Birth control

Birth control, also known as contraception and fertility control, is a method or device used to prevent 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 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 most effective methods of birth control are sterilization by means of vasectomy in males and tubal ligation in females, intrauterine devices (IUDs), and implantable birth control.[5] This is followed by a number of hormone-based methods including oral pills, patches, vaginal rings, and injections.[5] Less effective methods include physical barriers such as condoms, diaphragms and birth control sponges and fertility awareness methods.[5] The least effective methods are spermicides and withdrawal by the male before ejaculation.[5] Sterilization, while highly effective, is not usually reversible; all other methods are reversible, most immediately upon stopping them.[5] Safe sex practices, such as with the use of male or female condoms, can also help prevent sexually transmitted infections.[6] Other methods of birth control do not protect against sexually transmitted diseases.[7] Emergency birth control can prevent pregnancy if taken within the 72 to 120 hours after unprotected sex.[8][9] Some argue not having sex as a form of birth control, but abstinence-only sex education may increase teenage pregnancies if offered without birth control education, due to non-compliance.[10][11]

In teenagers, pregnancies are at greater risk of poor outcomes.[12] Comprehensive sex education and access to birth control decreases the rate of unwanted pregnancies in this age group.[12][13] While all forms of birth control can generally be used by young people,[14] long-acting reversible birth control such as implants, IUDs, or vaginal rings are more successful in reducing rates of teenage pregnancy.[13] After the delivery of a child, a woman who is not exclusively breastfeeding may become pregnant again after as few as four to six weeks.[14] Some methods of birth control can be started immediately following the birth, while others require a delay of up to six months.[14] In women who are breastfeeding, progestin-only methods are preferred over combined oral birth control pills.[14] In women who have reached menopause, it is recommended that birth control be continued for one year after the last period.[14]

About 222 million women who want to avoid pregnancy in developing countries are not using a modern birth control method.[15][16] 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.[17][18] By lengthening the time between pregnancies, birth control can improve adult women's delivery outcomes and the survival of their children.[17] In the developing world women's earnings, assets, weight, and their children's schooling and health all improve with greater access to birth control.[19] Birth control increases economic growth because of fewer dependent children, more women participating in the workforce, and less use of scarce resources.[19][20]

Video explaining how to prevent unwanted pregnancy
Birth control
Package of birth control pills
A package of birth control pills
SynonymsContraception, fertility control
MeSHD003267

Methods

Chance of pregnancy during first year of use[21][22]
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%[23] <2%[24]

Birth control methods include barrier methods, hormonal birth control, intrauterine devices (IUDs), sterilization, and behavioral methods. They are used before or during sex while emergency contraceptives are effective for up to five days after sex. Effectiveness is generally expressed as the percentage of women who become pregnant using a given method during the first year,[25] and sometimes as a lifetime failure rate among methods with high effectiveness, such as tubal ligation.[26]

The most effective methods are those that are long acting and do not require ongoing health care visits.[27] Surgical sterilization, implantable hormones, and intrauterine devices all have first-year failure rates of less than 1%.[21] Hormonal contraceptive pills, patches or vaginal rings, and the lactational amenorrhea method (LAM), if adhered to strictly, can also have first-year (or for LAM, first-6-month) failure rates of less than 1%.[27] With typical use, first-year failure rates are considerably high, at 9%, due to inconsistent use.[21] Other methods such as condoms, diaphragms, and spermicides have higher first-year failure rates even with perfect usage.[27] The American Academy of Pediatrics recommends long acting reversible birth control as first line for young individuals.[28]

While all methods of birth control have some potential adverse effects, the risk is less than that of pregnancy.[27] 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.[29]

For individuals with specific health problems, certain forms of birth control may require further investigations.[30] For women who are otherwise healthy, many methods of birth control should not require a medical exam—including birth control pills, injectable or implantable birth control, and condoms.[31] For example, a pelvic exam, breast exam, or blood test before starting birth control pills does not appear to affect outcomes.[32][33][34] In 2009, the World Health Organization (WHO) published a detailed list of medical eligibility criteria for each type of birth control.[30]

Hormonal

Hormonal contraception is available in a number of different forms, including oral pills, implants under the skin, injections, patches, IUDs and a vaginal ring. They are currently available only for women, although hormonal contraceptives for men have been and are being clinically tested.[35] There are two types of oral birth control pills, the combined oral contraceptive pills (which contain both estrogen and a progestin) and the progestogen-only pills (sometimes called minipills).[36] If either is taken during pregnancy, they do not increase the risk of miscarriage nor cause birth defects.[33] Both types of birth control pills prevent fertilization mainly by inhibiting ovulation and thickening cervical mucus.[37][38] They may also change the lining of the uterus and thus decrease implantation.[38] Their effectiveness depends on the user's adherence to taking the pills.[33]

Combined hormonal contraceptives are associated with a slightly increased risk of venous and arterial blood clots.[39] Venous clots, on average, increase from 2.8 to 9.8 per 10,000 women years[40] which is still less than that associated with pregnancy.[39] Due to this risk, they are not recommended in women over 35 years of age who continue to smoke.[41] Due to the increased risk, they are included in decision tools such as the DASH score and PERC rule used to predict the risk of blood clots.[42]

The effect on sexual desire is varied, with increase or decrease in some but with no effect in most.[43] Combined oral contraceptives reduce the risk of ovarian cancer and endometrial cancer and do not change the risk of breast cancer.[44][45] They often reduce menstrual bleeding and painful menstruation cramps.[33] 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.[44]

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.[39][46] 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.[39] 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.[47] The progestins drospirenone and desogestrel minimize the androgenic side effects but increase the risks of blood clots and are thus not first line.[48] The perfect use first-year failure rate of injectable progestin is 0.2%; the typical use first failure rate is 6%.[21]

Plaquettes de pilule

Three varieties of birth control pills in calendar oriented packaging

Birth Control Pills

Birth control pills

BirthControlPatch

A transdermal contraceptive patch

NuvaRing in hand

A NuvaRing vaginal ring

Barrier

Barrier contraceptives are devices that attempt to prevent pregnancy by physically preventing sperm from entering the uterus.[49] They include male condoms, female condoms, cervical caps, diaphragms, and contraceptive sponges with spermicide.[49]

Globally, condoms are the most common method of birth control.[50] Male condoms are put on a man's erect penis and physically block ejaculated sperm from entering the body of a sexual partner.[51] Modern condoms are most often made from latex, but some are made from other materials such as polyurethane, or lamb's intestine.[51] Female condoms are also available, most often made of nitrile, latex or polyurethane.[52] Male condoms have the advantage of being inexpensive, easy to use, and have few adverse effects.[53] Making condoms available to teenagers does not appear to affect the age of onset of sexual activity or its frequency.[54] In Japan, about 80% of couples who are using birth control use condoms, while in Germany this number is about 25%,[55] and in the United States it is 18%.[56]

Male condoms and the diaphragm with spermicide have typical use first-year failure rates of 18% and 12%, respectively.[21] With perfect use condoms are more effective with a 2% first-year failure rate versus a 6% first-year rate with the diaphragm.[21] 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.[5][57]

Contraceptive sponges combine a barrier with a spermicide.[27] Like diaphragms, they are inserted vaginally before intercourse and must be placed over the cervix to be effective.[27] 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.[21] The sponge can be inserted up to 24 hours before intercourse and must be left in place for at least six hours afterward.[27] Allergic reactions[58] and more severe adverse effects such as toxic shock syndrome have been reported.[59]

Kondom

A rolled up male condom.

