Birth Control Essay, Research Paper

The practice of birth control prevents

conception, thus limiting reproduction. The term

birth control, coined by Margaret SANGER in

1914, usually refers specifically to methods of

contraception, including STERILIZATION. The

terms family planning and planned parenthood

have a broader application. METHODS OF

BIRTH CONTROL Attempts to control fertility

have been going on for thousands of years.

References to preventing conception are found in

the writings of priests, philosophers, and

physicians of ancient Egypt and Greece. Some

methods, though crude, were based on sound

ideas. For example, women were advised to put

honey, olive oil, or oil of cedar in their vaginas to

act as barriers. The stickiness of these substances

was thought to slow the movement of sperm into

the uterus. Wads of soft wool soaked in lemon

juice or vinegar were used as tampons, in the

belief that they would make the vagina sufficiently

acidic to kill the sperm. The Talmud mentions

using a piece of sponge to block the cervix, the

entrance to the uterus. Sperm Blockage Several

modern methods of birth control are practiced by

creating a barrier between the sperm and the egg

cell. This consists of the use of a chemical foam, a

cream, or a suppository. Each contains a

chemical, or spermicide that stops sperm. They

are not harmful to vaginal tissue. Each must be

inserted shortly before COITUS. Foams are

squirted from aerosol containers with nozzles or

from applicators that dispense the correct amount

of foam and spread it over the cervix; creams and

jellies are squeezed from tubes and held in place

by a diaphragm or other device; and

suppositories–small waxy pellets melted by body

heat–are inserted by hand. More effective at

keeping sperm and egg apart are mechanical

barriers such as the diaphragm and cervical cap

(both used with a spermicide), the sponge, and the

condom. A diaphragm is a shallow rubber cup that

is coated with a spermicide and positioned over

the cervix before intercourse. Size is important;

women need to have a pelvic examination and get

a prescription for the proper diaphragm. The

cervical cap, less than half the size but used in the

same way, has been available worldwide for

decades. It was not popular in the United States,

however, and in 1977 it failed to gain approval by

the Food and Drug Administration (FDA); in

1988, the FDA again permitted its sale. The

contraceptive sponge, which keeps its spermidical

potency for 48 hours after being inserted in the

vagina, was approved in 1983. Like the

diaphragm and cervical cap, the sponge has an

estimated effectiveness rate of about 85%. The

devices only rarely produce side effects such as

irritation and allergic reactions and, very rarely,

infections. The condom, a rubber sheath, is rolled

onto the erect penis so that sperm, when

ejaculated, is trapped but care must be taken so

that the condom does not break or slip off. A

fresh condom should be used for each sexual act.

Condoms also help protect against the spread of

VENEREAL DISEASES, and, unlike other

barrier devices, condoms made of latex do

provide some protection–but not

foolproof–protection against AIDS (see AIDS).

Another method of preventing the sperm from

reaching the egg is withdrawal by the man before

ejaculation. This is the oldest technique of

contraception and, because of the uncertainty of

controlling the ejaculation, is considered one of the

least effective. Altering Body Functions Even in

ancient times, attempts were made to find a

medicine that would prevent a woman’s body from

producing a baby. Only within the last century,

however, have methods been developed that

successfully interrupt the complex reproductive

system of a woman’s body. The first attempt,

made in the 19th century, was based on a legend

that camel drivers about to go on long journeys in

the desert put pebbles in the wombs of female

camels to keep them from becoming pregnant.

Researchers tried to find something that would

work similarly in a woman’s cervix. The earliest

such objects were made of metal and were held in

by prongs. Later, wire rings were placed beyond

the cervix, in the uterus itself, thus giving rise to the

term intrauterine device, or IUD. IUDs appear to

work by altering the necessary environment in the

uterus for the fertilized egg. It was only with the

introduction of modern plastics such as

polyethylene, however, that IUDs were widely

accepted. Their pliability led to simpler insertion

techniques, and they could be left in place until

pregnancy was desired unless a problem arose

with their use. Copper-containing IUDs, and those

that slowly released the hormone progesterone,

had to be replaced periodically. Some users of

IUDs, however, complained increasingly of the

side effects of the devices. The most common

problem was bleeding, and the devices could also

cause uterine infections. More dangerous was the

possible inducement of pelvic inflammatory

disease (see UROGENITAL DISEASES), an

infection that may lead to blockage of the

Fallopian tubes and eventual sterility or an ectopic

pregnancy. Studies in the 1980s confirmed this

link with the increased risk of infertility even in the

absence of apparent infections, especially with

plastic IUDs. The A. H. Robins Company, in

particular, was ordered in 1987 to set aside nearly

$2.5 billion to pay the many thousands of claims

filed against it by women injured through use of its

Dalkon Shield. By that time only a single,

progesterone-releasing IUD remained on the U. S.

market, but a copper IUD later became available

and other steroid releasing devices were being

planned for issue. The birth control pill, taken once

a day, has become the most popular birth control

method among American women. Oral

contraceptives are similar in composition to the

hormones produced naturally in a woman’s body.

