Birth control
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
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.
Methods
Avoiding vaginal intercourse
Sexual abstinence (also known as celibacy), is the practice of avoiding all sexual activity. This is the only infallible form of birth control — provided it is executed correctly.
The risk of pregnancy is also low from non-vaginal sex, such as outercourse (sex without penetration), anal sex, or oral sex.
Coitus Interruptus
Coitus interruptus (literally "interrupted sex"), also known as the withdrawal method, is the practice of ending sexual intercourse ("pulling out") before ejaculation. The main risk of coitus interruptus is that the man may not make the maneuver in time. Although concern has been raised about the risk of pregnancy from sperm in pre-ejaculate, several small studies[1][7] have failed to find any viable sperm in the fluid.
Barrier methods
Barrier methods place a physical impediment to the movement of sperm into the female reproductive tract.
The most popular barrier method is the male condom, a latex sheath placed over the penis. The condom is also available in a female version, which is made of polyurethane. The female condom has a flexible ring at each end - one secures behind the pubic bone to hold the condom in place, while the other ring stays outside the vagina.
Cervical barriers are devices that are contained completely within the vagina. The cervical cap is the smallest cervical barrier. It stays in place by suction to the cervix or to the vaginal walls. The Lea's shield is a larger cervical barrier, also held in place by suction. The diaphragm fits into place behind the woman's pubic bone and has a spring to help it press against the vaginal walls. The contraceptive sponge has a depression to hold it in place over the cervix.
Hormonal methods
There are variety of delivery methods for hormonal contraception.
Combinations of estrogen and progestins (synthetic forms of progesterone) are commonly used. These include the combined oral contraceptive pill ("The Pill"), the Patch, the vaginal ring, and Lunelle (a monthly injection not currently available for sale).
Other methods contain only progesterone. These include the progesterone only pill (POP, minipill), Depo Provera (an injection every three months), and implants such as Norplant or Implanon. Progesterone only pill must be taken at more precisely remembered times each day than combined pills. The various progesterone-only methods may cause irregular bleeding for several months.
Intrauterine methods
These are devices that are placed in the uterus. They are usually shaped like a "T" - the arms of the T hold the device in place inside the uterus.
Intrauterine Devices ("IUDs") contain copper (which has a spermicidal effect).
IntraUterine Systems ("IUS") release progesterone or a progestin.
Periodic abstinence
Fertility awareness and most Natural family planning methods fall into this category. Various methods are used to determine when a woman is most and least fertile; sex is restricted to the least fertile period, and abstinence is practiced during the most fertile period.
Methods for determining a woman's fertility include monitoring of basal body temperature, monitoring of cervical mucus (Billings ovulation method, Creighton Model), and, much less reliable, statistical estimates (Rhythm Method).
Lactational
Most breastfeeding women have a period of infertility after the birth of their child. The Lactational Amenorrhea Method, or LAM, gives guidelines for determing the length of a woman's period of breastfeeding infertility.
Sterilization
Surgical sterilization is available in the form of tubal ligation for women and vasectomy for men.
A non-surgical sterilization procedure, Essure, is also available for women.
Emergency contraception
Most combined pills and POPs may be taken in high doses to prevent pregnancy after a birth control failure (such as a condom breaking) or after unprotected intercourse. Hormonal emergency contraception is also known as the "morning after pill," although it is licensed for use up to three days after intercourse.
Copper intrauterine devices may also be used as emergency contraception. For this use, they must be inserted within five days of the birth control failure or unprotected intercourse.
Induced abortion
Abortion can be done with surgical methods, usually suction-aspiration abortion (in the first trimester) or dilation and evacuation (in the second trimester). Chemical abortion uses drugs to end a pregnancy. This method is only approved for pregnancies of less than 7 weeks gestation (though it is commonly used to terminate pregnancies up to 9 weeks gestation in off-label use[citation needed]). Later-term abortions may use prostaglandins to induce premature delivery. An injection to stop the fetal heart may be used prior to induction.
Some herbs are believed to cause abortion (abortifacients). No peer-reviewed research has been done on these substances.
The use of abortion as birth control is a controversial issue, subject to ethical debate.
Experimental contraceptives for males
Research is being done into a variety of substances that have potential as male oral contraceptives.
RISUG (Reversible Inhibition of Sperm Under Guidance), is an injection into the vas deferens that coats the walls of the vas with a spermicidal substance. This method can be reversed by washing out the vas deferens with a second injection.
Vas-occlusive contraception would be analogous to intrauterine contraception in women.
Heat-based contraception involves heating the testicles to a high temperature for a short period of time.
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. While women are usually less fertile for the first few days of menstruation,[8] it is a 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
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.[9][10][11][12] 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[13]
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. [13][14]
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.[15]
Religious and cultural attitudes
Birth control education
Sexuality education classes that promote abstinence and do not teach birth control methods has been criticised. The practice of abstinence without proper instruction in birth control methods can inadvertently lead to pregnancy when the abstinent individual finally partakes in sexual intercourse with the opposite sex. Inexperience, lack of practice, and feelings of shame about the sex act--thus preventing the embarrassed individual from seeking proper information about contraceptives and abortifacients-- often combine to lead the newly initiated into pregnancy and STD's.