Condom unrolled durex

An unrolled male latex condom

Préservatif féminin

A polyurethane female condom

Contraceptive diaphragm

A diaphragm vaginal-cervical barrier, in its case with a quarter U.S. coin.

Éponge spermicide

A contraceptive sponge set inside its open package.

Intrauterine devices

Tête de stérilet
Copper T shaped IUD with removal strings

The current intrauterine devices (IUD) are small devices, often 'T'-shaped, containing either copper or levonorgestrel, which are inserted into the uterus. They are one form of long-acting reversible contraception which are the most effective types of reversible birth control.[60] Failure rates with the copper IUD is about 0.8% while the levonorgestrel IUD has a failure rates of 0.2% in the first year of use.[61] Among types of birth control, they, along with birth control implants, result in the greatest satisfaction among users.[62] As of 2007, IUDs are the most widely used form of reversible contraception, with more than 180 million users worldwide.[63]

Evidence supports effectiveness and safety in adolescents[62] and those who have and have not previously had children.[64] IUDs do not affect breastfeeding and can be inserted immediately after delivery.[65] They may also be used immediately after an abortion.[66] Once removed, even after long term use, fertility returns to normal immediately.[67]

While copper IUDs may increase menstrual bleeding and result in more painful cramps,[68] hormonal IUDs may reduce menstrual bleeding or stop menstruation altogether.[65] Cramping can be treated with painkillers like non-steroidal anti-inflammatory drugs.[69] Other potential complications include expulsion (2–5%) and rarely perforation of the uterus (less than 0.7%).[65][69] A previous model of the intrauterine device (the Dalkon shield) was associated with an increased risk of pelvic inflammatory disease, however the risk is not affected with current models in those without sexually transmitted infections around the time of insertion.[70] IUDs appear to decrease the risk of ovarian cancer.[71]

Sterilization

Surgical sterilization is available in the form of tubal ligation for women and vasectomy for men.[2] There are no significant long term side effects, and tubal ligation decreases the risk of ovarian cancer.[2] Short term complications are twenty times less likely from a vasectomy than a tubal ligation.[2][72] After a vasectomy, there may be swelling and pain of the scrotum which usually resolves in one or two weeks.[73] With tubal ligation, complications occur in 1 to 2 percent of procedures with serious complications usually due to the anesthesia.[74] Neither method offers protection from sexually transmitted infections.[2]

This decision may cause regret in some men and women. Of women aged over 30 who have undergone tubal ligation, about 5% regret their decision, as compared with 20% of women aged under 30.[2] By contrast, less than 5% of men are likely to regret sterilization. Men who are more likely to regret sterilization are younger, have young or no children, or have an unstable marriage.[75] In a survey of biological parents, 9% stated they would not have had children if they were able to do it over again.[76]

Although sterilization is considered a permanent procedure,[77] it is possible to attempt a tubal reversal to reconnect the fallopian tubes or a vasectomy reversal to reconnect the vasa deferentia. In women, the desire for a reversal is often associated with a change in spouse.[77] Pregnancy success rates after tubal reversal are between 31 and 88 percent, with complications including an increased risk of ectopic pregnancy.[77] The number of males who request reversal is between 2 and 6 percent.[78] Rates of success in fathering another child after reversal are between 38 and 84 percent; with success being lower the longer the time period between the vasectomy and the reversal.[78] Sperm extraction followed by in vitro fertilization may also be an option in men.[79]

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.[80] If used perfectly the first-year failure rate may be around 3.4%, however if used poorly first-year failure rates may approach 85%.[81]

Fertility awareness

Geburtenkontrollkette (cropped)
A CycleBeads tool, used for estimating fertility based on days since last menstruation

Fertility awareness methods involve determining the most fertile days of the menstrual cycle and avoiding unprotected intercourse.[80] Techniques for determining fertility include monitoring basal body temperature, cervical secretions, or the day of the cycle.[80] They have typical first-year failure rates of 24%; perfect use first-year failure rates depend on which method is used and range from 0.4% to 5%.[21] The evidence on which these estimates are based, however, is poor as the majority of people in trials stop their use early.[80] Globally, they are used by about 3.6% of couples.[82] If based on both basal body temperature and another primary sign, the method is referred to as symptothermal. First-year failure rates of 20% overall and 0.4% for perfect use have been reported in clinical studies of the symptothermal method.[83][21] A number of fertility tracking apps are available, as of 2016, but they are more commonly designed to assist those trying to get pregnant rather than prevent pregnancy.[84]

Withdrawal

The withdrawal method (also known as coitus interruptus) is the practice of ending intercourse ("pulling out") before ejaculation.[85] The main risk of the withdrawal method is that the man may not perform the maneuver correctly or in a timely manner.[85] First-year failure rates vary from 4% with perfect usage to 22% with typical usage.[21] It is not considered birth control by some medical professionals.[27]

There is little data regarding the sperm content of pre-ejaculatory fluid.[86] While some tentative research did not find sperm,[86] one trial found sperm present in 10 out of 27 volunteers.[87] The withdrawal method is used as birth control by about 3% of couples.[82]

Abstinence

Sexual abstinence may be used as a form of birth control, meaning either not engaging in any type of sexual activity, or specifically not engaging in vaginal intercourse, while engaging in other forms of non-vaginal sex.[88][89] Complete sexual abstinence is 100% effective in preventing pregnancy.[90][91] However, among those who take a pledge to abstain from premarital sex, as many as 88% who engage in sex, do so prior to marriage.[92] The choice to abstain from sex cannot protect against pregnancy as a result of rape, and public health efforts emphasizing abstinence to reduce unwanted pregnancy may have limited effectiveness, especially in developing countries and among disadvantaged groups.[93][94]

Deliberate non-penetrative sex without vaginal sex or deliberate oral sex without vaginal sex are also sometimes considered birth control.[88] While this generally avoids pregnancy, pregnancy can still occur with intercrural sex and other forms of penis-near-vagina sex (genital rubbing, and the penis exiting from anal intercourse) where sperm can be deposited near the entrance to the vagina and can travel along the vagina's lubricating fluids.[95][96]

Abstinence-only sex education does not reduce teenage pregnancy.[7][97] 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.[97] Some authorities recommend that those using abstinence as a primary method have backup methods available (such as condoms or emergency contraceptive pills).[98]

