Birth control
Birth control | |
---|---|
birth control pills | |
Other names | Contraception, fertility control |
Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unintended pregnancy.[1] Birth control has been used since ancient times, but effective and safe methods of birth control only became available in the 20th century.[2] Planning, making available, and using human birth control is called family planning.[3][4] Some cultures limit or discourage access to birth control because they consider it to be morally, religiously, or politically undesirable.[2]
The
In
About 222 million women who want to avoid pregnancy in developing countries are not using a modern birth control method.[17][18] Birth control use in developing countries has decreased the number of deaths during or around the time of pregnancy by 40% (about 270,000 deaths prevented in 2008) and could prevent 70% if the full demand for birth control were met.[19][20] By lengthening the time between pregnancies, birth control can improve adult women's delivery outcomes and the survival of their children.[19] In the developing world, women's earnings, assets, and weight, as well as their children's schooling and health, all improve with greater access to birth control.[21] Birth control increases economic growth because of fewer dependent children, more women participating in the workforce, and/or less use of scarce resources.[21][22]
Methods
Method | Typical use | Perfect use |
---|---|---|
No birth control | 85% | 85% |
Combination pill | 9% | 0.3% |
Progestin-only pill | 13% | 1.1% |
Sterilization (female) | 0.5% | 0.5% |
Sterilization (male) | 0.15% | 0.1% |
Condom (female) | 21% | 5% |
Condom (male) | 18% | 2% |
Copper IUD | 0.8% | 0.6% |
Hormonal IUD | 0.2% | 0.2% |
Patch | 9% | 0.3% |
Vaginal ring | 9% | 0.3% |
MPA shot | 6% | 0.2% |
Implant | 0.05% | 0.05% |
Diaphragm and spermicide | 12% | 6% |
Fertility awareness | 24% | 0.4–5% |
Withdrawal | 22% | 4% |
Lactational amenorrhea method (6 months failure rate) |
0–7.5%[25] | <2%[26] |
Birth control methods include
Birth control methods fall into two main categories:
The most effective methods are those that are long acting and do not require ongoing health care visits.
While all methods of birth control have some potential adverse effects, the risk is less than that of pregnancy.[29] After stopping or removing many methods of birth control, including oral contraceptives, IUDs, implants and injections, the rate of pregnancy during the subsequent year is the same as for those who used no birth control.[31]
For individuals with specific health problems, certain forms of birth control may require further investigations.
Hormonal
Combined hormonal contraceptives are associated with a slightly increased risk of
The effect on sexual drive is varied, with increase or decrease in some but with no effect in most.[45] Combined oral contraceptives reduce the risk of ovarian cancer and endometrial cancer and do not change the risk of breast cancer.[46][47] They often reduce menstrual bleeding and painful menstruation cramps.[35] The lower doses of estrogen released from the vaginal ring may reduce the risk of breast tenderness, nausea, and headache associated with higher dose estrogen products.[46]
Progestin-only pills, injections and intrauterine devices are not associated with an increased risk of blood clots and may be used by women with a history of blood clots in their veins.[41][48] In those with a history of arterial blood clots, non-hormonal birth control or a progestin-only method other than the injectable version should be used.[41] Progestin-only pills may improve menstrual symptoms and can be used by breastfeeding women as they do not affect milk production. Irregular bleeding may occur with progestin-only methods, with some users reporting no periods.[49] The progestins drospirenone and desogestrel minimize the androgenic side effects but increase the risks of blood clots and are thus not first line.[50] The perfect use first-year failure rate of injectable progestin is 0.2%; the typical use first failure rate is 6%.[23]
-
Three varieties of birth control pills in calendar oriented packaging
-
Birth control pills
-
A transdermal contraceptive patch
-
ANuvaRingvaginal ring
Barrier
Globally, condoms are the most common method of birth control.
Male condoms and the diaphragm with spermicide have typical use first-year failure rates of 18% and 12%, respectively.[23] With perfect use condoms are more effective with a 2% first-year failure rate versus a 6% first-year rate with the diaphragm.[23] Condoms have the additional benefit of helping to prevent the spread of some sexually transmitted infections such as HIV/AIDS, however, condoms made from animal intestine do not.[7][59]
Contraceptive sponges combine a barrier with a spermicide.[29] Like diaphragms, they are inserted vaginally before intercourse and must be placed over the cervix to be effective.[29] Typical failure rates during the first year depend on whether or not a woman has previously given birth, being 24% in those who have and 12% in those who have not.[23] The sponge can be inserted up to 24 hours before intercourse and must be left in place for at least six hours afterward.[29] Allergic reactions[60] and more severe adverse effects such as toxic shock syndrome have been reported.[61]
-
A rolled up male condom.
-
A polyurethane female condom
-
Abarrier, in its case with a quarter U.S. coin.
