Contraception

Definition

Contraception (birth control) prevents pregnancy by interfering with the normal process of ovulation, fertilization, and implantation. There are different kinds of birth control that act at different points in the process.

Purpose

Every month a woman's body begins the process that can potentially lead to pregnancy. An egg (ovum) matures, the mucus that is secreted by the cervix (a cylindrical-shaped organ at the lower end of the uterus) changes to be more inviting to sperm, and the lining of the uterus grows in preparation for receiving a fertilized egg. Any woman who wants to prevent pregnancy must use a reliable form of birth control. Birth control (contraception) is designed to interfere with the normal process and prevent the pregnancy that could result. There are different kinds of birth control that act at different points in the process, from ovulation through fertilization to implantation. Each method has its own side effects and risks. Some methods are more reliable than others.

Although there are many different types of birth control, they can be divided into a few groups based on how they work. These groups include:

• Hormonal methods: These use medications (hormones) to prevent ovulation. Hormonal methods include birth control pills (oral contraceptives ), Depo Provera injections, and Norplant.
• Barrier methods: These methods work by preventing the sperm from getting to and fertilizing the egg. Barrier methods include male condom and female condom, diaphragm, and cervical cap. The condom is the only form of birth control that also protects against sexually transmitted diseases , including human immunodeficiency virus (HIV) that causes acquired immune deficiency syndrome (AIDS).
• Spermicides: These medications kill sperm on contact. Most spermicides contain nonoxynyl-9. Spermicides come in many different forms such as jelly, foam, tablets, and even a transparent film. All are placed in the vagina. Spermicides work best when they are used at the same time as a barrier method.
• Intrauterine devices (IUDs): These devices are inserted into the uterus, where they stay from one to ten years. An IUD prevents the fertilized egg from implanting in the lining of the uterus and may have other effects as well.
• Tubal ligation: This medical procedure is a permanent form of contraception for women. Each fallopian tube is either tied or burned closed. The sperm cannot reach the egg, and the egg cannot travel to the uterus.
• Vasectomy: This medical procedure is a the male form of sterilization and should be considered permanent. In vasectomy, the vas defrens, the tiny tubes that carry the sperm into the semen, are cut and tied off.

Unfortunately, there is no perfect form of birth control. Only abstinence (not having sexual intercourse) protects against unwanted pregnancy with 100 percent reliability. The failure rates, or the rates at which pregnancy occurs, for most forms of birth control are quite low. However, some forms of birth control are more difficult or inconvenient to use than others. In actual practice, the birth control methods that are more difficult or inconvenient have much higher failure rates, because they are not used faithfully.

Description

All forms of birth control have one feature in common. They are only effective if used faithfully. Birth control pills work only if taken every day; the diaphragm is effective only if used during every episode of sexual intercourse. The same is true for condoms and the cervical cap. Some methods are automatically working every day, no matter what. These methods include Depo Provera, Norplant, the IUD, and tubal sterilization.

There are many different ways to use birth control. They can be divided into several groups:

• By mouth (oral): Birth control pills must be taken by mouth every day.
• Injected: Depo Provera is a hormonal medication that is given by injection every three months.
• Implanted: Norplant is a long-acting hormonal form of birth control that is implanted under the skin of the upper arm.
• Vaginal: Spermicides and barrier methods work in the vagina.
• Intra-uterine: The IUD is inserted into the uterus.
• Surgical: Tubal sterilization is a form of surgery. A doctor must perform the procedure in a hospital or surgical clinic. Many women need general anesthesia.

The methods of birth control differ from each other regarding when they are used. Some methods of birth control must be used specifically at the time of sexual intercourse (condoms, diaphragm, cervical cap, spermicides). All other methods of birth control must be working all the time to provide protection (hormonal methods, IUDs, tubal sterilization).

Condoms and spermicides

Condoms are about 85 percent effective in preventing pregnancies. That means that out of 100 females whose partners use condoms, 15 will still become pregnant during the first year of use, according to the nonprofit advocacy group Planned Parenthood. Unwanted pregnancies usually occur because the condom is not attached or used properly or breaks during intercourse. More protection against pregnancy is possible if a spermicide is used along with a condom. Spermicide is a pharmaceutical substance used to kill sperm, especially in conjunction with a birth-control device such as a condom or diaphragm. Spermicides come in foam, cream, gel, suppository, or as a thin film. The most common spermicide is called nonoxynol-9, and many condoms come with it already applied as a lubricant. However, spermicides do not kill HIV or other sexually transmitted viruses and do not prevent the spread of HIV and other STDs. Also, nonoxynol-9 can irritate vaginal tissue and thus increase the risk of getting an STD. In anal sex, especially between two males, spermicides also can irritate the rectum, increasing the risk of getting HIV. Spermicides are specifically discouraged for use by gay or bisexual males for anal sex.

Latex condoms are also recommended over condoms made from other materials, especially lambskin, because they are thicker and stronger and have less risk of breakage during sex. Non-latex condoms do not prevent the spread of STDs, including HIV, and should not be used by gay or bisexual men or men who have HIV or other sexually transmitted diseases. Condoms are available over-the-counter, meaning they do not require a prescription, and there are no age restrictions on purchasing condoms. They are available at a variety of locations, including drug stores, convenience stores, supermarkets, and family planning clinics. They are also available for purchase on the Internet.

FEMALE CONDOM The female condom is a seven-inch polyurethane pouch that fits into the vagina. It collects semen before, during, and after ejaculation, keeping semen from entering the uterus through the cervix and thus protecting against pregnancy. In one year of use, it is 79 percent effective in preventing pregnancies. It also reduces the risk of many STDs, including HIV. There is a flexible ring at the closed end of the thin, soft pouch of the female condom. A slightly larger ring is at the open end. The ring at the closed end holds the condom in place in the vagina. The ring at the open end rests outside the vagina. When the condom is in place during sexual intercourse, there is no contact of the vagina and cervix with the skin of the penis or with secretions from the penis. It can be inserted up to eight hours before sex.

Precautions

There are risks associated with some forms of birth control. Some of the risks of each method are:

• Birth control pills: The hormone (estrogen) in birth control pills can increase the risk of heart attack in women over forty who smoke.
• IUD: This device can increase the risk of serious pelvic infection. The IUD can also injure the uterus by poking into or through the uterine wall. Surgery might be needed to fix this injury.
• Tubal sterilization: "Tying the tubes" is a surgical procedure and has all the risks of any other surgery, including the risks of anesthesia, infection, and bleeding.
• Condom: The most common problems associated with condoms are breakage during use and improper technique in using condoms. These can lead to pregnancy and sexually transmitted diseases, especially HIV.

Preparation

No specific preparation is needed before using contraception. However, a woman must be sure that she is not already pregnant before using a hormonal method or having an IUD placed.

Risks

Many methods of birth control have side effects. Knowing the side effects can help a woman to determine which method of birth control is right for her. There is no perfect form of birth control. Every method has a small failure rate and side effects. Some methods carry additional risks. However, every method of birth control has fewer risks than pregnancy. The risks include:

• Hormonal methods: The hormones in birth control pills, Depo Provera, and Norplant can cause changes in menstrual periods, changes in mood, weight gain, acne , and headaches. In addition, once a woman stops using Depo Provera or Norplant, she may go many months before she begins ovulating again.
• Barrier methods: A woman must insert the diaphragm in just the right way to be sure that it works properly. Some women get more urinary tract infections if they use a diaphragm because the diaphragm can press against the urethra, the tube that connects the bladder to the outside.