Lactation

The lactational amenorrhea method involves the use of a woman's natural postpartum infertility which occurs after delivery and may be extended by breastfeeding.[99] This usually requires the presence of no periods, exclusively breastfeeding the infant, and a child younger than six months.[24] The World Health Organization states that if breastfeeding is the infant's only source of nutrition, the failure rate is 2% in the six months following delivery.[100] Six uncontrolled studies of lactational amenorrhea method users found failure rates at 6 months postpartum between 0% and 7.5%.[101] Failure rates increase to 4–7% at one year and 13% at two years.[102] Feeding formula, pumping instead of nursing, the use of a pacifier, and feeding solids all increase its failure rate.[103] In those who are exclusively breastfeeding, about 10% begin having periods before three months and 20% before six months.[102] In those who are not breastfeeding, fertility may return four weeks after delivery.[102]

Emergency

Emergency contraceptive (cropped)
A split dose of two emergency contraceptive pills

Emergency contraceptive methods are medications (sometimes misleadingly referred to as "morning-after pills")[104] or devices used after unprotected sexual intercourse with the hope of preventing pregnancy.[8] They work primarily by preventing ovulation or fertilization.[2][105] They are unlikely to affect implantation, but this has not been completely excluded.[105] A number of options exist, including high dose birth control pills, levonorgestrel, mifepristone, ulipristal and IUDs.[106] Providing emergency contraceptive pills to women in advance does not affect rates of sexually transmitted infections, condom use, pregnancy rates, or sexual risk-taking behavior.[107][108] All methods have minimal side effects.[106]

Levonorgestrel pills, when used within 3 days, decrease the chance of pregnancy after a single episode of unprotected sex or condom failure by 70% (resulting in a pregnancy rate of 2.2%).[8] Ulipristal, when used within 5 days, decreases the chance of pregnancy by about 85% (pregnancy rate 1.4%) and is more effective than levonorgestrel.[8][106][109] Mifepristone is also more effective than levonorgestrel, while copper IUDs are the most effective method.[106] IUDs can be inserted up to five days after intercourse and prevent about 99% of pregnancies after an episode of unprotected sex (pregnancy rate of 0.1 to 0.2%).[2][110] This makes them the most effective form of emergency contraceptive.[111] In those who are overweight or obese, levonorgestrel is less effective and an IUD or ulipristal is recommended.[112]

Dual protection

Dual protection is the use of methods that prevent both sexually transmitted infections and pregnancy.[113] This can be with condoms either alone or along with another birth control method or by the avoidance of penetrative sex.[114][115]

If pregnancy is a high concern, using two methods at the same time is reasonable.[114] For example, two forms of birth control are recommended in those taking the anti-acne drug isotretinoin or anti-epileptic drugs like carbamazepine, due to the high risk of birth defects if taken during pregnancy.[116][117]

Effects

Health

Maternal mortality rate worldwide
Maternal mortality rate as of 2010.[118]
Scatterplot of contraceptive use and TFR by region 2010
Birth control use and total fertility rate by region.

Contraceptive use in developing countries is estimated to have decreased the number of maternal deaths by 40% (about 270,000 deaths prevented in 2008) and could prevent 70% of deaths if the full demand for birth control were met.[17][18] These benefits are achieved by reducing the number of unplanned pregnancies that subsequently result in unsafe abortions and by preventing pregnancies in those at high risk.[17]

Birth control also improves child survival in the developing world by lengthening the time between pregnancies.[17] In this population, outcomes are worse when a mother gets pregnant within eighteen months of a previous delivery.[17][119] 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.[119]

Teenage pregnancies, especially among younger teens, are at greater risk of adverse outcomes including early birth, low birth weight, and death of the infant.[12] In the United States 82% of pregnancies in those between 15 and 19 are unplanned.[69] Comprehensive sex education and access to birth control are effective in decreasing pregnancy rates in this age group.[120]

Finances

Fertility rate world map 2
Map of countries by fertility rate (2018)

In the developing world, birth control increases economic growth due to there being fewer dependent children and thus more women participating in or increased contribution to the workforce.[19] Women's earnings, assets, body mass index, and their children's schooling and body mass index all improve with greater access to birth control.[19] Family planning, via the use of modern birth control, is one of the most cost-effective health interventions.[121] For every dollar spent, the United Nations estimates that two to six dollars are saved.[16] These cost savings are related to preventing unplanned pregnancies and decreasing the spread of sexually transmitted illnesses.[121] While all methods are beneficial financially, the use of copper IUDs resulted in the greatest savings.[121]

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.[122] In most other countries, the cost is less than half.[122] For a child born in 2011, an average US family will spend $235,000 over 17 years to raise them.[123]

Prevalence

SOWM2010 modern contraception
World map colored according to modern birth control use. Each shading level represents a range of six percentage points, with usage less than or equal to:

Globally, as of 2009, approximately 60% of those who are married and able to have children use birth control.[124] How frequently different methods are used varies widely between countries.[124] 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.[124] 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.[124]

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.[63] 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.[125] 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.[126] Usage of male forms of birth control has decreased between 1985 and 2009.[124] Contraceptive use among women in Sub-Saharan Africa has risen from about 5% in 1991 to about 30% in 2006.[127]

As of 2012, 57% of women of childbearing age want to avoid pregnancy (867 of 1,520 million).[128] 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.[128] This results in 54 million unplanned pregnancies and nearly 80,000 maternal deaths a year.[124] 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.[129] 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.[129]

History

Early history

Silphium
Ancient silver coin from Cyrene depicting a stalk of silphium

The Egyptian Ebers Papyrus from 1550 BC and the Kahun Papyrus from 1850 BC have within them some of the earliest documented descriptions of birth control: the use of honey, acacia leaves and lint to be placed in the vagina to block sperm.[130][131] Silphium, a species of giant fennel native to north Africa, may have been used as birth control in ancient Greece and the ancient Near East.[132][133] Due to its supposed desirability, by the first century AD, it had become so rare that it was worth more than its weight in silver and, by late antiquity, it was fully extinct.[132] Most methods of birth control used in antiquity were probably ineffective.[134]

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.[134] 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.[134] This method was not only ineffective, but also dangerous, as the later medical writer Soranus of Ephesus (c. 98–138 AD) pointed out.[134] Soranus attempted to list reliable methods of birth control based on rational principles.[134] 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.[134] Many of Soranus's methods were probably also ineffective.[134]

In medieval Europe, any effort to halt pregnancy was deemed immoral by the Catholic Church,[130] although it is believed that women of the time still used a number of birth control measures, such as coitus interruptus and inserting lily root and rue into the vagina.[135] Women in the Middle Ages were also encouraged to tie weasel testicles around their thighs during sex to prevent pregnancy.[136] The oldest condoms discovered to date were recovered in the ruins of Dudley Castle in England, and are dated back to 1640.[136] They were made of animal gut, and were most likely used to prevent the spread of sexually transmitted diseases during the English Civil War.[136] Casanova, living in 18th century Italy, described the use of a lambskin covering to prevent pregnancy; however, condoms only became widely available in the 20th century.[130]

Birth control movement

VictorianPostcard
"And the villain still pursues her", a satirical Victorian era postcard

The birth control movement developed during the 19th and early 20th centuries.[137] The Malthusian League, based on the ideas of Thomas Malthus, was established in 1877 in the United Kingdom to educate the public about the importance of family planning and to advocate for getting rid of penalties for promoting birth control.[138] It was founded during the "Knowlton trial" of Annie Besant and Charles Bradlaugh, who were prosecuted for publishing on various methods of birth control.[139]

