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Birth control, also known as contraception and fertility control, refers to methods or devices used to prevent pregnancy.[1] Planning and provision of birth control is called family planning.[2] Safe sex, such as the use of male or female condoms, can also help prevent transmission of sexually transmitted infections.[3][4] Contraceptive use in developing countries has cut the number of maternal deaths by 44% (about 270,000 deaths averted in 2008) but could prevent 73% if the full demand for birth control were met.[5][6] Because teenage pregnancies are at greater risk of poor outcomes such as preterm birth, low birth weight and infant death, some authors suggest adolescents need comprehensive sex education and access to reproductive health services, including contraception.[7][8] By lengthening the time between pregnancies, birth control can also improve adult women's delivery outcomes and the survival of their children.[5]

Effective birth control methods include barriers such as condoms, diaphragms, and the contraceptive sponge; hormonal contraception including oral pills, patches, vaginal rings, and injectable contraceptives; and intrauterine devices (IUDs).[9] Emergency contraception can prevent pregnancy after unprotected sex. Long-acting reversible contraception such as implants, IUDs, or vaginal rings are recommended to reduce teenage pregnancy.[8] Sterilization by means such as vasectomy and tubal ligation is permanent contraception. Some people regard sexual abstinence as birth control, but abstinence-only sex education often increases teen pregnancies when offered without contraceptive education.[10][11] Non-penetrative sex and oral sex are also sometimes considered contraception.[12]

Birth control methods have been used since ancient times but effective and safe methods only became available in the 20th century.[9] Some cultures deliberately limit access to contraception because they consider it to be morally or politically undesirable.[9] About 222 million women who want to avoid pregnancy in developing countries are not using a modern contraception method.[13][14] Birth control increases economic growth because of fewer dependent children, more women participating in the workforce, and less consumption of scarce resources.[15][16] Women's earnings, assets, body mass index, and their children's schooling and body mass index all substantially improve with greater access to contraception.[15]

MethodsEdit

Chance of pregnancy during first year of use:[9]
Method Typical use Perfect use
No birth control 85% 85%
Combination pill 8% 0.3%
Progestin-only pill 13% 1.1%
Sterilization (female) 0.5% 0.5%
Sterilization (male) 0.15% 0.10%
Condom (female) 21% 5%
Condom (male) 15% 2%
Copper IUD 0.8% 0.6%
Hormone IUD 0.2% 0.2%
Patch 8% 0.3%
Vaginal ring 8% 0.3%
Depo Provera 3% 0.3%
Implant 0.05% 0.05%
Diaphragm and spermicide 16% 6%
Withdrawal 27% 4%
Standard days method ~12-25% ~1-9%
Lactational amenorrhea method 0-7.5%[17] <2%[18]

Birth control includes barrier methods, hormonal contraception, intrauterine devices (IUDs), sterilization, and behavioral methods. Hormones may be delivered by injection, by mouth (orally), placed in the vagina, or implanted under the skin. The most common types of oral contraception include the combined oral contraceptive pill and the progestogen-only pill.[19] Most methods are typically used before or during sex while emergency contraception is effective for up to a few days after intercourse.

Determining whether a woman with a specific health problem can use a form of birth control sometimes requiring a pelvic examination or medical tests. The World Health Organization publishes a detailed list of medical eligibility criteria for each type of contraception.[20]

The effectiveness of a birth control method is generally expressed as the percentage of women who become pregnant using the method in the first year of use. Thus, if 100 women use a method that has a 10 percent first-year failure rate, then 10 of the women should become pregnant during the first year of use (equivalent to 10 pregnancies per 100 woman-years). Sometimes the effectiveness is expressed in lifetime failure rate, more commonly among methods with high effectiveness, such as vasectomy after a negative semen analysis.[21]

The most effective methods in typical use are those that do not depend upon regular user action. Surgical sterilization, injectable hormones, and intrauterine devices all have first-year failure rates of less than one percent with typical us. The typical failure rate of Depo-Provera is disagreed upon, with figures ranging from less than one percent up to three percent.[22][23]

Other methods may be highly effective if used correctly, however have typical use first-year failure rates that are considerably higher due to incorrect usage. Hormonal contraceptive pills, patches or rings, and the lactational amenorrhea method, if used strictly, can have first-year (or for LAM, first-6-month) failure rates of less than 1%.

