How American football works Essay Example for Free

How American football works Essay Football, also known as American football, is a team game that combines strategy and physical play. The object of football is to advance the ball up the field by running and passing the ball, and scoring a touchdown by crossing the ball into the end zone. Professional football, high school football, and college football are all highly popular spectator sports in the United States. Football History Football originated from a primitive game of rugby played in America in the 1840s. In 1880, Walter Camp, considered the Father of American Football, exchanged the traditional rugby scrum for a line of scrimmage. In 1882, the four down system was introduced to negate Princeton and Yales strategy to hold the ball without trying to score. The following year, Camp reduced the number of players to eleven, and introduced the seven-man offensive line, with a quarterback, two halfbacks, and a full back. The first professional game was played in 1895. The National Football League (NFL) began in the early 1920s. Today, football is one of the most popular sports in the United States. Football Rules Football is played by two teams, with eleven players from each team on the field at a time. A football field is 120 yards long and 53 1/3 yards wide, including a field of 100 yards and two end zones of ten yards each. A game of football consists of four 12-15 minute quarters, depending on the level of play. The game begins with a coin toss. The winning team gets to decide if they would like to receive the ball, or which end of the field they would like to defend in the first half. One team then kicks the ball to the other team. A kick off occurs at the beginning of each half, and after every score. The team that takes control of the ball has four attempts, called downs, in which to advance the ball ten yards. When the offense succeeds in gaining ten yards they receive a new set of downs. If the offensive team fails to gain ten yards after four plays, the other team gets possession of the ball. The ball is put into play by a snap, where the center passes the ball between his legs to the quarterback. The quarterback then has the option to throw or run the ball. Once the quarterback passes the line of scrimmage (an imaginary line across the field from where the ball was snapped), they can no longer throw the ball forward. A down ends when: The player with the ball is tackled to the ground, or has their forward motion stopped by the opposing team; A pass is thrown out of bounds or hits the ground; The ball or player with the ball goes out of bounds; A team scores. An official blows their whistle to signal that a down is over. A change of possession occurs when: A team fails to gain ten yards after four plays; A team kicks the ball off after a score, or at the beginning of a half; A team chooses to punt the ball; A player from the defensive team catches a pass in the air (interception); An offensive player drops the ball after displaying they had possession and a defensive player recovers it (fumble). After a kickoff, punt, interception, or fumble, the ball is live, and the team gaining possession can run with the ball up field. A touchdown is worth six points. A team scores a touchdown when a player runs into or catches a pass in the opponents end zone. After scoring a touchdown, a team has the option to attempt an extra point by trying to kick the ball through the upright. Teams can elect to go for two points and attempt to drive the ball into the end zone on one play, starting from the two or three yard line (depending on level of play). A team scores a field goal, worth three points, by kicking the ball over the crossbar and through the goal posts. A team scores a safety, worth two points, if an opposing player is downed in the end zone. The team with the most points at the end of the game wins. Football Tips Good football players are agile. Agility drills include: jumping rope, running through tires, and jumping over cones. There are a variety of lesser contact versions of Football available. Tackle Football is the sport practiced by major professional leagues such as the NFL, but flag football and touch football are varieties that allow the player to be tackled by either touching with two hands or pulling a piece of ribbon or flag off the opposing player. This also allows for Co-ed or womens teams to engage without fear of injury. Football Equipment Football requires each player to have a helmet, shoulder pads, football pants, cleats, and a mouth guard. The game is played with a spheroid shape leather ball. A football is 11 inches long and 22 inches in circumference in the middle.

The Shoe-Horn Sonata Essay Example for Free

The Shoe-Horn Sonata Essay John Misto, the person behind the play The Shoe-Horn Sonata, uses his distinctively visual text as a memorial for the Australian Army nurses who died in the war, as they were refused one by the government. â€Å"I do not have the power to build a memorial. So I wrote a play instead. † This drama illustrates the way the women were treated in the Japanese prisoner of war camps, during World War II through the two main characters Bridie – an Australian army nurse and Sheila – an English woman. The different dramatic techniques used in this play aid in the manipulation of the audience’s emotions and sway the preconceptions of the group. Misto utilises projected images and the emotive dialogue to create a vivid image in the viewer’s mind that is both distinctively visual and evokes emotions from the audience. Misto is not the only author to have used this technique in his work, John Schumann’s I Was Only 19 is a song that also features distinctively visual elements throughout the song. This text explores the conditions of the Vietnam war and the effect it has afterwards on someone as young as nineteen and has a similar purpose to Misto’s, to expose the terrible conditions of war and the effect it had and is still having on them today. Schumann uses intense emotive language to influence the listener’s opinion on war and draw attention to the conditions prisoners of war face. The Shoe-Horn Sonata digs deep into the readers mind and challenges their thoughts on the way they perceive injustices been done to the memory of the nurses, and of the thousands of other women and children who suffered with them. Misto is able to do this by projecting images onto a screen in the background. â€Å"Projected onto the screen is a photograph of row upon row of captured British and Australian women bowing to the Japanese. These images contribute to the creation of a physical, distinctively visual element in the drama. The confronting images shown forces the audience to reconsider their understanding of the prisoner of war camps in Japan. The audience begins to visualise the conditions the women faced and this leaves an impact on the viewer. Through this, Misto is able to convey his message to his audience through the distin ctively visual images, not only projected on the screen, but shaped in the viewer mind. Although Misto only intended to expose the injustices that had been done to the women’s memory, he has revealed the effect the war had on them and the aftermath of the camps. Misto brings to light the influence the camps had on the women involved in the war. â€Å"She stole every sheet and towel in her room – once she found out the Japanese own this place. † In this quote it is obvious that the women have still not recovered from the traumatic experience in the camp and still feel livid towards the Japanese. The distinctively visual dialogue is enough for the viewer to visualise the event taking place. The fact that the prisoners of war still feel resentment towards the Japanese suggests to the audience that the things they went through must have been worse than the responder originally assumed. The distinctively visual scene allows Misto to manipulate his audiences thinking, this emphasises the injustices that have been done to the women’s memory as the audience begins to realise the damage done to the women, mentally. The Shoe-Horn Sonata continues to battle the audience’s preconceptions of the prisoner of war camps in Japan by using stage directions as a medium for further exposing the effect the war had on its prisoners in Japan. The final scene Bride and Sheila finally feel free after over fifty years. â€Å"Bridie and Sheila are confidently dancing and the theatre is filled with Srauss’ music. It is the music of joy and triumph and survival. † As the two are dancing, triumphant music begins to play emphasising in the viewers mind that after all the years of fear and uncertainty, they finally feel free and confident again. The distinctively visual dancing reinforces the idea that they are free and dancing is a way of expressing your freedom. Misto was even able to, in his stage directions; convey the drama’s purpose through distinctively visual elements. John Schumann’s I Was Only 19 is abundant with different examples of how the distinctively visual conveys the author’s purpose. Schumann uses strong emotive language to produce a distinctively visual image in the reader’s mind. â€Å"And the Anzac legends didn’t mention mud and blood and tears,† the egative connotations attached to the words â€Å"mud†, â€Å"blood†, and â€Å"tears† contrasts with the idea of the Anzac legends, which has a positive connotations. These ideas contrast forcing the reader to reassess their thoughts on the Anzac legends and how they affected the Anzacs during and after the war. The emotive words create a distinctively visual image in the readers mind as they vi sualise the mud-covered jungles of Vietnam and the pain (blood) and suffering (tears) the Anzacs went through. Schumann is able to form a distinctively visual image using only strong emotive language, and he uses this technique to convey the purpose of his song. I Was Only 19 includes many more examples of how Schumann uses distinctively visual language to convey his message. â€Å"And night time’s just a jungle dark and a barking M16? † The emotive word â€Å"dark† creates a distinctively visual image of a dark, dangerous jungle which also incorporates an almost life-like sound of an M16 firing in the background. This image is formed from the powerful emotion in the language and the imagery it creates. As the viewer pictures the dark jungle, they are confronted with the idea that an actual person had fallen into that unfortunate situation and this is what Schumann wants his readers to reflect on, the idea that someone had to experience those conditions for years. Schumann is hopefully able to evoke sympathy in the reader for the soldiers that were in Vietnam. The distinctively visual imagery aids in the creation of this process. John Misto and John Schumann both have a message they want to get out to the world. They may be similar but they both are just as important as the other. These composers are trained in using language and dramatic techniques to manipulate the audience’s emotions and persuading them to think what they wanted them to think, which in this case, is to spread the story of the women nurses in prisoner of war camps and how this affected them and the Vietnam veterans, including their mental and physical diseases. They have successfully done this, using distinctively visual elements in their texts.

