Article: Birth control

For other uses, see Birth control (disambiguation).

Birth control is a regimen of one or more actions, devices, or medications followed in order to deliberately prevent or reduce the likelihood of a woman giving birth or becoming pregnant. Methods and intentions typically termed birth control may be considered a pivotal ingredient to family planning. Mechanisms which are intended to reduce the likelihood of the fertilisation of an ovum by a spermatozoon may more specifically be referred to as contraception. Contraception differs from abortion in that the former prevents fertilization, while the latter terminates an already established pregnancy. Methods of birth control which may prevent the implantation of an embryo if fertilization occurs are medically considered to be contraception but characterized by some opponents as abortifacients.

Birth control is a controversial political and ethical issue in many cultures and religions, and although it is generally less controversial than abortion specifically, it is still opposed by many. There are various degrees of opposition, including those who oppose all forms of birth control short of sexual abstinence; those who oppose forms of birth control they deem "unnatural," while allowing natural birth control; and those who support most forms of birth control that prevent fertilisation, but oppose any method of birth control which prevents a fertilized embryo from attaching to the uterus and initiating a pregnancy.

History of birth control

A major factor in reducing birth rates in developing countries such as Malaysia is the availability of family planning facilities, like this one in Kuala Trengganu.

"And the villain still pursues her." Humorous Victorian era postcard.

Probably the oldest methods of contraception (aside from sexual abstinence) are coitus interruptus, barrier methods, and herbal abortifacients.

Coitus interruptus (withdrawal of the penis from the vagina prior to ejaculation) probably predates any other form of birth control. Once the relationship between the emission of semen into the vagina and pregnancy was known or suspected, some men began to use this technique. This is not a particularly reliable method of contraception, as few men have the self-control to correctly practice the method at every single act of intercourse. Although it is commonly believed that pre-ejaculate fluid can cause pregnancy, modern research has shown that pre-ejaculate fluid does not contain viable sperm.^[1][2]

There are historic records of Egyptian women using a pessary (a vaginal suppository) made of various acidic substances (crocodile dung is alleged) and lubricated with honey or oil, which may have been somewhat effective at killing sperm. However, it is important to note that the sperm cell was not discovered until Anton van Leeuwenhoek invented the microscope in the late seventeenth century, so barrier methods employed prior to that time could not know of the details of conception. Asian women may have used oiled paper as a cervical cap, and Europeans may have used beeswax for this purpose. The condom appeared sometime in the seventeenth century, initially made of a length of animal intestine. It was not particularly popular, nor as effective as modern latex condoms, but was employed both as a means of contraception and in the hopes of avoiding syphilis, which was greatly feared and devastating prior to the discovery of antibiotic drugs.

Various abortifacients have been used throughout human history, although many do not associate induced abortion with the term 'birth control'. Some of them were effective, some were not; those that were most effective also had major side effects. One abortifacient reported to have low levels of side effects - silphium - was harvested to extinction around the 1st century.^[3] The ingestion of certain poisons by the female can disrupt the reproductive system; women have drunk solutions containing mercury, arsenic, or other toxic substances for this purpose. The Greek gynaecologist Soranus in the 2nd century suggested that women drink water that blacksmiths had used to cool metal. The herbs tansy and pennyroyal are well-known in folklore as abortive agents, but these also "work" by poisoning the woman. Levels of the active chemicals in these herbs that will induce a miscarriage are high enough to damage the liver, kidneys, and other organs, making them very dangerous. However, in those times where risk of maternal death from postpartum complications was high, the risks and side effects of toxic medicines may have seemed less onerous. Some herbalists claim that black cohosh tea will also be effective in certain cases as an abortifacient.^[4]

Presenters at a family planning conference told a tale of Arab traders inserting small stones into the uteruses of their camel in order to prevent pregnancy, a concept very similar to the modern IUD. Although the story has been repeated as truth, it has no basis in history and was meant only for entertainment purposes.^[5] The first interuterine devices (which occupied both the vagina and the uterus) were first marketed around 1900. The first modern intrauterine device (contained entirely in the uterus) was described in a German publication in 1909, although the author appears to have never marketed his product.^[6]

The Rhythm Method (with a rather high method failure rate of 10% per year) was developed in the early twentieth century, as researchers discovered that a woman only ovulates once per menstrual cycle. Not until the mid-20th century, when scientists better understood the functioning of the menstrual cycle and the hormones that controlled it, were oral contraceptives and modern methods of fertility awareness (sometimes called natural family planning) developed.

Birth control methods

Three colored condoms

Ortho Tri-cyclen, a brand of oral contraceptive, in a dial dispenser.