• Spermicides: Some women and men are allergic to spermicides or find them irritating to the skin.
• IUD: The device is a foreign object that stays inside the uterus, and the uterus tries to get it out. A woman may have heavier menstrual periods and more menstrual cramping with an IUD in place.
• Tubal ligation: Some women report increased menstrual discomfort after this surgery. It is not known if this side effect is related to the tubal ligation itself.

Parental concerns

Nearly 60 percent of sexually active girls under age 18 would discontinue at least some reproductive health services if their parents were informed that they were seeking contraceptive services, according to a study published in the August 14, 2002 issue of the Journal of the American Medical Association (JAMA). If parental notification would cause the majority of minor girls to stop seeking reproductive health services or to use less effective methods of contraception, the rates of teen pregnancies and STD infections would substantially increase, Carol Ford of the Adolescent Medicine Program at the University of North Carolina–Chapel Hill and Abigail English of the Center for Adolescent Health & the Law state in an accompanying JAMA editorial. Although there is widespread consensus that communication between adolescents and their parents about sexual decision-making is important, there is no reason that confidential reproductive health care and efforts to improve communication between parents and their adolescent children cannot occur simultaneously, these authors suggest.

Parents of adolescents often are concerned that distribution of contraceptives leads to increased sexual activity. However, a study of 4,100 high school students published in the June 2003 issue of the American Journal of Public Health found that students who had access at school to condoms and instructions on their proper use were no more likely to have sexual intercourse than students at schools without condom distribution programs.

KEY TERMS

Fallopian tubes —The pair of narrow tubes leading from a woman's ovaries to the uterus. After an egg is released from the ovary during ovulation, fertilization (the union of sperm and egg) normally occurs in the fallopian tubes.

Fertilization —The joining of the sperm and the egg; conception.

Implantation —The process in which the fertilized egg embeds itself in the wall of the uterus.

Ovulation —The monthly process by which an ovarian follicle ruptures releasing a mature egg cell.

See also Condom.

Resources

BOOKS

Birth Control Pills: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, CA: Icon Health Publications, 2003.

Peacock, Judith. Birth Control and Protection: Choices for Teens. Santa Rosa, CA: LifeMatters, 2000.

Whitney, Leon Fradley. Birth Control Today: A Practical Approach to Intelligent Family Planning. Temecula, CA: Textbook Publishers, 2003.

PERIODICALS

"Give Teens More Info to Bridge Information Gap." Contraceptive Technology Update 25(September 2004): 106–07.

Sullivan, Michele G. "Teens View Hormonal Contraception as Unsafe." Internal Medicine News 37 (July 15, 2004): 24.

"Teens Face Obstacles When Obtaining EC (Emergency Contraceptives)." Contraceptive Technology Update 25 (April 2004): 41–2.

Tucker, Miriam E. "Newer Contraceptives Give Teens More Options." OB GYN News 38 (August 1, 2003): 9.

ORGANIZATIONS

Advocates for Youth. 2000 M St. NW, Suite 750, Washington, DC 20036. Web site <www.advocatesforyouth.org>.

Planned Parenthood Federation of America Inc. 434 W. 33rd St., New York, NY 10001. Web site: <www.plannedparenthood.org>.

WEB SITES

"Teens and Condoms." Avert.org, August 13, 2004. Available online at <www.avert.org/teencondoms.htm> (accessed November 23, 2004).

Amy B. Tuteur Ken R. Wells

CONTRACEPTION

Contraception is the use of any of various methods to prevent pregnancy. Family planning, in contrast, involves the use of contraception or other measures to limit the number of children and plan the timing and spacing of births. Contraception has been used throughout history. Early methods, however, were ineffective (drinking potions or douching) or dangerous and not available to all people. By the middle of the twentieth century, only 13 percent of couples worldwide used effective methods of contraception. By the year 2000, UNICEF estimated that this figure had risen to 50 percent.

Contraceptive use is not equally distributed throughout the world. Most of western Europe, the United States, parts of Latin America, and Oceania demonstrate high levels of use. India, Pakistan, Nigeria, Sudan, Oman, Yemen, Haiti, Guatemala, Bolivia, and nations in sub-Sahara Africa demonstrate low contraceptive use and high fertility. In the past, family planning programs in some countries were, in effect, population control programs. They were often coercive and did not allow families choice. This is changing, as more people want to limit their family size. In some places, such as China, a strict population control policy is still in place.

In l994, the global attendees at the International Conference on Population and Development (ICPD) in Cairo, Egypt, placed family planning within a holistic context of reproductive health, and family planning is now considered to be a human right. Family planning helps save women's lives. Over 585,000 women die every year from unsafe abortion, childbirth, and pregnancy, with 90 percent of the deaths occurring in developing countries. These deaths are largely preventable; and contraception could play a role in preventing them.

Despite advances in contraceptive technologies, there is no single method that suits everyone. In some places, choice is limited and access is difficult, resulting in an unmet need for contraception (the condition of wanting to avoid or delay childbearing, but not using a contraceptive method).

One way to categorize contraceptive technologies is by the duration of protection. There are permanent, long-term, and short-term methods. In addition to these technologies, there are also behavioral methods of contraception. What follows is a list of all contraceptive technologies and behaviors, how they prevent pregnancy, their effectiveness, potential problems or side effects, and whether they also prevent reproductive tract infections (RTIs), hepatitis C, or sexual transmission of HIV (human immunodeficiency virus).

PERMANENT METHODS

The two permanent surgical methods of contraception are 99 to 99.5 percent effective. They do not prevent RTIs, or HIV transmission, and they both involve a risk of infection or bleeding. In male sterilization, or vasectomy, the vas deferens (the tubes that carry the sperm from the testicles to the penis) are blocked or cut. Female sterilization, or tubal ligation, is a surgical procedure in which a woman's fallopian tubes are cut, burnt, or blocked to prevent sperm from reaching and fertilizing the egg.

LONG-ACTING METHODS

None of the long-acting methods protect against RTIs or HIV transmission. IUDs, implants, and injections are 99 percent effective. Oral contraceptive pills are theoretically 99 percent effective, but pregnancies do occur if pills are missed or not taken on time.

IUD. An intrauterine device (IUD) is most often a nonhormonal method of contraception. The IUD is a small plastic or plastic and copper device placed inside a woman's uterus by a trained health care provider, and it protects against pregnancy for up to twelve years. The IUD may increase the risk of RTIs for women who have more than one partner. Side effects include increased cramping and bleeding during monthly periods. Some IUDs contain a hormone (progesterone) to increase their pregnancy protection while decreasing the risk of heavy bleeding. All of the other long-acting contraceptive methods are hormonal method.