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.[24]

HormonalEdit

Hormonal contraceptives inhibit ovulation and fertilization.[25] These include oral pills, subdermal implants, and injectable contraceptives as well as the patch, hormonal IUDs and the vaginal ring. The most commonly used hormonal contraceptive is the combined oral contraceptive pill—commonly known as "the pill"—which includes a combination of an estrogen and a progestin (progestogen).[26] There is also a progestin-only pill.[27] Currently, hormonal contraceptives are available only for females.

Combined hormonal contraceptives are associated with a slight increased cardiovascular risk, including an increased risk of venous and arterial thrombosis, blood clots that can cause permanent disability or even death. However, the benefits are greater than the risk of pregnancy, because pregnancy also increases those risks.[28]

Oral contraceptives reduce the risk of ovarian cancer and endometrial cancer but increase the risk of breast cancer and cervical cancer. Some reduce water retention, and several are used to treat mild to moderate acne. Some types of combination hormonal contraceptives may reduce the symptoms of premenstrual dysphoric disorder and can reduce heavy menstrual bleeding and painful menstruation. Lower doses of estrogen required by vaginal administration (i.e., from the vaginal ring or hormonal IUDs instead of the pill) may reduce the risk of breast tenderness, nausea, and headache associated with oral contraceptives.[26] The effect on sexual desire is mixed with it increased or decreased in some but with no effect in most.[29]

Progestin-only pills and intrauterine devices are not associated with an increased risk of thromboses and may be used by women with previous venous thrombosis, or hepatitis.[27][28][30] In those with a history of arterial thrombosis, non-hormonal birth control should be used.[28] Progestin-only pills may improve menstrual symptoms such as dysmenorrhea, menorrhagia, premenstrual syndrome, and anemia, and are recommended for breast-feeding women because they do not affect lactation.[27] Irregular bleeding can be a side effect of progestin-only methods, with about 20% of users reporting no periods (often considered a benefit) and about 40% of women experiencing regular menstrual cycles, leaving the remaining 40% with irregular spotting or bleeding. Uncommon side effects of progestin-only pills, injections, and implants include headache, breast tenderness, mood effects, and painful periods, with these symptoms often resolving with time. Newer progestins, such as drospirenone and desogestrel, minimize the androgenic side effects of their predecessors but increase the risks of blood clots and are thus not first line.[27][31]

BarrierEdit

File:Condoms 08293403.jpg

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

The condom is most commonly used during sexual intercourse to reduce the likelihood of pregnancy and of spreading sexually transmitted infections. It is put on a man's erect penis and physically blocks ejaculated semen from entering the body of a sexual partner. Modern condoms are most often made from latex, but some are made from other materials such as polyurethane,polyisoprene, or lamb intestine. A female condom is also available, most often made ofnitrile. Male condoms have the advantage of being inexpensive, easy to use, and have few side effects. In Japan about 80% of couple who are using contraception use condoms while in Germany this number is about 25%.[32]

Contraceptive sponges combine a barrier with spermicide. Like diaphragms, they are inserted vaginally prior to intercourse and must be placed over the cervix to be effective. Typical effectiveness during the first year of use is about 84% overall, and 68% among women who have already given birth.[33] The sponge can be inserted up to 24 hours before intercourse and must be left in place for at least six hours afterward. Some people are allergic to spermicide used in the sponge. Women who use contraceptive sponges have an increased risk of yeast infections and urinary tract infections. Leaving the sponge in for more than 30 hours can result in toxic shock syndrome.

Condoms and cervical barriers such as the diaphragm have similar typical use first-year failure rates (15 and 16%, respectively), but perfect usage of the condom is more effective (2 percent first-year failure vs 6%) and condoms have the additional feature of helping to prevent the spread of sexually transmitted infectionss such as HIV/AIDS.

