Birth control is a term that includes all methods used to regulate or prevent the birth of children. Other terms with a similar meaning are birth planning, family planning, fertility control, and planned parenthood.
When people talk about birth control, they are usually referring to artificial methods. But nature itself has built-in controls for limiting and spacing births. A woman can become pregnant only during a small fraction of her monthly menstrual cycle. In addition, women are able to conceive only during a certain time in their lives—usually between the ages of 13 and 45. Also, some couples, for various reasons, are temporarily or permanently infertile (unable to have children). See Infertility.
Couples practice birth control for various reasons. They may want to limit or space their children, or to have no children at all. Young couples often postpone having children so that both the husband and wife can work full-time. Other couples space their children so they can give each child as much attention as possible. Doctors advise some women to prevent pregnancy for health reasons. In many countries with rapidly growing populations, the government encourages couples to limit the size of their families.
Most people in industrialized nations agree that some form of family limitation or spacing is desirable for the good of the family and society. But individuals and groups—especially religious groups—differ sharply on the methods of birth control that they consider moral and acceptable. This article discusses the main arguments for and against birth control, the principal methods of birth control, and the status of birth control programs.
The birth control movement
For thousands of years, birth control received little public attention. Death rates were extremely high, particularly in infancy and childhood. Large numbers of children were necessary to ensure that enough would survive to adulthood and have children of their own. Then, during the 1700’s and 1800’s, scientific and technological advances in industrialized countries increased food supplies, controlled diseases, and made work easier. The death rate then dropped in these countries. More children survived and had children themselves.
In 1798, the British economist Thomas Robert Malthus published his famous Essay on the Principle of Population. Malthus argued that populations tend to increase faster than food supplies. To reduce births, he recommended that young men and women postpone marriage. During the 1800’s, a number of people in Europe and the United States worked to promote birth control. Partly through their efforts, birth rates in industrialized countries began to drop to the present low levels. See Malthus, Thomas Robert.
Most developing countries continue to have high birth rates. For example, Bangladesh and Pakistan have about 40 live births a year for every 1,000 people. Industrialized nations have much lower birth rates. For example, the United States has about 16 births a year per 1,000 population. Japan has about 10.
Death rates in developing countries have dropped since the mid-1940’s, partly because of improved public health. The result of continuing high birth rates and low death rates has been rapid population growth in Asia, Africa, and Latin America. In many countries, far more children are born than can be adequately fed, housed, educated, or employed under present conditions.
The fear of overpopulation has spurred interest in birth control. The population of the world passed 5 billion in 1987 and reached about 6 billion in the late 1990’s. At the present rate of increase, the world population will have reached about 10 billion by the year 2030.
Sanger helped found the American Birth Control League, which later became the Planned Parenthood Federation of America. Similar private family planning groups in other countries started many of the birth control programs that are now carried on both privately and by governments throughout the world.
Methods of birth control
An understanding of birth control requires some knowledge of human reproduction. About every four weeks, an egg is released by one of the two ovaries in a woman’s body. The egg then passes through a fallopian tube. If it is not fertilized while in the fallopian tube, it dies there and eventually disintegrates in the uterus. The egg then passes out of the woman’s body as part of the normal monthly bleeding called menstruation (see Menstruation).
During sexual intercourse, millions of sperm are released by the man into the woman’s vagina. Some sperm travel through the uterus into the fallopian tubes. If an egg and sperm unite in one of the tubes, conception (fertilization of the egg) occurs. If the fertilized egg becomes attached to the wall of the uterus, a new human being begins to develop. About nine months later, a baby is born. See Reproduction, Human.
Most birth control methods are designed to prevent conception and are called contraceptives. The most effective contraceptive method is surgical sterilization. The operation can be performed on both men and women. It makes conception impossible by blocking the sperm ducts in men or the fallopian tubes in women. Such an operation is called a vasectomy on a male. On a female, it is called a laparoscopic sterilization, a tubal ligation, or a tubectomy, depending on the procedure used. These operations can seldom be reversed if a couple later desires to have children.
Other highly effective contraceptive methods involve the use of hormone drugs in order to prevent pregnancy. Oral birth control pills contain the sex hormones estrogen and progesterone. These drugs, also called oral contraceptives, hinder both the normal release of an egg once a month and the attachment of an egg to the uterus. Birth control pills are relatively expensive and may produce harmful side effects in some women. To effectively prevent pregnancy, they must be taken regularly prior to sexual intercourse. In some cases, a woman who has already had sexual intercourse may seek emergency contraception by taking a “morning-after pill.” Such pills contain higher doses of the same hormones used in regular birth control pills and, when taken within 72 hours after intercourse, can significantly reduce the chances of pregnancy.
In many developing nations, hormone drugs may be injected into the body. The injections must be given every 90 days and are as effective as regular birth control pills. In addition, contraceptive implants that contain hormone drugs are available in some countries, including the United States and Canada. The implants consist of tiny capsules that are surgically placed under the skin. The capsules slowly release hormone drugs into the body. The implants must be replaced periodically by a doctor and may be removed if pregnancy is desired.