Oral Contraceptive Pill. "The Pill" was introduced in the United States in the 1960s. It contains one or two hormones (either estrogen and progesterone together, or progesterone alone) that prevent ovulation and create a hostile environment for sperm. Although there was originally controversy over the health risks of the pill, it is now considered to be relatively safe for nonsmokers. In fact, it may protect against cancer of the ovaries and uterus. Side effects include nausea, breast tenderness, spotting, weight gain, mood changes, and headaches. Women who smoke should not take the pill as it may cause fatal blood clots. The pill's effectiveness is 99.5 percent if used perfectly, but 95 percent in real use.

Contraceptive Implants. Manufactured under the brand name Norplant®, contraceptive implants are silicone rods containing the hormone progesterone. Six of these matchstick-sized rods are placed under the skin of a woman's upper arm. The progesterone is released over time, and the implants remain effective for five years. While the effectiveness of implants is 99 percent, side effects include irregular monthly periods, spotting, acne, headaches, weight gain, and hair loss. Newer implants use one or two rods and may contain more than one hormone.

Hormonal Injections. Progesterone injections are given every two to three months, while those containing estrogen and progesterone are administered monthly. Injections work by stopping ovulation and making the cervical mucus hostile to sperm. Side effects include irregular periods, spotting, weight gain, headaches, depression, loss of libido, and hair loss.

SHORT-ACTING METHODS

Somewhat less effective than long-lasting methods, these contraceptives have fewer side effects. They are primarily physical or chemical barriers that also prevent or decrease the chances of transmitting RTIs and HIV.

Male Condom. This type of condom consists of a latex or animal intestine sheath that is placed over the erect penis before intercourse. Effectiveness is about 86 percent, as condoms can tear or slip off. Some people are allergic to latex and cannot use this type of condom. Latex condoms protect against RTIs and HIV infection, while those made from animal intestine do not.

Female Condom. The thin, female condom is plastic, tunnel-shaped device that is closed on one end. The closed end is placed over the cervix. It protects against both RTIs and pregnancy. One advantage of the female condom is that is it controlled by the woman. This feature is particularly important in a relationship where the woman cannot negotiate for safe sex. There are no medical limitations or side effects. At 80 percent effectiveness, the female condom is slightly less effective than the male condom.

Spermicides and Vaginal Barriers. Spermicides are chemicals that kill sperm or immobilize them. They come in many forms, including foaming tablets or suppositories, melting suppositories, foam, melting film, creams, and jellies. All are placed in the vagina prior to intercourse. Some women have allergic reactions to spermicides. Effectiveness is 80 percent. Spermicides can be used alone or in combination with condoms or vaginal barriers. These devices may also protect against RTIs and HIV, but their effectiveness in this regard is as of yet unknown.

Vaginal barriers (diaphragm, cervical cap, and sponge) are inserted in the vagina before inter-course and must be used with spermicides to be effective. A diaphragm is a soft rubber cup that covers the cervix, a cervical cap is a smaller rubber cup that fits right over the cervix, and a contraceptive sponge is a sponge impregnated with spermicide.

Emergency Contraceptive Pills. Also known as morning-after pills or post-coital pills, these are either estrogen and progesterone or progesterone-only pills that are taken within seventy-two hours of unprotected intercourse or in cases of contraception failure (e.g., forgotten pills, condom breakage, or slippage). Taken as directed they reduce the risk of pregnancy by 75 percent. They provide no RTI or HIV protection.

BEHAVIORAL METHODS

There are a number of ways to prevent pregnancy that rely on human behavior rather than contraceptive technology.

Abstinence. Abstaining from sexual inter-course, whether completely or periodically, is 100 percent effective, but may be difficult to maintain.

Fertility Awareness. There are a variety of methods a woman can use to tell the fertile time of her menstrual cycle. These include calendar calculation, cervical secretions, basal body temperature (BBT), chemical ovulation prediction kits, and cervical changes. All of these methods are used in combination with either barrier methods (during the fertile time) or periodic abstinence (not having intercourse during the fertile time). Effectiveness is approximately 75 to 80 percent. Fertility awareness can also be used to time intercourse in order to facilitate pregnancy.

Lactational Amenorrhea Method (LAM). This is a behavioral method used by women who have recently given birth. It involves simply the use of breastfeeding during the first six months postpartum, and requires that 85 percent of the baby's food be breast milk. During this period and under these conditions, LAM is 100 percent effective. It is also inexpensive, has no hormonal side effects, and benefits the baby.

FUTURE METHODS

Methods of contraception being developed include both variations of existing methods and new concepts. Among the modifications of current methods are biodegradable hormonal implants, subdermal hormonal pellets, injectable hormonal "microspheres" (hybrids of injectables and implants), and intravaginal hormonal rings. New methods include male hormonal contraceptive pills, hormonal patches for men and women, and vaccines against sperm, ovum, or hormones. Microbicides—chemicals that kill bacteria and viruses—are also being tested for use alone, or in combination with spermicides for dual protection.

Suellen Miller

(see also: Abstinence; Condoms; Contraception; Family Health; Family Planning Behavior; Maternal and Child Health; Menstrual Cycle; Planned Parenthood; Pregnancy; Reproduction; Sexually Transmitted Diseases; Women's Health )

Bibliography

Casterline, J. B., and Sinding, S. W. (2000). Unmet Need for Family Planning in Developing Countries and Implications for Population Policy. Working Paper #135. New York: Population Council.

Hatcher, R. A.; Rinehart, W.; Blackburn, R.; Geller, J. S. and Shelton, J. D. (1997). The Essentials of Contraceptive Technology. Baltimore, MD: Population Information Communication Programs, Johns Hopkins School of Public Health.

Hatcher, R. A.; Trussell, J.; Stewart, F.; Cates, W.; Stewart, G. K.; Guest, F.; and Kowal, D. (1998). Contraceptive Technology, 17th edition. New York: Ardent Media.

Klein, S.; Miller, S.; Bishop, J.; and Hansen, M. A Book for Midwives: A Manual for Traditional Birth Attendants and Community Midwives. Palo Alto, CA: Hesperian Foundation.

Speroff, L., and Darney, P. (1992). A Clinical Guide for Contraception. Baltimore, MD: Williams and Watkins.

contraception Many social practices reduce the birth rate — delaying marriage, imposing taboos on the frequency of marital intercourse, and prolonged breastfeeding, for example. Contraception, however, is usually taken to mean deliberate resort to practices to prevent sexual intercourse resulting in the birth of a child, or, more strictly speaking, to preclude conception. Methods can be divided into ‘natural’ — those not requiring any apparatus — and ‘artificial’ means. The latter can be subdivided, though not entirely, into barrier and chemical methods locally applied to the genitals; intrauterine; surgical; and the more recent hormonal contraceptives. Magical prescriptions, of dubious efficacy, for the prevention of pregnancy have also proliferated.

Refraining from sexual intercourse may have been an underestimated element in attempts to restrict family size. A modification is indulgence only when the woman is believed to be infertile: however, the relationship between menstruation and ovulation was not reliably established until 1929, and many previous calculations of a ‘safe period’ were seriously in error — though, due to variation in the cycles of individual women, even an inaccurate idea may have been occasionally effective in delaying if not preventing conception. The independent discoveries of the Japanese K. Ogino and Austrian Hermann Knaus enabled more effective calculations, but nonetheless the ‘rhythm method’ is widely known as ‘Vatican roulette’ (as the only method, apart from abstention, approved by the Catholic Church) because of its unreliability. Recently developed devices, however, now enable extremely precise pinpointing of the actual period of fertility through hormonal analysis of the female urine.