Health In New Zealand Health And Social Care Essay

Health In New Zealand Health And Social Care Essay Health is multi factorial and is the product of reciprocal interaction between individuals and their environment. Social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system (World Health Organisation, 2008). As in most countries, health in New Zealand is also distributed unequally throughout the society. This reflects that there is an uneven allocation of social determinants of health such as income, education, occupation and access to health for certain groups compared with others. This essay will examine income as one of the social determinates of health and the effect of low economic status in Maori health. Further it will discuss how the nurses can care for Maori people with inequalities in health and the importance of the government strategy developed to address Maori health concerns. Finally this essay will analyse the psychological factors associated with smoking behaviours and its consequences. Income, employment, education, housing, culture and social cohesion are the distinct social determinants which directly or indirectly influence health outcome of an individual. The people who are more vulnerable to ill heath mostly come under low income category. Income inequalities increased evidently in New Zealand between 1987 and 1991 due to unemployment. The growth in income inequalities is especially seen in Maori population (Davis Dew, 2005). Income is one of the major determinants of health, which contribute to the poor health status of Maori. Indigenous Maori have the poorest health status among any other ethnic groups in New Zealand. The median annual income of Maori in 2006 was $20900 compared to $24400 of the total population in New Zealand (McMurray Clendon, 2010). According to the New Zealand statistics 2005, the average weekly income of Maori was $471 compared to $637 of non-Maori (Robson Harris, 2007). Income and wealth are the major modifiable determinants of heal th which affect the access to healthy environment, living condition, housing, education and timely effective health care. Level of home ownership, property ownership and income producing assets are lower among Maori than non-Maori population. In addition to these, lower equivalent income levels limit the availability of the Maori families to accumulate wealth out of current income (Dew Mathewson, 2008). Compared to non-Maori, inequalities in health status and mortality are higher and increasing among Maori, with increased incidence of conditions such as coronary heart disease and higher fatality rates (McMurray Clendon, 2010). The current economic situation of the Maori and non-Maori is profoundly linked to the history of colonization of New Zealand. Besides this, economic reforms also cause loss of income from changing nature of work arrangements for Maori (Broom, 2007). The income inequalities can be also explained in terms of lower educational qualification and under representa tion of Maori workers in high profile jobs. In New Zealand society Maori are the lowest salary earners and this leads to a low socio economic status (Robson Harris, 2007). Besides this, income level can affect mental health, caring for children and family. People belonging to low economic status always struggle to care their life and childrenà ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s health (Marmot Wilkinson, 2001). Being health professional, nurses have obligation to identify unfairness or inequalities in health. Nurses should work to address the underlying determinants of health and working towards to ensure equitable health and wellbeing of everyone in the society (McMurray Clendon, 2010). In order to deliver proper health care nurses have to be aware about the needs and rights of Maori (Broom, 2007). Principles of Treaty act as a model for nurses to work with Maori. Nurses should respect the cultural beliefs and deliver health services in a culturally acceptable manner (Francis et al., 2008). Nurses should work in a manner to improve the access to health, especially to those who lacks financial resources. Approaches like selecting a central location and convenient time for health services can improve access of health facilities by the low income groups. Nurses should identify vulnerable groups with low income such as unemployed, single mothers and parents with more dependent children. In or der to ensure unbiased health to low income group nurses have to educate them regarding the health facilities and their right to health irrespective of economic status. Increasing conventional services like employing of indigenous health workers and establishing indigenous programs is another nursing intervention for reorienting health service for Maori. (Mason Durie, 2003) For instance Maori can be cared better by employing more Maori nurses as they will have enhanced understanding. Improvements in Maori health status are critical, because Maori has the poorest health status among other New Zealanders. The New Zealand government identified the importance of prioritising the Maori health problems and the need to eradicate health inequalities which has a negative impact on Maori health. He Korowai Oranga is a health strategy set for Maori health development in the health and disability sector. This strategy acts as a basis for the health sector to deal with the health problems of Whanau. The focus of He Korowai Oranga is on Whanau or family wellbeing. The outcomes are mainly aimed at empowering Whanau with physical, social, mental and emotional health; enabling them to take control over their health, creating better quality of life and ensuring their active participation in New Zealand society (Francis et al., 2008). He Korowai Oranga stands on the principles such as partnership, participation and protection which are the core principles of Treaty of Waitangi. He Korowai Oranga tries to identify health inequalities among Maori people in terms of education, income, occupation and access to health health. This strategy aims at considering Maori approaches and models to health for improving Maori outcomes. Inequalities among health statuses of Maori are clearly documented in this. Nationwide population health priorities for Maoris are also enlisted in appendix 3 of this strategy. Besides this it also provide guidelines to district health board for effective assessment and monitoring of Maori health status. This strategy also has made provisions to improve Maori access to mainstream health services like public hospitals or primary health centres (Ministry of Health, 2002). Risk taking behaviours are those which affect the physical and mental health of individuals. Risk taking behaviours may include smoking, alcoholism, unsafe sexual habits, gambling and participating in dangerous activities. Tobacco is the major cause of preventable death in New Zealand. Smoking kills around 4300 to 4700 people per year, among this almost 600 are Maori (Maori Affairs Committee, 2010). Some people consider smoking as a method of channelizing their stress or escape mechanism from their stressful situation or frustrated family life. Some consider smoking as a way to get peer pleasure and to kick out their boredom (Marks, Murray, Evans Willig, 2001). Increased risk of smoking is usually seen in those who are divorced, separated or lone parents. 80-90% of smoking prevalence is seen among people who are under severe deprivation areas such as prisoners, homeless and poor (Marmot Wilkinson, 2001). Young people consider smoking as a way of developing their identity, method of relaxing tension and making peers. Parents and role models can greatly influence smoking behaviour of adolescents (McMurray Clendon, 2010). Media plays a great role in influencing people to smoke even though they advertise about the repercussions of smoking (Marks et al., 2001). The use of tobacco gives rise to many health hazards. Smoking contributes to the higher incidence of coronary artery disease, chronic obstructive pulmonary disease, pneumonia, reduced lung function, impaired lung growth in children and various cancers especially lung cancer. Smoking aggravates the symptoms of many other illnesses, for instance smoking can reduce fertility, increased cataract incidence, poor wound healing, and worsen peptic ulcer. Smoking during pregnancy can lead to birth complications, premature death, small gestational age and low birth weight. Passive smoking is another health risk associated with smoking. Non-smokers living with smokers have 30% increased chance of lung cancer (Maori A ffairs Committee, 2010). In brief social conditions are particularly important in determining health status of an individual. When a social environment is supportive, the person is more likely to be empowered in their health. There is a well-established evidence of relationship between income and Maori health status. Nurses can play an important role in reducing the inequalities in health. In addition to this smoking remains a major contributor to disparities in health status because this behaviour is strongly shaped by income deprivation, occupation and education.

