From Encyclopedia of Sex and Sexuality
Throughout most of human history, the concept of limiting births would never have occurred to anyone; most children did not live past their fifth birthdays and the only certain way a couple could pass on their genes was to have as many children as possible. In addition, in agricultural societies the more potential farmhands, the better.
It was certainly the desire to prevent out-of-wedlock pregnancies that generated early demand for birth control, but as society began to change, other factors came into play. The Industrial Revolution signaled the end of agrarian societies and the need for very large families. As women became more educated, they developed the desire to control their own fertility. During the two world wars, as more and more women joined the work force—at first temporarily to fill in for men who had gone to war and later permanently—large families became incompatible with women’s new life-styles. Now, with overpopulation threatening the existence of the planet, things have turned totally around: it seems that birth control has now become a necessity for the survival of our species.
There are two basic methods of birth control—the prevention of pregnancy and the prevention of birth through abortion. Abortion was probably the first avenue tried by women, who may not have understood how they could prevent pregnancy but certainly knew they wanted to end their pregnancies before they resulted in births. Most of the abortion potions cooked up by witch doctors and medicine women probably did nothing more than make women sick, but certainly the desire was there, if not the means.
In preventing pregnancy, douching became the first line of defense. The first historical evidence we have for such potions is from graves dated as far back as 1850 B.C.E., in which recipes for “spermicides” were buried with the dead. These spermicides included such ingredients as honey, carbonate of soda, and crocodile dung. Other birth control methods used by women included the diaphragm, the cervical cap and the female condom. The first “diaphragm” may well have been used by the noted lover, Giovanni Casanova, who is said to have placed the hollowed halves of lemons over the cervixes of his partners. By 1864 the British medical association had compiled a list of 123 kinds of vaginal barrier methods, or “pessaries,” being used in the British Empire.
During the 1870s, with the passage of what were known as the Comstock Laws, it became illegal to send birth control devices or information about birth control through the United States mail. In 1916 Margaret Sanger, the founder of the Planned Parenthood Federation of America, began campaigning to reverse such laws. She believed that women’s rights to control their own fertility should not be limited by government regulations. Her battle continued until 1965, when the United States Supreme Court, in Griswold v. Connecticut, struck down state laws prohibiting birth control.
Today condoms have become the leading barrier method of birth control. They are sold and used not so much because of their ability to prevent births as because of their effectiveness against sexually transmitted diseases. Most condoms are made out of latex, hence the nickname “rubbers.”
Because some men stubbornly resist using a condom, a female condom was developed so that a woman could benefit from the condom’s dual role as a protector against disease and pregnancy. It has only recently become available and research is still scanty. Some women who have used it complain that it is difficult to insert, but many women, once they get the hang of it, like it. The female condom’s ability to prevent pregnancy and the spread of sexually transmitted disease should approximate that of the male condom. Two other popular barrier methods of birth control are the diaphragm and the cervical cap. Both are inserted into the vagina in order to block the cervix, the entrance from the vagina into the uterus, through which sperm pass to reach the eggs. The diaphragm is slightly larger and easier for a clinician to fit and for the woman to put into place, but the cervical cap can be left in place for up to forty-eight hours, while the diaphragm can only be inserted six hours in advance of intercourse and left in place for twenty-four hours. Both of these devices are used in combination with a spermicide (a gel or foam that kills the sperm, which can normally live up to seven days). In typical use, each is rated at 18 (that is, 18 possible pregnancies per 100 women for each year of use), but with perfect use the rating increases to a 6. All of these barrier methods of birth control are reversible—that is, women can stop using them if they wish, and immediately become pregnant.
The contraceptive sponge is another barrier method of birth control. Like the diaphragm and cervical cap, it is inserted into the vagina in order to block the opening of the cervix and access to the woman’s eggs. The sponge also contains a spermicide. The sponge is not quite as effective as the diaphragm and cervical cap for women who already have a child. The numbers are 28 and 9 pregnancies per 100 women per year of use, respectively. (For women who have not had a child, the sponge’s effectiveness is the same as the other two methods.) With use of the sponge there is also a slight risk of a woman developing toxic shock syndrome.
The sponge is available without a prescription, as are many foams, gels, creams, films, and suppositories (see contraceptive creams, foams, and gels) that work by creating a barrier over the cervix and killing the sperm with a spermicide. These products are very easy to use, which is why many women like them, and their rates of effectiveness are in a similar range as the other products, 21 per 100 per year for typical use and 3 per 100 for perfect use. Side effects are minimal (some women are allergic to them, as are some men) but they only offer limited protection against sexually transmitted diseases.
The next group of contraceptives are the reversible prescription methods. These must be prescribed by a doctor and work either by keeping the woman from releasing her eggs or by preventing a fertilized egg from implanting itself in the uterus.
