th edition of Contraceptive Technology is used throughout the "effectiveness" section of this article (except for the one modification under discussion) and in many other birth control articles (condom, female condom, diaphragm (contraceptive), cervical cap, fertility awareness, coitus interruptus, Lactational Amenorrhea Method, Rhythm Method). I previously had a lengthly discussion on the condom page about this very issue of 17th vs. 18th. If we're going to deem a source reliable, we should be willing to cite its most recent findings on all relevant topics. If it's not reliable, then it shouldn't be anywhere - alternative sources should be found for all these articles. Picking and choosing outdated sources and using them as if they are authoritative is not right.

• The 18th edition of Contraceptive Technology IS NOT used consistently throughout the Birth control articles nor used consistently throughout the Comparison of birth control methods - Comparison table -- picking and choosing sources (or providing no source at all) may not be right, but IS what is currently done:
• Source of typical use failure rate:
  • Contraceptive Technology 18th ed. table:
    • Cervical cap
    • Contraceptive sponge
  • Contraceptive Technology 17th ed. table:
    • Combined oral contraceptive pill
    • Progestogen only pill
    • Depo-Provera
  • Contraceptive Technology 16th = 17th = 18th = 19th eds. tables:
    • Rhythm Method
    • Female condom
    • Intrauterine device
    • Norplant
    • Implanon
    • Vasectomy
    • Tubal ligation
  • not Contraceptive Technology table:
    • Fertility awareness
    • Coitus interruptus
    • Condom
    • Diaphragm (contraceptive)
    • Contraceptive patch
    • NuvaRing
    • IntraUterine System
  • not in Contraceptive Technology table
    • Lactational Amenorrhea Method
    • Lea's shield
    • Ormeloxifene
    • Essure
• The lengthy discussion on the condom page was about 17th vs. 18th ed. perfect use failure rates of 3% vs. 2%.
• This discussion is about 17th vs. 18th ed. Depo-Provera typical use failure rates of 0.3% vs. 3%.

69.208.163.127 17:56, 17 June 2007 (UTC)

If it's not a question of reliability of the source, but rather disagreement between reliable sources, then the best solution would seem to be citing both sources. While this overview article isn't the place to get into details, we could simply say something along the lines of "the typical failure rate of Depo Provera is disagreed upon, with figures ranging from less than one percent up to three percent" and cite both Trussell (18th) and the original Depo study. Lyrl _C 13:44, 16 June 2007 (UTC)

• It is not a question of the overall reliability of the sources. The FDA and the medical reference textbook Contraceptive Technology are both reliable sources.
• It is a question of a large (10-fold) disagreement between reliable sources:
  • the 16th (1994) and 17th (1998) editions of Contraceptive Technology,
  • the FDA's current (1998) contraceptive labeling guidelines,
  • the FDA's draft (2004) contraceptive labeling guidelines
    • say Depo-Provera's typical failure rate is 0.3% (or less than 1%) based on:
      • the largest (3,857 users) clinical trial of Depo-Provera PMID 4698589
  • the 18th (2004) and 19th (2007) editions of Contraceptive Technology
    • say Depo-Provera's typical failure rate is 3% based on:
      • a 2.6% failure rate from 1995 NSFG retrospective survey data (from 209 users) PMID 10224543.

69.208.163.127 17:56, 17 June 2007 (UTC)

Good work, Lyrl! --Coppertwig 15:14, 16 June 2007 (UTC)

The FDA does not want to change all the labels it has approved since 1998, and so is sticking to the 1997 edition. This seems to me an administrative decision regarding clerical difficulties, not in any way a judgment of the 2004 edition's numbers. Because Misplaced Pages does not have these same bureaucratic concerns, I stand by my assertion that Misplaced Pages should only use the most recently available edition. The "comparisons" table is problematic in that its format allows only one number - so a discussion of available evidence as is done here or here is not possible. For the outdated numbers, all I can say is inclusion is not an indicator of validity.

Anyway, my current proposal is to modify the sentence in this article to read along the lines of the typical failure rate of Depo Provera is disagreed upon, with figures ranging from less than one percent up to three percent and citing both Trussell (18th) (I wouldn't cite the NSFG directly - to me, Trussell is more authoritative on effectiveness numbers) and the large clinical trial the FDA has proposed using (PMID 4698589 - I'd rather cite the FDA directly, but considering the document is still in the draft stage, I suggest going directly to the clinical trial data for now). How does that sound? Lyrl _C 18:24, 17 June 2007 (UTC)

As long as we're discussing method comparison

... would folks mind stepping in to review my question about the sorting of the comparison table at Comparison of birth control methods? Please see my question here. Thank you. (Very nice work on the above, Lyrl!) Joie de Vivre 02:27, 18 June 2007 (UTC)

Urine hormone tests as contraception?

Perhaps urine hormone testing (most famously Persona) should be included as a method of birth control - possibly included within Fertility Awareness methods. This method seems to be relatively common in the UK, I'm not sure about elsewhere.