Reader Response of Nam’s At the Door :: Wong Phui Nam

Wong Phui Nam’s â€Å"At the Door† is mainly giving a voice to the unwanted unborn who struggles with death in the early stage of its life. The persona begins by questioning its mother on why did she poisons it. From line â€Å"the poisons seep down, blacken leaf and stem† giving readers the images of death as the poison oozes slowly in painful and destroying manner. The news of pregnancy and birth are in general received as something blissful and joyful, however it is obviously not the case for this pregnancy. This poem illustrates sadness and grief of the discarded foetus, giving it a melancholy tone. The foetus is seen as a plant. The new life of the foetus as symbolises in â€Å"leaf†, â€Å"stem† and â€Å"roots† are â€Å"blacken†, â€Å"pinch† and â€Å"disarrange† and it is deformed before birth by the poison. More images of deformity can be seen in the second stanza. The persona states the â€Å"streams† and â€Å"blood† that gives the notion of new life, is contaminated and hence deformed its â€Å"hooked tail† which is supposed to develop to be its legs and the â€Å"forked ends† as its fingers. The stained and ruined blood causes by the poison has fatally lead the deformity of the foetus and disregard the existence of this new life. The persona’s unwanted existence is described more in the moment of its birth in the third stanza. The persona again questions its mother wonder if she ever pictures the condition of her child in her womb. Instead of developing into a well transformed human being, due to the seeping poison the foetus â€Å"melted back into glistening bunched gel†. This image offers readers an ugly sight of the deformed, unwanted embryo. The deformed foetus that is depicted as â€Å"glistening bunched gel, / red grapes† is â€Å"expelled† from the womb, reinforcing the idea of the unwanted existence by being violently thrown out from the womb where it is presumed to be safe and warm for the new comer. The persona continues by inquiring its mother if she finds life difficult like the way it feels and this notion is portrayed through the dictions, â€Å"harsh† and â€Å"sharp anxieties†. Persona sees itself as â€Å"delicate† â€Å"crystals† implying the notion of fragility and can easily be destroyed. Reader Response of Nam’s At the Door :: Wong Phui Nam Wong Phui Nam’s â€Å"At the Door† is mainly giving a voice to the unwanted unborn who struggles with death in the early stage of its life. The persona begins by questioning its mother on why did she poisons it. From line â€Å"the poisons seep down, blacken leaf and stem† giving readers the images of death as the poison oozes slowly in painful and destroying manner. The news of pregnancy and birth are in general received as something blissful and joyful, however it is obviously not the case for this pregnancy. This poem illustrates sadness and grief of the discarded foetus, giving it a melancholy tone. The foetus is seen as a plant. The new life of the foetus as symbolises in â€Å"leaf†, â€Å"stem† and â€Å"roots† are â€Å"blacken†, â€Å"pinch† and â€Å"disarrange† and it is deformed before birth by the poison. More images of deformity can be seen in the second stanza. The persona states the â€Å"streams† and â€Å"blood† that gives the notion of new life, is contaminated and hence deformed its â€Å"hooked tail† which is supposed to develop to be its legs and the â€Å"forked ends† as its fingers. The stained and ruined blood causes by the poison has fatally lead the deformity of the foetus and disregard the existence of this new life. The persona’s unwanted existence is described more in the moment of its birth in the third stanza. The persona again questions its mother wonder if she ever pictures the condition of her child in her womb. Instead of developing into a well transformed human being, due to the seeping poison the foetus â€Å"melted back into glistening bunched gel†. This image offers readers an ugly sight of the deformed, unwanted embryo. The deformed foetus that is depicted as â€Å"glistening bunched gel, / red grapes† is â€Å"expelled† from the womb, reinforcing the idea of the unwanted existence by being violently thrown out from the womb where it is presumed to be safe and warm for the new comer. The persona continues by inquiring its mother if she finds life difficult like the way it feels and this notion is portrayed through the dictions, â€Å"harsh† and â€Å"sharp anxieties†. Persona sees itself as â€Å"delicate† â€Å"crystals† implying the notion of fragility and can easily be destroyed.

Chinua Achebes Things Fall Apart †Finding Unoka in the Mirror :: Things Fall Apart Essays

Things Fall Apart – Finding Unoka in the Mirror I wish I could say that the character Okonkwo, in the novel Things Fall Apart by Chinua Achebe, is very similar to myself, but I would be lying. Okonkwo is filled with many admirable traits: drive, ambition, goals, and his ability to overcome through his constant productivity. Okonkwo had the determination to become a great man, and even with the odds against him, he succeeded. â€Å"With a father like Unoka, Okonkwo did not have the start in life which many young men had. He neither inherited a barn nor a title, or even a young wife. But in spite of these disadvantages, he had begun even in his father’s lifetime to lay the foundations of a prosperous future† (18). Most of his accomplishments were despite his father, whom Okonkwo loathed, but with whom I connected. In the novel, I relate more to Okonkwo’s father, Unoka, a much more laid back character. Like Unoka, I am in love with life, lazy, not worried about tomorrow, and deeply in debt. Unoka had a great appreciation for the moment. For instance, â€Å"he loved this season of the year, when the rains had stopped and the sun rose every morning with dazzling beauty. And it was not too hot either†¦Ã¢â‚¬  (5). Such a description makes me want to lay down drowsy in the grass and enjoy the beauty of the day, for as Unoka â€Å"loved it all† (5), I too love it all (5)! What I would give for another summer day to simply nap, sprawled on my stomach in the grass of my back yard, feeling the warmth of the sun and security of a newborn napping in its mother’s arms. How deeply do I love these moments of drowsiness and warmth nature supplies her children. I imagine Unoka had similar experiences through playing the flute. â€Å"He was very good on his flute, and his happiest moments were the two or three moons after the harvest when the village musicians brought down their instruments, hung above the fireplace. Unoka would play with them, his face beaming wit h blessedness and peace† (4). Unoka and I enjoy the simple things life has to offer. Perhaps this appreciation is rooted in our struggle against society, one which demands the focus of our lives to lie beyond the setting sun. However, there must come a day when you ask yourself, will I even be alive tomorrow?

