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Birth control: the story on HearLore | HearLore
Birth control
The first documented attempt to prevent pregnancy dates back to 1550 BC, yet the methods described in the Egyptian Ebers Papyrus were so primitive they relied on inserting honey, acacia leaves, and lint into the vagina to block sperm. This ancient desperation for control over reproduction highlights a stark reality that has persisted for millennia: the desire to prevent pregnancy is as old as civilization itself, but effective and safe methods remained elusive for thousands of years. In ancient Greece, the philosopher Aristotle recommended applying cedar oil to the womb, a practice that likely worked only on rare occasions, while a Hippocratic text suggested drinking copper salt dissolved in water to prevent pregnancy for a year. This method was not only ineffective but also dangerous, a fact later pointed out by the medical writer Soranus of Ephesus who lived between 98 and 138 AD. Soranus attempted to list reliable methods based on rational principles, rejecting superstition and amulets in favor of mechanical methods like vaginal plugs and pessaries made of wool covered in oils. Despite these early efforts, most methods used in antiquity were probably ineffective, leaving women vulnerable to unintended pregnancies and the social consequences that followed.
The Birth Control Crusade
The modern birth control movement began to take shape in the 19th and early 20th centuries, driven by figures who risked their freedom to challenge the status quo. In 1914, Margaret Sanger and Otto Bobsein popularized the phrase birth control, advocating for it initially to prevent women from seeking unsafe abortions and later to reduce mental and physical defects. Under the Comstock Law, distribution of birth control information was illegal in the United States, leading Sanger to jump bail in 1914 after her arrest for distributing birth control information and flee to the United Kingdom. There, influenced by Havelock Ellis, she further developed her arguments, believing women needed to enjoy sex without fearing pregnancy. Upon returning to the United States, she established a short-lived birth-control clinic in the Brownville section of Brooklyn, New York, in 1916, which was shut down after eleven days and resulted in her arrest. The publicity surrounding this arrest sparked birth control activism across the United States. Sanger was supported by her sister Ethel Bryne and her first husband William Sanger, who distributed copies of Family Limitation. Her second husband, James Noah H. Slee, later became the movement's main funder. Sanger also contributed to the funding of research into hormonal contraceptives in the 1950s, helping to fund research by John Rock and biologist Gregory Pincus that resulted in the first hormonal contraceptive pill, later called Enovid. The first human trials of the pill were done on patients in the Worcester State Psychiatric Hospital, after which clinical testing was done in Puerto Rico before Enovid was approved for use in the U.S. The people participating in these trials were not fully informed of the medical implications of the pill and often had minimal to no other family planning options. The newly approved birth control method was not made available to the participants after the trials, and contraceptives are still not widely accessible in Puerto Rico.
When was the first documented attempt to prevent pregnancy recorded?
The first documented attempt to prevent pregnancy dates back to 1550 BC. This ancient effort relied on primitive methods described in the Egyptian Ebers Papyrus, which involved inserting honey, acacia leaves, and lint into the vagina to block sperm.
Who popularized the phrase birth control and when did this movement begin?
Margaret Sanger and Otto Bobsein popularized the phrase birth control in 1914. The modern birth control movement began to take shape in the 19th and early 20th centuries, driven by figures who risked their freedom to challenge the status quo.
When was the first hormonal contraceptive pill approved for use in the United States?
The first hormonal contraceptive pill, later called Enovid, was approved for use in the U.S. in the 1960s. Clinical testing was conducted in Puerto Rico after human trials were done on patients in the Worcester State Psychiatric Hospital.
When did the Affordable Care Act require health insurance plans to cover contraceptive methods?
The Affordable Care Act, passed into law on the 23rd of March 2010, requires all plans in the Health Insurance Marketplace to cover contraceptive methods. This law mandates coverage for barrier methods, hormonal methods, implanted devices, emergency contraceptives, and sterilization procedures.
What percentage of women of childbearing age wanted to avoid pregnancy as of 2012?
As of 2012, 57% of women of childbearing age wanted to avoid pregnancy. Despite this desire, about 222 million women were not able to access birth control, with 53 million of whom were in sub-Saharan Africa and 97 million of whom were in Asia.
When was the first US daily oral nonprescription over-the-counter birth control pill approved for manufacturing?
On the 13th of July 2023, the first US daily oral nonprescription over-the-counter birth control pill was approved for manufacturing by the FDA. The pill, Opill, is expected to be available in 2024 and is expected to be more effective in preventing unintended pregnancies than condoms are.