-
A contraceptive sponge set inside its open package.
Intrauterine devices
The current
Evidence supports effectiveness and safety in adolescents[64] and those who have and have not previously had children.[66] IUDs do not affect breastfeeding and can be inserted immediately after delivery.[67] They may also be used immediately after an abortion.[68][69] Once removed, even after long term use, fertility returns to normal immediately.[70]
While
Sterilization
Two broad categories exist, surgical and non-surgical.
The permanence of this decision may cause regret in some men and women. Of women who have undergone tubal ligation after the age of 30, about 6% regret their decision, as compared with 20-24% of women who received sterilization within one year of delivery and before turning 30, and 6% in
Although sterilization is considered a permanent procedure,
Behavioral
Behavioral methods involve regulating the timing or method of intercourse to prevent introduction of sperm into the female reproductive tract, either altogether or when an egg may be present.[91] If used perfectly the first-year failure rate may be around 3.4%; however, if used poorly first-year failure rates may approach 85%.[92]
Fertility awareness
Withdrawal
The
There is little data regarding the sperm content of
Abstinence
Deliberate
Abstinence-only sex education does not reduce teenage pregnancy.[9][108] Teen pregnancy rates and STI rates are generally the same or higher in states where students are given abstinence-only education, as compared with comprehensive sex education.[108] Some authorities recommend that those using abstinence as a primary method have backup methods available (such as condoms or emergency contraceptive pills).[109]
Lactation
The
Emergency
Dual protection
Dual protection is the use of methods that prevent both sexually transmitted infections and pregnancy.[124] This can be with condoms either alone or along with another birth control method or by the avoidance of penetrative sex.[125][126]
If pregnancy is a high concern, using two methods at the same time is reasonable.
Effects
Health
Contraceptive use in
Birth control also improves child survival in the developing world by lengthening the time between pregnancies.[19] In this population, outcomes are worse when a mother gets pregnant within eighteen months of a previous delivery.[19][130] Delaying another pregnancy after a miscarriage, however, does not appear to alter risk and women are advised to attempt pregnancy in this situation whenever they are ready.[130]
Teenage pregnancies, especially among younger teens, are at greater risk of adverse outcomes including early birth, low birth weight, and death of the infant.[14] In 2012 in the United States 82% of pregnancies in those between the ages of 15 and 19 years old are unplanned.[72] Comprehensive sex education and access to birth control are effective in decreasing pregnancy rates in this age group.[131]
Birth control methods, especially hormonal methods, can also have undesirable side effects. Intensity of side effects can range from minor to debilitating, and varies with individual experiences. These most commonly include change in menstruation regularity and flow, nausea, breast tenderness, headaches, weight gain, and mood changes (specifically an increase in depression and anxiety).[132][133] Additionally, hormonal contraception can contribute to bone mineral density loss, impaired glucose metabolism, increased risk of venous thromboembolism.[133][132] Comprehensive sex education and transparent discussion of birth control side effects and contraindications between healthcare provider and patient is imperative.[132]
Finances
In the developing world, birth control increases
The total medical cost for a pregnancy, delivery and care of a newborn in the United States is on average $21,000 for a vaginal delivery and $31,000 for a caesarean delivery as of 2012.[135] In most other countries, the cost is less than half.[135] For a child born in 2011, an average US family will spend $235,000 over 17 years to raise them.[136]
Prevalence
6% 12% 18% 24% | 30% 36% 48% 60% | 66% 78% 86% No data |
Globally, as of 2009, approximately 60% of those who are married and able to have children use birth control.[138] How frequently different methods are used varies widely between countries.[138] The most common method in the developed world is condoms and oral contraceptives, while in Africa it is oral contraceptives and in Latin America and Asia it is sterilization.[138] In the developing world overall, 35% of birth control is via female sterilization, 30% is via IUDs, 12% is via oral contraceptives, 11% is via condoms, and 4% is via male sterilization.[138]
While less used in the developed countries than the developing world, the number of women using IUDs as of 2007 was more than 180 million.[65] Avoiding sex when fertile is used by about 3.6% of women of childbearing age, with usage as high as 20% in areas of South America.[139] As of 2005, 12% of couples are using a male form of birth control (either condoms or a vasectomy) with higher rates in the developed world.[140] Usage of male forms of birth control has decreased between 1985 and 2009.[138] Contraceptive use among women in Sub-Saharan Africa has risen from about 5% in 1991 to about 30% in 2006.[141]
As of 2012, 57% of women of childbearing age want to avoid pregnancy (867 of 1,520 million).[142] About 222 million women, however, were not able to access birth control, 53 million of whom were in sub-Saharan Africa and 97 million of whom were in Asia.[142] This results in 54 million unplanned pregnancies and nearly 80,000 maternal deaths a year.[138] Part of the reason that many women are without birth control is that many countries limit access due to religious or political reasons,[2] while another contributor is poverty.[143] Due to restrictive abortion laws in Sub-Saharan Africa, many women turn to unlicensed abortion providers for unintended pregnancy, resulting in about 2–4% obtaining unsafe abortions each year.[143]
History
Early history
The Egyptian
The ancient Greek philosopher Aristotle (c. 384–322 BC) recommended applying cedar oil to the womb before intercourse, a method which was probably only effective on occasion.[148] A Hippocratic text On the Nature of Women recommended that a woman drink a copper salt dissolved in water, which it claimed would prevent pregnancy for a year.[148] This method was not only ineffective, but also dangerous, as the later medical writer Soranus of Ephesus (c. 98–138 AD) pointed out.[148] Soranus attempted to list reliable methods of birth control based on rational principles.[148] He rejected the use of superstition and amulets and instead prescribed mechanical methods such as vaginal plugs and pessaries using wool as a base covered in oils or other gummy substances.[148] Many of Soranus's methods were probably also ineffective.[148]
In medieval Europe, any effort to halt pregnancy was deemed immoral by the
Birth control movement
The birth control movement developed during the 19th and early 20th centuries.