Another possibility occurring to the ingenious very early in human history was the practice of coitus interruptus, whereby the man withdraws and ejaculates outside the vagina (cf. Onan — Genesis 38:9). To think of this method means that a connection must be made between emission of semen and conception. Another method requiring no appliances is anal intercourse.

Barrier methods

Barrier methods have a long history. Egyptian papyri describe pessaries and vaginal douches, which could have been effective. The pessaries both formed a barrier, and consisted of substances either spermicidal, or likely to slow sperm motility, while the douches could have altered the chemical balance of the vagina, rendering conception less likely. Many other societies are recorded as having had similar devices capable of lowering the probability of conception.

The condom, or male sheath, was quite a late development. It became more widely used following the discovery of the vulcanization of rubber in the 1840s, which also led to the development of various forms of occlusive cap for female use. These required, to be most effective, careful fitting — indeed, the first were custom-made for each individual. The most commonly used type is the ‘Dutch cap’ or diaphragm, invented by the German physician Wilhelm Mensinga of Flensburg in the 1870s, a domed rubber cap with a metallic spring in the rim, which comes in a range of sizes and is easier to fit than similar devices. Used conscientiously, with spermicide, and left in for several hours following intercourse, it has a success rate of around 95% in preventing pregnancy. The smaller cap, covering only the cervix, has had its advocates. Rubber itself tends to destroy sperm. Using sponges for birth control dates back probably to the eighteenth century, a method particularly efficacious if the sponge is soaked in some spermicidal or sperm-weakening substance, such as vinegar, olive oil, or even soapy water; modern sponges, for a single use only, are permeated with spermicide. The recently-promoted female condom, covering the entire interior surface of the vagina, has a longer history than often realized, and is primarily a protective against sexually transmitted disease.

Spermicides

The nineteenth century also saw the commercial development of chemical contraceptives, usually in the form of pessaries for insertion into the vagina. In theory these contained a spermicidal substance (though some worked because the greasy agents hindered the sperm), but in the unregulated industry of contraceptive manufacture, the unreliability of these products led to the belief (as with condoms) that the law required one ‘dud’ in every box. In Britain the issue of an ‘Approved List’ of effective products by the National Birth Control Association (later the Family Planning Association) led to improvement in standards, though spermicidal activity as measured in laboratory circumstances and in practice can still differ widely. Chemical contraceptives currently come as creams and jellies (specifically for use with a barrier method), pessaries, and foam and are recommended to be employed in conjunction with a barrier method.

IUD

As far as can be ascertained, the intrauterine device in its modern form dates back to the experiments of Gr̈afenburg and other German gynaecologists before World War I, although the British obstetrician C. H. F. Routh claimed in the 1870s that women were using uterine pessaries intended for gynaecological conditions for contraceptive purposes. Early IUDs were made of gold or silver; modern ones are made of plastic or copper. They work, it is believed, by irritating the uterus so that implantation of the fertilized ovum does not take place. The method has fallen into some disfavour following the highly damaging effects of the Dalkon Shield, which became apparent during the 1970s.

Sterilization

sterilization may be regarded as a contraceptive method, but unlike other methods it cannot be reversed, or not with any substantial probability of success. In women ligating the Fallopian tubes was originally a relatively major abdominal operation, carried out under general anaesthesia. More recently, sterilizations have been performed using a laparoscope, inserted through a small incision, to locate the tubes so that they can be cauterized; this can be done as an outpatient operation. Vasectomy is a much less serious operation.

The Pill

The greatest advance in contraceptive technology in the twentieth century was the female contraceptive pill. Ever since the discovery of the sex hormones and steroids there were hopes of a contraceptive which could be taken orally or injected. The earliest combination birth control pill, developed in the late 1950s, contained both oestrogen and progestin, and was taken for 21 days followed by a 5-day break during which menstruation occurred. It caused the suppression of ovulation and the thickening of the cervical mucus, hindering sperm from entering the uterus. The sequential pill (1965) consisted of oestrogen-only pills taken for the first 16 days of the cycle and combination oestrogen-progestin pills for the final five days, inhibiting ovulation but having no effect on the cervical mucus. The minipill, conversely, contains only progestin, is taken without breaks, and works by the constant production of thick cervical mucus which blocks the entry of the sperm. There are a number of other variations, and hormonal contraceptives are also given as implants or injections (e.g. Depo-Provera) with long-term efficacy. Related developments are the ‘morning after’ pill, a post-coital contraceptive, and the so-far unfulfilled hope of a ‘male pill’.

The Pill came into general use in the 1960s. It is an extremely reliable contraceptive method (97–99%) and has the important qualities of being totally detached from the genital organs, not requiring any dexterity to fit, and being unintrusive on the sexual act. This rendered it popular with both doctors and the general public. Side-effects, ranging from mild to extremely serious, and the implications for the dissemination of sexually transmitted disease of a reliable non-barrier method of contraception, have dimmed the initial glowing enthusiasm it generated, but it is still one of the most widely used methods of birth control.

Family limitation and society

Methods of birth control have been known from distant antiquity, but it is less easy to establish to what extent they may have been used. As Angus McLaren pointed out in A History of Contraception (1992), the desire of human couples to exercise control over their reproductive capacities may in some epochs veer towards the promotion of conception rather than its prevention. Many factors bear upon the possibility of even imagining that births might be restricted, and upon the putting of such a possibility into efficacious practice. Economic, social, and cultural factors led to increasing debate on the subject during the nineteenth century, particularly associated with the name of the political economist T. R. Malthus and his calculation that the population would always tend to outrun the means of subsistence — though he did not recommend artificial interference with this state of affairs. French peasants were apparently already limiting their families through coitus interruptus during the eighteenth century, because of their reluctance to let family holdings be divided between several heirs. The cause-and-effect relationship between the decline in infant mortality and the rise of family limitation is not clear: it is often claimed that the increased chances of child survival encouraged parents to reduce family size, but it can also be argued that infants born at wider intervals into smaller families have a better chance of survival through access to more maternal attention, and division of family resources between fewer family members.

In spite of the number of birth control methods available, they are still far from universally employed, due to simple lack of access; economic factors, either local factors encouraging large families, or the inability to afford the means; and in large areas of the world, because of religious objections.

Lesley A. Hall

Contraception

Definition

Contraception (birth control) prevents pregnancy by interfering with the normal process of ovulation, fertilization, and implantation. There are different kinds of birth control that act at different points in the process.

Purpose

Every month, a woman's body begins the process that can potentially lead to pregnancy. An egg (ovum) matures, the mucus that is secreted by the cervix (a cylindrical-shaped organ at the lower end of the uterus) changes to be more inviting to sperm, and the lining of the uterus grows in preparation for receiving a fertilized egg. Any woman who wants to prevent pregnancy must use a reliable form of birth control.

Birth control (contraception) is designed to interfere with the normal process and prevent the pregnancy that could result. There are different kinds of birth control that act at different points in the process, from ovulation, through fertilization, to implantation. Each method has its own side effects and risks. Some methods are more reliable than others.