In the United States, Margaret Sanger and Otto Bobsein popularized the phrase "birth control" in 1914.[140][141] Sanger primarily advocated for birth control on the idea that it would prevent women from seeking unsafe abortions, but during her lifetime, she began to campaign for it on the grounds that it would reduce mental and physical defects.[142][143] She was mainly active in the United States but had gained an international reputation by the 1930s. At the time, under the Comstock Law, distribution of birth control information was illegal. She jumped bail in 1914 after her arrest for distributing birth control information and left the United States for the United Kingdom.[144] In the U.K., Sanger, influenced by Havelock Ellis, further developed her arguments for birth control. She believed women needed to enjoy sex without fearing a pregnancy. During her time abroad, Sanger also saw a more flexible diaphragm in a Dutch clinic, which she thought was a better form of contraceptive.[143] Once Sanger returned to the United States, she established a short-lived birth-control clinic with the help of her sister, Ethel Bryne, based in the Brownville section of Brooklyn, New York[145] in 1916. It was shut down after eleven days and resulted in her arrest.[146] The publicity surrounding the arrest, trial, and appeal sparked birth control activism across the United States.[147] Besides her sister, Sanger was helped in the movement by her first husband, William Sanger, who distributed copies of “Family Limitation.” Sanger’s second husband, James Noah H. Slee, would also later become involved in the movement, acting as its main funder.[143]

The increased use of birth control was seen by some as a form of social decay.[148] 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.[148] These organizations failed to enlist more than 100,000 women because the use of birth control was often compared to eugenics;[148] 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.[149]

The first permanent birth-control clinic was established in Britain in 1921 by Marie Stopes working with the Malthusian League.[150] The clinic, run by midwives and supported by visiting doctors,[151] 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.[152] 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.[153] 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.[154]

The National Birth Control Association was founded in Britain in 1931, and became the Family Planning Association eight years later. The Association amalgamated several British birth control-focused groups into 'a central organisation' for administering and overseeing birth control in Britain. The group incorporated the Birth Control Investigation Committee, a collective of physicians and scientists that was founded to investigate scientific and medical aspects of contraception with 'neutrality and impartiality'.[155] Subsequently, the Association effected a series of 'pure' and 'applied' product and safety standards that manufacturers must meet to ensure their contraceptives could be prescribed as part of the Association's standard two-part-technique combining ‘a rubber appliance to protect the mouth of the womb’ with a ‘chemical preparation capable of destroying... sperm’.[156] Between 1931 and 1959, the Association founded and funded a series of tests to assess chemical efficacy and safety and rubber quality.[157] These tests became the basis for the Association's Approved List of contraceptives, which was launched in 1937, and went on to become an annual publication that the expanding network of FPA clinics relied upon as a means to 'establish facts [about contraceptives] and to publish these facts as a basis on which a sound public and scientific opinion can be built'.[158]

In 1936 the U.S. court ruled in U.S. v. One Package that medically prescribing contraception to save a person's life or well-being was not illegal under the Comstock Law; following this decision, the American Medical Association Committee on Contraception revoked its 1936 statement condemning birth control. A national survey in 1937 showed 71 percent of the adult population supported the use of contraception. By 1938 347 birth control clinics were running in the United States despite their advertisement still being illegal. First Lady Eleanor Roosevelt publicly supported birth control and family planning.[159] In 1966, President Lyndon B. Johnson started endorsing public funding for family planning services, and the Federal Government began subsidizing birth control services for low-income families.[160] The Affordable Care Act, passed into law on March 23, 2010 under President Barack Obama, requires all plans in the Health Insurance Marketplace to cover contraceptive methods. These include barrier methods, hormonal methods, implanted devices, emergency contraceptives, and sterilization procedures.[161]

Modern methods

In 1909, Richard Richter developed the first intrauterine device made from silkworm gut, which was further developed and marketed in Germany by Ernst Gräfenberg in the late 1920s.[162] In 1951, a chemist, named Carl Djerassi from Mexico City made the hormones in progesterone pills using Mexican yams.[163] Djerassi had chemically created the pill but was not equipped to distribute it to patients. Meanwhile, Gregory Pincus and John Rock with help from the Planned Parenthood Federation of America developed the first birth control pills in the 1950s, such as mestranol/noretynodrel, which became publicly available in the 1960s through the Food and Drug Administration under the name Enovid.[152][164] Medical abortion became an alternative to surgical abortion with the availability of prostaglandin analogs in the 1970s and mifepristone in the 1980s.[165]

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.[166]

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 1971, Eisenstadt v. Baird extended this right to privacy to single people.[167]

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 the year 2020. Additionally, they aim to eradicate discrimination against girls and young women who seek contraceptives.[168] The American Congress of Obstetricians and Gynecologists (ACOG) recommended in 2014 that oral birth control pills should be over the counter medications.[169]

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 1873–2013 they found a divide between institutional ideology and real-life experiences of women.[170]

Religious views

Religions vary widely in their views of the ethics of birth control.[171] The Roman Catholic Church officially only accepts natural family planning,[172] although large numbers of Catholics in developed countries accept and use modern methods of birth control.[173][174][175] Among Protestants, there is a wide range of views from supporting none, such as in the Quiverfull movement, to allowing all methods of birth control.[176] Views in Judaism range from the stricter Orthodox sect, which prohibits all methods of birth control, to the more relaxed Reform sect, which allows most.[177] Hindus may use both natural and modern contraceptives.[178] A common Buddhist view is that preventing conception is acceptable, while intervening after conception has occurred is not.[179] In Islam, contraceptives are allowed if they do not threaten health, although their use is discouraged by some.[180]

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.[181] It is supported by a group of governments and international NGOs, including the Office of Population Affairs, the Asian Pacific Council on Contraception, Centro Latinamericano Salud y Mujer, the European Society of Contraception and Reproductive Health, the German Foundation for World Population, the International Federation of Pediatric and Adolescent Gynecology, International Planned Parenthood Federation, the Marie Stopes International, Population Services International, the Population Council, the United States Agency for International Development (USAID), and Women Deliver.[181]

Misconceptions

There are a number of common misconceptions regarding sex and pregnancy.[182] Douching after sexual intercourse is not an effective form of birth control.[183] Additionally, it is associated with a number of health problems and thus is not recommended.[184] Women can become pregnant the first time they have sexual intercourse[185] and in any sexual position.[186] It is possible, although not very likely, to become pregnant during menstruation.[187]

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.[27] A number of alterations of existing contraceptive methods are being studied, including a better female condom, an improved diaphragm, a patch containing only progestin, and a vaginal ring containing long-acting progesterone.[188] This vaginal ring appears to be effective for three or four months and is currently available in some areas of the world.[188] For women who rarely have sex, the taking of the hormonal birth control levonorgestrel around the time of sex looks promising.[189]