• celibacy, or sexual abstinence

• non-vaginal sex, such as
  • Sex without penetration ("outercourse")
  • Anal sex or oral sex

• Withdrawal, i.e. coitus interruptus

• Barrier methods, often combined with spermicides
  • Condom (male and female)
  • Diaphragm
  • Lea's shield
  • Cervical cap
  • Contraceptive sponge

• Chemical methods
  • Combined estrogen & progesterone:
    • Combined oral contraceptive pill ("The Pill")
    • Contraceptive patch
    • Contraceptive vaginal ring
    • Lunelle (monthly injection)
  • Progesterone used alone:
    • Progesterone only pill (POP)
    • Depo Provera (injection every three months)
    • Implants (such as Norplant or Implanon)

(Most combined pills and POPs may also be taken in high doses as emergency contraception, also known as the morning after pill.)

• Intrauterine methods
  • Intrauterine Device ("IUD") which may also be used for emergency contraception
  • IntraUterine System ("IUS")

• Fertility awareness, sometimes called Natural family planning
  • Basal body temperature
  • Billings ovulation method
  • Creighton Model
• Rhythm Method
• Lactational Amenorrhea Method (LAM)

• Abortion methods
  • Surgical abortion
  • Chemical abortion
  • Herbal abortifacients

• Surgical sterilization
  • Tubal ligation for women
  • Vasectomy for men

• Experimental male contraceptives (future alternatives to condoms and vasectomy)

Modern Folklore

Modern folklore has suggested douching immediately following intercourse as a contraceptive method, and while it seems like a sensible idea to try to wash the ejaculate out of the vagina, it does not work due to the nature of the fluids and the structure of the female reproductive tract — if anything, douching spreads semen further towards the uterus. Some slight spermicidal effect may occur if the douche solution is particularly acidic, but overall it is not scientifically observed to be a reliably effective method.

Other urban legends concerning birth control exist throughout the world. The suggestion to shake a bottle of Coca-Cola and stick it into the vagina after ejaculation is not an effective form of birth control, and this method can also promote Candidiasis (yeast infections).

High school circles often spread the myth that a female cannot get pregnant on her first time having sexual intercourse, and even some college professors have spread the myth that a woman cannot get pregnant if she has sex during her period. Similarly, having sex in a hot tub does not prevent pregnancy, but it does provide a great environment for bacteria.

Although some sex positions may encourage pregnancy, no sexual positions prevent pregnancy. Having sex while standing up or with a woman on top will not keep the sperm from entering the uterus. The force of ejaculation and the ability of sperm to swim overrides gravity. Sneezing or urinating after sex is also not effective.

Effectiveness of birth control

Poster released in the 1970s by the Family Planning Association of Victoria, Australia.

The most effective methods in typical use are those that do not depend upon regular user action. Surgical sterilization and intrauterine devices (IUDs) both have failure rates of less than 1% per year.

Other methods may be highly effective if used consistently and correctly, but can have typical use failure rates that are considerably lower due to incorrect or ineffective usage by the user. Hormonal contraceptives, fertility awareness methods, and ecological breastfeeding (a strict form of LAM) can have failure rates of less than 1% per year.^{[7][8][9][10]} Typical use failure rates of hormonal contraceptives are as high as 8% per year. Periodic abstinence methods (there is insufficient data to distinguish between statistical methods, i.e. Rhythm, and observational methods, i.e. fertility awareness) have typical use failure rates as high as 25% per year^[11]

Condoms and cervical barriers such as the diaphragm have similar typical use failure rates (15.0% and 16%, respectively), but perfect usage of the condom is more effective (2% failure vs 6%) and condoms have the additional feature of helping to prevent the spread of sexually transmitted diseases such as HIV. The withdrawal method, if used consistently and correctly, has a failure rate of 4%. Due to the difficulty of consistently using withdrawal correctly, it has a typical use failure rate is 27% and is not recommended by medical professionals. ^[11][12]

Protection against sexually-transmitted infections

Not all methods of birth control offer protection against sexually-transmitted infections. Abstinence from all forms of sexual behavior will protect against the sexual transmission of these infections. The male latex condom offers some protection against some of these diseases with correct and consistent use, as does the female condom, although the latter has only been approved for vaginal sex. The female condom may offer greater protection against sexually-transmitted infections that pass through skin to skin contact, as the outer ring covers more exposed skin than the male condom, and can be used during anal sex to guard against sexually-transmitted infections, though knowledge of the product is important in order to ensure its effectiveness.

The remaining methods of birth control do not offer significant protection against the sexual transmission of these diseases.

However, so-called sexually-transmitted infections may also be transmitted non-sexually, and therefore, abstinence from sexual behavior does not guarantee 100% protection against sexually-transmitted infections. For example, HIV may be transmitted through contaminated needles which may be used in tattooing, body piercing, or injections. Health-care workers have acquired HIV through occupational exposure to accidental injuries with needles.^[13]

Religious and cultural attitudes toward birth control

Christianity

Main article: Christian views on contraception

Contraception was disallowed by all Christian faiths until the 1930s when the Anglican Communion changed its policy. Soon after, most Protestant groups came to approve the use of modern contraceptives when couples do not desire children.