Christianity
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."[16]
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
References
- ^ a b Researchers find no sperm in pre-ejaculate fluid. Contraceptive Technology Update. Volume 14, Number 10, October 1993, pp.154-6. Cite error: The named reference "HIV study" was defined multiple times with different content (see the help page).
- ^ Zukerman, Z. et. al. Short Communication: Does Preejaculatory Penile Secretion Originating from Cowper's Gland Contain Sperm? Journal of Assisted Reproduction and Genetics. Volume 20, Number 4, April 2003, pp. 157-159(3).
- ^ Tatman, John. Silphium: Ancient Wonder Drug? Accessed December 21, 2005
- ^ Riddle, John M. (1999). Eve's Herbs: A History of Contraception and Abortion in the West. Harvard MA: Harvard University Press. ISBN 0674270266.
- ^ "A History of Birth Control Methods". Planned Parenthood. June 2002. Retrieved 2006-07-05.
{{cite web}}: CS1 maint: year (link), which cites:
Thomas, Patricia. (1988). Contraceptives, Medical World News, 29(5) (14 March), 48 - ^ "Evolution and Revolution: The Past, Present, and Future of Contraception". Contraception Online (Baylor College of Medicine). 10 (6). 2000.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ Zukerman, Z. (April 2003). "Short Communication: Does Preejaculatory Penile Secretion Originating from Cowper's Gland Contain Sperm?". Journal of Assisted Reproduction and Genetics. 20 (4): 157–159. PMID 12762415.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help)CS1 maint: year (link) - ^ Kippley, John (1996). The Art of Natural Family Planning (4th addition ed.). Cincinatti, OH: The Couple to Couple League. pp. 108–111, 148. ISBN 0926412132.
{{cite book}}: Unknown parameter|coauthors=ignored (|author=suggested) (help), which cites:
- Wade ME, McCarthy P, Braunstein GD; et al. (October 1981). "A randomized prospective study of the use-effectivness of two methods of natural family planning". American journal of obstetrics and gynecology. 141 (4): 368–376. PMID 7025639.
{{cite journal}}: Explicit use of et al. in:|author=(help)CS1 maint: multiple names: authors list (link) CS1 maint: year (link) - Barbato M, Bertolotti G (1988). "Natural methods for fertility control: A prospective study - first part". International Journal of Fertility. 33 Suppl: 48–51. PMID 2902027.
- Roetzer, J (1979). "Sympto-thermal method - Ten years of change". Linacre Quarterly. 45: 358–374. PMID 12309198.
- Wade ME, McCarthy P, Braunstein GD; et al. (October 1981). "A randomized prospective study of the use-effectivness of two methods of natural family planning". American journal of obstetrics and gynecology. 141 (4): 368–376. PMID 7025639.
- ^ Ecochard, R.; Pinguet, F.; Ecochard, I.; De Gouvello, R.; Guy, M.; and Huy, F. (1998) "Analysis of natural family planning failures. In 7007 cycles of use", Fertilite Contraception Sexualite 26(4):291-6
- ^ Hilgers T.W. and Stanford J.B. (1998) "Creighton Model NaProEducation Technology for avoiding pregnancy. Use effectiveness", Journal of Reproductive Medicine 43(6):495-502
- ^ Evaluation of the Effectiveness of a Natural Fertility Regulation Programme in China: Shao-Zhen Qian, et al. Reproduction and Contraception (English edition), in press 2000.
- ^ Howard, M.P. and Stanford, J.B. (1999) "Pregnancy probabilities during use of the Creighton Model Fertility Care System", Archives of Family Medicine 8(5):391-402
- ^ a b James Trussell et al.Contraceptive effectiveness rates. Contraceptive Technology — 18th Edition, New York: Ardent Media. On-press, 2000.
- ^ Skouby, SO. The European Journal of Contraception and Reproductive Health Care (2004) "Contraceptive use and behavior in the 21st century: a comprehensive study across five European countries." 9(2):57-68
- ^ Do AN, Ciesielski CA, Metler RP, Hammett TA, Li J, Fleming PL (2003). "Occupationally acquired human immunodeficiency virus (HIV) infection: national case surveillance data during 20 years of the HIV epidemic in the United States". Infect Control Hosp Epidemiol. 24 (2): 86–96. PMID 12602690.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Sheikh Muhammed Salih Al-Munajjid. Question #1219. Islam Q&A. Accessed April 2006.
External links
- Reproline - Family Planning.
- Planned Parenthood of America - Birth Control Methods
- Contraception Resource Center from the Association of Reproductive Health Professionals.
- Descriptions of various birth control options.
- American FDA Baby Guide: approved contraceptive method profiles (1997).
- Wiki FAQ on Birth Control: questions and answers on contraception.
- A Guide to Condoms and birth control methods.
- G. E. M. Anscombe: Contraception and Chastity
- Couple to Couple League: natural family planning.
- History of Contraception
- "The Contraception Museum" (The History of Contraception Museum, Cleveland, Ohio, US.)
- Ingenious: archive of historical images related to obstetrics, gynaecology, and contraception.