A number of methods to perform sterilization via the cervix are being studied. One involves putting quinacrine in the uterus which causes scarring and infertility. While the procedure is inexpensive and does not require surgical skills, there are concerns regarding long-term side effects.[190] Another substance, polidocanol, which functions in the same manner is being looked at.[188] A device called Essure, which expands when placed in the fallopian tubes and blocks them, was approved in the United States in 2002.[190]

Males

Methods of male birth control include condoms, vasectomies and withdrawal.[191][192] Between 25 and 75% of males who are sexually active would use hormonal birth control if it was available for them.[126][191] A number of hormonal and non-hormonal methods are in trials,[126] and there is some research looking at the possibility of contraceptive vaccines.[193]

A reversible surgical method under investigation is reversible inhibition of sperm under guidance (RISUG) which consists of injecting a polymer gel, styrene maleic anhydride in dimethyl sulfoxide, into the vas deferens. An injection with sodium bicarbonate washes out the substance and restores fertility. Another is an intravas device which involves putting a urethane plug into the vas deferens to block it. A combination of an androgen and a progestin seems promising, as do selective androgen receptor modulators.[126] Ultrasound and methods to heat the testicles have undergone preliminary studies.[194]

Other animals

Neutering or spaying, which involves removing some of the reproductive organs, is often carried out as a method of birth control in household pets. Many animal shelters require these procedures as part of adoption agreements.[195] In large animals the surgery is known as castration.[196]

Birth control is also being considered as an alternative to hunting as a means of controlling overpopulation in wild animals.[197] Contraceptive vaccines have been found to be effective in a number of different animal populations.[198][199] Kenyan goat herders fix a skirt, called an olor, to male goats to prevent them from impregnating female goats.[200]

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  199. ^ Levy, JK (July 2011). "Contraceptive vaccines for the humane control of community cat populations". American Journal of Reproductive Immunology (New York: 1989). 66 (1): 63–70. doi:10.1111/j.1600-0897.2011.01005.x. PMC 5567843. PMID 21501281.
  200. ^ "Goat 'condoms' save Kenyan herds". BBC News. October 6, 2008. Archived from the original on October 6, 2008. Retrieved October 6, 2008.

Further reading

  • Speroff, Leon; Darney, Philip D. (2010). A clinical guide for contraception (5th ed.). Philadelphia: Lippincott Williams & Wilkins. ISBN 978-1-60831-610-6.
  • Stubblefield, Phillip G.; Roncari, Danielle M. (2011). "Family Planning", pp. 211–69, in Berek, Jonathan S. (ed.) Berek & Novak's Gynecology, 15th ed. Philadelphia: Lippincott Williams & Wilkins, ISBN 978-1-4511-1433-1.
  • Jensen, Jeffrey T.; Mishell, Daniel R. Jr. (March 19, 2012). "Family Planning: Contraception, Sterilization, and Pregnancy Termination", pp. 215–72, in Lentz, Gretchen M.; Lobo, Rogerio A.; Gershenson, David M.; Katz, Vern L. (eds.) Comprehensive Gynecology, 6th ed. Philadelphia: Mosby Elsevier, ISBN 978-0-323-06986-1.
  • Gavin, L; Moskosky, S; Carter, M; Curtis, K; Glass, E (Apr 25, 2014). Godfrey, E; Marcell, A; Mautone-Smith, N; Pazol, K; Tepper, N; Zapata, L; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. "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.

External links

Antibiotic

An antibiotic is a type of antimicrobial substance active against bacteria and is the most important type of antibacterial agent for fighting bacterial infections. Antibiotic medications are widely used in the treatment and prevention of such infections. They may either kill or inhibit the growth of bacteria. A limited number of antibiotics also possess antiprotozoal activity. Antibiotics are not effective against viruses such as the common cold or influenza; drugs which inhibit viruses are termed antiviral drugs or antivirals rather than antibiotics.

Sometimes, the term antibiotic which means "opposing life", based on Greek roots, (ἀντι-) anti: "against" and (βίος-) biotic: "life", is broadly used to refer to any substance used against microbes, but in the usual medical usage, antibiotics (such as penicillin) are those produced naturally (by one microorganism fighting another), whereas nonantibiotic antibacterials (such as sulfonamides and antiseptics) are fully synthetic. However, both classes have the same goal of killing or preventing the growth of microorganisms, and both are included in antimicrobial chemotherapy. "Antibacterials" include antiseptic drugs, antibacterial soaps, and chemical disinfectants, whereas antibiotics are an important class of antibacterials used more specifically in medicine and sometimes in livestock feed.

There's evidence of antibiotic use since ancient times. Many civilizations used topical application of mouldy bread, with many references to its beneficial effects arising from ancient Egypt, China, Serbia, Greece and Rome. The first person to directly document the use of moulds to treat infections was John Parkinson (1567–1650). Antibiotics truly revolutionized medicine in the 20th century. Alexander Fleming (1881–1955) discovered modern day penicillin in 1928. After realizing the great potential there was in penicillin, Fleming pursued the challenge of how to market it and translate it to commercial use. With help from other biochemists, penicillin was finally available for widespread use. This was significantly beneficial during wartime. Unfortunately, it didn't take long for resistance to begin. Effectiveness and easy access have also led to their overuse and some bacteria have developed resistance. This has led to widespread problems, and the World Health Organization have classified antimicrobial resistance as a "serious threat [that] is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country".

Birth control movement in the United States

The birth control movement in the United States was a social reform campaign beginning in 1914 that aimed to increase the availability of contraception in the U.S. through education and legalization. The movement began in 1914 when a group of political radicals in New York City, led by Emma Goldman, Mary Dennett, and Margaret Sanger, became concerned about the hardships that childbirth and self-induced abortions brought to low-income women. Sanger, in particular, simultaneously sought to connect birth control to the organized eugenics movement, regularly appealing to the authority of eugenic scientists Karl Pearson, Charles Davenport, and others in her Birth Control Review from the early 1920s. Such figures sought to prevent population segments they deemed genetically 'undesirable' from reproducing. While seeking legitimacy for the birth control movement partly through the approval of organized eugenics, Sanger and other activists also worked on the political front. Since contraception was considered to be obscene at the time, the activists targeted the Comstock laws, which prohibited distribution of any "obscene, lewd, and/or lascivious" materials through the mail. Hoping to provoke a favorable legal decision, Sanger deliberately broke the law by distributing The Woman Rebel, a newsletter containing a discussion of contraception. In 1916, Sanger opened the first birth control clinic in the United States, but the clinic was immediately shut down by police, and Sanger was sentenced to 30 days in jail.

A major turning point for the movement came during World War I, when many U.S. servicemen were diagnosed with venereal diseases. The government's response included an anti-venereal disease campaign that framed sexual intercourse and contraception as issues of public health and legitimate topics of scientific research. This was the first time a U.S. government institution had engaged in a sustained, public discussion of sexual matters; as a consequence, contraception transformed from an issue of morals to an issue of public health.

Encouraged by the public's changing attitudes towards birth control, Sanger opened a second birth control clinic in 1923, but this time there were no arrests or controversy. Throughout the 1920s, public discussion of contraception became more commonplace, and the term "birth control" became firmly established in the nation's vernacular. The widespread availability of contraception signaled a transition from the stricter sexual mores of the Victorian era to a more sexually permissive society.