The most famous of these, and the one credited with initiating the sexual revolution, is simply called “The Pill.” Composed of female hormones, the pill keeps the ovaries from releasing eggs. The pill must be taken once a day. Women who use the pill perfectly, taking it every day, have less than a 1 percent chance of becoming pregnant. Even the typical rate—allowing for mistakes in use—is only 3 percent. The side effects from using the pill are minimal, especially with the new mini-pills that contain lower doses of hormones. Women over thirty-five years of age who smoke should not use the pill and it must be remembered that the pill provides no protection against sexually transmitted diseases (see oral contraceptives).
Because women sometimes forget to take the pill, other methods of delivering the same hormones have been developed. One, depo-provera, consist of an injection which lasts for twelve weeks. Another, called Norplant, consists of six soft capsules that are inserted under the skin of the upper arm and release hormones continually for five years. Norplant is the most effective of all these methods, with only 4 women in 10,000 becoming pregnant during one year of use: there is no possibility of the woman making a mistake. Because these hormones do cause side effects, they are not recommended for use by every woman, and again, they do not prevent sexually transmitted diseases.
Another type of reversible prescription method of birth control is the IUD, or Intrauterine Device. IUDs are small plastic devices that contain either copper or a hormone and are inserted into the woman’s uterus by a clinician. They work by preventing either the fertilization of the egg or by preventing implantation of a fertilized egg in the uterine wall. In typical use, only 3 women in 100 per year will become pregnant with an IUD in place. The string extending from the IUD must be checked regularly to ensure that the IUD remains in place. Most women adjust to an IUD easily, but there are potential side effects, some of which, while rare, are life-threatening. A clinician will usually ask a patient to sign a consent form saying that all the risks were explained to her before the IUD’s insertion.
The next group of methods are the permanent ones—tubal sterilization (see sterilization) for women and vasectomy (see Vasectomy and the Male Pill) for men. Both require surgery and both are very effective (though, surprisingly, not 100 percent, even though the fallopian tubes in women and the vas deferens in men are permanently blocked). These are both very safe procedures, though complications can arise, and while the initial cost is higher than for other methods, they are one-time expenses. These methods are not effective against sexually transmitted diseases, and it is very important to remember that they are rarely reversible, so if at a later time the desire develops to have another child, that option may be closed.
The final group of methods falls under the category of natural family planning. With these methods there are no artificial devices or procedures used. Many of these methods can also be used to help a woman become pregnant, particularly if she is having difficulty doing so, by letting her know when the best time to conceive is in the calendar of her menstrual cycle.
The first of these methods is called abstinence, which means not engaging in sexual intercourse. When two people are sexually involved, for abstinence to be 100 percent effective, care must be taken not to bring semen into contact with the vagina, even without intercourse. If a man ejaculates close to the vagina, or if either partner touches the semen and then touches the women’s vagina, sperm could be introduced into it and impregnate the woman.
The other methods are based on partial abstinence (or the use of a contraceptive device only at certain times). These methods rely on the woman knowing when she will ovulate and refraining from intercourse or by using a contraceptive during those times. Because sperm can live up to seven days and the egg as long as three days, the period of abstinence must be long enough to take these factors into consideration. When used perfectly, these methods can be very effective, but in typical use their rate of failure is 20 percent per year of use.
The most common method of partial abstinence is called the calendar, or “rhythm,” method. The woman keeps a chart of her menstrual cycles and tries to predict when she will next be fertile. The more regular a woman’s periods are, the more reliable this method will be, though even with perfect use the failure rate is 9 percent per year of use. The woman must abstain from intercourse or must use a contraceptive at least eight days before she thinks she will ovulate and for three days afterward.
With the basal body temperature method, the woman takes her temperature every morning before rising. Assuming there is no other cause for her temperature to fluctuate (such as an infection from a cold or flu) she will notice a slight rise in her temperature on the day of ovulation.
Another way of testing for ovulation is by the cervical mucus method. Normally cloudy, the mucus will become clear and slippery in the few days before ovulation. It can then be stretched between the fingertips. (One way that some women can confirm that they have, in fact, ovulated is to be aware of mittleschmerz, a slight pain in the lower abdomen that signals ovulation has occurred. But many women never experience the signal.)
Of course, to optimize the effectiveness of these methods, they should be used in conjunction with the calendar method so that the woman can refrain from intercourse (or use a contraceptive) eight days prior to ovulation and three days afterward. When all are used together, it is called the symptothermal method.
There is one last method which some people use as an intended means of birth control—the withdrawal method. In the withdrawal method, the man withdraws his penis from the woman’s vagina just before he ejaculates. The basic flaw to this method is that before a man ejaculates, the Cowper’s gland releases fluid which serves as a lubricant to help the sperm make their way up the urethra. This fluid can also contain thousands of sperm which can be on their way to fertilize the egg long before the man actually ejaculates. The other danger is that if the man does not withdraw fast enough, he may end up ejaculating inside the vagina. The withdrawal method has a typical failure rate of 18 per 100 and a perfect rate of 4 per 100 per year.
Finally, there are those people who take no precautions, but play “Russian roulette,” even though they do not want to become parents. Out of 100 such women, over the course of a year 85 will become pregnant. That is why we have so many unwanted pregnancies, but it also why our species continues to populate our planet.