Intrauterine devicesEdit

The contemporary intrauterine device (IUD) is a small 'T'-shaped birth control device, containing either copper or progesterone, which is inserted into the uterus. IUDs are a form of long-acting reversible contraception, and the most effective type of reversible birth control.[34] As of 2002, IUDs were the most widely used form of reversible contraception, with nearly 160 million users worldwide.[35] Evidence supports both effectiveness and safety in adolescents.[36]

Advantages of the copper IUD include its ability to provide emergency contraception up to five days after unprotected sex. It is the most effective form of emergency contraception available.[37] It contains no hormones, so it can be used while breastfeeding, and fertility returns quickly after removal.[38][39] Disadvantages include the possibility of heavier menstrual periods and more painful cramps.[40]

Hormonal IUDs do not increase bleeding as copper-containing IUDs do. Rather, they reduce menstrual bleeding or stop menstruation altogether, and can be used as a treatment for heavy periods. Levonorgestrel-releasing IUDs may be used during breastfeeding whether or not they also include copper.[38][41]

Intrauterine devices were once associated with health risks, but most recent models of the IUD, including the ParaGard and Mirena, are both extremely safe and effective, and require very little maintenance.[42]

SterilizationEdit

Surgical sterilization is available in the form of tubal ligation for women and vasectomy for men.[9] There are no significant long term side effects and tubal ligation decreases the risk of ovarian cancer.[9] Some women regret such a decision: about 5% over 30 years, and about 20% under 30.[9] Short term complications are less likely from a vasectomy than a tubal ligation.[9] Neither method offers protection from sexually transmitted infections.[9]

Although sterilization is considered a permanent procedure, it is possible to attempt a tubal reversal to reconnect the fallopian tubes in females or a vasectomy reversal to reconnect the vasa deferentia in males. The rate of success depends on the original technique, tubal damage, and the person's age.

BehavioralEdit

Behavioral methods involve regulating the timing or methods of intercourse to prevent introduction of sperm into the female reproductive tract, either altogether or when an egg may be present.[43] If used properly the failure rate is about 3.4%, however if used poorly failure rates may approach 85% for a year.[44]

The withdrawal method, if used consistently and correctly, has a first-year failure rate of four percent. Due to the difficulty of consistently using withdrawal correctly, it has a typical use first-year failure rate of 19 percent, and is not recommended by some medical professionals.[22][45] Fertility awareness methods as a whole have typical use first-year failure rates as between 12 and 25 percent; perfect use effectiveness depends on which system is used and are typically 1 to 9 percent.[9] The evidence on which these estimates are based however is poor.[43]

Fertility awarenessEdit

The fertility awareness methods, involve determining the most fertile days of the menstrual cycle and avoiding unprotected intercourse.[43] They are used by about 3.6% of couples.[46] Effectiveness of these methods is not clear as the majority of people in trials stop there use early.[43] Techniques for determining fertility include monitoring: basal body temperature, cervical secretions, or the day of the cycle.[43]

If based on both basal body temperature and another primary sign, the method is referred to as symptothermal. Unplanned pregnancy rates have been reported between 1% and 20% for typical users of the symptothermal method.[47]

WithdrawalEdit

Coitus interruptus (literally "interrupted sexual intercourse"), also known as the withdrawal or pull-out method, is the practice of ending sexual intercourse ("pulling out") before ejaculation.[48] The main risk of coitus interruptus is that the man may not perform the maneuver correctly or in a timely manner.[48] Effectiveness varies from 4% with perfect usage to 27% with typical usage.[20]

There is little evidence regarding the sperm content of pre-ejaculatory fluid.[49] While some tentative research does did not find sperm[49] one trial found it present in 10 out of 27 volunteers.[50] It is used as a method of birth control by about 3% of couples.[46]

AbstinenceEdit

Though some groups advocate total sexual abstinence, by which they mean the avoidance of all sexual activity, in the context of birth control the term usually means abstinence from vaginal intercourse.[51][52] Abstinence is 100% effective in preventing pregnancy; however, not everyone who intends to be abstinent refrains from all sexual activity, and in many populations there is a significant risk of pregnancy from nonconsensual sex.[53][54]

