Birth control encompasses a variety of methods designed to prevent pregnancy. Historical records dating back to 1550 b.c.e detail attempts to control fertility, which suggests that preventing conception and controlling population has been a prevalent and continuing issue facing individuals and societies for thousands of years. However, birth control has been the subject of controversy both in ancient and in modern times. Religious leaders in Jewish, Christian, and Muslim faiths have debated the morality of contraception. Additionally, the focus on population control in the latter part of the 20th century expands the morally and ethically charged birth control debate. Issues regarding involuntary sterilizations and state-controlled reproduction, such as China's one-child policy that began in 1979, continue to be matters of public concern.
A variety of methods are currently employed to prevent conception. These methods range from the natural to the pharmaceutical; each method varies in terms of its efficacy and invasiveness. From abstinence to barrier methods to sterilization, the type of birth control chosen by an individual is dependent upon medical factors and personal preferences.
The oldest form of birth control is continued abstinence, which requires couples to refrain from sexual intercourse. Continued abstinence is the only 100 percent reliable form of birth control and has no risk of sexually transmitted disease. However, success is dependent upon individuals refraining from sexual intercourse and/or oral sex (sexually transmitted diseases). For many people this not a viable alternative.
Natural family planning (NFP) and fertility awareness requires women to increase their awareness of their monthly cycle in order to recognize when they are ovulating. Women practicing NFP prevent conception during their fertile period by avoiding intercourse. Because NFP does not allow for other forms of birth control methods to be applied, it is considered “natural” and is sanctioned by religious groups such as the Catholic Church, which often disapproves of “artificial” methods.
Another “natural” method of birth control is breastfeeding. Women who consistently breastfeed their infants are less likely to become pregnant due to the body's release of hormones. However, breastfeeding usually protects against pregnancy only in the first six months and only if the woman breastfeeds exclusively.
Women using fertility awareness may choose to use a barrier method, such as a condom, when fertile. Fertility can be ascertained by taking the basal temperature each morning and by recognizing changes in cervical mucus. Some women also track hormonal changes with the aid of a home ovulation kit. It is important to remember that sperm can survive for several days, which increases the number of days that pregnancy is possible. Fertility awareness works better for women who have regular menstrual cycles than for women who have irregular menstrual cycles. If practiced perfectly, fertility awareness can be a successful birth control method. However, the rate of pregnancy increases significantly for a woman who does not abstain or use an alternative method of birth control on the day she is fertile.
Coitus interruptus occurs when a man removes his penis from a woman's vagina before ejaculation. This method is dependent upon the man's ability to withdraw before ejaculating. It is not a recommended method, as sperm can be present in pre-ejaculate fluid on the tip of the penis.
Barrier methods of birth control include condoms (male and female), cervical caps, and diaphragms. A male condom is a latex or polyurethane sheath that fits directly over the penis and prevents semen from entering the vagina. Male condoms may or may not include a spermicide. When used correctly, they have a 98 percent efficacy rating; if they are used improperly, the number drops significantly. For those with latex allergies, polyurethane condoms are an option. Because users often state they have increased sensation with the polyurethane condoms, polyurethane condoms tend to be more expensive.
Female condoms are also available; however, they are not widely used. Female condoms are a sheath, usually made of polyurethane, with two flexible rings at both ends. One end is closed and the other is open. The condom is inserted in the vagina with the closed end at the cervix and the open end covering part of the labia. Similar to the male condoms, the polyurethane provides increased sensitivity and decreases the chance of an allergic reaction. As with any form of birth control, there is a difference between perfect use and typical use. The female condom is about 95 percent effective when used perfectly and 75 percent effective in typical use. Male and female condoms provide an added benefit of protecting against sexually transmitted diseases. However, when used improperly or past their expiration date, condoms can break.
A cervical cap and/or diaphragm is individually fitted by a health care provider. The rubber cap stretches to cover the mouth of the cervix, which blocks the sperm from entering the uterus. Cervical caps are smaller and used less frequently than the diaphragms. However, the cervical cap and the diaphragm are used in combination with a spermicide, which, as the name suggests, kills sperm. The diaphragm has a 94 percent success rate when used properly, although improper use can significantly limit its effectiveness.
Also available is the sponge, which is a small, round, pliable barrier. The sponge works in a similar manner to a diaphragm and contains spermicide that is activated by water. Precautions are needed if one is sensitive to sulfa. Additionally, there is an increased risk of contracting toxic shock syndrome if the sponge remains in place too long (30 or more hours).
There is a wide range of hormonal birth control options, with their accompanying concerns; they carry with them the risk of blood clots, heart attack and stroke, and should never be used by those who smoke. The “Pill” is the most widely recognized, and is taken orally on a daily basis. Other methods of hormonal protection include injection, such as Depro Provera®; the Patch (worn on the skin); and the NuvaRing® (placed in the vagina monthly). Each option releases hormones that usually include a combination of estrogen and progesterone.