The Catholic Church is opposed to contraception on moral grounds, believing that all sexual acts must be open to the transmission of life. Although it approves the use of natural family planning (NFP) methods for those married couples with serious reasons for spacing or avoiding pregnancy, all artificial forms of contraception are prohibited. (Cf. Humanae Vitae)

There are individuals and groups who disagree with their movement's official teaching, however. For example, the quiverfull movement within Protestantism is morally opposed to all forms of family planning (including NFP), and the "Winnipeg Statement" by the Canadian Catholic Bishops states their belief that Catholics can in good conscience use artificial contraception.

Islam

The Qur'an does not make any explicit statements about the morality of contraception, but contains statements encouraging procreation. Various interpretations have been set forth over time, and at the time of this writing, discussions on the web can be found easily that take various positions. Early Muslim literature discusses various contraceptive methods, and a study sponsored by the Egyptian government concluded that not only was azl (coitus interruptus) acceptable from a moral standpoint, but any similar method that did not produce sterility was also acceptable.

"It is permissible to use condoms so long as this does not cause any harm and so long as both husband and wife consent to their use, because this is similar to ‘azl (coitus interruptus or “withdrawal”). But it reduces the sensation of pleasure, which is the right of both partners, and reduces the chance of conception, which is also the right of both partners. Neither one of them is allowed to deprive the other of these rights. And Allaah is the course of strength."^[14]

However, there are several schools of thought on this as well as other issues concerning Islamic morality. In Iran, an Islamic country, contraceptive methods are not only taught to married couples, but also encouraged to youngsters through posters and advertisements.

Judaism

The Jewish view on birth control currently varies between the Orthodox, Conservative, and Reform branches of Judaism. Among Orthodox Judaism, use of birth control has been considered only acceptable for use in limited circumstances. Conservative Judaism, while generally encouraging its members to follow the traditional Jewish views on birth control has been more willing to allow greater exceptions regarding its use to fit better within modern society. Reform Judaism has generally been the most liberal with regard to birth control allowing individual followers to use their own judgment in what, if any, birth control methods they might wish to employ.

Among traditional interpretations of the Torah, active prevention of pregnancy is in violation of the commandment "be fruitful and multiply" (Genesis 1:22). Some Rabbinic authorities further consider the possibility (generally not accepted) that a union that by definition cannot lead to pregnancy would amount to "spilling seed", the sin of Onan (Genesis 38:9).

The option of contraception is raised by the Talmud (tractate Yevamot 12b), where the use of a pessary is discussed for women who are too young to get pregnant, presently pregnant, or nursing. In each case either the woman or her child is at risk for serious complications, and this is the basis for many rabbinic authorities permitting contraception in situations where pregnancy would seriously harm the woman. In those cases, the most "natural" method is preferred; as the use of a condom or pessary creates a physical barrier, "the pill" (or an intrauterine device) is preferred by most authorities.

Contraceptive measures that lead to sterility, especially male sterility (e.g. through vasectomy), are problematic, and a sterilized man may have to separate from his wife (based on Deuteronomy 23:2).

Such regulations regarding contraception affect the traditional streams of Judaism (including, but not limited to the Ultra-Orthodox and Modern-Orthodox sects) more so than others because of their strict adherence to Halakhah, or Jewish law. These regulations affect liberal strains of Judaism (including, but not limited to, the Reform, Reconstructionist, and Conservative movements; particularly in Western society) much less, where the emphasis is on applying Halakhah to modern life rather than observing it strictly. Many modern Jews feel that the benefits of contraception, be they female health, family stability, or disease prevention, uphold the commandment in Judaism to "choose life" much more strongly than they violate the commandment to "be fruitful and multiply".

When Orthodox Jewish couples contemplate the use of contraceptives, they generally consult a rabbi who evaluates the need for the intervention and which method is preferable from a halachic point of view.

Generally, the introduction of oral contraceptives has not caused the stir in Jewish circles that it caused in other religious groups. It was followed by a number of responsa from rabbinic decisors (poskim) which outlined the proper approach to the new phenomenon. There has been surprisingly little talk of the potential risk of increased promiscuity (z'nut). For example, an innovative use of the contraceptive pill in Judaism is employed by young brides. The laws of family purity state that intercourse cannot take place while a woman is menstruating (see niddah). In order to decrease the chance of menstruation occurring just before (or on) the wedding night, many brides briefly regulate their periods in the months leading up to their wedding.

See also

• Population control
• One-child policy