The practice of birth control prevents conception, thus limiting reproduction. The term “birth control,” coined by Margaret Sanger in 1914, usually refers specifically to methods of contraception, including sterilization. The terms “family planning” and “planned parenthood” have a broader application.
Methods of Birth Control: Attempts to control fertility have been going on for thousands of years. References to preventing conception are found in the writings of priests, philosophers, and physicians of ancient Egypt and Greece. Some methods, though crude, were based on sound ideas. For example, women were advised to put honey, olive oil, or oil of cedar in their vaginas to act as barriers. The stickiness of these substances was thought to slow the movement of sperm into the uterus. Wads of soft wool soaked in lemon juice or vinegar were used as tampons, in the belief that they would make the vagina sufficiently acidic to kill the sperm. The Talmud mentions using a piece of sponge to block the cervix, the entrance to the uterus.
Sperm Blockage: Several modern methods of birth control are practiced by creating a barrier between the sperm and the egg cell. This consists of the use of a chemical foam, a cream, or a suppository. Each contains a chemical, or spermicide, that stops sperm. They are not harmful to vaginal tissue. Each must be inserted shortly before coitus.
Foams are squirted from aerosol containers with nozzles or from applicators that dispense the correct amount of foam and spread it over the cervix. Creams and jellies are squeezed from tubes and held in place by a diaphragm or other device. Suppositories – small waxy pellets melted by body heat – are inserted by hand. More effective at keeping sperm and egg apart are mechanical barriers such as the diaphragm and cervical cap (both used with a spermicide), the sponge, and the condom. A diaphragm is a shallow rubber cup that is coated with a spermicide and positioned over the cervix before intercourse. Size is important; women need to have a pelvic examination and get a prescription for the proper diaphragm.
The cervical cap, less than half the size but used in the same way, has been available worldwide for decades. It was not popular in the United States, however, and in 1977 it failed to gain approval by the Food and Drug Administration (FDA). In 1988, the FDA again permitted its sale. The contraceptive sponge, which keeps its spermicidal potency for 48 hours after being inserted in the vagina, was approved in 1983. Like the diaphragm and cervical cap, the sponge has an estimated effectiveness rate of about 85%.
The devices only rarely produce side effects, such as irritation, allergic reactions, and very rarely, infections. The condom, a rubber sheath, is rolled onto the erect penis so that sperm, when ejaculated, is trapped. But care must be taken so that the condom does not break or slip off. A fresh condom should be used for each sexual act. Condoms also help protect against the spread of venereal diseases, and unlike other barrier devices, condoms made of latex do provide some protection–but not foolproof–protection against AIDS (see AIDS). Another method of preventing the sperm from reaching the egg is withdrawal by the man before ejaculation.
This is the oldest technique of contraception and, because of the uncertainty of controlling the ejaculation, is considered one of the least effective. Altering Body Functions Even in ancient times, attempts were made to find a medicine that would prevent a woman’s body from producing a baby. Only within the last century, however, have methods been developed that successfully interrupt the complex reproductive system of a woman’s body. The first attempt, made in the 19th century, was based on a legend that camel drivers, about to go on long journeys in the desert, put pebbles in the wombs of female camels to keep them from becoming pregnant. Researchers tried to find something that would work similarly in a woman’s cervix.
The earliest such objects were made of metal and were held in by prongs. Later, wire rings were placed beyond the cervix, in the uterus itself, thus giving rise to the term intrauterine device, or IUD. IUDs appear to work by altering the necessary environment in the uterus for the fertilized egg. It was only with the introduction of modern plastics, such as polyethylene, however, that IUDs were widely accepted. Their pliability led to simpler insertion techniques, and they could be left in place until pregnancy was desired, unless a problem arose with their use. Copper-containing IUDs and those that slowly released the hormone progesterone had to be replaced periodically.
Some users of IUDs, however, complained increasingly of the side effects of the devices. The most common problem was bleeding, and the devices could also cause uterine infections. More dangerous was the possible inducement of pelvic inflammatory disease (see UROGENITAL DISEASES), an infection that may lead to blockage of the Fallopian tubes and eventual sterility or an ectopic pregnancy. Studies in the 1980s confirmed this link with the increased risk of infertility even in the absence of apparent infections, especially with plastic IUDs.
The A. H. Robins Company, in particular, was ordered in 1987 to set aside nearly $2.5 billion to pay the many thousands of claims filed against it by women injured through the use of its Dalkon Shield. By that time, only a single progesterone-releasing IUD remained on the U.S. market, but a copper IUD later became available, and other steroid-releasing devices were being planned for issue. The birth control pill, taken once a day, has become the most popular birth control method among American women. Oral contraceptives are similar in composition to the hormones produced naturally in a woman’s body. Most pills prevent ovaries from producing eggs. Use of the pill, however, does not prevent menstruation; usage may even cause periods to be more regular, with less cramps and blood loss.