The Pill prevents the ovaries from releasing an egg. The hormones also cause the mucus located in the cervix to thicken, which assists to prevent sperm from entering the uterus. The pill is 99 percent effective when used properly.
Additionally, some types of hormone delivery can decrease the duration of or eliminate menstruation for several months. Hormones are gradually absorbed from a small, square patch worn on the skin, which is replaced monthly. The NuvaRing works in the same manner as the patch, but is placed in the vagina and removed monthly to allow for menstruation.
Finally, Norplant® is a hormonal delivery option that is less frequently used. Rods containing hormones are inserted into the female's forearm. This method is effective up to five years. The Norplant rods have to be inserted and removed by a health care provider.
Intrauterine devices (IUDs) consist of a small, T-shaped apparatus placed inside the uterus, and is more than 99 percent effective. The body recognizes the IUD as a foreign body and causes the level of white cells to increase. These white cells destroy the egg, whether it is unfertilized or fertilized. Recently, IUDs containing the hormone progesterone have been developed. While the IUD does not prevent sexually transmitted disease, it does carry a low risk of infection and may cause spotting between periods.
Sterilization is considered a permanent form of birth control and, like the IUD and other forms of hormonal birth control, is 99 percent effective. While procedures such as a vasectomy (male sterilization) are sometimes reversible, it is advisable for those who consider having children in the future to choose another form of contraception. Tubal ligation (female sterilization) is not reversible. Surgically speaking, a vasectomy is a less complicated procedure than a tubal ligation. Additionally, the recovery time for a vasectomy is shorter. As with any surgery, complications can occur.
Emergency contraception refers to contraception used after intercourse and works by preventing fertilization or implantation. It works best when taken as soon as possible after unprotected sex. As the name implies, emergency contraception is usually used in the event that contraception failed or was not used, or in the case of sexual assault. Emergency contraception includes hormonal contraceptives such as Plan B® or the insertion of an IUD such as the Copper T®. Occasionally, a pharmacist will refuse to fill prescriptions for emergency contraception, in these cases, women can immediately contact a physician who will write a prescription.
In the Hebrew Bible, Genesis 28:7-10 tells the story of Onan, who spilled his seed upon the ground and was slain by the Lord. There is considerable debate regarding the sin of Onan. Some religious leaders have interpreted the text as a warning against masturbation, while others interpret the tale as a warning against contraception. There are other scholars who suggest that Onan's sin is his refusal to accept his brother's widow. In addition to its implications regarding contraception and religious dogma, the story has been interpreted to imply that once people in ancient societies realized the connection between coitus and conception, they began practicing withdrawal to prevent pregnancy.
One of the first written records containing a prescription for birth control is Eber's Papyrus, an Egyptian text that dates back to 1550 B.C.E. The papyrus contains a formula that combines lint, honey, and acacia leaves to act as a barrier to sperm when placed in the vagina. First-century Roman author Pliny the Elder in his Natural History provided a list of herbs that would cause sterility, and Soranos, credited as the first gynecologist, wrote of methods to prevent conception as well as medicines to produce an abortion.
In medieval times, the Roman Catholic Church condemned sex outside of marriage and asserted that the purpose of sex within marriage was reserved for procreation; any practice that interfered with conception was routinely condemned. However, according to historian John Riddle, women in medieval society would have passed on information regarding herbs that could act either to reduce the chance of conception or as an abortifacient. Common plants used in an attempt to prevent contraception included juniper, pennyroyal and Queen Anne's lace. In the East, the medieval physician Avicenna of Persia also wrote of herbal contraception in The Canon of Medicine, one of the most famous and influential medical texts in history.
With the arrival of the Renaissance, a new look at romantic love developed in western Europe. Reports regarding the use of condoms come from the writings of the Italian heartthrob Casanova, who used a lambskin sheath to prevent pregnancy and sexually transmitted disease.
By the 18th century, individual decisions regarding family and pregnancy became public matters of concern. Economist Thomas Robert Malthus's An Essay on the Principals of Population focused public attention on the relationship between population, resources, and economic development. Malthus posited that the increases in population could have an impoverishing effect on economies. Malthus's work would have a profound effect on those interested in population control in the 20th century.
Charles Knowles published Fruits of Philosophy in 1832. The text was influential in that it introduced birth control as a topic of discourse in the early 19th century. Knowles birth control information, however, was far from revolutionary, but it was his text that became the focal point for England's most famous birth control trial. In 1877 Charles Bradlaugh and Annie Besant were brought to trial for publishing Fruits of Philosophy, which was considered obscene. While Bradlaugh and Besant were originally sentenced to prison for refusing to give up their copies of the book, they appealed and were eventually exonerated.