In the United States,
The increased use of birth control was seen by some as a form of social decay.[166] A decrease of fertility was seen as a negative. Throughout the Progressive Era (1890–1920), there was an increase of voluntary associations aiding the contraceptive movement.[166] These organizations failed to enlist more than 100,000 women because the use of birth control was often compared to eugenics;[166] however, there were women seeking a community with like-minded women. The ideology that surrounded birth control started to gain traction during the Progressive Era due to voluntary associations establishing community. Birth control was unlike the Victorian Era because women wanted to manage their sexuality. The use of birth control was another form of self-interest women clung to. This was seen as women began to gravitate towards strong figures, like the Gibson Girl.[167]
The first permanent birth-control clinic was established in Britain in 1921 by Marie Stopes working with the Malthusian League.[168] The clinic, run by midwives and supported by visiting doctors,[169] offered women's birth-control advice and taught them the use of a cervical cap. Her clinic made contraception acceptable during the 1920s by presenting it in scientific terms. In 1921, Sanger founded the American Birth Control League, which later became the Planned Parenthood Federation of America.[170] In 1924 the Society for the Provision of Birth Control Clinics was founded to campaign for municipal clinics; this led to the opening of a second clinic in Greengate, Salford in 1926.[171] Throughout the 1920s, Stopes and other feminist pioneers, including Dora Russell and Stella Browne, played a major role in breaking down taboos about sex. In April 1930 the Birth Control Conference assembled 700 delegates and was successful in bringing birth control and abortion into the political sphere – three months later, the Ministry of Health, in the United Kingdom, allowed local authorities to give birth-control advice in welfare centres.[172]
The National Birth Control Association was founded in Britain in 1931, and became the
In 1936, the
Modern methods
In 1909, Richard Richter developed the first intrauterine device made from silkworm gut, which was further developed and marketed in Germany by
Society and culture
Legal positions
Human rights agreements require most governments to provide family planning and contraceptive information and services. These include the requirement to create a national plan for family planning services, remove laws that limit access to family planning, ensure that a wide variety of safe and effective birth control methods are available including emergency contraceptives, make sure there are appropriately trained healthcare providers and facilities at an affordable price, and create a process to review the programs implemented. If governments fail to do the above it may put them in breach of binding international treaty obligations.[189]
In the United States, the 1965 Supreme Court decision Griswold v. Connecticut overturned a state law prohibiting dissemination of contraception information based on a constitutional right to privacy for marital relationships. In 1972, Eisenstadt v. Baird extended this right to privacy to single people.[190]
In 2010, the United Nations launched the Every Woman Every Child movement to assess the progress toward meeting women's contraceptive needs. The initiative has set a goal of increasing the number of users of modern birth control by 120 million women in the world's 69 poorest countries by 2020. Additionally, they aim to eradicate discrimination against girls and young women who seek contraceptives.
Since at least the 1870s, American religious, medical, legislative, and legal commentators have debated contraception laws. Ana Garner and Angela Michel have found that in these discussions men often attach reproductive rights to moral and political matters, as part of an ongoing attempt to regulate human bodies. In press coverage between 1873 and 2013 they found a divide between institutional ideology and real-life experiences of women.[193]
Religious views
Religions vary widely in their views of the
World Contraception Day
September 26 is World Contraception Day, devoted to raising awareness and improving education about sexual and reproductive health, with a vision of a world where every pregnancy is wanted.
