Addressing misconceptions about birth control: case studies immersing students in the facts & real-life decisions.
Abstract: Case studies generate active discussion and decision-making skills. This 50-minute case-study lesson teaches high school and undergraduate students about a fundamental and private aspect of their lives, birth control methods. Students direct their own learning by researching, teaching one another about, and making recommendations about the methods. Students are more likely to apply what they have learned to their own lives after being involved in and practicing decision-making skills during the cases. Because students openly discuss their ideas in relation to the cases, instructors can correct misconceptions about birth control without embarrassing students.

Key Words: Birth control; case study; decision making; active learning.
Article Type: Report
Subject: Birth control (Tests, problems and exercises)
Case method (Management)
Sex education (Study and teaching)
Authors: Zojonc, Stephanie
Lavoie, Bethann
Pub Date: 08/01/2011
Publication: Name: The American Biology Teacher Publisher: National Association of Biology Teachers Audience: Academic; Professional Format: Magazine/Journal Subject: Biological sciences; Education Copyright: COPYRIGHT 2011 National Association of Biology Teachers ISSN: 0002-7685
Issue: Date: August, 2011 Source Volume: 73 Source Issue: 6
Topic: Event Code: 200 Management dynamics Computer Subject: Company business management
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 265291907
Full Text: ** Rationale

High school and undergraduate students have pervasive misconceptions about birth control methods and often do not apply their knowledge, when correct, to decisions they must make in their lives. Unintended pregnancies accounted for almost one-half of pregnancies in the United States in 2001 (Finer & Henshaw, 2006), and teen pregnancies result in lower educational attainment and job income (Centers for Disease Control, 2011). Even the National Science Education Standards address birth control methods, in 9-12 Life Science Content Standard F (National Research Council, 1996).

Using mini-cases about birth control methods can teach the facts, address misconceptions, and develop decision-making skills that may transfer to real-life situations.

Case studies involve a story to which students apply knowledge learned in class to challenge ideas, perceptions, and beliefs regarding the story (Herreid, 1994). Because the cases focus on a story that is not threatening, students discuss topics more openly and are more interested in what they are learning (Smith & Murphy, 1998; Zojonc, 2009). Additionally, case studies enhance students' understanding of concepts (Hodges, 2005), problem solving and critical thinking skills (Dori et al., 2003), and ability to make objective judgments (Dinan, 2002).

** Objectives

By the end of the mini-case-study lesson, students should be able to (1) compare and contrast birth control methods in terms of failure rate, cost, how they work, proper use, and long-term effects, especially for the male condom, the pill, fertility awareness, withdrawal, and the vaginal ring; (2) know which methods of birth control reduce the transmission of sexually transmitted diseases; (3) determine which method(s) are best for a set of real-life circumstances, including their own; and (4) openly communicate about birth control with a partner.

** Materials & Engagement

The only required materials are the four mini-cases (see Figure 1) for each student to read and the research each student brings to class about a birth control method. The cases follow a young woman and her partners from her high school prom until after she is married and has had children. They engage students of both genders in learning about birth control methods and making decisions about birth control. Most high school and college students can relate immediately to one of these stages of life and can imagine some of the others. As students analyze the cases, they have the opportunity to talk about someone other than themselves, making very private topics, sexuality and birth control, less intimidating and embarrassing.

Other materials, although optional, make the lesson concrete, personal, and relevant to students. A sign-up sheet that allows students to choose a particular birth control method to research, while requiring them to divide up equally among the methods, facilitates analysis and discussion of the cases. Students are engaged and motivated by researching a topic that is personally interesting and useful. Since students are often unfamiliar with some methods of birth control or have misconceptions about how to use them, the sign-up sheet should include most or all of the methods of birth control found in Table 1. Furthermore, students have sometimes heard the name of a birth control method but do not know what it looks like. It is helpful if the instructor can show students examples of the more easily obtained birth control methods, including male condom, female condom, birth control pill case, sponge, and spermicide. Other optional materials include a water-based lubricant to show students while discussing how oil-based lubricants make latex condoms fail and one condom to hand out per student, if appropriate.