Immunitarian Democracy :: Democracy Politics Community

Immunitarian Democracy 1. Does "community" refer to democracy? If not, could it or is it too deeply embedded in the conceptual lexicon of the Romantic, authoritarian and racist Right? This is the question, one already asked by American neo-communitarianism, that is emerging again in Europe at the precise moment when, some, especially in France and in Italy, are risking thinking community anew. At issue is not only a legitimate question, but in some ways even an inevitable one, in which democractic culture deeply examines its own theoretical precepts and future. This doesn't change the fact though that it's the wrong question or that it's badly put. Wrong or badly put because it takes as its term of comparison -- in order to be related to the category of community - a concept, that of democracy that is utterly incapable of "understanding" it, not only because its modern meaning at least, arrives much later, but also because it is flatter and increasingly overwhelmed in a dimension that is entirely political and institutional. With respect to this lack of depth and substance of the politicological notion of democracy, community has a very different semantic width, both on the vertical level of history and on the synchronic one of meaning. This isn't the place to attempt a complete reconstruction, though my recent research beginning with the etymological origins of the term communitas and even more before that of munus in Latin does confirm the historical and semantic richness of the concept (R. Esposito, 1998). What we can infer from the above discussion, however, is that the correct question isn't whether the community can become a part of the democratic lexicon, but whether even democracy can be a part or at a minimum acquire some of its meaning in the lexicon of community. Without wanting to show my hand too quickly, a first step is required, which focuses more on the second term. Here we aren't helped at all by the conceptual dichotomies with which 20th century philosophy has tried to define comm unity, one that lost along the way the original meaning of community. I'm not talking only of the one constructed by the so-called American communitarians with respect to their presumed adversaries, the liberals, who constitute rather their exact interface in the specific sense that they unconsciously share the same subjectivist as well as exclusively partisan lexicon, applied not to the community but to the individual (where communities like individuals are distinguished between them, one from the other).

Family Planning

Real Distinction between the Natural Family Planning to the Artificial Family Planning What is Family Planning? What are the differences between the Natural and Artificial Family Planning? Family planning  is the  planning  of when to have  children,  and the use of  birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education,  prevention and management of  sexually transmitted infections, pre-conception counseling  and  management, and  infertility management.Family planning is sometimes used as a synonym for the use of  birth control, however, it often includes a wide variety of methods, and practices that are not birth control. It is most usually applied to a  female-male  couple who wish to limit the number of children they have and/or to control the timing of  pregnancy  (also known as  spacing children). Family planning may encompass  sterilization, as well as  abortion.Family plann ing services are defined as â€Å"educational, comprehensive medical or social activities which enable individuals, including minors, to determine freely the number and spacing of their children and to select the means by which this may be achieved. † Natural family planning  (NFP) comprises the  family planning  methods approved by the Roman Catholic Church. In accordance with the Church's teachings regarding  sexual behavior  in keeping with its philosophy of the dignity of the human person, NFP excludes the use of other methods of  birth control, which it refers to as â€Å"artificial contraception. Periodic  abstinence  is the only method deemed moral by the Church for avoiding pregnancy. When used to avoid pregnancy, NFP limits sexual intercourse to naturally infertile periods; portions of the  menstrual cycle, during pregnancy, and after  menopause. Various methods may be used to identify whether a woman is likely to be  fertile; this information may be used in attempts to either avoid or achieve pregnancy. There are three main types of NFP: the symptoms-based methods, the calendar-based methods, and the breastfeeding or  lactational amenorrhea method.Symptoms-based methods rely on biological signs of fertility, while calendar-based methods estimate the likelihood of fertility based on the length of past menstrual cycles. Clinical studies by the  Guttmacher Institute  found that periodic abstinence resulted in a 25. 3 percent failure under typical conditions, though it did not differentiate between symptom-based and calendar-based methods. Symptoms-based Some methods of NFP track biological signs of fertility. When used outside of the Catholic concept of NFP, these methods are often referred to simply as  fertility awareness-based methods  rather than NFP.The three primary signs of a woman's fertility are her  basal body temperature, her  cervical  mucus, and her cervical position. Computerized  fertility m onitors  may track basal body temperatures, hormonal levels in urine, changes in electrical resistance of a woman's saliva or a mixture of these symptoms. From these symptoms, a woman can learn to assess her fertility without use of a computerized device. Some systems use only cervical mucus to determine fertility. Two well-known mucus-only methods are the  Billings ovulation method  and the  Creighton Model Fertility Care System.If two or more signs are tracked, the method is referred to as a symptothermal method. Two popular symptothermal systems are taught by the  Couple to Couple League  and the Fertility Awareness Method (FAM) taught by  Toni Weschler. A study completed in Germany in 2007 found that the symptothermal method has a method effectiveness of 99. 6%. In Canada, the symptothermal method is taught by  SERENA Canada  which is an inter-denominational organization which has been developing the Symptothermal Method as a part of NFP since 1955.They are als o not specifically affiliated with the Roman Catholic Church. It is also taught by  Justisse Healthworks for Women, a pro-choice feminist organization that allows and supports women to combine other methods of birth control with their fertility awareness practice. A study by the World Health Organization involving 869 fertile women from Australia, India, Ireland, the Philippines, and El Salvador found that 93% could accurately interpret their body's signals regardless of education and culture. In a 36-month study of 5,752 women, the method was 99. 86% effective. Calendar-basedCalendar-based methods determine fertility based on a record of the length of previous menstrual cycles. They include the Rhythm Method and the Standard Days Method. The Standard Days method was developed and proven by the researchers at the Institute for Reproductive Health of Georgetown University. CycleBeads, unaffiliated with religious teachings, is a visual tool based on the Standard Days method. Accordi ng to the Institute of Reproductive Health, when used as birth control, CB has a 95% effectiveness rating. Computer programs are available to help track fertility on a calendar.Lactational amenorrhea The  lactational amenorrhea method  (LAM) is a method of avoiding pregnancy based on the natural  postpartum  infertility  that occurs when a woman is  amenorrheic  and fully  breastfeeding. The rules of the method help a woman identify and possibly lengthen her infertile period. A strict version of LAM is known as  ecological breastfeeding. Artificial Family Planning/Birth Control, also known as  contraception  and  fertility control, refers to methods or devices used to prevent  pregnancy. Planning and provision of birth control is called  family planning.Safe sex, such as the use of male or  female condoms, can also help prevent transmission of  sexually transmitted diseases. Contraceptive use in  developing countries has cut the number of  materna l deaths  by 44% (about 270,000 deaths averted in 2008) but could prevent 73% if the full demand for birth control were met. Because  teenage pregnancies  are at greater risk of adverse outcomes such as  preterm birth,  low birth weight and  infant mortality, adolescents need comprehensive  sex education  and access to reproductive health  services, including contraception.By lengthening the time between pregnancies, birth control can also improve adult women's delivery outcomes and the survival of their children. Effective birth control methods include  barriers  such as  condoms,  diaphragms, and the contraceptive sponge;  hormonal contraception  including  oral pills,  patches,  vaginal rings, and injectable contraceptives; and  intrauterine devices  (IUDs). Emergency contraception  can prevent pregnancy after unprotected sex. Long-acting reversible contraception  such as implants, IUDs, or vaginal rings are recommended to reduce  tee nage pregnancy.Sterilization  