The development of the birth control pill marked a turning point in medical history, yet its journey to public availability was fraught with legal and ethical challenges. In 1951, an Austrian-born American chemist named Carl Djerassi at Syntex in Mexico City made the hormones in progesterone pills using Mexican yams. 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. The legal landscape shifted dramatically in 1936 when the United States Court of Appeals for the Second Circuit ruled in United States v. One Package of Japanese Pessaries that medically prescribing contraception to save a person's life or well-being was not illegal under the Comstock Laws. 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, 374 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. The restrictions on birth control in the Comstock laws were effectively rendered null and void by Supreme Court decisions Griswold v. Connecticut in 1965 and Eisenstadt v. Baird in 1972. 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. The Affordable Care Act, passed into law on the 23rd of March 2010, under President Barack Obama, requires all plans in the Health Insurance Marketplace to cover contraceptive methods, including barrier methods, hormonal methods, implanted devices, emergency contraceptives, and sterilization procedures.
The Silent Epidemic
Despite the availability of modern methods, a significant portion of the global population remains without access to birth control, leading to a silent epidemic of unintended pregnancies and maternal deaths. As of 2012, 57% of women of childbearing age want to avoid pregnancy, yet about 222 million women were not able to access birth control, with 53 million of whom were in sub-Saharan Africa and 97 million of whom were in Asia. This results in 54 million unplanned pregnancies and nearly 80,000 maternal deaths a year. Part of the reason that many women are without birth control is that many countries limit access due to religious or political reasons, while another contributor is poverty. In the developing world, 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. Contraceptive use among women in Sub-Saharan Africa has risen from about 5% in 1991 to about 30% in 2006. In the United States, African American, Hispanic, and young women are disproportionately affected by limited access to birth control, as a result of financial disparity. For example, Hispanic and African American women often lack insurance coverage and are more often poor. New immigrants in the United States are not offered preventive care such as birth control. In September 2021, France announced that women aged under 25 in France will be offered free contraception from 2022, and from August 2022 onwards contraception for women aged between 17 and 25 years will be free in the Republic of Ireland. These efforts highlight the ongoing struggle to ensure equitable access to reproductive health services.
The Science of Safety
The safety and effectiveness of birth control methods vary significantly, with some methods offering near-perfect protection while others carry higher risks of failure. The most effective methods are long-acting and do not require ongoing health care visits, including surgical sterilization, implantable hormones, and intrauterine devices, all of which have first-year failure rates of less than 1%. Hormonal contraceptive pills, patches or vaginal rings, and the lactational amenorrhea method, if adhered to strictly, can also have first-year failure rates of less than 1%. With typical use, first-year failure rates are considerably higher, at 9%, due to inconsistent use. Other methods, such as condoms, diaphragms, and spermicides, have higher first-year failure rates even with perfect usage. While all methods of birth control have some potential adverse effects, the risk is less than that of pregnancy. 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. For individuals with specific health problems, certain forms of birth control may require further investigations. 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. In 2009, the World Health Organization published a detailed list of medical eligibility criteria for each type of birth control, ensuring that women with specific medical conditions can safely use these methods.
The Global Cost
The economic and social impact of birth control extends far beyond individual health, influencing global economic growth and the well-being of families. In the developing world, birth control increases economic growth due to there being fewer dependent children and thus more women participating in or making increased contributions to the workforce. Women's earnings, assets, body mass index, and their children's schooling and body mass index all improve with greater access to birth control. Family planning, via the use of modern birth control, is one of the most cost-effective health interventions. For every dollar spent, the United Nations estimates that two to six dollars are saved. These cost savings are related to preventing unplanned pregnancies and decreasing the spread of sexually transmitted illnesses. While all methods are beneficial financially, the use of copper IUDs resulted in the greatest savings. 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. In most other countries, the cost is less than half. For a child born in 2011, an average US family will spend $235,000 over 17 years to raise them. 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. 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.
The Future of Fertility
The future of birth control holds promise for new methods and improved accessibility, yet significant challenges remain in the development and distribution of these technologies. Improvements in existing birth control methods are needed, as around half of those who get pregnant unintentionally are using birth control at the time. Many 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. This vaginal ring appears to be effective for three or four months and is currently available in some areas of the world. For women who rarely have sex, the taking of the hormonal birth control levonorgestrel around the time of sex looks promising. A number of methods to perform sterilization via the cervix are being studied, including putting quinacrine in the uterus which causes scarring and infertility, and a device called Essure, which expands when placed in the fallopian tubes and blocks them. The device was approved in the United States in 2002, but in 2016, a black boxed warning regarding potentially serious side effects was added, and in 2018, the device was discontinued. Despite high levels of interest in male contraception, progress has been stymied by a lack of industry involvement. Most funding for male contraceptive research is derived from government or philanthropic sources. Several novel contraceptive methods based on hormonal and non-hormonal mechanisms of action are in various stages of research and development, up to and including clinical trials, including gels, pills, injectables, implants, wearables, and oral contraceptives. On the 13th of July 2023, the first US daily oral nonprescription over-the-counter birth control pill was approved for manufacturing by the FDA. The pill, Opill, is expected to be more effective in preventing unintended pregnancies than condoms are, and is expected to be available in 2024, though the price has yet to be set.