O Student & Teacher Procedures

High school or undergraduate students can complete the birth control mini-case lesson with advance preparation and additional time after the class to complete a summative assessment activity. Although the lesson can be taught in 50 minutes, additional time is recommended, especially for student presentations and the accompanying discussion. Prior to the lesson, students choose a method of birth control from Table 1 and research how it works, cost, proper use, long-term effects, and failure rate, using credible online sources and/or package inserts. Recommended sources include Planned Parenthood (2011), the National Library of Medicine's (2011) Medline Plus, and the National Women's Health Information Center (2009). Students divide equally among the methods. The instructor plans groupings for the case studies, at least four groups with a maximum of four students per group for a class of 20-30 students. Students need to be separated if they have researched similar methods of birth control so that each of the four groups can exchange information about varied methods. Key methods to separate include (1) fertility awareness, abstinence, and withdrawal; (2) patch, implant, and shot; (3) pill and vaginal ring; (4) spermicide and sponge; and (5) male and female condom.

During the lesson, students begin class by listening to a short lecture about the different classes of birth control methods: physical barriers, chemical barriers, hormonal, surgical, and others, including abstinence. The instructor briefly explains how each class works to prevent pregnancy (e.g., blocking sperm, killing sperm, or preventing ovulation).

Students then split into the predetermined small groups to read and analyze the mini-cases about Kaylee as she moves through the stages of her life. As students read the cases and answer the corresponding questions, they share information about the birth control methods they researched, teaching one another how each method works and its cost, proper use, long-term effects, and failure rate. Using this information and other prior knowledge about birth control methods, students then recommend a birth control method for each case based on real-life constraints such as cost, ease of use, ability to obtain the method, and future reproductive decisions.

When students finish in their small groups, the instructor reconvenes the whole class and randomly asks each group to present their recommendations for Kaylee during one period of her life. This way, students are accountable for all of the assigned cases, but there is little redundancy during the presentations. As students present, the instructor verifies information about the birth control method chosen and corrects misconceptions. The instructor should ask the following questions to emphasize important points during the discussion:

* Which methods of birth control also help prevent sexually transmitted infections?

* Which methods of birth control are easy enough to use correctly during spontaneous situations and also are effective at preventing pregnancy?

* Which steps of using a male condom are often done incorrectly?

* What reduces the effectiveness of the pill?

* What are some common problems encountered when using spermicide or a sponge?

* What is the most effective way to be sure you don't get pregnant?

* Who should be responsible for birth control in a relationship?

* Where and how can you obtain birth control?

While or after addressing the questions above, the instructor should broaden the discussion by including the following points:

* There is no one best birth control method for everyone.

* A health care provider is an appropriate person to consult when selecting methods of birth control.

* Decisions may be influenced by personal values, cultural beliefs, and religious beliefs.

** Assessment

The instructor assesses the lesson formatively and summatively. The instructor can observe or collect students' research, answers to case questions, and presentations. To assess the whole group's understanding, students individually and privately complete an anonymous reflective assignment after the lesson. They select the most appropriate birth control method for themselves at this time and justify why they would use it (cost, ease of use of the method, ability to obtain the method, current stage of relationship[s], and future reproductive decisions). They also describe its cost, how they would pay for it, where they would obtain it, and how they plan to begin a conversation about birth control with their partner(s) (an exact, planned statement). What better way is there to apply learning about such an important topic than to make an informed decision and carry it out?

DOI: 10.1525/abt.2011.73.6.9

References

Centers for Disease Control. (2011). Unintended Pregnancy. Available at http://www.cdc.gov/reproductivehealth/unintendedpregnancy/ index.htm.

Dinan, F. (2002). Chemistry by the case. Journal of College Science Teaching, 32, 36-41.

Dori, Y, Tal, R. & Tsausu, M. (2003). Teaching biotechnology through case studies - can we improve higher order thinking skills of non-science majors? Science Education, 87, 767-793.

Finer, LB. & Henshaw, S.K. (2006). Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspectives on Sexual and Reproductive Health, 38, 90-96.

Herreid, C.F. (1994). Case studies in science: a novel method of science education. Journal of College Science Teaching, 23, 221-229.