by means such as  vasectomy  and  tubal ligation  is permanent contraception. Some people regard  sexual abstinence  as birth control, but  abstinence-only sex education often increases teen pregnancies when offered without contraceptive education. Non-penetrative sex  and  oral sex  are also sometimes considered contraception. Birth control methods have been used since ancient times, but effective and safe methods only became available in the 20th century. For some people, contraception involves moral issues, and many cultures limit access to birth control due to the moral and political issues involved.About 222 million women who want to avoid pregnancy in developing countries are not using a modern contraception method. Birth control increases  economic growth  because of fewer dependent children, more women participating in the work force, and less consumption of scarce resources. Women's earnings, assets,  body mass index , and their children's schooling and body mass index all substantially improve with greater access to contraception. Methods of Artificial Family Planning Artificial Family Planning/Birth control includes  barrier methods,  hormonal contraception,  intrauterine devices  (IUDs), sterilization, and behavioral methods.Hormones can be  delivered by injection, by mouth (orally),  placed in the vagina, or implanted under the skin. The most common types of oral contraception include the  combined oral contraceptive pill  and the  progestogen-only pill. Methods are typically used before sex but  emergency contraception  is effective shortly after intercourse. Determining whether a woman with one or more illnesses, diseases, risk factors, or abnormalities can use a particular form of birth control is a complex medical question sometimes requiring a  pelvic examination  or medical tests.The  World Health Organization publishes a detailed list of medical eligibility criteria for each type of contraception. Birth control methods * An unrolled male  latex condom * A polyurethane  female condom * A  diaphragm  vaginal-cervical  barrier, in its case with a  quarter U. S. coin  to show scale * A  contraceptive sponge  set inside its open package * Three varieties of  birth control pills  in calendar oriented packaging * A transdermal contraceptive patch * A  Nuva Ring  vaginal ring * A hormonal  intrauterine device  (IUD) against a background showing placement in the  uterus *A copper IUD next to a dime  to show scale * A split dose of two emergency contraceptive pills (most morning after pills now only require one) Barrier Barrier contraceptives  are devices that attempt to prevent  pregnancy  by physically preventing  sperm  from entering the  uterus. They include: male  condoms,  female condoms,  cervical caps,  diaphragms, and  contraceptive sponges  with  spermicide. The condom is mos t commonly used during  sexual intercourse  to reduce the likelihood of  pregnancy  and of spreading  sexually transmitted diseases  (STDs—such as  gonorrhea,  syphilis, and  HIV).It is put on a man's erect  penis  and physically blocks ejaculated semen from entering the body of a sexual partner. Modern condoms are most often made from  latex, but some are made from other materials such as  polyurethane,  polyisoprene, or lamb intestine. A  female condom  is also available, most often made of  nitrile. Male condoms have the advantage of being inexpensive, easy to use, and having few side effects. Contraceptive sponges combine a barrier with spermicide. Like diaphragms, they are inserted vaginally prior to intercourse and must be placed over the  cervix  to be effective.Typical effectiveness during the first year of use is about 84% overall, and 68% among women who have already given birth. The sponge can be inserted up to 24 hours before intercourse and must be left in place for at least six hours afterward. Some people are allergic to spermicide used in the sponge. Women who use contraceptive sponges have an increased risk of  yeast infections  and  urinary tract infections. Leaving the sponge in for more than 30 hours can result in  toxic shock syndrome. Hormonal Hormonal contraceptives  inhibit  ovulation  and  fertilization.These include  oral pills,  subdermal  implants, and  injectable contraceptivesas well as the  patch,  hormonal IUDs  and the  vaginal ring. The most commonly used hormonal contraceptive is the  combined oral contraceptive pill—commonly known as â€Å"the pill†Ã¢â‚¬â€which includes a combination of an  estrogen  and a  progestin  (progestogen). There is also a progestin-only pill. Currently, hormonal contraceptives are available only for females. Combined hormonal contraceptives are associated with a slight increased cardiovascular risk , including a small increased risk of  venousand  arterial thrombosis. However, the benefits are greater than the risk.Oral contraceptives reduce the risk of  ovarian cancer  and  endometrial cancer  without increasing the risk for  breast cancer. They can lower body weight by reducing  water retention  (not loss of fat), and several are used to treat mild to moderate  acne. Between 2% and 10% of women of childbearing age experience emotional and physical symptoms associated with  premenstrual syndrome  (PMS) andpremenstrual dysphoric disorder  (PMDD). Combination hormonal contraceptives often ameliorate or effectively treat these problems and can effectively treat heavy menstrual bleeding and  dysmenorrhea  (painful menstruation) as well.Lower doses of estrogen required by vaginal administration (i. e. , from the vaginal ring or hormonal IUDs instead of the pill) may reduce the untoward side effects associated with higher oral doses such as breast tend erness,  nausea, and headache. Progestogen-only pills and intrauterine devices are not associated with an increased risk of thromboses and may be used by women with previous venous thrombosis, or hepatitis. In those with a history of arterial thrombosis, non-hormonal birth control should be used. Progestogen-only pills may improve menstrual symptoms such s  dysmenorrhea,  menorrhagia, premenstrual syndrome, and anemia, and are recommended for breast-feeding women because they do not affect lactation. Irregular bleeding can be a side effect of progestin-only methods, with about 20% of users reporting  amenorrhea  (often considered a benefit) and about 40% of women experiencing regular menstrual cycles, leaving the remaining 40% with irregular spotting or bleeding. Uncommon side effects of progestin-only pills, injections, and implants include headache, breast tenderness, mood effects, and  dysmenorrhea, but those symptoms often resolve with time.Newer progestins, such as drospirenone and desogestrel, minimize the  androgenic  side effects of their predecessors. Intrauterine devices The modern  intrauterine device  (IUD) is a small ‘T'-shaped birth control device, containing either copper or progesterone, which is inserted into the uterus. IUDs are a form of  long-acting reversible contraception, the most effective type of reversible birth control. As of 2002, IUDs were the most widely used form of reversible contraception, with nearly 160 million users worldwide. Evidence supports both effectiveness and safety in adolescents.Advantages of the copper IUD include its ability to provide  emergency contraception  up to five days after unprotected sex. It is the most effective form of emergency contraception available. It contains no hormones, so it can be used while breast feeding, and fertility returns quickly after removal. Disadvantages include the possibility of heavier menstrual periods and more painful cramps. Hormonal IUDs do not increase bleeding as copper-containing IUDs do. Rather, they reduce menstrual bleeding or stop menstruation altogether, and can be used as a treatment for  heavy periods.Levonorgestrel-releasing IUDs may be used during breastfeeding whether or not they also include copper. Sterilization Surgical sterilization  is available in the form of  tubal ligation  for women and  vasectomy  for men. There are no significant long term side effects and tubal ligation decreases the risk of  ovarian cancer. Some women regret such a decision: about 5% over 30 years, and about 20% under 30. Short term complications are less likely from a vasectomy than a tubal ligation. Neither method offers protection from  sexually transmitted nfections. Although sterilization is considered a permanent procedure, it is possible to attempt a  tubal reversal  to reconnect the  Fallopian tubes  in females or a  vasectomy reversal  to reconnect the  vasa deferentia  in males. The ra te of success depends on the original technique, tubal damage, and the person's age. Behavioral Behavioral methods involve  regulating the timing  or methods of intercourse to prevent introduction of sperm into the female reproductive tract, either altogether or when an egg may be present. ]LactationalFrom ancient times women have extended breastfeeding in an effort to avoid a new pregnancy. The  lactational amenorrhea method, or LAM, outlines guidelines for determining the length of a woman's period of breastfeeding infertility. For women who meet the criteria, LAM is highly effective during the first six months postpartum  if breastfeeding is the infant’s only (or almost only) source of nutrition. Feeding formula, pumping instead of