Legal victories in the 1930s continued to weaken anti-contraception laws. The court victories motivated the American Medical Association in 1937 to adopt contraception as a core component of medical school curricula, but the medical community was slow to accept this new responsibility, and women continued to rely on unsafe and ineffective contraceptive advice from ill-informed sources. In 1942, the Planned Parenthood Federation of America was formed, creating a nationwide network of birth control clinics. After World War II, the movement to legalize birth control came to a gradual conclusion, as birth control was fully embraced by the medical profession, and the remaining anti-contraception laws were no longer enforced.

Coitus interruptus

Coitus interruptus, also known as the rejected sexual intercourse, withdrawal or pull-out method, is a method of birth control in which a man, during sexual intercourse, withdraws his penis from a woman's vagina prior to orgasm (and ejaculation) and then directs his ejaculate (semen) away from the vagina in an effort to avoid insemination.

This method of contraception, widely used for at least two millennia, is still in use today. This method was used by an estimated 38 million couples worldwide in 1991. Coitus interruptus does not protect against sexually transmitted infections (STIs/STDs).

Combined oral contraceptive pill

The combined oral contraceptive pill (COCP), often referred to as the birth control pill or colloquially as "the pill", is a type of birth control that is designed to be taken orally by women. It includes a combination of an estrogen (usually ethinylestradiol) and a progestogen (specifically a progestin). When taken correctly, it alters the menstrual cycle to eliminate ovulation and prevent pregnancy.

They were first approved for contraceptive use in the United States in 1960, and are a very popular form of birth control. They are currently used by more than 100 million women worldwide and by almost 12 million women in the United States. As of 2012, 16% of U.S. women aged 15–44 reported being on the birth control pill, making it the most widely used contraceptive method among women of that age range. Use varies widely by country, age, education, and marital status. One third of women aged 16–49 in the United Kingdom currently use either the combined pill or progestogen-only pill,

compared with less than 3% of women in Japan.Two forms of combined oral contraceptives are on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system. The pill was a catalyst for the sexual revolution.

Compulsory sterilization

Compulsory sterilization, also known as forced or coerced sterilization, programs are government policies which force people to undergo surgical or other sterilization. The reasons governments implement sterilization programs vary in purpose and intent. In the first half of the 20th century, several such programs were instituted in countries around the world, usually as part of eugenics programs intended to prevent the reproduction of members of the population considered to be carriers of defective genetic traits.Other bases for compulsory sterilization have included general population growth management, sex discrimination, "sex-normalizing" surgeries of intersex persons, limiting the spread of HIV, and reducing the population of ethnic groups. The last is counted as an act of genocide under the Statute of Rome. Some countries require transgender people to undergo sterilization before gaining legal recognition of their gender, a practice that Juan E. Méndez, the United Nations Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment cites as a violation of the Yogyakarta Principles.Compulsory sterilization has been proposed as a means of human population planning.

Comstock laws

The Comstock Laws were a set of federal acts passed by the United States Congress under the Grant administration along with related state laws. The "parent" act (Sect. 211) was passed on March 3, 1873, as the Act for the "Suppression of Trade in, and Circulation of, Obscene Literature and Articles of Immoral Use". This Act criminalized usage of the U.S. Postal Service to send any of the following items:

obscenity

contraceptives

abortifacients

sex toys

personal letters with any sexual content or information

or any information regarding the above items.A similar federal act (Sect. 245) of 1909 applied to delivery by interstate "express" or any other common carrier (such as railroad, instead of delivery by the U.S. Postal Service).

In Washington, D.C., where the federal government had direct jurisdiction, another Comstock act (Sect. 312) also made it illegal (punishable by up to 5 years at hard labor), to sell, lend, or give away any "obscene" publication, or article used for contraception or abortion. Section 305 of the Tariff Act of 1922 forbade the importation of any contraceptive information or means.In addition to these federal laws, about half of the states enacted laws related to the federal Comstock laws. These state laws are considered by Dennett to also be "Comstock laws".

The laws were named after their chief proponent, Anthony Comstock. Comstock received a commission from the Postmaster General to serve as a special agent for the U.S. Postal Service.Numerous failed attempts were made to repeal or modify these laws and eventually, many of them (or portions of them) were declared unconstitutional. In 1919 in a law journal, a judge, after reviewing the various laws (especially state laws) called the set of them "haphazard and capricious" and lacking "any clear, broad, well-defined principle or purpose".

Condom

A condom is a sheath-shaped barrier device, used during sexual intercourse to reduce the probability of pregnancy or a sexually transmitted infection (STI). There are both male and female condoms. With proper use—and use at every act of intercourse—women whose partners use male condoms experience a 2% per-year pregnancy rate. With typical use the rate of pregnancy is 18% per-year. Their use greatly decreases the risk of gonorrhea, chlamydia, trichomoniasis, hepatitis B, and HIV/AIDS. They also to a lesser extent protect against genital herpes, human papillomavirus (HPV), and syphilis.The male condom is rolled onto an erect penis before intercourse and works by blocking semen from entering the body of a sexual partner. Male condoms are typically made from latex and less commonly from polyurethane or lamb intestine. Male condoms have the advantages of ease of use, easy to access, and few side effects. In those with a latex allergy a polyurethane or other synthetic version should be used. Female condoms are typically made from polyurethane and may be used multiple times.Condoms as a method of preventing STIs have been used since at least 1564. Rubber condoms became available in 1855, followed by latex condoms in the 1920s. They are on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. The wholesale cost in the developing world is about 0.03 to US$0.08 each. In the United States condoms usually cost less than US$1.00. Globally less than 10% of those using birth control are using the condom. Rates of condom use are higher in the developed world. In the United Kingdom the condom is the second most common method of birth control (22%) while in the United States it is the third most common (15%). About six to nine billion are sold a year.

Dysmenorrhea

Dysmenorrhea, also known as painful periods, or menstrual cramps, is pain during menstruation. Its usual onset occurs around the time that menstruation begins. Symptoms typically last less than three days. The pain is usually in the pelvis or lower abdomen. Other symptoms may include back pain, diarrhea, or nausea.In young women painful periods often occur without an underlying problem. In older women it is more often due to an underlying issues such as uterine fibroids, adenomyosis, or endometriosis. It is more common among those with heavy periods, irregular periods, whose periods started before twelve years of age, or who have a low body weight. A pelvic exam in those who are sexually active and ultrasound may be useful to help in diagnosis. Conditions that should be ruled out include ectopic pregnancy, pelvic inflammatory disease, interstitial cystitis, and chronic pelvic pain.Dysmenorrhea occurs less often in those who exercise regularly and those who have children early in life. Treatment may include the use of a heating pad. Medications that may help include NSAIDs such as ibuprofen, hormonal birth control, and the IUD with progestogen. Taking vitamin B or magnesium may help. Evidence for yoga, acupuncture, and massage is insufficient. Surgery may be useful if certain underlying problems are present.Estimates of the percentage of women of reproductive age affected varying from 20 to 90%. It is the most common menstrual disorder. Typically it starts within a year of the first menstrual period. When there is no underlying cause often the pain improves with age or following having a child.