Edits to introduction

I've modified the recently rewritten introduction in several ways:

• I removed the references to Ancient Greece and Rome - these civilizations did not even begin to exist for many centuries after the Kahun Papyrus was written.
• I listed the two ancient contraceptive methods (withdrawal and pessaries) together, followed by the possibly abortifacient herbal methods.
• I removed the reference to absorbents - I believe the description "pessary" includes things like pieces of wool soaked in (supposed) spermicide, which like modern contraceptive sponges work both spermicidally and also by absorbing semen.
• I removed the references to the earliest hormonal contraceptive and earliest condoms. Condoms were a comparatively unpopular method of birth control prior to the development of modern manufacturing techniques by Julius Fromm - I think the 16th century date for a linen condom implies an undue level of importance to these early devices. Hormonal contraceptives and condoms are the most widely used methods today, but in a historical context the development of spermicides, the female barriers of diaphragms (more important in the U.S.) and cervical caps (more important in Europe), and IUDs were also significant developments. I believe it's better to leave this discussion to the history section, rather than selectively mentioning these two methods in the introduction.
• I removed the discussion focused on effectiveness and just straight linked to the "comparisons" article. In addition to being false (the IUS has a lower failure rate than sterilization) and misleading (LAM and strict forms of fertility awareness also have pregnancy rates lower than 1% per year), it completely ignored other factors people use in choosing their birth control method such as ease of use and level of side effects.
• I also shortened the paragraph on religious and cultural attitudes and added a section link. The introduction was almost going into more detail on this topic than the section did - for example, attitudes concerning open discussions of sex are not currently mentioned in the "attitudes" section at all.

Lyrl _C 14:20, 2 September 2007 (UTC)

I wrote the introduction to help comply with WP:LEAD; I'm fine with what you've done. I have a tendency to ramble. I was basing the birth control effectiveness off of typical (rather than perfect) use ranges. I also completely forgot to distinguish between IUS and IUD- I would qualify the IUS as "hormonal" but that's probably unnecessarily pedantic.-Wafulz 02:26, 3 September 2007 (UTC)

I'm sorry for being a little harsh describing my reasons for the changes - I've gotten into disputes over several of these issues in the past and let my emotional reaction get away with me. You're right about the IUS being hormonal, too, I hadn't really thought that statement through. Thank you for explaining your edits, also - despite my being nitpicky on some issues, I believe they improved the lead significantly. Lyrl _C 14:52, 3 September 2007 (UTC)

sti's, std's

I think in section (i think) 26, about birth control education, it says std's, i think it shuld say STI's, isn't that the proper term? --Jameogle 02:38, 10 September 2007 (UTC)

The Misplaced Pages article is currently located at sexually transmitted disease, so I think it's currently fine to use STD. I suspect eventually the Misplaced Pages article will be moved to sexually transmitted infection (which is currently a redirect), and at that point I would support changing other articles to use STI instead. (You could suggest that at Talk:Sexually transmitted disease, if you're interested - it looks like the last time this was discussed was in March 2006, although at that time the move was rejected because STD is the more commonly used term.) Lyrl _C 22:12, 10 September 2007 (UTC)

Plants or other natural products used as contraceptives?

Just added to the Jatropha article about the nuts and seeds used as a contraceptive in South Sudan. What about a paragraphe listing whatever plant (or other) turns up?

Adding at beginning of paragraph (written in red and bold, possibly, or some other way of alert) a serious warning, mini skull-and-bones sign in front of each plant maybe also, and whatever else in that line.

Could be a table, with columns for 1-the name(s) of the product; 2- reference(s) of where it is said to be used as such; 3-side-effects known; if we don't know of any, make it clear what is meant exactly, by writing "side-effects unknown - caution is required" (or similar) by default, or changing that into "no known side-effects" when we are absolutely sure that it has none (probably not that many if not very few). 4 - anything else that may be thought of.

Made a link to here, but the feed-back from here to the plant is amiss. —Preceding unsigned comment added by Basicdesign (talk • contribs) 06:19, 6 December 2007 (UTC)

Stats on usage

This article could really benefit from some stats on how many women use which method. If I missed that info, would someone mind pointing it out - thanks! --Phyesalis (talk) 18:19, 13 February 2008 (UTC)

A number of the sub-articles have a "prevalence" section which discusses how popular the method is: condom#Prevalence, female condom#Worldwide use, intrauterine device#Popularity, for example. Fertility awareness does not have a section like that, but there is the related natural family planning#Prevalence. The diaphragm and cervical cap articles discuss popularity in their "history" sections, and the pill article touches on it in the introductory paragraph. If you think it would benefit this article, feel free to incorporate some of the information from the sub-articles. Lyrl _C 21:48, 13 February 2008 (UTC)

Although it primarily covers United States, this article might also give some useful data. Zodon (talk) 21:08, 21 April 2008 (UTC)

Douching

I think it should be clarified that while douching with water, juice, milk, soda, etc. does not prevent pregnancy, it is inappropriate to clam douching with ANY liquid will not be effective. Douching with rubbing alcohol for instance will not only prevent pregnancy (as well as being very painful), but it can also make a woman sterile. And don't think no one is stupid enough to try it, I know that is not true. 74.240.193.57 (talk) 02:09, 20 March 2008 (UTC)

During the 1930s, women attempted to avoid pregnancy by douching with toxic mercury compounds, or with Lysol. Medical estimates at the time were that 70% of these women got pregnant each year. Article. While this may be a reduction from the pregnancy rate from doing nothing at all, I would hardly call a method with a 70% failure rate "effective". Lyrl _C 01:20, 21 March 2008 (UTC)

Scope of see also section

The introduction of this article defines birth control as actions taken to prevent pregnancy.