Abstinence-only sex education does not reduce teen pregnancy.[4][55] Teen pregnancy rates are higher in students given abstinence-only education, compared to comprehensive sex education. [56][55] Some authorities recommend that those using abstinence as a primary method have backup method(s) available (such as condoms or emergency contraceptive pills).[57] Non-penetrative and oral sex will generally avoid pregnancy, but pregnancy can still occur with intercrural sex and other forms of penis-near-vagina sex (genital rubbing, and the penis exiting from anal intercourse) where semen can be deposited near the entrance to the vagina and can itself travel along the vagina's lubricating fluids.[58][59]

LactationEdit

The lactational amenorrhea method, involves the use of a woman's natural postpartum infertility which occurs after delivery and may be extended by breastfeeding.[60] This usually requires the presence of no periods, exclusively breastfeeding the infant, and a child younger than six months.[18] If breastfeeding is the infant's only source of nutrition the World Health Organization states that it is 98% effective in the six months following delivery.[61] Trials have found effectiveness rates between 92.5% and 100%.[17] Effectiveness decreases to 93-96% at one year and 87% at two years.[62] Feeding formula, pumping instead of nursing, the use of a pacifier, and feeding solids all reduce its effectiveness. [63] In those who are exclusively breastfeeding about 10% begin having periods before three months and 20% before six months.[62] In those who are not breastfeeding fertility may return four weeks after delivery.[62]

EmergencyEdit

Emergency contraceptives, are medications (morning-after pills) or devices used after unprotected sexual intercourse with the intent to prevent pregnancy.[64] They work primarily by preventing ovulation or fertilization.[65] A number of different option exist including: high dose birth control pills, levonorgestrel, mifepristone, ulipristal and IUDs.[66] Levonorgestrel pills are about 70% effective (pregnancy rate 2.2%) in preventing pregnancy when used within 3 days after unprotected sex or condom failure.[64] Ulipristal is about 85% effective (pregnancy rate 1.4%) up to 5 days and might be a bit more effective than levonorgestrel.[67][66][64] Mifepristone is also more effective than levonorgestrel while copper IUDs are the most effective method.[66] IUDs can be inserted up 5 days after intercourse and are about 99% effective (pregnancy rate of 0.1 to 0.2%).[65][68]

Providing morning after pills to women in advance does not affect rates of sexually transmitted infection, condom use, pregnancy rates, or sexual risk-taking behavior.[69][70] All methods have good safety and minimal side effects.[66]

Dual protectionEdit

Dual protection is the use of methods that prevent both sexually transmitted infections and pregnancy.[71] This can be with condoms either alone or along with another birth control method or by the avoidance of penetrative sex.[72][73] If pregnancy is a high concern using two methods at the same time is reasonable,[72] and two forms of birth control is recommended in those taking the anti-acne drug isotretinoin, due to the high risk of birth defects if taken during pregnancy.[74]

EffectsEdit

HealthEdit

File:Maternal mortality rate worldwide.jpg

Contraceptive use in developing countries has cut the number of maternal deaths by 44% (about 272,000 deaths averted in 2008) but could prevent 73% if the full demand for birth control were met.[6] Birth control can also improve adult women's birth outcomes and child survival by lengthening the time between pregnancies.[5]

Because teenage pregnancies, especially among younger teens, are at greater risk of many adverse outcomes including preterm birth, low birth weight, and infant mortality, adolescents benefit from comprehensive sex education and access to reproductive health services, including contraception.[7][8] Waiting until the mother is at least 18 years old before trying to have children improves maternal and child health.[76] Also, if additional children are desired after a child is born, it is healthier for the mother and the child to wait at least 2 years after the previous birth before attempting to conceive (but not more than 5 years).[76] After a miscarriage or abortion, it is healthier to wait at least 6 months.[76]

FinancesEdit

File:Countriesbyfertilityrate.svg

Birth control increases economic growth because of fewer dependent children, more women participating in the workforce, and less consumption of scarce resources.[15][16] Women's earnings, assets, body mass indexes, and their children's schooling and body-mass indexes all substantially improve with greater access to contraception.[15]

Family planning is among the most cost-effective of all health interventions.[77] "The cost savings stem from a reduction in unintended pregnancy, as well as a reduction in transmission of sexually transmitted infections, including HIV."[77] Childbirth and prenatal health care cost averaged US$7,090 for normal delivery in the US in 1996.[78] US Department of Agriculture estimates that for a child born in 2007, a US family will spend an average of $11,000 to $23,000 per year for the first 17 years of child's life.[79] (The total inflation adjusted estimated expenditure is $196,000 to $393,000, depending on household income.)[79]

Providing the current level of contraceptive care in the developing world costs $4 billion yearly and saves $5.6 billion in maternal and newborn health service costs.[80] To fully cover all need for modern contraceptive methods would cost $8.1 billion per year.[80] The effects of fulfilling the current unmet need for modern contraceptive methods would create a huge impact.