Hodges, L.C. (2005). From problem-based learning to interrupted lecture: using case-based teaching in different class formats. Biochemistry and Molecular Biology Education, 33, 101-104.

Medline Plus. (2011). Birth control. Available at http://www.nlm.nih.gov/ medlineplus/birthcontrol.html.

National Research Council. (1996). National Science Education Standards. Washington, DC: National Academy Press.

National Women's Health Information Center. (2009). Birth control methods. Available at http://www.womenshealth.gov/faq/ birth-control-methods.cfm.

Planned Parenthood. (2011). Birth control. Available at http://www.planned parenthood.org/health-topics/birth-control-4211.htm.

Smith, R.A. & Murphy, S.K. (1998). Using case studies to increase learning and interest in biology. American Biology Teacher, 60, 265-268.

Zojonc, S.J. (2009). The utilization of case-based learning in changing student attitudes towards biology. Master's thesis, Minnesota State University, Mankato.

STEPHANIE ZOJONC (stephanie.zojonc@mnsu.edu) is Instructor of Biological Sciences at Minnesota State University, Mankato, 242 Trafton Science Center, South,Mankato, MN 56001, where BETHANN LAVOIE (bethann.lavoie@mnsu. edu) is Associate Professor of Biological Sciences.
Figure 1. Birth control mini-cases.

Birth Control...What are the options?

Directions: Using the information you learned researching various
methods of birth control, read each of the following cases and
answer each of the questions below. Be prepared to present the case
and your findings to the class.

At first...

As Kaylee tries her prom dress on at the last fitting, she can't
help but think what a special night prom is going to be. She and
Jason have been dating for a several months, and now is the perfect
time to take their relationship to the next level. But what about
birth control? Having a baby is not in her immediate future. Kaylee
believes her parents just would not understand if she went to them
asking about birth control. She knows the doctor is not supposed to
divulge personal information, but she worries that someone might
see her at the doctor's office or the pharmacy.

1. What are three birth control options Kaylee and Jason could
consider at this time?

2. Which of the options you chose also reduce(s) sexually
transmitted infection (STI) transmission?

3. What are the advantages and disadvantages of the various options
(cost, failure rate, ease of use, etc.)?

4. Which option would you recommend for Kaylee and Jason and why?

Two years later...

Kaylee and her friends are hanging out when someone brings up her
friend Stacy's class entitled 'The Biology of Women." Stacy is
describing some of the forms of birth control that are out there
and available to women now. Her friends start talking about the
types they use and how well they like them. Knowing that she and
her boyfriend Derek have relied on condoms and spermicide, she
wonders what other types of birth control she and Derek could be
thinking about.

1. What are three birth control options Kaylee and Derek could
consider at this time?

2. Which of the options you chose also reduce(s) sexually
transmitted infection (STI) transmission?

3. What are the advantages and disadvantages of the various options
(cost, failure rate, ease of use, etc.)?

4. Which birth control option would you recommend for them and why?

5. Where can they go to receive birth control options that are
affordable in this area?

Seven years later...

Marriage has been good... Kaylee is the proud mother of two little
girls, ages three and six months. She and her husband Aaron have
decided that they are not ready for more children right now, but
are still considering having another when the girls are a little
older. Knowing this she is looking into birth control methods that
allow for her busy lifestyle and may not need to be taken every
day. She makes an appointment with her doctor to discuss the
options.

1. What are three birth control options Kaylee and Aaron could
consider at this time?

2. What are the advantages and disadvantages of the various options
(cost, failure rate, ease of use, etc.)?

3. Which option do you recommend for them and why?

Five years later...

Life has changed a lot in the last five years for Kaylee and Aaron.
They not only have two little girls, but also are now the proud
parents of 18-month-old twin boys. At this point in their lives,
Aaron and Kaylee believe their family is complete, but would like
to explore all their birth control options. Before going to her
doctor, Kaylee wants to educate herself about what is available for
women who are interested in more long-term birth control options.

1. What types of birth control options are available to couples
like Kaylee and Aaron, who have finished having children?