Recent studies seem to indicate that the pill may also protect its users against several relatively common ailments, including iron deficiency anemia (the result of heavy menstrual bleeding), pelvic inflammatory disease, and some benign breast disorders. In addition (and contrary to fears that were expressed when the pills were first marketed and contained much higher levels of hormones), long-term statistical studies point to a lower incidence of ovarian and uterine cancer among women who use contraceptive pills. Other studies, however, have linked its use with the increased occurrence of breast cancer. Ongoing studies by such organizations as the American Cancer Society continue to study a possible breast cancer link. For some users, the pill may have undesirable and sometimes serious side effects, such as weight gain, nausea, hypertension, or the formation of blood clots or noncancerous liver tumors.
The risk of such effects increases above the age of 35 among women who smoke. Pills are obtainable only by prescription and after a woman’s medical history and a check of her physical condition. In 1991, the FDA approved the use of Norplant, a long-lasting contraceptive that is implanted under the skin on the inside of a woman’s upper arm. The implant consists of six matchstick-size flexible tubes that contain a synthetic hormone called progestin. Released slowly and steadily over a five-year period, this drug inhibits ovulation and thickens cervical mucus, preventing sperm from reaching eggs.
Avoiding Intercourse: The time to avoid sex, when conception is not desired, is about midway in a woman’s menstrual cycle; this was not discovered until the 1930s when studies established that an egg is released (ovulation) from an ovary about once a month, usually about 14 days before the next menstrual flow. Conception may occur if the egg is fertilized during the next 24 hours or so, or if intercourse happens a day or two before or after the egg is released because live sperm can still be present. Therefore, the days just before, during, and immediately following ovulation are considered unsafe for unprotected intercourse; other days in the cycle are considered safe.
The avoidance of intercourse around ovulation, the rhythm method, is the only birth control method approved by the Roman Catholic church. Maintenance of calendar records of menstrual cycles proved unreliable because cycles may vary due to fatigue, colds, or physical or emotional stress. A woman’s body temperature, however, rises slightly during ovulation and remains high until just before the next flow begins. Immediately preceding the release of the egg, the mucus in the vagina becomes clear, and the flow is heavier. As the quantity of mucus is reduced, it becomes cloudy and viscous and may disappear. These signals can help a woman determine the time when she must avoid intercourse to prevent pregnancy.
Permanent Contraception Couples who wish to have no more children or none at all may choose sterilization of the man or of the woman instead of prolonged use of temporary methods. To be considered irreversible, sterilization blocks or separates the tubes that carry the sperm or the eggs to the reproductive system. The man is still capable of ejaculating, but his semen no longer contains sperm. The woman continues to menstruate, and an egg is released each month, but it does not reach her uterus. Neither operation affects hormone production, male or female characteristics, sex drive, or orgasm. Tubes may be separated by surgically cutting them, they may be blocked with clips or bands, or they may be sealed using an electric current. The man’s operation, or VASECTOMY, is simpler and is usually performed in a doctor’s office or a clinic.
The operation for women is usually performed in a hospital or an out-patient surgical center. Some of the most recent techniques require a stay of only a few hours. Some soreness and discomfort may be expected after surgery, occasionally with swelling, bleeding, or infection; the risk of serious complication is slight. In the 1980s, sterilization became the preferred method among U.S. couples desiring no further children. The most optimistic prospects for reversing sterilization for women and men exist when there is the least damage to their tubes at the time of sterilization. It is estimated that as many as 60 percent of reversals are successful (success is measured by a pregnancy). Many individuals, however, may not even be candidates for an attempt at reversal, especially women who have undergone electrocauterization or surgical cutting of their tubes.
New or Experimental Contraceptives Several new drugs and contraceptive devices are at present undergoing examination in the United States. Thus, an injection of the synthetic progesterone Depo-Provera (currently used in more than 90 countries) prevents ovulation for three months. Animal tests, however, suggest that the drug may induce some cancers and have other undesirable side-effects. Also in use in several countries is a capsule implanted beneath the skin of the upper arm that slowly releases the synthetic hormone levonorgestrel over a period of five years. The capsule, which was approved by the World Health Organization in 1985 for distribution by United Nations agencies, has minimal known side effects but should not be used by women who have liver disease or breast cancer. Another contraceptive approach successful in animals and currently undergoing human trials is vaccination. One vaccine delivers antibodies against a hormone that plays a crucial role in pregnancy. A second works against a hormone in the matrix surrounding the egg, blocking sperm from penetrating. Male and unisex oral contraceptives are currently in research.