Recently introduced to the "See also" section were links to the lifestyle choice of childfree (though oddly the actual link is a redirect to that page), and the social philosophy of natalism. I propose that both of these links would be more appropriate for a "see also" section in the family planning article, not here. Neither a discussion of a lifestyle or a social philosophy is directly related to the methods of birth control. (This article should probably link to family planning, however, as it is a subset of that topic.)

What do others think? Lyrl _C 13:51, 20 April 2008 (UTC)

Common thread seems to be employing contraception (or its opposite). They seem at least as relevant to contraception as Population control and One-child policy (which are both social concepts that often employ contraception), which are also in the see also section. I added childless by choice as a balance to these links. Pop control and one child policy have some connotations of externally imposed restrictions, so for balance offering link that relates to personal freedom and choice enabled by contraception. (Sorry about linking to redirect - that is the name I am most familiar with, so what I remember.) If want to move Pop control and one-child policy to family planning (childfree and natalism already there) and remove them all here, that's fine by me. If going to keep some and not others here, we probably need to formulate some guidelines to clarify what goes where. Zodon (talk) 19:44, 21 April 2008 (UTC)

Task force proposal

Interested in improving birth control articles? I've proposed a task force to help coordinate work in this category: Misplaced Pages talk:WikiProject Medicine/Task forces#Reproductive medicine

I do not anticipate this being a high-workload task force. Just having a few people to bounce ideas off of every once in a while would be great! Please add your name to the proposal description if you're interested. Lyrl _C 00:44, 18 June 2008 (UTC)

This task force has been created. The task force's page is here and all interested editors are welcome. You don't have to be a medical expert -- just willing to put the talk page on your watchlist or to take a look at it every now and again. WhatamIdoing (talk) 21:37, 19 June 2008 (UTC)

Delete this run-on sentence?

In a non-random, Internet survey of 1,400 women who found and completed a 10-minute multiple-choice online questionnaire listed in one of several popular search engines, women who received sex education from schools providing primarily abstinence information, or contraception and abstinence information equally, reported fewer unplanned pregnancies than those who received primarily contraceptive information, who in turn reported fewer unplanned pregnancies than those who received no information.

This sentence is very wordy. What is the popular search engine? What questionnaire did they complete? It is my understanding that women, specifically teen girls who receive abstinence-only education have higher rates of teen pregnancy and STD's than those who receive medically accurate information regarding sexual intercourse. This sentence makes absolutely no sense. It states that women who received information about contraception, (i.e. they use it), are having more babies than those who don't use contraception? With no method of birth control at all, 80% of women become pregnant within the first year of sexual intercourse with a partner/partners.

The pill(contraceptive) is 99.9% effective at preventing pregnancy. A woman who takes the pill is much less likely to have a baby than a woman who relies on condoms or nothing at all.

It's like a complicated story problem from math class in which you are asked to determine which group of women has had the fewest babies. It is also very vague. Fix it please. —Preceding unsigned comment added by Tjanata (talk • contribs) 04:05, 17 October 2008 (UTC)

Probability of pregnancy from single unprotected intercourse

According to it's "about .014 (i.e., the odds are 1 in 70)." Could be mentioned somewhere in this article. 78.105.220.50 (talk) 23:22, 16 November 2008 (UTC)

It's not a static number, though. On the most fertile day of the menstrual cycle, odds are 2 in 3 ( odds ratio of .667 on peak day of cervical mucus). Starting several days into the luteal phase, odds are more like 1 in 100,000. The .014 average seems very useful for population and fertility studies, but given the wide day-to-day variation in female fertility, I'm not sure it would be helpful for those trying to learn about birth control. Lyrl _C 00:20, 17 November 2008 (UTC)

Hindu attitude

There is a major error within the religious section in the article, specifically the part that talks about Hindus. Hindus may NOT, per scripture, use contraception, nor may they perform abortion. I attempted to access the link that is supposedly given as a reference that says it is acceptable, and the webpage could not be accessed. Please fix, thank you. I would fix it, but the article is protected. —Preceding unsigned comment added by 71.154.9.255 (talk) 00:59, 25 December 2008 (UTC)

Also I understand that a couple of recent prominent Hindus have suggested that it may be okay, and perhaps there are some Hindus (as there are with every religion) that do use contraception instead of abstinence, but per the accepted scriptures, it is unacceptable to use contraception. Please fix, thanks.

This is an archive of past discussions about Birth control. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

1. "Reducing unintended pregnancy in the United States". Contraception. January 2008.