Intrauterine devices, also called IUD’s, are another highly effective method of contraception. An IUD is a tiny device made of plastic and metal. It is inserted into the uterus. Doctors are not yet sure how IUD’s prevent pregnancy. When a woman wishes to become pregnant, she has the device removed. IUD’s are relatively inexpensive and they require little attention for most women. But some users experience undesirable side effects. Such effects cease when the IUD is removed.
There are also several other methods of contraception. The condom is a thin sheath worn over the penis during sexual intercourse. Sperm are trapped inside the condom. The diaphragm and the cervical cap are devices that are inserted into the vagina so that they cover the opening of the uterus. A spermicide—a drug that kills sperm—must be applied to the diaphragm or cervical cap. These devices then hold the spermicide near the opening of the uterus. A spermicide-treated device called the vaginal sponge works on similar principles as the diaphragm and the cervical cap. Vaginal spermicides, in the form of creams, gels, and suppositories, can be used by themselves, but they are less effective in preventing conception. An even less effective method is withdrawal, in which the male attempts to withdraw the penis from the vagina before the sperm are released.
Natural family planning consists of several methods that can be used either to prevent or to encourage conception. The rhythm method of birth control calls for avoidance of intercourse during the estimated period each month when an egg can be fertilized. The rhythm method works for some couples, but it is generally less effective than many of the other methods discussed. The chief problem of the rhythm method is determining a woman’s fertile period. The method is most unreliable for women with irregular menstrual cycles. Another method of natural family planning tests mucus from the woman’s cervix (neck of the uterus). By observing periodic changes in the mucus, a woman can predict her fertile period. Another method uses body temperature measurements to indicate the fertile period. The sympto-thermal method combines the taking of temperature with the testing of mucus and other observations of changes in the cervix.
An induced abortion ends a pregnancy by removing the unborn fetus. Physicians can perform abortions through several different procedures. In the early stages of pregnancy, abortions can also be caused by a drug called mifepristone or RU-486. Traditionally, many countries have outlawed abortion except when necessary to save a woman’s life. But in the 1970’s, many countries—including the United States—changed their laws, making it easier for abortions to be obtained. See Abortion.
Opposition to birth control
Opposition to birth control continues, even though the practice has gained in acceptance. Some people fear that birth control encourages sexual relations outside of marriage. Some fear that governments might impose birth control as a means of political control. Some religions oppose birth control on moral grounds.
The Roman Catholic Church teaches that artificial methods of birth control are immoral because they separate the two purposes of intercourse in marriage—conjugal love and the procreation of children. In 1968, Pope Paul VI repeated the traditional Roman Catholic viewpoint in a papal encyclical. He wrote that “… each and every marriage act must remain open to the transmission of life.” Although the Roman Catholic Church opposes all artificial birth control, it considers natural family planning acceptable.
In the past, most other major religions also opposed birth control or kept silent on the subject. Today, most Protestant faiths and Judaism accept contraception, and many Protestants and Jews support legalized abortion. Hindu and Buddhist religious leaders have seen no religious conflict in the development of government birth control programs in Asian nations.
Birth control today
During the 1960’s, many countries—and most states in the United States—adopted government programs of family planning. Where necessary, they repealed laws restricting distribution of birth control information and devices. Today, about 80 countries have national birth control programs. Sweden, the United States, and other developed countries have given funds and technical assistance to developing nations. Private organizations and such international organizations as the United Nations and the World Health Organization also have helped countries set up birth control programs.
In the United States,
according to national surveys, most married couples use some form of birth control. Most Americans obtain birth control information and supplies from their family physician or a pharmacist. The federal government and the states provide family planning as part of their health and welfare programs.
In other countries.
In 1948, Japan became the first country to take national action on family planning. That year, the Japanese government legalized abortion and contraception, and began to make both readily available. During the next 10 years, the Japanese birth rate dropped from 33 to 17 live births per 1,000 population, largely as a result of widespread use of abortion. Legal abortion has also become a major birth control method in Eastern Europe.
China, one of the world’s most populous countries, established a government agency to promote birth control in 1964. The country’s birth rate dropped from about 40 births per 1,000 in 1964 to 20 births per 1,000 in 1979. It remained at that level through the late 1990’s. The agency encouraged later marriages and the use of contraceptives, chiefly sterilization and IUD’s.
India began supporting a national birth control program in the early 1950’s. Many states in India have developed programs calling for voluntary sterilization of males. Pakistan began a birth control program in 1959. In the early 1960’s, South Korea and Taiwan began birth control programs. Similar programs have been started in many developing countries. Most of these programs rely on oral birth control pills.
In Canada, many provincial and city governments support family planning with assistance by the national government. In the United Kingdom, family planning services are part of the National Health Service. Most other countries in Europe also have government-supported programs of family planning.