PrevalenceEdit

File:SOWM2010 modern contraception.svg

Globally approximately 45% of those who are married and able to have children use contraception.[81] Avoiding sex when fertile is used by about 3.6% of women of child bearing age, with usage as high as 20% in areas of South America.[82]

As of 2012, 57% of women of child bearing age wanted to avoid pregnancy (867 of 1520 million).[83] About 222 million women however were not able to access birth control, 53 million of whom were in sub-Saharan Africa and 97 million of whom were in Asia.[83] Many countries limit access to birth control due to the religious and political issues.[9]

AfricaEdit

Contraceptive use among women in Sub-Saharan Africa has risen from about 5% in 1991 to about 30% in 2006.[84] However due to extreme poverty, lack of access to birth control, and restrictive abortion laws many women still resort to clandestine abortion providers for unintended pregnancy, resulting in about 3% obtaining unsafe abortions each year.[85][86] South Africa, Botswana, and Zimbabwe have successful family planning programs, but other central and southern African countries continue to encounter extreme difficulties in achieving higher contraceptive prevalence and lower fertility for a wide variety of compounding reasons.[87]

ChinaEdit

File:Red Triangle.svg

The one-child policy of the People's Republic of China requires couples to have no more than one child. Beginning in 1979, the policy was implemented to control rapid population growth.[88] Chinese women receive free contraception and family planning services.[89] Greater than 70% of those of childbearing age use contraception.[81] Since the policy was put into place in 1979, over 400 million births have been prevented.[89] Because of various exemptions, fertility rate is about 1.7 children per woman, down from 5.9 in the 1960s. A strong preference for boys and free access to fetus sex determination and abortion has resulted in a artificial high proportion of males in both rural and urban areas.[89]

IndiaEdit

Awareness of contraception is near-universal among married women in India.[90] However, the vast majority of married Indians (76% in a 2009 study) reported significant problems in accessing a choice of contraceptive methods.[91] In 2009, 48.3% of married women were estimated to use a contraceptive method, i.e. more than half of all married women did not.[91] About three-fourths of these were using female sterilization, which is by far the most prevalent birth-control method in India.[91] Condoms, at a mere 3%, were the next most prevalent method.[91] Meghalaya, Bihar and Uttar Pradesh had the lowest usage of contraception among all Indian states with rates below 30%.[91]

PakistanEdit

In 2011 just one in five Pakistani women aged 15 to 49 used modern birth control.[92] In 1994, Pakistan pledged that by 2010 it would provide universal access to family planning.[93] but contraception is shunned under traditional social mores that are fiercely defended as fundamentalist Islam gains strength.[92] Most women who say they do not want any more children or would like to wait a period of time before their next pregnancy do not have the contraceptive resources available to them in order to do so.[93] In the 1990s, women increasingly reported to wanting fewer children, and 24 percent of recent births were reported to be unwanted or mistimed.[93] The rate of unwanted pregnancies is higher for women living in poor or rural environments; this is especially important since two-thirds of women live in rural areas.[93] While 96 percent of married women were reported to know about at least one method of contraception, only half of them had ever used it.[93] The most commonly reported reasons for married women electing not to use family planning methods include the belief that fertility should be determined by God (28 percent); opposition to use by the woman, her husband, others or a perceived religious prohibition (23 percent); infertility (15 percent); and concerns about health, side effects or the cost of family planning (12 percent).[93]