Griswold v. Connecticut

Griswold v. Connecticut, 381 U.S. 479 (1965), is a landmark case in the United States about access to contraception. The case involved a Connecticut "Comstock law" that prohibited any person from using "any drug, medicinal article or instrument for the purpose of preventing conception." The court held that the statute was unconstitutional, and that "the clear effect of [the Connecticut law ...] is to deny disadvantaged citizens ... access to medical assistance and up-to-date information in respect to proper methods of birth control." By a vote of 7–2, the Supreme Court invalidated the law on the grounds that it violated the "right to marital privacy", establishing the basis for the right to privacy with respect to intimate practices. This and other cases view the right to privacy as a right to "protect[ion] from governmental intrusion."

Although the Bill of Rights does not explicitly mention "privacy", Justice William O. Douglas wrote for the majority that the right was to be found in the "penumbras" and "emanations" of other constitutional protections, such as the self-incrimination clause of the Fifth Amendment. Douglas wrote, "Would we allow the police to search the sacred precincts of marital bedrooms for telltale signs of the use of contraceptives? The very idea is repulsive to the notions of privacy surrounding the marriage relationship." Justice Arthur Goldberg wrote a concurring opinion in which he used the Ninth Amendment in support of the Supreme Court's ruling. Justice Byron White and Justice John Marshall Harlan II wrote concurring opinions in which they argued that privacy is protected by the due process clause of the Fourteenth Amendment.

Hormonal contraception

Hormonal contraception refers to birth control methods that act on the endocrine system. Almost all methods are composed of steroid hormones, although in India one selective estrogen receptor modulator is marketed as a contraceptive. The original hormonal method—the combined oral contraceptive pill—was first marketed as a contraceptive in 1960. In the ensuing decades many other delivery methods have been developed, although the oral and injectable methods are by far the most popular. Altogether, 18% of the world's contraceptive users rely on hormonal methods. Hormonal contraception is highly effective: when taken on the prescribed schedule, users of steroid hormone methods experience pregnancy rates of less than 1% per year. Perfect-use pregnancy rates for most hormonal contraceptives are usually around the 0.3% rate or less. Currently available methods can only be used by women; the development of a male hormonal contraceptive is an active research area.

There are two main types of hormonal contraceptive formulations: combined methods which contain both an estrogen and a progestin, and progestogen-only methods which contain only progesterone or one of its synthetic analogues (progestins). Combined methods work by suppressing ovulation and thickening cervical mucus; while progestogen-only methods reduce the frequency of ovulation, most of them rely more heavily on changes in cervical mucus. The incidence of certain side effects is different for the different formulations: for example, breakthrough bleeding is much more common with progestogen-only methods. Certain serious complications occasionally caused by estrogen-containing contraceptives are not believed to be caused by progestogen-only formulations: deep vein thrombosis is one example of this.

Intrauterine device

An intrauterine device (IUD), also known as intrauterine contraceptive device (IUCD or ICD) or coil, is a small, often T-shaped birth control device that is inserted into a woman's uterus to prevent pregnancy. IUDs are one form of long-acting reversible birth control (LARC). Among birth control methods, IUDs, along with contraceptive implants, result in the greatest satisfaction among users. One study found that female family planning providers choose LARC methods more often (41.7%) than the general public (12.1%).IUDs are safe and effective in adolescents as well as those who have not previously had children. Once an IUD is removed, even after long-term use, fertility returns to normal rapidly. Copper devices have a failure rate of about 0.8% while hormonal (levonorgestrel) devices fail about 0.2% of the time within the first year of use. In comparison, male sterilization and male condoms have a failure rate of about 0.15% and 15%, respectively. Copper IUDs can also be used as emergency contraception within 5 days of unprotected sex.Although copper IUDs may increase menstrual bleeding and result in painful cramps, hormonal IUDs may reduce menstrual bleeding or stop menstruation altogether. However, women can have daily spotting for several months and it can take up to three months for there to be a 90% decrease in bleeding. Cramping can be treated with NSAIDs. More serious potential complications include expulsion (2–5%) and rarely perforation of the uterus (less than 0.7%). IUDs do not affect breastfeeding and can be inserted immediately after delivery. They may also be used immediately after an abortion.The use of IUDs has increased within the United States from 0.8% in 1995 to 5.6% from the period of 2006 to 2010. The use of IUDs as a form of birth control dates from the 1800s. A previous model known as the Dalkon shield was associated with an increased risk of pelvic inflammatory disease (PID). However, current models do not affect PID risk in women without sexually transmitted infections during the time of insertion.

Levonorgestrel

Levonorgestrel is a hormonal medication which is used in a number of birth control methods. In pill form, sold under the brand name Plan B among others, it is useful within 120 hours as emergency birth control. It becomes less effective the longer after sex and only works before pregnancy has occurred. It is also combined with an estrogen to make combined oral birth control pills. Within an intrauterine device (IUD), sold as Mirena among others, it is effective for long-term prevention of pregnancy. An implantable form of levonorgestrel is also available in some countries.Common side effects include nausea, breast tenderness, headaches, and increased, decreased, or irregular menstrual bleeding. When used as a form of emergency contraception, if pregnancy occurs, there is no evidence its use harms the baby. It is safe to use during breastfeeding. Birth control that contains levonorgestrel will not change the risk of sexually transmitted infections. It is a progestin and has effects similar to those of the hormone progesterone. It works mostly by preventing ovulation and closing off the cervix to prevent the passage of sperm.Levonorgestrel was discovered in 1963 and was introduced for medical use together with ethinylestradiol in 1970. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. It is available as a generic medication. The wholesale cost in the developing world costs between 0.23 and US$1.65 for the dose required for emergency birth control. In the United States it is over the counter for all ages.

Malthusianism

Malthusianism is the idea that population growth is potentially exponential while the growth of the food supply is linear. It derives from the political and economic thought of the Reverend Thomas Robert Malthus, as laid out in his 1798 writings, An Essay on the Principle of Population. Malthus believed there were two types of "checks" that in all times and places kept population growth in line with the growth of the food supply: "preventive checks", such as moral restraints (abstinence, delayed marriage until finances become balanced), and restricting marriage against persons suffering poverty or perceived as defective, and "positive checks", which lead to premature death such as disease, starvation and war, resulting in what is called a Malthusian catastrophe. The catastrophe would return population to a lower, more "sustainable", level. Malthusianism has been linked to a variety of political and social movements, but almost always refers to advocates of population control.Neo-Malthusianism is the advocacy of population control programs to ensure resources for current and future populations. In Britain the term 'Malthusian' can also refer more specifically to arguments made in favour of preventive birth control, hence organizations such as the Malthusian League. Neo-Malthusians differ from Malthus's theories mainly in their enthusiasm for contraception. Malthus, a devout Christian, believed that "self-control" (abstinence) was preferable to artificial birth control. In some editions of his essay, Malthus did allow that abstinence was unlikely to be effective on a wide scale, thus advocating the use of artificial means of birth control as a solution to population "pressure". Modern "neo-Malthusians" are generally more concerned than Malthus was with environmental degradation and catastrophic famine than with poverty.