There are more different types of birth control available today than ever. They can be divided into a few groups based on how they work. These groups include:

• Hormonal methods—These use medications (hormones) to prevent ovulation. Hormonal methods include birth control pills (oral contraceptives ), Depo Provera injections, and Norplant.
• Barrier methods—These methods work by preventing the sperm from getting to and fertilizing the egg. Barrier methods include the condom, diaphragm, and cervical cap. The condom is the only form of birth control that also protects against sexually transmitted diseases, including HIV (the virus that causes AIDS).
• Spermicides—These medications kill sperm on contact. Most spermicides contain nonoxynyl-9. Spermicides come in many different forms such as jelly, foam, tablets, and even a transparent film. All are placed in the vagina. Spermicides work best when they are used at the same time as a barrier method.
• Intrauterine devices—Intrauterine contraceptive devices (IUDs) are inserted into the uterus, where they stay from one to 10 years. An IUD prevents the fertilized egg from implanting in the lining of the uterus, and may have other effects as well.
• Tubal sterilization—Tubal sterilization is a permanent form of contraception for women. Each fallopian tube is either tied or burned closed. The sperm cannot reach the egg, and the egg cannot travel to the uterus.

• Vasectomy—is the male form of sterilization, and should also be considered permanent. In vasectomy, the vas defrens, the tiny tubes that carry the sperm into the semen, are cut and tied off. Thus, no sperm can get into the semen.
• A newer and somewhat controversial form of birth control is emergency contraception. This type is used after unprotected intercourse and sometimes is referred to as the "morning-after pill".

Unfortunately, there is no perfect form of birth control. Only abstinence (not having sexual intercourse) can protect against unwanted pregnancy with 100% reliability. The failure rates, which means the rates of pregnancy, for most forms of birth control are quite low. However, some forms of birth control are more difficult or inconvenient to use than others. In actual practice, the birth control methods that are more difficult or inconvenient have much higher failure rates because they are not used regularly or as prescribed.

Description

Most forms of birth control have one thing in common. They are only effective if used faithfully. Birth control pills will work only if taken every day; the diaphragm is effective only if used during every episode of sexual intercourse. The same is true for condoms and the cervical cap. Some methods automatically work every day. These methods include Depo Provera, Norplant, the IUD, and tubal sterilization.

There are many different ways to use birth control. They can be divided into several groups:

• By mouth (oral)—Birth control pills must be taken by mouth every day.
• Injected—Depo Provera is a hormonal medication that is given by injection every three months.
• Implanted—Norplant is a long-acting hormonal form of birth control that is implanted under the skin of the upper arm.
• Vaginal—Spermicides and barrier methods work in the vagina.
• Intra-uterine—The IUD is inserted into the uterus.
• Surgical—Tubal sterilization is a form of surgery. A doctor must perform the procedure in a hospital or surgical clinic. Many women need general anesthesia.

The methods of birth control differ from each other in the timing of when they are used. Some methods of birth control must be used specifically at the time of sexual intercourse (condoms, diaphragm, cervical cap, spermicides). Emergency contraception must be started as soon as possible after intercourse and no more than 72 hours after. All other methods of birth control (hormonal methods, IUDs, tubal sterilization) must be working all the time to provide protection.

Precautions

There are risks associated with certain forms of birth control. Some of the risks of each method are listed below:

• Birth control pills—The hormone (estrogen) in birth control pills can increase the risk of heart attack in women over 35, particularly those who smoke. Certain women cannot use birth control pills.
• IUD—The IUD can increase the risk of serious pelvic infection. The IUD can also injure the uterus by poking into or through the uterine wall. Surgery might be needed to fix this.
• Tubal sterilization—"Tying the tubes" is a surgical procedure and has all the risks of any other surgery, including those associated with anesthesia, as well as infection and bleeding.
• Emergency contraceptive pills should not be used regularly for birth control. They can interrupt the menstrual cycle and are not 100% effective. If the emergency contraception fails, an ectopic pregnancy can occur.

Preparation

No specific preparation is needed before using contraception. However, a woman must be sure that she is not already pregnant before using a hormonal method or having an IUD placed.

Aftercare

No aftercare is needed.

Risks

Many methods of birth control have side effects. Knowing the side effects can help a woman to determine which method of birth control is right for her.

• Hormonal methods—The hormones in birth control pills, Depo Provera, and Norplant can cause changes in menstrual periods, changes in mood, weight gain, acne, and headaches. In addition, it may take many months to begin ovulating again once a woman stops using Depo Provera or Norplant.
• Barrier methods—A woman must insert the diaphragm in just the right way to be sure that it works properly. Some women get more urinary tract infections if they use a diaphragm. This is because the diaphragm can press against the urethra, the tube that connects the bladder to the outside.
• Spermicides—Some women and men are allergic to spermicides or find them irritating to the skin.
• IUD—The IUD is a foreign body that stays inside the uterus, and the uterus tries to get it out. A woman may have heavier menstrual periods and more menstrual cramping with an IUD in place.
• Tubal sterilization—Some women report increased menstrual discomfort after tubal ligation. It is not known if this is related to the tubal ligation itself.

There is no perfect form of birth control. Every method has a small failure rate and side effects. Some methods carry additional risks. However, every method of birth control can be effective if used properly.

Resources

PERIODICALS

"Contraception; Overview." NWHRC Health Center—Contraception March 9, 2004.

"Ectopic Pregnancy Is a Possibility When Emergency Contraception Fails." Health & Medicine Week March 15, 2004: 222.

KEY TERMS

Fallopian tubes— The thin tubes that connect the ovary to the uterus. Ova (eggs) travel from the ovary to the uterus. If the egg has been fertilized, it can implant in the uterus.

Fertilization— The joining of the sperm and the egg; conception.

Implantation— The process in which the fertilized egg embeds itself in the wall of the uterus.

Ovulation— The release of an egg (ovum) from the ovary.

Contraception

RELIGION AND PUBLIC POLICY

HISTORY OF CONTRACEPTION AND CURRENT METHODS

INTERNATIONAL STRATEGIES

BIBLIOGRAPHY

The Fourth World Conference on Women, held in Beijing in 1995, reinforced that all human beings have the right to “decide freely and responsibly the number and spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health” (para. 95). A discussion of contraception provides us with an understanding of how access to comprehensive family planning services can improve the lives of women, men, and children around the world.

Contraception, or birth control, is the deliberate prevention of conception by hormones, devices, surgery, or avoiding intercourse during a woman’s fertile time of the month. Family planning is the intentional decision on the number and spacing of children a couple will bear.

According to the World Health Organization (WHO), there are approximately 123 million women, mostly in developing countries, who are not using contraception. Some of the reasons include poor access to comprehensive services, inadequate information, male partner disapproval, and fears about side effects and safety. Religious beliefs and public policies also play an important role in methods that are available to couples in both developing and developed nations.