2. What are the advantages and disadvantages of the various options
(cost, failure rate, ease of use, etc.)?

3. Which option would you suggest to Kaylee and Aaron and why?


Table 1. Summary of birth control methods: How they work, common
problems when using them, and failure rates
(Planned Parenthood, 2011).

Name of Method  Type of Method        Problems/Disadvantages of Use

Male condom      Physical barrier     Oil-based lubricants
                                      Allergies
                                      Storage

Female condom    Physical barrier     Bulky
                                      Requires practice

Sponge           Physical and         Inserted prior to intercourse
                 chemical barrier     Allergies
                                      Reduced effectiveness after
                                      having a child

Diaphragm        Physical barrier     Not used during menstruation
                                      Inserting properly
                                      May need to be refitted
Implant          Hormonal             Some medications and supplements
                                       reduce effect

IUD              Hormonal             Slip out of uterus
                                      Slight risk of infection

Patch            Hormonal             Must be replaced when becomes
                                      loose or falls off
                                      Higher risk of blood clots
                                      Some medications and supplements
                                       reduce effectiveness
                                      Effectiveness reduced if weigh
                                       over 198 lbs.

Pill             Hormonal             Not taken as prescribed-missed
                                       Dosages
                                      Some medications and supplements
                                       reduce effectiveness
                                      Higher risk of blood clots
Shot             Hormonal             Not taken as prescribed-
                                       missed/late dosages

Vaginal ring     Hormonal            Increased risk of heart attack,
                                      stroke, blood irritation and
                                      infection
                                     Not using as prescribed
                                     Some medications and supplements
                                      reduce effectiveness

Spermicide       Physical and        Allergies
                 chemical barrier    Messy
                                     Improperly applied--no barrier

Vasectomy        Surgical            Reversal difficult
                                     Surgical risks: pain, infection,
                                      Swelling
Tubal ligation   Surgical            Reversal difficult, low success
                                      Rate
                                     Surgical risks: bleeding,
                                      infection, ectopic pregnancy,
                                      damage to surrounding organs
Fertility                            Accurate and consistent records
awareness                             required
                                     Difficult if have irregular
                                      periods

Withdrawal                           Requires self-control
                                     Not for men who prematurely
                                      ejaculate

Abstinence                           No genital contact to be
                                      Effective
                                                              Failure
                                                     Failure   Rate,
                                                      Rate,    Not
                                                      Used     Always
Name of Method   Problems/Disadvantages of Use       Properly  Used
                                                               Properly

Male condom      Oil-based lubricants                    2%     15%
                 Allergies
                 Storage

Female condom    Bulky                                   5%     20%
                 Requires practice

Sponge           Inserted prior to intercourse           9%     16%
                 Allergies
                 Reduced effectiveness after
                  having a child

Diaphragm        Not used during menstruation            6%     16%
                 Inserting properly
                 May need to be refitted

Implant          Some medications and supplements       <1%
                  reduce effect

IUD              Slip out of uterus                     <1%
                 Slight risk of infection

Patch            Must be replaced when becomes          <1%      8%
                  loose or falls off
                 Higher risk of blood clots
                 Some medications and supplements
                  reduce effectiveness
                 Effectiveness reduced if weigh
                  over 198 lbs.

Pill             Not taken as prescribed-missed         <1%      8%
                  dosages
                 Some medications and supplements
                  reduce effectiveness
                 Higher risk of blood clots

Shot             Not taken as prescribed-               <1%      3%
                  missed/late dosages

Vaginal ring     Increased risk of heart attack,        <1%      8%
                  stroke, blood irritation and
                  infection
                 Not using as prescribed
                 Some medications and supplements
                  reduce effectiveness

Spermicide       Allergies                              15%     29%
                 Messy
                 Improperly applied--no barrier

Vasectomy        Reversal difficult                     <1%
                 Surgical risks: pain, infection,
                  Swelling

Tubal ligation   Reversal difficult, low success        <1%
                  Rate
                 Surgical risks: bleeding,
                  infection, ectopic pregnancy,
                  damage to surrounding organs

Fertility        Accurate and consistent records                12-25%
awareness         required
                 Difficult if have irregular
                  periods

Withdrawal       Requires self-control                   4%     27%
                 Not for men who prematurely
                  ejaculate
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