Most pills prevent ovaries from producing eggs.

Use of the pill, however, does not prevent

MENSTRUATION; usage may even cause

periods to be more regular, with less cramps and

blood loss. Recent studies seem to indicate that

the pill may also protect its users against several

relatively common ailments, including iron

deficiency anemia (the result of heavy menstrual

bleeding), pelvic inflammatory disease, and some

benign breast disorders. In addition (and contrary

to fears that were expressed when the pills were

first marketed and contained much higher levels of

hormones), long-term statistical studies point to a

lower incidence of ovarian and uterine cancer

among women who use contraceptive pills. Other

studies, however, have linked its use with the

increased occurrence of breast cancer. Ongoing

studies by such organizations as the American

Cancer Society continue to study a possible breast

cancer link. For some users, the pill may have

undesirable and sometimes serious side effects

such as weight gain, nausea, hypertension, or the

formation of blood clots or noncancerous liver

tumors. The risk of such effects increases above

the age of 35 among women who smoke. Pills are

obtainable only by prescription and after a

woman’s medical history and check of her physical

condition. In 1991 the FDA approved the use of

Norplant, a long-lasting contraceptive that is

implanted under the skin on the inside of a

woman’s upper arm. The implant consists of six

matchstick-size flexible tubes that contain a

synthetic hormone called progestin. Released

slowly and steadily over a five-year period, this

drug inhibits ovulation and thickens cervical

mucus, preventing sperm from reaching eggs.

Avoiding Intercourse The time to avoid sex, when

conception is not desired, is about midway in a

woman’s menstrual cycle; this was not discovered

until the 1930s, when studies established that an

egg is released (ovulation) from an ovary about

once a month, usually about 14 days before the

next menstrual flow. Conception may occur if the

egg is fertilized during the next 24 hours or so or if

intercourse happens a day or two before or after

the egg is released, because live sperm can still be

present. Therefore, the days just before, during,

and immediately following the ovulation are

considered unsafe for unprotected intercourse;

other days in the cycle are considered safe. The

avoidance of intercourse around ovulation, the

rhythm method, is the only birth control method

approved by the Roman Catholic church.

Maintenance of calendar records of menstrual

cycles proved unreliable, because cycles may vary

due to fatigue, colds, or physical or emotional

stress. A woman’s body temperature, however,

rises slightly during ovulation and remains high until

just before the next flow begins. Immediately

preceding the release of the egg, the mucus in the

vagina becomes clear and the flow is heavier. As

the quantity of mucus is reduced, it becomes

cloudy and viscous and may disappear. These

signals can help a woman determine the time when

she must avoid intercourse to prevent pregnancy.

Permanent Contraception Couples who wish to

have no more children or none at all may choose

sterilization of the man or of the woman instead of

prolonged use of temporary methods. To be

considered irreversible, sterilization blocks or

separates the tubes that carry the sperm or the

eggs to the reproductive system. The man is still

capable of ejaculating, but his semen no longer

contains sperm. The woman continues to

menstruate and an egg is released each month, but

it does not reach her uterus. Neither operation

affects hormone production, male or female

characteristics, sex drive, or orgasm. Tubes may

be separated by surgically cutting them, they may

be blocked with clips or bands, or they may be

sealed using an electric current. The man’s

operation, or VASECTOMY, is simpler and is

usually performed in a doctor’s office or a clinic.

The operation for women is usually performed in a

hospital or an out-patient surgical center. Some of

the most recent techniques require a stay of only a

few hours. Some soreness and discomfort may be

expected after surgery, occasionally with swelling,

bleeding, or infection; the risk of serious

complication is slight. In the 1980s sterilization

became the preferred method among U.S. couples

desiring no further children. The most optimistic

prospects for reversing sterilization for women and

men exists when there is the least damage to their

tubes at the time of sterilization. It is estimated that

as many as 60 percent of reversals are successful

(success is measured by a pregnancy). Many

individuals, however, may not even be candidates

for an attempt at reversal, especially women who

have undergone electrocauterization or surgical

cutting of their tubes. New or Experimental

Contraceptives Several new drugs and

contraceptive devices are at present undergoing

examination in the United States. Thus an injection

of the synthetic progesterone Depo-Provera

(currently used in more than 90 countries)

prevents ovulation for three months. Animal tests,

however, suggest that the drug may induce some

cancers, and have other undesirable side-effects.

Also in use in several countries is a capsule,

implanted beneath the skin of the upper arm, that

slowly releases the synthetic hormone

levonorgestrel over a period of five years. The

capsule, which was approved by the World

Health Organization in 1985 for distribution by

United Nations agencies, has minimal known side

effects but should not be used by women who

have liver disease or breast cancer. Another

contraceptive approach, successful in animals and

currently undergoing human trials, is vaccination.