RELIGION AND PUBLIC POLICY

Humans have been using birth control from the earliest times. Ancient Islamic texts, Jewish writings, and Hindu sacred scriptures all mentioned that herbs could be used as temporary contraceptives. Modern religious stances vary according to their definition of the place of sex within marriage; for example, the Catholic Church prohibits any artificial means of birth control because it believes that the sole purpose of sexual intercourse is procreation. Some Christian fundamentalists, Evangelicals, and Anglicans share this view. Orthodox Judaism permits female contraceptives only for health reasons; while Conservative and Reform views leave the decision to the married couple, as does Christianity’s Eastern Orthodox Church. The Islamic faith has wide variations on attitudes toward birth control, but despite this, procreation is emphasized as religious duty. There is no prohibition to birth control in Hinduism. As noted by Kathleen O’Grady in her 1999 article “Contraception and Religion, a Short History,” the two common concerns of all major religions are fear of illicit sex and immorality, and destruction of the family. Particularly among non-Western religions, the worry is that liberal family planning policies could encourage Western modes of living, not only destroying the family, but family values as well. Some Christian fundamentalists in the United States agree with this stance. On the other hand, women’s rights activists argue that prohibiting birth control is a fundamental way to control women and keep them dependent on men.

National and international public policy also plays a role with respect to sponsoring or funding reproductive health services, and policies are modified with changes in national leadership. In the United States, for example, President George W. Bush instituted a global “gag” rule regarding abortion in 2001. This means that foreign agencies, such as the WHO, no longer receive funding if they counsel women about abortion, consequently affecting family planning programs as well.

HISTORY OF CONTRACEPTION AND CURRENT METHODS

Despite religious decrees about contraception, there are many references that document three major methods that go as far back as ancient Greece: the use of herbal remedies as abortifacients, coitus interruptus (withdrawal of the penis from the vagina before ejaculation, hereafter referred to as withdrawal ), and abstinence. Condoms were described as protection against sexually transmitted infections (STIs) in the early sixteenth century. Rubber condoms became available in the United States in the nineteenth century along with cervical caps, diaphragms, metal pessaries, and male and female sterilization. The birth control pill revolutionized contraception with its

debut in 1959. There have been many advances in hormonal and non-hormonal contraceptive technologies for women in the last thirty years. Although research is being conducted on systemic methods for men, condoms, withdrawal, and sterilization remain the only contraceptive options for them. See Table 1 for current methods.

Male latex condoms, when used reliably and properly, are highly effective in preventing STIs and the human immunodeficiency virus (HIV). The female condom is the only female method that is effective in preventing pregnancy and STIs/HIV. People at risk for sexually transmitted infections (STIs) and/or HIV may be afforded dual protection against STI/HIV and pregnancy by using either male or female condoms. Using condoms and another form of birth control are even more effective measures of contraception.

INTERNATIONAL STRATEGIES

The World Health Organization has taken the lead on providing resources for international family planning since its inception in 1948. Paul Van Look, director of the WHO Department of Reproductive Health and Research, has stated that sexual and reproductive health are concerns for everyone at all stages of life and are fundamental to the economic and social development of nations, but also mirror basic inequalities such as wealth and gender. Women have been particularly harmed by lack of access to reproductive health services; research documents that the ability to space pregnancies impacts a woman’s health and quality of life, as well as the health of her children. Family planning programs can also improve the economic and social situation of women’s lives.

SEE ALSO Abortion; AIDS; AIDS/HIV in Developing Countries, Impact of; Birth Control; Bush, George W.; Family Planning; Fundamentalism, Christian; Population Control; Population Studies; Reproduction; Sexuality;

BIBLIOGRAPHY

Hatcher, Robert A. 2004. Contraceptive Technology, 18th ed. New York: Ardent Media.

O’Grady, Kathleen. 1999. Contraception and Religion, A Short History. In The Encyclopedia of Women and World Religion, ed. Serinity Young. New York: Macmillan Reference.

Potts, Malcolm, and Martha Campbell. 2002. History of Contraception. Gynecology and Obstetrics 6, ch. 8. http://big.berkeley.edu/ifplp.history.pdf.

United Nations Fourth World Conference on Women. 1995. Action for Equality, Development and Peace. Beijing: UN. http://www.un.org/womenwatch/daw/beijing/platform/health.htm#object1.

World Health Organization. 2006. Medical Eligibility Criteria for Contraceptive Use. Geneva: World Health Organization Press. http://www.who.int/reproductive-health.

Linda C. Andrist

Contraception

Contraception, also called birth control, is the deliberate effort to halt conception a child (to keep a woman from becoming pregnant). Attempts to prevent pregnancy date back to ancient times and cultures. Some form of contraception is used by more than half the women in the United States. Although widespread, contraception remains controversial, with some religious and political groups opposed to distribution of contraceptives.

Ancient methods in use today

Some early methods of contraception involved techniques still used today. Gum arabic—a substance with which Egyptians coated tampons to kill sperm—is used to make spermicides contained in modern contraceptive jellies and foams. The ancient practice of prolonged nursing of infants to prevent conception of future children remains in current use, although it is by no means 100 percent effective. The modern diaphragm has its origin in a device made from bamboo that Asian women used as a barrier to the cervix (the opening to the uterus, or womb). The Chinese promoted "coitus interruptus," the withdrawal of the man's penis from the woman's vagina before ejaculation. Probably the most common contraceptive method in the world, this practice has resulted in numerous accidental pregnancies. The rhythm method (in which intercourse is avoided on the days of the month when a woman is most likely to become pregnant) was and remains the only form of birth control approved by the Roman Catholic Church.

Words to Know

Fallopian tube: One of a pair of structures in the female reproductive system that carries eggs from the ovaries to the uterus.

Fertilization: The union of an egg and sperm to form a new individual.

Hormone: A chemical messenger or substance produced by the body that has an effect on organs in other parts of the body.

Ovary: One of a pair of female reproductive organs that produces eggs and female sex hormones.

Ovulation: The release of an egg, or ovum, from an ovary.

Ovum: A mature female sex cell produced in the ovaries.

Sperm: A mature male sex cell secreted in semen during male ejaculation.

Uterus: The female organ in which the fetus develops before birth.

Evolution of the condom

The practice of using condoms to prevent pregnancy and sexually transmitted diseases began in the sixteenth century, when cloth condoms were promoted to protect against syphilis. By the eighteenth century, condoms were made of animal membrane, making them waterproof and more effective as birth control devices. Latex (rubber) condoms were first produced during the Industrial Revolution (about 1750 to about 1850). The emergence of acquired immunodeficiency syndrome (AIDS) in the 1980s again resulted in the widespread promotion of condom use as an effective barrier to disease.

Modern methods of contraception

Contraceptive devices that were developed in the late nineteenth century and are still used today include the diaphragm, a rubber cap that fits over the cervix and prevents the passage of sperm into the uterus; the contraceptive sponge, also a device used to cover the cervix before sexual intercourse; and foams and jellies containing spermicides that are inserted into the vagina before intercourse.

Advances in medical knowledge led to the development in the 1960s of the IUD (or intrauterine device), which is placed in the uterus to prevent or interrupt the process of conception. Birth control pills, approved for use in 1960 and the most popular contraceptive in the United States, contain hormones that are released into a woman's system on a regular basis (some are taken 21 days per month, others are taken every day) to prevent pregnancy. Different pills act in different ways: some inhibit ovulation (the release of an egg from the ovary), some prevent implantation

of a fertilized egg (thereby denying cells the nourishment they need to develop into an embryo), and some thicken the secretions throughout the woman's reproductive system so that her partner's sperm has less of a chance to meet her egg.