United KingdomEdit

Contraception has been available for free under the National Health Service since 1974, and 74% of reproductive age women use some form of contraception.[94] The levonorgestrel intrauterine system has been massively popular.[94] Sterilization is popular in older age groups, among those 45-49, 29% of men and 21% of women have been sterilized.[94] Female sterilization has been declining since 1996, when the intrauterine system was introduced.[94] Emergency contraception has been available since the 1970s, a product was specifically licensed for emergency contraception in 1984, and emergency contraceptives became available over the counter in 2001.[94] Since becoming available over the counter it has not reduced the use of other forms of contraception, as some moralists feared it might.[94] In any year only 5% of women of childbearing age use emergency hormonal contraception.[94] Despite widespread availability of contraceptives, almost half of pregnancies were unintended circa 2005.[94] Abortion was legalized in 1967.[94]

United StatesEdit

In the United States 98% of women have used birth control at some point in time and 62% of those of reproductive age are currently using birth control.[9] The two most common methods are the pill (11 million) and sterilization (10 million).[9] Despite the availability of highly effective contraceptives, about half of US pregnancies are unintended.[95] In the United States, contraceptive use saves about $19 billion in direct medical costs each year.[95]

Usage of the IUD more than tripled between 2002 and 2011 in the United States. During the year ending August 2011, IUDs were 10.4% of all birth control methods, as women increasingly view the IUD as the most convenient, safe, and most effective yet reversible form of contraception. Additional benefits from using an IUD for birth control include lower risk of developing endometrial and cervical cancer.[96][97]

HistoryEdit

File:Silphium.jpg

The Egyptian Ebers Papyrus from 1550 BCE and the Kahun Papyrus from 1850 BCE have within them some of the earliest documented descriptions of birth control, the use of honey, acacia leaves and lint to be placed in the vagina to block sperm.[98][99] Ancient Egyptian drawings also show the use of condoms.[32] The Book of Genesis references withdrawal, or coitus interruptus, as a method of contraception when Onan "spills his seed" (ejaculates) on the ground so as to not father a child with his deceased brother's wife Tamar.[98] In Ancient Greece it is believed that silphium was used as birth control which due to its effectiveness and thus desirability was harvested into extinction.[100] In medieval Europe any efforts to halt pregnancy were deemed immoral by the Catholic Church.[98] It is believed that women of the time still used a number of birth control measures such coitus interruptus, inserting lily root and rue into the vagina and infanticide after birth.[101] Casanova, during the Italian Renaissance described the use of a lambskin covering to prevent pregnancy however general availability of condoms did not occur until the 20th century.[98] In 1909, Richard Richter developed the first intrauterine device made from silkworm gut which was further developed and marketed in Germany by Ernst Gräfenberg in the late 1920s.[102] In 1916 Margaret Sanger opened the first birth control clinic in the United States which resulted in her arrest.[98] This was followed in 1921 by the first clinic in the UK, opened by Marie Stopes.[98] Gregory Pincus and John Rock with help from the Planned Parenthood Federation of America developed the first birth control pills in the 1950s which became publicly available in the 1960s.[103] Medical abortion became an alternative to surgical abortion with the availability of prostaglandin analogs in 1970s and the availability of mifepristone in the 1980s.[104]

Society and cultureEdit

File:The Testimony Chairman Issa Doesn't Want You to Hear.ogv

Public policyEdit

The Vatican's opposition towards birth control continues to this day and has been a major influence on U.S. policies concerning the problem of population growth and unrestricted access to birth control.[105][106]

Recently, as an implementation policy of the 2009 Affordable Health Care for America Act, the Department of Health and Human Services developed a mandate to require all insurance policies to provide free contraceptives. In 2012, the GOP led an attempt to exempt insurance policies sponsored or paid for by religious institutions opposed to birth control on religious or moral grounds, from the mandate to provide free contraceptive care. The GOP opposition to this mandate is based on the view that it violates the "Free Exercise Clause" of the First Amendment of the U.S. Constitution. The bill was dismissed by the U.S. Senate by a vote of 51-48 along largely partisan lines and is viewed as a victory for President Barack Obama's health care law.[107]

Legal positionsEdit

Seven measures required by the human rights standards of international law for governments to eliminate unmet need for family planning and achieve universal access to contraceptive information and services have been put forwards:[108]