Misconceptions
There are a number of
Accessibility
Access to birth control may be affected by finances and the laws within a region or country.[213] In the United States African American, Hispanic, and young women are disproportionately affected by limited access to birth control, as a result of financial disparity.[214][215] For example, Hispanic and African American women often lack insurance coverage and are more often poor.[216] New immigrants in the United States are not offered preventive care such as birth control.[217]
In the United Kingdom contraception can be obtained free of charge via contraception clinics, sexual health or GUM (genitourinary medicine) clinics, via some GP surgeries, some young people's services and pharmacies.[218][219]
In September 2021, France announced that women aged under 25 in France will be offered free contraception from 2022. It was elaborated that they "would not be charged for medical appointments, tests, or other medical procedures related to birth control" and that this would "cover hormonal contraception, biological tests that go with it, the prescription of contraception and all care related to this contraception".[220]
From August 2022 onwards contraception for women aged between 17 and 25 years will be free in the Republic of Ireland.[221][222]
Public provisioning for contraception
In most parts of the world, the political attitude to contraception determines whether and how much state provisioning of contraceptive care occurs. In the United States, for example, the Republican party and the Democratic party have held opposite positions, contributing to continuous policy shifts over the years.[223][224] In the 2010s, policies, and attitudes to contraceptive care shifted abruptly between Obama’s and Trump's administrations.[223] The Trump administration extensively overturned the efforts for contraceptive care, and reduced federal spending, compared to efforts and funding during the Obama administration.[223]
Advocacy
Approval
On July 13, 2023 the first US daily oral nonprescription over-the-counter birth control pill was approved for manufacturer by the FDA. The pill, Opill is expected to be more effective in preventing unintended pregnancies than condoms are. Opill is expected to be available in 2024 but the price has yet to be set. Perrigo, a pharmaceutical company based in Dublin is the manufacturer. [228]
Research directions
Females
Improvements of existing birth control methods are needed, as around half of those who get pregnant unintentionally are using birth control at the time.
A number of methods to perform sterilization via the cervix are being studied. One involves putting
Males
Current common methods of male birth control include condoms, vasectomies and withdrawal.[235][236]
A number of novel contraceptive methods based on hormonal and non-hormonal mechanisms of action are in various stages of research and development, up to and including clinical trials.[237][238][239][240][241][242] Methods in development include long-acting reversible contraceptives (LARCs), daily transdermal gels and oral pills, injectables, implants, wearables, and oral on-demand contraceptives.[243][244][245]
Men consistently report high levels of interest in novel forms of male contraception.[246][247][248] Development of novel male contraceptive methods has been ongoing for many decades, but progress been stymied by a lack of industry involvement. Most funding for male contraceptive research is derived from government or philanthropic sources.[249][250][251][252]
Animals
Birth control is also being considered as an alternative to hunting as a means of controlling
See also
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Further reading
- Speroff L, Darney PD (2010). A clinical guide for contraception (5th ed.). Philadelphia: Lippincott Williams & Wilkins. pp. 242–43. ISBN 978-1-60831-610-6. Archivedfrom the original on May 6, 2016.
- Stubblefield PG, Roncari DM (2011). "Family Planning". In Berek JS (ed.). Berek & Novak's Gynecology (15th ed.). Philadelphia: Lippincott Williams & Wilkins. pp. 211–69. ISBN 978-1-4511-1433-1.
- Jensen JT, Mishell Jr DR (March 2012). "Family Planning: Contraception, Sterilization, and Pregnancy Termination". In Lentz GM, Lobo RA, Gershenson DM, Katz VL (eds.). Comprehensive Gynecology (6th ed.). Philadelphia: Mosby Elsevier. pp. 215–72. ISBN 978-0-323-06986-1.
- Gavin L, Moskosky S, Carter M, Curtis K, Glass E, Godfrey E, et al. (Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC) (April 2014). "Providing quality family planning services: Recommendations of CDC and the U.S. Office of Population Affairs". MMWR. Recommendations and Reports. 63 (RR-04): 1–54. PMID 24759690.
- World Health Organization Department of Reproductive Health and Research and Johns Hopkins Bloomberg School of Public Health (2011). Family planning: A global handbook for providers: Evidence-based guidance developed through worldwide collaboration (PDF) (Rev. and Updated ed.). Geneva: WHO and Center for Communication Programs. ISBN 978-0-9788563-7-3.
- Curtis KM, Jatlaoui TC, Tepper NK, Zapata LB, Horton LG, Jamieson DJ, Whiteman MK (July 2016). "U.S. Selected Practice Recommendations for Contraceptive Use, 2016". MMWR. Recommendations and Reports. 65 (4): 1–66. PMID 27467319.
External links
- Birth control at Curlie
- "WHO Fact Sheet". July 2017. Retrieved July 23, 2017.
- "Birth Control Comparison Chart". Cedar River Clinics.
- Bulk procurement of birth control by the World Health Organization