nursing, and feeding solids all reduce the effectiveness of LAM. Fertility awarenessCalendar-based contraceptive methods  such as the discredited rhythm method and the  Standard Days Method  estimate the likelihood of fertility bas ed on the length of past menstrual cycles. To avoid pregnancy with fertility awareness, unprotected sex is restricted to a woman's least fertile period. During her most fertile period, barrier methods may be used, or she may abstain from intercourse. The term â€Å"natural family planning† (NFP) is sometimes used to refer to any use of fertility awareness methods. However, this term specifically refers to the practices that are permitted by the  Roman Catholic Church.The effectiveness of  fertility awareness-based methods of contraception is unknown because of the lack of completed standardized and controlled scientific trials. More effective than calendar-based methods, systems of fertility awareness that track basal body temperature, cervical mucus, or both, are known as symptoms-based methods. Teachers of symptoms-based methods take care to distance their systems from the poor reputation of the rhythm method. Many consider the rhythm method to have been obsolete for at least 20 years, and some even exclude calendar-based methods from their definition of fertility awareness.A  Cycle Beads  birth control chain, used for a rough estimate of fertility based on days since menstruation The  Standard Days Method  has a simpler rule set and is more effective than the rhythm method. The Standard Days Method has a typical failure rate of 12% per year. A product called  Cycle Beads  was developed alongside the method to help the user keep track of estimated high and low fertility points during her menstrual cycle. The Standard Days Method may only be used by women whose cycles are always between 26 and 32 days in length.In this system: * Days 1-7 of a woman's menstrual cycle are considered infertile * Days 8-19 are considered fertile; considered unsafe for unprotected intercourse * From Day 20, infertility is considered to resume Symptoms-based methods of fertility awareness involve a woman's observation and charting of her body's fertility sign s, to determine the fertile and infertile phases of her cycle. Charting may be done by hand or with the assistance of  fertility monitors. Most methods track one or more of the three primary fertility signs:  changes in  basal body temperature, in cervical mucus, and in cervical position.If a woman tracks both basal body temperature and another primary sign, the method is referred to as â€Å"symptothermal. † Other bodily cues such as  mittelschmerz  are considered secondary indicators. Unplanned pregnancy rates have been reported from 1% to 20% for typical users of the symptothermal method. Withdrawal Coitus interruptus  (literally â€Å"interrupted sexual intercourse†), also known as the withdrawal or pull-out method, is the practice of ending sexual intercourse (â€Å"pulling out†) before ejaculation.The main risk of coitus interruptus is that the man may not perform the maneuver correctly or in a timely manner. Despite older studies claiming that no sperm was found in preejaculatory penile secretion, a more recent study states that â€Å"41% [of subjects] produced pre-ejaculatory samples that contained spermatozoa and in 37% a reasonable proportion of the sperm was motile†. Abstinence Though some groups advocate total  sexual abstinence, by which they mean the avoidance of all sexual activity, in the context of birth control the term usually means abstinence from vaginally penetrative sexual activity.Abstinence is 100% effective in preventing pregnancy; however, not everyone who intends to be abstinent refrains from all sexual activity, and in many populations there is a significant risk of pregnancy from nonconsensual sex. Abstinence-only sex education  does not reduce  teen pregnancy. Teen pregnancy rates are higher in students given abstinence only education, compared to comprehensive sex education. Some authorities recommend that those using abstinence as a primary method have backup method(s) available (su ch as condoms or emergency contraceptive pills).Non-penetrative  and  oral sex will generally avoid pregnancy, but pregnancy can still occur with  Intercrural sex  and other forms of penis-near-vagina sex (genital rubbing, and the penis exiting from  anal intercourse) where semen can be deposited near the entrance to the vagina and can itself travel along the vagina's lubricating fluids. Emergency (after sex) Emergency contraceptives, or â€Å"morning-after pills,† are drugs taken after sexual intercourse intended to prevent pregnancy. Levonorgestrel  (progestin) pills, marketed as â€Å"Plan B† and â€Å"Next Choice,† are available without prescription (to women and men aged 17 and older in the U.S. ) to prevent pregnancy when used within 72 hours (3 days) after unprotected sex or condom failure. Ulipristal(â€Å"Ella†) is the newest emergency contraceptive, available by prescription only for use up to 120 hours (5 days) after unprotected sex , resulting in a pregnancy risk 42% lower than levonorgestrel up to 72 hours and 65% lower in the first 24 hours following sex. Providing morning after pills to women in advance does not affect sexually transmitted infection rates, condom use, pregnancy rates, or sexual risk-taking behavior. Pharmacists  are a major source of access to emergency contraception.Morning after pills have almost no health risk, no matter how often they are used. Copper T-shaped IUDs can also be used as emergency contraceptives. Copper IUDs can be inserted up to the time of implantation (6–12 days after ovulation) but are generally not inserted more than five days after unprotected sex. For every eight expected pregnancies, the use of levonorgestrel morning after pills will prevent seven. Ulipristal is about twice as effective as levonorgestrel. Copper IUDs are more than 99% effective in reducing pregnancy risk. Family Planning Real Distinction between the Natural Family Planning to the Artificial Family Planning What is Family Planning? What are the differences between the Natural and Artificial Family Planning? Family planning  is the  planning  of when to have  children,  and the use of  birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education,  prevention and management of  sexually transmitted infections, pre-conception counseling  and  management, and  infertility management.Family planning is sometimes used as a synonym for the use of  birth control, however, it often includes a wide variety of methods, and practices that are not birth control. It is most usually applied to a  female-male  couple who wish to limit the number of children they have and/or to control the timing of  pregnancy  (also known as  spacing children). Family planning may encompass  sterilization, as well as  abortion.Family plann ing services are defined as â€Å"educational, comprehensive medical or social activities which enable individuals, including minors, to determine freely the number and spacing of their children and to select the means by which this may be achieved. † Natural family planning  (NFP) comprises the  family planning  methods approved by the Roman Catholic Church. In accordance with the Church's teachings regarding  sexual behavior  in keeping with its philosophy of the dignity of the human person, NFP excludes the use of other methods of  birth control, which it refers to as â€Å"artificial contraception. Periodic  abstinence  is the only method deemed moral by the Church for avoiding pregnancy. When used to avoid pregnancy, NFP limits sexual intercourse to naturally infertile periods; portions of the  menstrual cycle, during pregnancy, and after  menopause. Various methods may be used to identify whether a woman is likely to be  fertile; this information may be used in attempts to either avoid or achieve pregnancy. There are three main types of NFP: the symptoms-based methods, the calendar-based methods, and the breastfeeding or  lactational amenorrhea method.Symptoms-based methods rely on biological signs of fertility, while calendar-based methods estimate the likelihood of fertility based on the length of past menstrual cycles. Clinical studies by the  Guttmacher Institute  found that periodic abstinence resulted in a 25. 3 percent failure under typical conditions, though it did not differentiate between symptom-based and calendar-based methods. Symptoms-based Some methods of NFP track biological signs of fertility. When used outside of the Catholic concept of NFP, these methods are often referred to simply as  fertility awareness-based methods  rather than NFP.The three primary signs of a woman's fertility are her  basal body temperature, her  cervical  mucus, and her cervical position. Computerized  fertility m onitors  may track basal body temperatures, hormonal levels in urine, changes in electrical resistance of a woman's saliva or a mixture of these symptoms. From these symptoms, a woman can learn to assess her fertility without use of a computerized device. Some systems use only cervical mucus to determine fertility. Two well-known mucus-only methods are the  Billings ovulation method  and the  Creighton Model Fertility Care System.If two or more signs are tracked, the method is referred to as a symptothermal method. Two popular symptothermal systems are taught by the  Couple to Couple League  and the Fertility Awareness Method (FAM) taught by  Toni Weschler. A study completed in Germany in 2007 found that the symptothermal method has a method effectiveness of 99. 