Malthusianism has attracted criticism from a diverse range of differing schools of thought, including Marxists and socialists, libertarians and free market enthusiasts, social conservatives, feminists and human rights advocates, characterising it as excessively pessimistic, misanthropic or inhuman. Many critics believe Malthusianism has been discredited since the publication of Principle of Population, often citing advances in agricultural techniques and modern reductions in human fertility. Many modern proponents believe that the basic concept of population growth eventually outstripping resources is still fundamentally valid, and "positive checks" are still likely in humanity's future if there is no action to curb population growth.

Margaret Sanger

Margaret Higgins Sanger (born Margaret Louise Higgins, September 14, 1879 – September 6, 1966, also known as Margaret Sanger Slee) was an American birth control activist, sex educator, writer, and nurse. Sanger popularized the term "birth control", opened the first birth control clinic in the United States, and established organizations that evolved into the Planned Parenthood Federation of America.Sanger used her writings and speeches primarily to promote her way of thinking. She was prosecuted for her book Family Limitation under the Comstock Act in 1914. She was afraid of what would happen, so she fled to Britain until she knew it was safe to return to the US. Sanger's efforts contributed to several judicial cases that helped legalize contraception in the United States. Due to her connection with Planned Parenthood, Sanger is a frequent target of criticism by opponents of abortion. However, Sanger drew a sharp distinction between birth control and abortion and was opposed to abortion through the bulk of her career. Sanger remains an admired figure in the American reproductive rights movement. She has been criticized for supporting eugenics.In 1916, Sanger opened the first birth control clinic in the United States, which led to her arrest for distributing information on contraception, after an undercover policewoman bought a copy of her pamphlet on family planning. Her subsequent trial and appeal generated controversy. Sanger felt that in order for women to have a more equal footing in society and to lead healthier lives, they needed to be able to determine when to bear children. She also wanted to prevent so-called back-alley abortions, which were common at the time because abortions were illegal in the United States. She believed that while abortion was sometimes justified it should generally be avoided, and she considered contraception the only practical way to avoid them.In 1921, Sanger founded the American Birth Control League, which later became the Planned Parenthood Federation of America. In New York City, she organized the first birth control clinic staffed by all-female doctors, as well as a clinic in Harlem with an all African-American advisory council, where African-American staff were later added. In 1929, she formed the National Committee on Federal Legislation for Birth Control, which served as the focal point of her lobbying efforts to legalize contraception in the United States. From 1952 to 1959, Sanger served as president of the International Planned Parenthood Federation. She died in 1966, and is widely regarded as a founder of the modern birth control movement.

Non-penetrative sex

Non-penetrative sex or outercourse is sexual activity that usually does not include sexual penetration. It generally excludes the penetrative aspects of vaginal, anal, or oral sexual activity, but includes various forms of sexual and non-sexual activity, such as frottage, mutual masturbation, kissing, or cuddling. Some forms of non-penetrative sex, particularly when termed outercourse, include penetrative aspects, such as penetration that may result from forms of fingering or oral sex.People engage in non-penetrative sex for a variety of reasons, including as a form of foreplay or as a primary or preferred sexual act. Heterosexual couples may engage in non-penetrative sex as an alternative to penile-vaginal penetration, to preserve virginity, or as a type of birth control. Same-sex couples may also engage in non-penetrative sex to preserve virginity, with gay males using it as an alternative to anal penetration.Although sexually transmitted infections (STIs/STDs) such as herpes, HPV, and pubic lice can be transmitted through non-penetrative genital-genital or genital-body sexual activity, non-penetrative sex may be used as a form of safer sex because it is less likely that body fluids (the main source of STI/STD transmission) will be exchanged during the activities, especially with regard to aspects that are exclusively non-penetrative.

Oral contraceptive pill

Oral contraceptives, abbreviated OCPs, also known as birth control pills, are medications taken by mouth for the purpose of birth control.

Planned Parenthood

Planned Parenthood Federation of America, Inc. (PPFA), or Planned Parenthood, is a nonprofit organization that provides reproductive health care in the United States and globally. It is a tax-exempt corporation under Internal Revenue Code section 501(c)(3) and a member association of the International Planned Parenthood Federation (IPPF). PPFA has its roots in Brooklyn, New York, where Margaret Sanger opened the first birth control clinic in the U.S. in 1916. Sanger founded the American Birth Control League in 1921, which changed its name to Planned Parenthood in 1942.

Planned Parenthood consists of 159 medical and non-medical affiliates, which operate over 600 health clinics in the U.S. It partners with organizations in 12 countries globally. The organization directly provides a variety of reproductive health services and sexual education, contributes to research in reproductive technology and advocates for the protection and expansion of reproductive rights.PPFA is the largest single provider of reproductive health services, including abortion, in the U.S. In their 2014 Annual Report, PPFA reported seeing over 2.5 million patients in over 4 million clinical visits and performing a total of nearly 9.5 million discrete services including 324,000 abortions. Its combined annual revenue is US$1.3 billion, including approximately $530 million in government funding such as Medicaid reimbursements. Throughout its history, PPFA and its member clinics have experienced support, controversy, protests, and violent attacks.

Reproductive health

Within the framework of the World Health Organization's (WHO) definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene, addresses the reproductive processes, functions and system at all stages of life. UN agencies claim sexual and reproductive health includes physical, as well as psychological well-being vis-a-vis sexuality.Reproductive health implies that people are able to have a responsible, satisfying and safer sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. One interpretation of this implies that men and women ought to be informed of and to have access to safe, effective, affordable and acceptable methods of birth control; also access to appropriate health care services of sexual, reproductive medicine and implementation of health education programs to stress the importance of women to go safely through pregnancy and childbirth could provide couples with the best chance of having a healthy infant.

Individuals do face inequalities in reproductive health services. Inequalities vary based on socioeconomic status, education level, age, ethnicity, religion, and resources available in their environment. It is possible for example, that low income individuals lack the resources for appropriate health services and the knowledge to know what is appropriate for maintaining reproductive health.

Safe sex

Safe sex is sexual activity using methods or devices (such as condoms) to reduce the risk of transmitting or acquiring sexually transmitted infections (STIs), especially HIV. "Safe sex" is also sometimes referred to as safer sex or protected sex to indicate that some safe sex practices do not completely eliminate STI risks. It is also sometimes used to describe methods aimed at preventing pregnancy.

The concept of safe sex emerged in the 1980s as a response to the global AIDS epidemic. Promoting safe sex is now one of the aims of sex education and STI prevention, especially reducing new HIV infections. Safe sex is regarded as a harm reduction strategy aimed at reducing risks of STI transmission.Although some safe sex practices (like condoms) can also be used as birth control (contraception), most forms of contraception do not protect against STIs. Likewise, some safe sex practices, like partner selection and low-risk sex behavior, may not be effective forms of contraception.

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