One vaccine delivers antibodies against a hormone

that plays a crucial role in pregnancy. A second

works against a hormone in the matrix surrounding

the egg, blocking sperm from penetrating. Male

and unisex oral contraceptives are currently in

research. SOCIAL ISSUES Birth control, or

limiting reproduction, has become an issue of

major importance in the contemporary world

because of the problems posed by

POPULATION growth. Until relatively recently,

however, most cultures have stressed increasing,

rather than reducing, procreation. The English

economist Thomas MALTHUS (1766-1834) was

the first to warn that the population of the world

was increasing at a faster rate than its means of

support. However, 19th-century reformers who

advocated birth control as a means of controlling

population growth met bitter opposition both from

the churches and from physicians. The American

Charles Knowlton, author of an explicit treatise on

contraception entitled The Fruits of Philosophy

(1832), was prosecuted for obscenity, and similar

charges were brought against the free-thinkers

Annie BESANT and Charles Bradlaugh, who

distributed the book in Britain. Nonetheless, the

movement persisted, gathering strength at the end

of the century from the WOMEN’S RIGHTS

MOVEMENT. In Britain and continental Europe,

Malthusian leagues were formed, and the Dutch

league opened the first birth control clinic in 1881.

An English clinic was started by Dr. Marie Stopes

(1882-1958) in 1921. In the United States,

Margaret Sanger’s first clinic (1916) was closed

by the police, but Sanger opened another in 1923.

Her National Birth Control League, founded in

1915, became the Planned Parenthood Federation

of America in 1942 and then, in 1963, the Planned

Parenthood-World Population organization. In

GRISWOLD V. CONNECTICUT (1965) the U.

S. Supreme Court struck down the last state

statute banning contraceptive use for married

couples, and in 1972 the Court struck down

remaining legal restrictions on birth control for

single people. The federal government began

systematically to fund family planning programs in

1965. Contraceptive assistance was provided to

minors without parental consent until Congress

ruled in 1981 that public health-service clinics

receiving federal funds must notify parents of

minors for whom contraceptives have been

prescribed. Suits challenging the regulation have

been upheld; the government has announced plans

to appeal. Despite the wide availability of

contraceptives and birth control information, the

rate of childbirth among unmarried teenage girls

rose throughout the 1970s and 1980s. A major

focus of current concern, therefore, is the

improvement of SEX EDUCATION for

adolescents. Other countries where the birth

control movement has been notably successful

include Sweden, the Netherlands, and Britain,

where family planning associations early received

government support; Japan, which has markedly

reduced its birthrate since enacting facilitating

legislation in 1952; and the Communist countries,

which after some fluctuations in policy, now

provide extensive contraceptive and abortion

services to their inhabitants. Many of the less

developed countries are now promoting birth

control programs, supported by technical,

educational, and financial assistance from various

United Nations agencies and the International

Planned Parenthood Federation. A series of

World Population Conferences has sought to

strengthen the focus on population control as a

major international issue. At present the strongest

opposition to birth control in the Western world

comes from the Roman Catholic church, which

continues to ban the use of all methods except

periodic abstinence. In Third World countries

resistance to birth control programs has arisen

from both religious and political motives. In India,

for example, a country whose population is

increasing at a net rate of 10-13 million a year, the

traditional Hindu emphasis on fertility has impeded

the success of the birth control movement. Some

Third World countries continue to encourage

population growth for internal economic reasons,

and a few radical spokespersons have alleged that

the international birth control movement is

attempting to curtail the population growth of

Third World countries for racist reasons. A similar

argument has been heard within the United States

with regard to ethnic minorities; the latter,

however, voluntarily seek family planning in an

equal proportion to nonminorities. Despite such

arguments, most educated individuals and

governments acknowledge that the health benefits

of regulating fertility and slowing the natural

expansion of the world’s population are matters of

critical importance. Louise B. Tyrer, M.D.

Bibliography: Belcastro, P. A., The Birth Control

Book (1986); Bullough, Bonnie, Contraception: A

Guide to Birth Control Methods (1990); Djerassi,

Carl, The Politics of Contraception (1981);

Filshie, Marchs, and Guillebaud, John,

Contraception: Science and Practice (1989);

Gordon, Linda, Woman’s Body, Woman’s Right:

A Social History of Birth Control in America

(1976); Harper, Michael J. K., Birth Control

Technologies: Prospects by the Year 2000

(1983); Kennedy, David M., Birth Control in

America: The Career of Margaret Sanger (1970);

Knight, James W., and Callahan, Joan C.,

Preventing Birth: Contemporary Methods and

Related Moral Controversies (1989); Leathard,

Audrey, The Fight for Family Planning (1980);

Lieberman, E. J., and Peck, Ellen, Sex and Birth

Control: A Guide for the Young, rev. ed. (1981);

Loudon, Nancy, and Newton, John, eds.,

Handbook of Family Planning (1985); Sutton,

Graham, ed., Birth Control Handbook (1980);

Zatuchni, G. I., et al., Male Contraception (1986);

Zatuchni, G.I., et al., Male Contraception (1986).