Other recent developments include a matchsticklike device that is implanted under the skin of a woman's upper arm; it lasts about five years, releasing a contraceptive into the bloodstream that inhibits ovulation. An injectable form of contraceptive provides protection from pregnancy for three months at a time, but the most common reported side effects—including significant weight gain and mood swings—make this an unattractive choice for many women. In addition, a condom that can be inserted into the vagina of females became available in the mid-1990s, but its effectiveness is still being debated.

In 2000, in a landmark decision that received both widespread praise and protest, the U.S. Food and Drug Administration (FDA) approved the marketing of an abortion-inducing pill. This was the first alternative to surgical abortion approved in the United States. The prescription drug, called mifepristone or RU-486, was first developed in France in 1980. As of the end of 2000, 16 countries around the world had approved its use.

An abortion using mifepristone takes place in three steps. First, in a doctor's office, a woman is given a pregnancy test. If she is pregnant and it has been no longer than seven weeks since her last menstrual period, she is given three pills of mifepristone. The drug blocks the hormone progesterone, which is required to maintain a pregnancy. The woman then returns to the doctor's office within two days to take two tablets of a second drug, misoprostol. This second drug is a hormonelike substance that causes a woman's uterus to contract, expelling the fetal tissue, usually within six hours of taking the drug. Fourteen days later, she returns to her doctor's office and is checked to make sure she is no longer pregnant and no fetal tissue remains in her uterus. About 5 percent of the time, the abortion is incomplete and a woman will have to have a surgical abortion. Mifepristone fails completely in about 1 percent of the women who take it. The side effects of this abortion procedure are similar to a spontaneous miscarriage: uterine cramping, bleeding, nausea, and fatigue.

Sterilization

Sterilization, the surgical alteration of a male or female to prevent them from bearing children, is the most common form of birth control for women in the United States. In men, the operation is called a vasectomy. It is a simple out-patient procedure that involves snipping the vessel through which sperm passes so that semen—the off-white secretion ejected from the penis at the time of sexual climax—no longer contains sperm.

In women, sterilization involves a procedure called tubal ligation, in which the fallopian tubes that carry eggs from the ovaries to the uterus are tied or clipped. An egg that is released by an ovary during ovulation does not reach the uterus, thus preventing fertilization.

Challenges of contraception

Developing a foolproof method of birth control that has little or no side effects, is simple to use, and is agreeable to both men and women is a challenge. Sterilization is such a method, but only if the person undergoing the operation no longer wants to bear children.

Unwanted pregnancies can be measured by the rate of abortion (the ending of a pregnancy). Although many women who undergo abortions do not practice birth control, some pregnancies are the result of contraceptive failure. Abortion rates typically are highest in countries where contraceptives are not readily available. Some experts believe that easier access to contraceptive services would result in lower rates of accidental pregnancy and abortion.

[See also Fertilization; Reproduction ]

Contraception The Supreme Court's involvement in defining the constitutional right to obtain and use contraceptives has been limited until the relatively recent past. In 1927, however, the Court upheld the constitutionality of one contraceptive practice. Buck v. Bell (1927) involved the forced eugenic sterilization of a woman in a state mental institution who was considered to be genetically “unfit.” Justice Oliver Wendell Holmes, writing for the Court, found that none of her rights were violated and that sterilization was “better for all the world” (p. 207) than childbearing by persons with poor genes. In Skinner v. Oklahoma (1942), the Court limited the permissible scope of forced sterilizations, overturning an Oklahoma law providing for compulsory sterilization as a punishment for repeat offenders of certain crimes. The Court held that the right to procreate was a fundamental liberty protected by the Constitution. Skinner was decided on equal protection grounds and did not reverse Buck v. Bell. Although at odds with present privacy jurisprudence, Buck has never been overruled.

Legal restriction on the sale and use of birth control dates back to Congress's passage in 1873 of the Comstock Act, which made sending contraceptives or information about them through the mails or in interstate commerce a crime. Many states passed their own statutes restricting the sale or use of birth control. During the first half of the twentieth century, the lower federal courts and some state courts narrowly construed bans on birth control so that by the 1940s, in most jurisdictions, prescription of contraceptives by medical professionals was legal. In the states of Connecticut and Massachusetts, however, birth control bans continued. These statutes kept birth control clinics closed for years, interfering with access to effective birth control methods by low‐income women.

The Supreme Court had opportunities to review the constitutionality of birth control bans on a number of occasions but dismissed cases on standing grounds, Tileston v. Ullman (1943), or for want of a substantial federal question, Gardner v. Massachusetts (1938). In Poe v. Ullman (1961), the Court denied review of a declaratory judgment action challenging the Connecticut law because it believed that the statute was not being enforced.

After Planned Parenthood of Connecticut opened a birth control clinic, the clinic's executive director and medical director were arrested for violating the state law. Their conviction was appealed to the U.S. Supreme Court in Griswold v. Connecticut (1965). The Court struck down the law, finding that married persons have a constitutionally protected privacy right to use contraceptives. This right of marital privacy was “older than the Bill of Rights” (p. 486). Although not explicitly mentioned in the Constitution, it was implicitly protected, for it lay “within the zone of privacy created by several fundamental constitutional guarantees” (p. 485).

Griswold's holding centered on privacy in marital relations. The right to privacy in the use of birth control was extended to unmarried persons in Eisenstadt v. Baird (1972). Justice William J. Brennan wrote that “[i]f the right of privacy means anything, it is the right of the individual, married or single, to be free from unwarranted governmental intrusion into matters so fundamentally affecting a person as the decision whether to bear or beget a child” (p. 453). This right was extended to minors when, in 1977, a plurality struck down a ban on distribution of contraceptives to persons under the age of sixteen because minors, as well as adults, had privacy rights (Carey v. Population Services International, 1977).

Also in Carey, the Court overturned a New York law permitting only pharmacists to distribute nonprescription contraceptives because the statute burdened the fundamental right to decide whether to bear a child, without serving any compelling state interests. It struck down the statute's total ban on advertising contraceptives on the ground that it suppressed commercial speech in violation of the First Amendment. The Court expanded First Amendment protection of the advertising of contraceptives when it struck down a federal ban on mailing unsolicited advertisements for contraceptives: Bolger v. Youngs Drug Product Corp. (1983).

The right to privacy developed in the birth control cases served as the basis for the Court's ruling that women have a privacy right to obtain an abortion in Roe v. Wade (1973). Although the Court has recently retreated somewhat in its protection of abortion rights (e.g., Webster v. Reproductive Health Services, 1989), the right to obtain and use contraceptives remains firmly, and broadly, protected.

See also Due Process, Substantive; Family and Children; Gender; Privacy.

