JOAN C. CALLAHAN
The most significant ethical issues that surround contemporary contraception are those involving abortion, the continued medicalization of reproduction, dangers to women, availability to minors, informed consent, and the imposition of contraceptive technologies as punishment.
True contraceptive technologies do just what their name implies, namely, preclude conception. The most effective true contraceptive intervention is male or female sterilization. Most other technologies for women popularly known as contraceptives have prevention of conception as their primary action but include secondary actions that have effects after conception should fertilization occur. For example, so-called oral contraceptives have prevention of ovulation as their primary action. But should breakthrough ovulation and fertilization occur, oral contraceptives have "backup" mechanisms that interfere with implantation or support of an embryo. Similarly, intrauterine devices (IUDS) may act as true contraceptives or they may act by interfering with the implantation of an embryo. An IUD is a foreign object in the uterus, and a woman's body responds by attempting to neutralize it. This is done by increasing the number of phagocytic leucocytes (destructive white blood cells) in the uterus, making it an inhospitable environment for either sperm or an embryo. Thus when an IUD is in place, it is particularly difficult for sperm to traverse a woman's uterus. However, some sperm may well get through (particularly in long-term IUD users), and fertilization can occur. When this happens, successful birth