Priority measures required by human rights standards and principles for governments to eliminate the unmet need for family planning:[108]
National and sub-national plans for sexual and reproductive health education, information, and services, including family planning Design plans, through a participatory process, to provide universal access (not only for married but also for unmarried people, adolescents, others marginalised by income, occupation, or other factors); to encompass all appropriate public, private, national, and international actors; and to include certain features, such as objectives and how they are to be achieved, timeframes, a detailed budget, financing, reporting, indicators, and benchmark measures.
Removal of legal and regulatory barriers Remove barriers that impede access to sexual and reproductive health education, information, and services, including family planning, particularly by disadvantaged groups.
Commodities Make available the widest feasible range of safe and effective modern contraceptives, including emergency contraception, as enumerated in a national List of Essential Medicines based on the WHO Model List and delivered through all appropriate public and private channels.
Community-based and clinic-based health workers Train adequate numbers of health workers who are skilled and supervised to provide good quality sexual and reproductive health services, including full and accurate contraceptive information and modern contraceptives, using the local language and exercising respect for privacy, confidentiality, diversity, and other basic ethical and human rights values.
Health facilities Provide health facilities that are clean, provide seating and privacy for user—provider interaction, are adequately stocked and equipped, adhere to published hours of services, and inform users of their rights.
Financial access Provide state subsidies and community insurance schemes to allow access for people who would not otherwise be able to afford services.
Monitoring and accountability Establish mechanisms that provide effective, accessible, transparent, and continuous review of the quality of services; assess progress toward equitable access and other objectives; and check that the commitments of all stakeholders are met.

Governments have a formal legal obligation to do all they reasonably can to put these measures in place as a matter of urgent priority, and failing to do so without a compelling reason places them in breach of binding international treaty obligations pertaining to health and human rights.[108] Cottingham et al. recommend that governments, NGOs, health-care providers and citizen advocates act to compel enforcement of these obligations to secure the existence and support of effective and inclusive birth control policies, improve the quality of reproductive health services, and achieve universal access to reproductive health including family planning. Guidance and assistance are available to help meet these obligations. For example, a World Health Organization publication can help identify inconsistencies between national laws and international human rights obligations (e.g., denying unmarried women contraceptive services.)[109] WHO staff can assist with removal of such barriers to access to and the provision of high quality sexual and reproductive health services, which can help meet the considerable remaining need for family planning.[109]

The United Nations created the "Every Woman Every Child initiative" to asses the progress toward meeting women's contraceptive needs and modern family planning services.[110] These initiatives have set their goals in terms of expected increases in the number of users of modern methods because this is a direct indicator that typically increases in response to interventions.[110] In previous years, London began the London Summit on Family Planning in an effort to make modern contraceptive services accessible to an added 120 million women in the world's poorest 69 countries by the year 2020.[110] A goal of this initiative is reduce the number of women who have an "unmet need" for modern methods. The Summit wants to eradicate discrimination or coercion against girls who seek contraceptives.

Another initiative is the Millennium Development Goals which was established in 2000 by 193 United Nations member states and 23 international organizations.[111] There are eight goals aimed at reducing inequality. Of the 8 goals, the fifth is improving maternal health. The maternal mortality ratio in developing regions is still 15 times higher than in the developed regions.[111] The maternal health initiative calls for countries to reduce their maternal mortality rate by three quarters by 2015.[111] Eritrea is one of the four African countries said to be on track to achieve Millennium Development Goal.[111] This means attaining a rate of less than 350 deaths per 100,000 births.

Cultural attitudesEdit

According to Peter Mulira, "Reproduction in Africa is a cultural issue in which large families are seen as a source of free labour and wealth."[112]

Many nations in Western Europe today would have declining populations if it were not for international immigration.[113] The feminist movement has affected change in Western society, including education; and the reproductive rights of women to make individual decisions on pregnancy (including access to contraceptives and abortion).[114]

A number of nations today are experiencing population decline.[115] Growing female participation in the work force and greater numbers of women going into further education has led to many women delaying or deciding against having children, or to not have as many.[116] The World Bank issued a report predicting that between 2007 and 2027 the populations of Georgia and Ukraine will decrease by 17% and 24% respectively.[117]