SOCIAL ISSUES Birth control, or limiting reproduction, has become an issue of major importance in the contemporary world because of the problems posed by population growth.
Until relatively recently, however, most cultures have stressed increasing, rather than reducing, procreation. The English economist Thomas Malthus (1766-1834) was the first to warn that the population of the world was increasing at a faster rate than its means of support. However, 19th-century reformers who advocated birth control as a means of controlling population growth met bitter opposition both from the churches and from physicians. The American Charles Knowlton, author of an explicit treatise on contraception entitled The Fruits of Philosophy (1832), was prosecuted for obscenity, and similar charges were brought against the free-thinkers Annie Besant and Charles Bradlaugh, who distributed the book in Britain.
Nonetheless, the movement persisted, gathering strength at the end of the century from the women’s rights movement. In Britain and continental Europe, Malthusian leagues were formed, and the Dutch league opened the first birth control clinic in 1881. An English clinic was started by Dr. Marie Stopes (1882-1958) in 1921. In the United States, Margaret Sanger’s first clinic (1916) was closed by the police, but Sanger opened another in 1923. Her National Birth Control League, founded in 1915, became the Planned Parenthood Federation of America in 1942 and then, in 1963, the Planned Parenthood-World Population organization.
In Griswold v. Connecticut (1965), the U.S. Supreme Court struck down the last state statute banning contraceptive use for married couples, and in 1972 the Court struck down remaining legal restrictions on birth control for single people. The federal government began systematically to fund family planning programs in 1965. Contraceptive assistance was provided to minors without parental consent until Congress ruled in 1981 that public health-service clinics receiving federal funds must notify parents of minors for whom contraceptives have been prescribed. Suits challenging the regulation have been upheld; the government has announced plans to appeal.
Despite the wide availability of contraceptives and birth control information, the rate of childbirth among unmarried teenage girls rose throughout the 1970s and 1980s. A major focus of current concern, therefore, is the improvement of sex education for adolescents. Other countries where the birth control movement has been notably successful include Sweden, the Netherlands, and Britain, where family planning associations early received government support; Japan, which has markedly reduced its birthrate since enacting facilitating legislation in 1952; and the Communist countries, which after some fluctuations in policy, now provide extensive contraceptive and abortion services to their inhabitants. Many of the less developed countries are now promoting birth control programs, supported by technical, educational, and financial assistance from various United Nations agencies and the International Planned Parenthood Federation.
A series of World Population Conferences has sought to strengthen the focus on population control as a major international issue. At present, the strongest opposition to birth control in the Western world comes from the Roman Catholic Church, which continues to ban the use of all methods except periodic abstinence. In Third World countries, resistance to birth control programs has arisen from both religious and political motives.
In India, for example, a country whose population is increasing at a net rate of 10-13 million a year, the traditional Hindu emphasis on fertility has impeded the success of the birth control movement. Some Third World countries continue to encourage population growth for internal economic reasons, and a few radical spokespersons have alleged that the international birth control movement is attempting to curtail the population growth of Third World countries for racist reasons. A similar argument has been heard within the United States with regard to ethnic minorities; the latter, however, voluntarily seek family planning in an equal proportion to non-minorities. Despite such arguments, most educated individuals and governments acknowledge that the health benefits of regulating fertility and slowing the natural expansion of the world’s population are matters of critical importance.
- Belcastro, P. A., The Birth Control Book (1986);
- Bullough, Bonnie, Contraception: A Guide to Birth Control Methods (1990);
- Djerassi, Carl, The Politics of Contraception (1981);
- Filshie, Marchs, and Guillebaud, John, Contraception: Science and Practice (1989);
- Gordon, Linda, Woman’s Body, Woman’s Right: A Social History of Birth Control in America (1976);
- Harper, Michael J. K., Birth Control Technologies: Prospects by the Year 2000 (1983);
- Kennedy, David M., Birth Control in America: The Career of Margaret Sanger (1970);
- Knight, James W., and Callahan, Joan C., Preventing Birth: Contemporary Methods and Related Moral Controversies (1989);
- Leathard, Audrey, The Fight for Family Planning (1980);
- Lieberman, E. J., and Peck, Ellen, Sex and Birth Control: A Guide for the Young, rev. ed. (1981);
- Loudon, Nancy, and Newton, John, eds., Handbook of Family Planning (1985);
- Sutton, Graham, ed., Birth Control Handbook (1980);
- Zatuchni, G. I., et al., Male Contraception (1986);
- Zatuchni, G. I., et al., Male Contraception (1986).
- Louise B. Tyrer, M.D. “Human Sexuality