Bibliography

C. Thomas Dienes , Law, Politics, and Birth Control (1972).

Mary L. Dudziak

contraception (birth control) Use of devices or techniques to prevent pregnancy. The pill is a hormone preparation that prevents the release of an egg (ovum) and thickens the cervical mucus. The intra-uterine device (IUD) is a small spring made from plastic or metal inserted into the womb. It stops the fertilized egg embedding itself in the uterine lining. Barrier methods include the male and female condom and the diaphragm. The male condom is a latex sheath that covers the penis and collects the ejaculated semen; the female condom lines the inside of the vagina, preventing any sperm entering the womb. The use of condoms is widely advocated because they protect against some sexually transmitted diseases, including acquired immune deficiency syndrome (AIDS). Devices, such as diaphragms or caps, cover the cervix thus preventing sperm entering the womb. Less effective is the ‘rhythm method’, which involves the avoidance of sex on days when conception is most likely (when the woman is ovulating). It is not a reliable method as ovulation cannot always be predicted accurately. Emergency contraception, known as the ‘morning-after pill’, can be taken up to 72 hours after unprotected sexual intercourse; it prevents the fertilized ovum embedding itself in the womb. It is not suitable to be used regularly. See also sexual reproduction

contraception was outlawed in the Irish Free State by the Criminal Law Amendment Act (1935); information about it had already been categorized as ‘indecent literature’ by the Censorship of Publications Act (1928). Some deputies and senators spoke out against the ban, mainly because they believed that it would drive contraception underground and promote ‘immorality’. Some doctors and Protestant clergymen on the Commission on Emigration in 1956 dissented from the commission's disapproval of ‘family limitation’, on the grounds that large families on low income weakened women's and children's health. From the 1960s doctors were permitted to prescribe the contraceptive pill for menstrual regulation. Many Irish Catholics, however, were mindful of their church's ban on artificial birth control, reinforced by the papal encyclical Humanae vitae in 1968. In 1974 the Supreme Court upheld people's right to import contraceptives for their own use. In 1979 the sale and distribution of contraception information was no longer deemed obscene and indecent, and in the same year the Health (Family Planning) Act legalized the sale and distribution of contraceptives to people for bona fide family planning purposes. Soon afterwards all restrictions on the sale of contraceptives were removed.

Caitriona Clear

contraception (kon-tră-sep-shŏn) n. the prevention of unwanted pregnancy. See coitus (interruptus), condom, diaphragm, IUCD, IUS, oral contraceptive, postcoital (contraception), rhythm method, sterilization.
—contraceptive adj., n.

con·tra·cep·tion / ˌkäntrəˈsepshən/ • n. the deliberate use of artificial methods or other techniques to prevent pregnancy as a consequence of sexual intercourse.

Contraception. See Birth Control and Family Planning.

CONTRACEPTION

CONTRACEPTION. SeeBirth Control .

Contraception: see BIRTH AND POPULATION CONTROL.

contraception and contraceptive: see birth control .

contraception See birth control.

contraception •ashen, fashion, passion, ration •abstraction, action, attraction, benefaction, compaction, contraction, counteraction, diffraction, enaction, exaction, extraction, faction, fraction, interaction, liquefaction, malefaction, petrifaction, proaction, protraction, putrefaction, redaction, retroaction, satisfaction, stupefaction, subtraction, traction, transaction, tumefaction, vitrifaction •expansion, mansion, scansion, stanchion •sanction •caption, contraption •harshen, Martian •cession, discretion, freshen, session •abjection, affection, circumspection, collection, complexion, confection, connection, convection, correction, defection, deflection, dejection, detection, direction, ejection, election, erection, genuflection, imperfection, infection, inflection, injection, inspection, insurrection, interconnection, interjection, intersection, introspection, lection, misdirection, objection, perfection, predilection, projection, protection, refection, reflection, rejection, resurrection, retrospection, section, selection, subjection, transection, vivisection •exemption, pre-emption, redemption •abstention, apprehension, ascension, attention, circumvention, comprehension, condescension, contention, contravention, convention, declension, detention, dimension, dissension, extension, gentian, hypertension, hypotension, intention, intervention, invention, mention, misapprehension, obtention, pension, prehension, prevention, recension, retention, subvention, supervention, suspension, tension •conception, contraception, deception, exception, inception, interception, misconception, perception, reception •Übermenschen • subsection •ablation, aeration, agnation, Alsatian, Amerasian, Asian, aviation, cetacean, citation, conation, creation, Croatian, crustacean, curation, Dalmatian, delation, dilation, donation, duration, elation, fixation, Galatian, gyration, Haitian, halation, Horatian, ideation, illation, lavation, legation, libation, location, lunation, mutation, natation, nation, negation, notation, nutation, oblation, oration, ovation, potation, relation, rogation, rotation, Sarmatian, sedation, Serbo-Croatian, station, taxation, Thracian, vacation, vexation, vocation, zonation •accretion, Capetian, completion, concretion, deletion, depletion, Diocletian, excretion, Grecian, Helvetian, repletion, Rhodesian, secretion, suppletion, Tahitian, venetian •academician, addition, aesthetician (US esthetician), ambition, audition, beautician, clinician, coition, cosmetician, diagnostician, dialectician, dietitian, Domitian, edition, electrician, emission, fission, fruition, Hermitian, ignition, linguistician, logician, magician, mathematician, Mauritian, mechanician, metaphysician, mission, monition, mortician, munition, musician, obstetrician, omission, optician, paediatrician (US pediatrician), patrician, petition, Phoenician, physician, politician, position, rhetorician, sedition, statistician, suspicion, tactician, technician, theoretician, Titian, tuition, volition •addiction, affliction, benediction, constriction, conviction, crucifixion, depiction, dereliction, diction, eviction, fiction, friction, infliction, interdiction, jurisdiction, malediction, restriction, transfixion, valediction •distinction, extinction, intinction •ascription, circumscription, conscription, decryption, description, Egyptian, encryption, inscription, misdescription, prescription, subscription, superscription, transcription •proscription •concoction, decoction •adoption, option •abortion, apportion, caution, contortion, distortion, extortion, portion, proportion, retortion, torsion •auction •absorption, sorption •commotion, devotion, emotion, groschen, Laotian, locomotion, lotion, motion, notion, Nova Scotian, ocean, potion, promotion •ablution, absolution, allocution, attribution, circumlocution, circumvolution, Confucian, constitution, contribution, convolution, counter-revolution, destitution, dilution, diminution, distribution, electrocution, elocution, evolution, execution, institution, interlocution, irresolution, Lilliputian, locution, perlocution, persecution, pollution, prosecution, prostitution, restitution, retribution, Rosicrucian, solution, substitution, volution •cushion • resumption • München •pincushion •Belorussian, Prussian, Russian •abduction, conduction, construction, deduction, destruction, eduction, effluxion, induction, instruction, introduction, misconstruction, obstruction, production, reduction, ruction, seduction, suction, underproduction •avulsion, compulsion, convulsion, emulsion, expulsion, impulsion, propulsion, repulsion, revulsion •assumption, consumption, gumption, presumption •luncheon, scuncheon, truncheon •compunction, conjunction, dysfunction, expunction, function, junction, malfunction, multifunction, unction •abruption, corruption, disruption, eruption, interruption •T-junction • liposuction •animadversion, aspersion, assertion, aversion, Cistercian, coercion, conversion, desertion, disconcertion, dispersion, diversion, emersion, excursion, exertion, extroversion, immersion, incursion, insertion, interspersion, introversion, Persian, perversion, submersion, subversion, tertian, version •excerption