Religious viewsEdit

Religions vary widely in their views of the ethics of birth control.[118] The Roman Catholic Church officially only accepts natural family planning in certain cases,[119] although large numbers of Catholics in developed countries accept and use modern methods of birth control.[120][121][122] Protestants maintain a wide range of views from allowing none to very lenient.[123] Views in Judaism range from the stricter Orthodox sect to the more relaxed Reform sect.[124] Hindus may use both natural and artificial contraceptives.[125] A common Buddhist view of birth control is that preventing conception is ethically acceptable, while intervening after conception has occurred or may have occurred is not.[126]

In Islam, contraceptives are allowed if they do not threaten health, although their use is discouraged by some.[127] The Quran does not make any explicit statements about the morality of contraception, but contains statements encouraging procreation. Prophet Muhammad also is reported to have said "marry and procreate".[128]

World Contraception Day Edit

The 26th of September is World Contraception Day, devoted to raising awareness of contraception and improving education about sexual and reproductive health, with a vision of a world where every pregnancy is wanted.[129] It is supported by a group of international governments and NGOs, including Asian Pacific Council on Contraception, Centro Latinamericano Salud y Mujer, European Society of Contraception and Reproductive Health, German Foundation for World Population, International Federation of Pediatric and Adolescent Gynecology, International Planned Parenthood Federation, Marie Stopes International, Population Services International, the Population Council, the United States Agency for International Development (USAID), and Women Deliver.[129]

Misconceptions Edit

There are a number of common misconceptions regarding sex and pregnancy corrected below.[130] Douching after sexual intercourse is not an effective form of birth control.[131] Additionally it is associated with a number of health problems and thus is not recommended.[132] Women can become pregnant the first time they have sexual intercourse[133] and in any sexual position.[134] It is possible, but not very likely to become pregnant during menstration.[135]

ResearchEdit

FemalesEdit

  • The SILCS diaphragm is a silicone barrier that is still in clinical testing. It has a finger cup molded on one end for easy removal. Unlike currently available diaphragms, the SILCS diaphragm will be available in only one size.
  • A longer acting vaginal ring is being developed that releases both estrogen and progesterone, and is effective for over 12 months.[136]
  • Two types of progestogen-only vaginal rings are being developed. Progestogen-only products may be particularly useful for women who are breastfeeding.[136] The rings may be used for four months at a time.[137]
  • A progesterone-only contraceptive is being developed that would be sprayed onto the skin once a day.[138]
  • Quinacrine sterilization (non-surgical) and the Adiana procedure (similar to Essure) are two permanent methods of birth control being developed.[139]

MalesEdit

Other than condoms and withdrawal, there is currently only one common method of birth control available: undergoing a vasectomy, a minor surgical procedure wherein the vasa deferentia of a man are severed, and then tied/sealed in a manner which prevents sperm from entering the seminal stream (ejaculate). Several methods are in research and development:

  • As of 2007, a chemical called Adjudin was in Phase II human trials as a male oral contraceptive.[140]
  • Reversible inhibition of sperm under guidance (RISUG) consists of injecting a polymer gel, styrene maleic anhydride in dimethyl sulfoxide, into the vas deferens. The polymer has a positive charge, and when negatively charged sperm pass through the vas deferens, the charge differential severely damages the sperm. An injection with sodium bicarbonate washes out the substance and restores fertility.[141]
  • Experiments in vas-occlusive contraception involve an implant placed in the vasa deferentia.
  • Experiments in heat-based contraception involve heating the testicles to a high temperature for a short period of time. Ultrasound is the application of high-frequency sound waves to the testes, which can absorb the sound waves' energy as heat, leading to temporary infertility.[141]
  • Research on the safety and effectiveness of using ultrasound treatments to kill sperm has undergone since the idea originally came about following experiments in the 1970s by Mostafa S. Fahim which noticed ultrasound killed microbes and decreased fertility.[142] As of 2012 a study conducted on rats found that two 15 minute treatments of ultrasound delivered 2 days apart in a warm salt bath effectively lowered their sperm count to below fertile levels.[142] Further experiments on its effectiveness on humans, the longevity of the results, and its safety have yet to be conducted.[142]

Other animalsEdit

Artificial contraception is now being considered as an alternative to hunting as a means of controlling the population of animals which overbreed.[143]

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