6%. In Canada, the symptothermal method is taught by  SERENA Canada  which is an inter-denominational organization which has been developing the Symptothermal Method as a part of NFP since 1955.They are als o not specifically affiliated with the Roman Catholic Church. It is also taught by  Justisse Healthworks for Women, a pro-choice feminist organization that allows and supports women to combine other methods of birth control with their fertility awareness practice. A study by the World Health Organization involving 869 fertile women from Australia, India, Ireland, the Philippines, and El Salvador found that 93% could accurately interpret their body's signals regardless of education and culture. In a 36-month study of 5,752 women, the method was 99. 86% effective. Calendar-basedCalendar-based methods determine fertility based on a record of the length of previous menstrual cycles. They include the Rhythm Method and the Standard Days Method. The Standard Days method was developed and proven by the researchers at the Institute for Reproductive Health of Georgetown University. CycleBeads, unaffiliated with religious teachings, is a visual tool based on the Standard Days method. Accordi ng to the Institute of Reproductive Health, when used as birth control, CB has a 95% effectiveness rating. Computer programs are available to help track fertility on a calendar.Lactational amenorrhea The  lactational amenorrhea method  (LAM) is a method of avoiding pregnancy based on the natural  postpartum  infertility  that occurs when a woman is  amenorrheic  and fully  breastfeeding. The rules of the method help a woman identify and possibly lengthen her infertile period. A strict version of LAM is known as  ecological breastfeeding. Artificial Family Planning/Birth Control, also known as  contraception  and  fertility control, refers to methods or devices used to prevent  pregnancy. Planning and provision of birth control is called  family planning.Safe sex, such as the use of male or  female condoms, can also help prevent transmission of  sexually transmitted diseases. Contraceptive use in  developing countries has cut the number of  materna l deaths  by 44% (about 270,000 deaths averted in 2008) but could prevent 73% if the full demand for birth control were met. Because  teenage pregnancies  are at greater risk of adverse outcomes such as  preterm birth,  low birth weight and  infant mortality, adolescents need comprehensive  sex education  and access to reproductive health  services, including contraception.By lengthening the time between pregnancies, birth control can also improve adult women's delivery outcomes and the survival of their children. Effective birth control methods include  barriers  such as  condoms,  diaphragms, and the contraceptive sponge;  hormonal contraception  including  oral pills,  patches,  vaginal rings, and injectable contraceptives; and  intrauterine devices  (IUDs). Emergency contraception  can prevent pregnancy after unprotected sex. Long-acting reversible contraception  such as implants, IUDs, or vaginal rings are recommended to reduce  tee nage pregnancy.Sterilization  by means such as  vasectomy  and  tubal ligation  is permanent contraception. Some people regard  sexual abstinence  as birth control, but  abstinence-only sex education often increases teen pregnancies when offered without contraceptive education. Non-penetrative sex  and  oral sex  are also sometimes considered contraception. Birth control methods have been used since ancient times, but effective and safe methods only became available in the 20th century. For some people, contraception involves moral issues, and many cultures limit access to birth control due to the moral and political issues involved.About 222 million women who want to avoid pregnancy in developing countries are not using a modern contraception method. Birth control increases  economic growth  because of fewer dependent children, more women participating in the work force, and less consumption of scarce resources. Women's earnings, assets,  body mass index , and their children's schooling and body mass index all substantially improve with greater access to contraception. Methods of Artificial Family Planning Artificial Family Planning/Birth control includes  barrier methods,  hormonal contraception,  intrauterine devices  (IUDs), sterilization, and behavioral methods.Hormones can be  delivered by injection, by mouth (orally),  placed in the vagina, or implanted under the skin. The most common types of oral contraception include the  combined oral contraceptive pill  and the  progestogen-only pill. Methods are typically used before sex but  emergency contraception  is effective shortly after intercourse. Determining whether a woman with one or more illnesses, diseases, risk factors, or abnormalities can use a particular form of birth control is a complex medical question sometimes requiring a  pelvic examination  or medical tests.The  World Health Organization publishes a detailed list of medical eligibility criteria for each type of contraception. Birth control methods * An unrolled male  latex condom * A polyurethane  female condom * A  diaphragm  vaginal-cervical  barrier, in its case with a  quarter U. S. coin  to show scale * A  contraceptive sponge  set inside its open package * Three varieties of  birth control pills  in calendar oriented packaging * A transdermal contraceptive patch * A  Nuva Ring  vaginal ring * A hormonal  intrauterine device  (IUD) against a background showing placement in the  uterus *A copper IUD next to a dime  to show scale * A split dose of two emergency contraceptive pills (most morning after pills now only require one) Barrier Barrier contraceptives  are devices that attempt to prevent  pregnancy  by physically preventing  sperm  from entering the  uterus. They include: male  condoms,  female condoms,  cervical caps,  diaphragms, and  contraceptive sponges  with  spermicide. The condom is mos t commonly used during  sexual intercourse  to reduce the likelihood of  pregnancy  and of spreading  sexually transmitted diseases  (STDs—such as  gonorrhea,  syphilis, and  HIV).It is put on a man's erect  penis  and physically blocks ejaculated semen from entering the body of a sexual partner. Modern condoms are most often made from  latex, but some are made from other materials such as  polyurethane,  polyisoprene, or lamb intestine. A  female condom  is also available, most often made of  nitrile. Male condoms have the advantage of being inexpensive, easy to use, and having few side effects. Contraceptive sponges combine a barrier with spermicide. Like diaphragms, they are inserted vaginally prior to intercourse and must be placed over the  cervix  to be effective.Typical effectiveness during the first year of use is about 84% overall, and 68% among women who have already given birth. The sponge can be inserted up to 24 hours before intercourse and must be left in place for at least six hours afterward. Some people are allergic to spermicide used in the sponge. Women who use contraceptive sponges have an increased risk of  yeast infections  and  urinary tract infections. Leaving the sponge in for more than 30 hours can result in  toxic shock syndrome. Hormonal Hormonal contraceptives  inhibit  ovulation  and  fertilization.These include  oral pills,  subdermal  implants, and  injectable contraceptivesas well as the  patch,  hormonal IUDs  and the  vaginal ring. The most commonly used hormonal contraceptive is the  combined oral contraceptive pill—commonly known as â€Å"the pill†Ã¢â‚¬â€which includes a combination of an  estrogen  and a  progestin  (progestogen). There is also a progestin-only pill. Currently, hormonal contraceptives are available only for females. Combined hormonal contraceptives are associated with a slight increased cardiovascular risk , including a small increased risk of  venousand  arterial thrombosis. However, the benefits are greater than the risk.Oral contraceptives reduce the risk of  ovarian cancer  and  endometrial cancer  without increasing the risk for  breast cancer. They can lower body weight by reducing  water retention  (not loss of fat), and several are used to treat mild to moderate  acne. Between 2% and 10% of women of childbearing age experience emotional and physical symptoms associated with  premenstrual syndrome  (PMS) andpremenstrual dysphoric disorder  (PMDD). Combination hormonal contraceptives often ameliorate or effectively treat these problems and can effectively treat heavy menstrual bleeding and  dysmenorrhea  (painful menstruation) as well.Lower doses of estrogen required by vaginal administration (i. e. , from the vaginal ring or hormonal IUDs instead of the pill) may reduce the untoward side effects associated with higher oral doses such as breast tend erness,  nausea, and headache. Progestogen-only pills and intrauterine devices are not associated with an increased risk of thromboses and may be used by women with previous venous thrombosis, or hepatitis. In those with a history of arterial thrombosis, non-hormonal birth control