Despite the social awareness of birth control, its efficacy did not increase substantially until manufacturers were able to vulcanize rubber, which allowed for the mass production of condoms. Initially promoted to prevent the transmission of sexual disease, the condom became an affordable and widely available form of birth control by the 20th century. Yet birth control still received social censure from Victorian moralists.
In the late 1800s in the United States, Anthony Comstock mounted a crusade against “vice,” which included birth control. As a result, the Comstock laws prohibited the distribution of birth control information by mail. In England, specific law restricting access to birth control information did not exist; however, Victorian sensibilities regarding human sexuality made birth control information difficult to obtain.
In the 20th century, Marie Stopes and Margaret Sanger became prominent advocates of birth control. Marie Stopes, a British scientist, worked to promote family planning. Her book Married Love provided information regarding human sexuality, and she opened first family planning clinic in the British Empire in 1921. Social activist Margaret Sanger dedicated her adult life to promote women's access to birth control. Sanger attributed her crusade to an event that occurred while she was a young nurse. Sanger was called upon to take care of a young woman, Sadie Sachs, who had performed a home abortion. As a result, the young woman developed an infection and nearly died; Sanger nursed her back to health. Once recovered, Sadie Sachs asked her physician how to prevent future pregnancies. The doctor responded sarcastically, telling Sadie to have her husband sleep on the roof. Sachs later became pregnant again, attempted to induce an abortion, and died. Sanger's devotion to the advocacy of birth control was unwavering. She was jailed for opening the first U.S. birth control clinic in 1916, but continued to work to change world opinion regarding contraception. She finally succeeded when the Supreme Court decided in United States v. One Package that the Comstock laws were unconstitutional.
Sanger also established the International Planned Parenthood Federation, worked to promote family planning, and supported research to develop an oral contraceptive. In the 1960s, the development of the birth control pill made contraception widely available in Western countries, and continued research has led to a wide variety of birth control options in recent years. However, birth control remains a political as well as personal and medical issue. Norman Himes, in his comprehensive Medical History of Contraception, noted that the future of birth control would be dictated by public and governmental support. Thus, perhaps it is not surprising that in many underdeveloped nations, women still do not have access to affordable, safe, reliable birth control.
The alliance between eugenics, population control and birth control proved a profoundly regrettable episode in history. Eugenics was a pseudoscience developed in the late 19th century that encouraged the breeding of “better” people. Therefore, people with physical deformities or those considered “feeble minded” were considered unfit. Countless numbers of people in mental institutions as well as institutions for those with developmental disabilities were sterilized without their consent. Both Margaret Sanger and Marie Stopes were involved to some extent with the Eugenics Movement; however, Sanger repeatedly reaffirmed her belief that birth control was a woman's choice. The Eugenics Movement declined after World War II, when people realized that the Nazi's adoption of several of the movement's tenets in their quest to create an Aryan world had resulted in the Holocaust and the devastation of Europe. While a woman's reproductive autonomy is at the root of the second wave of feminism, individual's desires regarding reproduction were not always at the heart of efforts to slow population growth. In the latter half of the 20th century, many people in the West became alarmed at increasing global populations, particularly in what were considered “less developed” nations. Politicians in the United States restricted aid to poorer countries unless those countries agreed to implement some form of population control. For example, between 1975-77 in India, many impoverished people were coerced into “voluntary” sterilization.
Today in China, the one-child policy is still in effect. Instituted in 1979, women are allowed to bear one child; after her first child, if a woman becomes pregnant, she is strongly encouraged to abort. If a woman has more than one child, she is severely fined for the second child. The Chinese government for many years has been accused of using coercive population control, including cases of forced abortions; subsequently, U.S. funding for the United Nations Population Fund was cut off by President Ronald Reagan and President George W. Bush. President Barack Obama reinstated the funding in 2009, but the debate continues.
Because of the Chinese preference for sons, many girls have been abandoned. The availability of infant girls for adoption has had a dramatic impact on adoption in the United States, where many couples have opted to adopt Chinese infant girls. China is facing a series of problems connected with its one-child policy, including a higher percentage of men in the ratio between men and women, which may cause difficulties for men who wish to marry. In addition, Chinese economists and sociologists have become increasingly concerned about their rapidly aging population.
Decreasing birth rates in countries such as Japan and Germany also worry some economists, who ponder the effect of the increasing number of elderly who will need to be supported by fewer and fewer workers. Some countries have developed programs that allow for extended leave and monetary support in order to encourage women to have children. Access to safe and effective birth control and issues of population, economy, and birth control remain pressing concerns across the globe.
China, Eugenics, Germany, India, Japan, Pregnancy, Religion and Mothering, Reproduction, Reproduction of Mothering, Reproductive Labor, Reproductive Technologies
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