should be used. Progestogen-only pills may improve menstrual symptoms such s  dysmenorrhea,  menorrhagia, premenstrual syndrome, and anemia, and are recommended for breast-feeding women because they do not affect lactation. Irregular bleeding can be a side effect of progestin-only methods, with about 20% of users reporting  amenorrhea  (often considered a benefit) and about 40% of women experiencing regular menstrual cycles, leaving the remaining 40% with irregular spotting or bleeding. Uncommon side effects of progestin-only pills, injections, and implants include headache, breast tenderness, mood effects, and  dysmenorrhea, but those symptoms often resolve with time.Newer progestins, such as drospirenone and desogestrel, minimize the  androgenic  side effects of their predecessors. Intrauterine devices The modern  intrauterine device  (IUD) is a small ‘T'-shaped birth control device, containing either copper or progesterone, which is inserted into the uterus. IUDs are a form of  long-acting reversible contraception, the most effective type of reversible birth control. As of 2002, IUDs were the most widely used form of reversible contraception, with nearly 160 million users worldwide. Evidence supports both effectiveness and safety in adolescents.Advantages of the copper IUD include its ability to provide  emergency contraception  up to five days after unprotected sex. It is the most effective form of emergency contraception available. It contains no hormones, so it can be used while breast feeding, and fertility returns quickly after removal. Disadvantages include the possibility of heavier menstrual periods and more painful cramps. Hormonal IUDs do not increase bleeding as copper-containing IUDs do. Rather, they reduce menstrual bleeding or stop menstruation altogether, and can be used as a treatment for  heavy periods.Levonorgestrel-releasing IUDs may be used during breastfeeding whether or not they also include copper. Sterilization Surgical sterilization  is available in the form of  tubal ligation  for women and  vasectomy  for men. There are no significant long term side effects and tubal ligation decreases the risk of  ovarian cancer. Some women regret such a decision: about 5% over 30 years, and about 20% under 30. Short term complications are less likely from a vasectomy than a tubal ligation. Neither method offers protection from  sexually transmitted nfections. Although sterilization is considered a permanent procedure, it is possible to attempt a  tubal reversal  to reconnect the  Fallopian tubes  in females or a  vasectomy reversal  to reconnect the  vasa deferentia  in males. The ra te of success depends on the original technique, tubal damage, and the person's age. Behavioral Behavioral methods involve  regulating the timing  or methods of intercourse to prevent introduction of sperm into the female reproductive tract, either altogether or when an egg may be present. ]LactationalFrom ancient times women have extended breastfeeding in an effort to avoid a new pregnancy. The  lactational amenorrhea method, or LAM, outlines guidelines for determining the length of a woman's period of breastfeeding infertility. For women who meet the criteria, LAM is highly effective during the first six months postpartum  if breastfeeding is the infant’s only (or almost only) source of nutrition. Feeding formula, pumping instead of nursing, and feeding solids all reduce the effectiveness of LAM. Fertility awarenessCalendar-based contraceptive methods  such as the discredited rhythm method and the  Standard Days Method  estimate the likelihood of fertility bas ed on the length of past menstrual cycles. To avoid pregnancy with fertility awareness, unprotected sex is restricted to a woman's least fertile period. During her most fertile period, barrier methods may be used, or she may abstain from intercourse. The term â€Å"natural family planning† (NFP) is sometimes used to refer to any use of fertility awareness methods. However, this term specifically refers to the practices that are permitted by the  Roman Catholic Church.The effectiveness of  fertility awareness-based methods of contraception is unknown because of the lack of completed standardized and controlled scientific trials. More effective than calendar-based methods, systems of fertility awareness that track basal body temperature, cervical mucus, or both, are known as symptoms-based methods. Teachers of symptoms-based methods take care to distance their systems from the poor reputation of the rhythm method. Many consider the rhythm method to have been obsolete for at least 20 years, and some even exclude calendar-based methods from their definition of fertility awareness.A  Cycle Beads  birth control chain, used for a rough estimate of fertility based on days since menstruation The  Standard Days Method  has a simpler rule set and is more effective than the rhythm method. The Standard Days Method has a typical failure rate of 12% per year. A product called  Cycle Beads  was developed alongside the method to help the user keep track of estimated high and low fertility points during her menstrual cycle. The Standard Days Method may only be used by women whose cycles are always between 26 and 32 days in length.In this system: * Days 1-7 of a woman's menstrual cycle are considered infertile * Days 8-19 are considered fertile; considered unsafe for unprotected intercourse * From Day 20, infertility is considered to resume Symptoms-based methods of fertility awareness involve a woman's observation and charting of her body's fertility sign s, to determine the fertile and infertile phases of her cycle. Charting may be done by hand or with the assistance of  fertility monitors. Most methods track one or more of the three primary fertility signs:  changes in  basal body temperature, in cervical mucus, and in cervical position.If a woman tracks both basal body temperature and another primary sign, the method is referred to as â€Å"symptothermal. † Other bodily cues such as  mittelschmerz  are considered secondary indicators. Unplanned pregnancy rates have been reported from 1% to 20% for typical users of the symptothermal method. Withdrawal Coitus interruptus  (literally â€Å"interrupted sexual intercourse†), also known as the withdrawal or pull-out method, is the practice of ending sexual intercourse (â€Å"pulling out†) before ejaculation.The main risk of coitus interruptus is that the man may not perform the maneuver correctly or in a timely manner. Despite older studies claiming that no sperm was found in preejaculatory penile secretion, a more recent study states that â€Å"41% [of subjects] produced pre-ejaculatory samples that contained spermatozoa and in 37% a reasonable proportion of the sperm was motile†. Abstinence Though some groups advocate total  sexual abstinence, by which they mean the avoidance of all sexual activity, in the context of birth control the term usually means abstinence from vaginally penetrative sexual activity.Abstinence is 100% effective in preventing pregnancy; however, not everyone who intends to be abstinent refrains from all sexual activity, and in many populations there is a significant risk of pregnancy from nonconsensual sex. Abstinence-only sex education  does not reduce  teen pregnancy. Teen pregnancy rates are higher in students given abstinence only education, compared to comprehensive sex education. Some authorities recommend that those using abstinence as a primary method have backup method(s) available (su ch as condoms or emergency contraceptive pills).Non-penetrative  and  oral sex will generally avoid pregnancy, but pregnancy can still occur with  Intercrural sex  and other forms of penis-near-vagina sex (genital rubbing, and the penis exiting from  anal intercourse) where semen can be deposited near the entrance to the vagina and can itself travel along the vagina's lubricating fluids. Emergency (after sex) Emergency contraceptives, or â€Å"morning-after pills,† are drugs taken after sexual intercourse intended to prevent pregnancy. Levonorgestrel  (progestin) pills, marketed as â€Å"Plan B† and â€Å"Next Choice,† are available without prescription (to women and men aged 17 and older in the U.S. ) to prevent pregnancy when used within 72 hours (3 days) after unprotected sex or condom failure. Ulipristal(â€Å"Ella†) is the newest emergency contraceptive, available by prescription only for use up to 120 hours (5 days) after unprotected sex , resulting in a pregnancy risk 42% lower than levonorgestrel up to 72 hours and 65% lower in the first 24 hours following sex. Providing morning after pills to women in advance does not affect sexually transmitted infection rates, condom use, pregnancy rates, or sexual risk-taking behavior. Pharmacists  are a major source of access to emergency contraception.Morning after pills have almost no health risk, no matter how often they are used. Copper T-shaped IUDs can also be used as emergency contraceptives. Copper IUDs can be inserted up to the time of implantation (6–12 days after ovulation) but are generally not inserted more than five days after unprotected sex. For every eight expected pregnancies, the use of levonorgestrel morning after pills will prevent seven. Ulipristal is about twice as effective as levonorgestrel. Copper IUDs are more than 99% effective in reducing pregnancy risk.