Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent pregnancy.
The World Health Organization and United States Centers for Disease Control and Prevention provide guidance on the safety of birth control methods among women with specific medical conditions.
In teenagers, pregnancies are at greater risk of poor outcomes. Comprehensive sex education and access to birth control decreases the rate of unintended pregnancies in this age group. While all forms of birth control can generally be used by young people, long-acting reversible birth control such as implants, IUDs, or vaginal rings are more successful in reducing rates of teenage pregnancy. After the delivery of a child, a woman who is not exclusively breastfeeding may become pregnant again after as few as four to six weeks. Some methods of birth control can be started immediately following the birth, while others require a delay of up to six months. In women who are breastfeeding, progestin-only methods are preferred over combined oral birth control pills. In women who have reached menopause, it is recommended that birth control be continued for one year after the last menstrual period.
About 222 million women who want to avoid pregnancy in developing countries are not using a modern birth control method. Birth control use in developing countries has decreased the number of maternal death by 40% (about 270,000 deaths prevented in 2008) and could prevent 70% if the full demand for birth control were met. By lengthening the time between pregnancies, birth control can improve adult women's delivery outcomes and the survival of their children. In the developing world, women's earnings, assets, and weight, as well as their children's schooling and health, all improve with greater access to birth control. Birth control increases economic growth because of fewer dependent children, more women participating in the workforce, and/or less use of scarce resources.
+Chance of pregnancy during first year of use (2025). 9781597080040, Ardent Media. ISBN 9781597080040
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Birth control methods include barrier methods, hormonal birth control, intrauterine devices (IUDs), sterilization, and behavioral methods. They are used before or during sex while emergency contraceptives are effective for up to five days after sex. Effectiveness is generally expressed as the percentage of women who become pregnant using a given method during the first year,
and sometimes as a lifetime failure rate among methods with high effectiveness, such as tubal ligation.Birth control methods fall into two main categories: male contraception and female contraception. Common male contraceptives are withdrawal, condoms, and vasectomy. Female contraception is more developed compared to male contraception, these include contraceptive pills (combination and progestin-only pill), hormonal or non-hormonal IUD, patch, vaginal ring, diaphragm, shot, implant, fertility awareness, and tubal ligation.
The most effective methods are long-acting and do not require ongoing health care visits. Surgical sterilization, implantable hormones, and intrauterine devices all have first-year failure rates of less than 1%. Hormonal contraceptive pills, patches or vaginal rings, and the lactational amenorrhea method (LAM), if adhered to strictly, can also have first-year (or for LAM, first-6-month) failure rates of less than 1%. With typical use, first-year failure rates are considerably higher, at 9%, due to inconsistent use. Other methods such as condoms, diaphragms, and spermicides have higher first-year failure rates even with perfect usage. The American Academy of Pediatrics recommends long acting reversible birth control as first line for young individuals.
While all methods of birth control have some potential adverse effects, the risk is less than that of pregnancy.
For individuals with specific health problems, certain forms of birth control may require further investigations. For women who are otherwise healthy, many methods of birth control should not require a medical exam—including birth control pills, injectable or implantable birth control, and condoms.
Combined hormonal contraceptives are associated with a slightly increased risk of venous and arterial blood clots. Venous clots, on average, increase from 2.8 to 9.8 per 10,000 women years which is still less than that associated with pregnancy. Due to this risk, they are not recommended in women over 35 years of age who continue to smoke. Due to the increased risk, they are included in decision tools such as the DASH score and PERC rule used to predict the risk of blood clots.
The effect on sexual drive is varied, with an increase or decrease in some but with no effect in most. Combined oral contraceptives reduce the risk of ovarian cancer and endometrial cancer and do not change the risk of breast cancer. They often reduce menstrual bleeding and dysmenorrhea.
Progestin-only pills, injections, and intrauterine devices are not associated with an increased risk of blood clots and may be used by women with a history of blood clots in their veins. In those with a history of arterial blood clots, non-hormonal birth control or a progestin-only method other than the injectable version should be used. Progestin-only pills may improve menstrual symptoms and can be used by breastfeeding women as they do not affect lactation. Irregular bleeding may occur with progestin-only methods, with some users reporting amenorrhea. The progestins drospirenone and desogestrel minimize the side effects but increase the risks of blood clots and are thus not the first line. The perfect use first-year failure rate of injectable progestin is 0.2%; the typical use first failure rate is 6%.
Globally, condoms are the most common method of birth control.
Male condoms and the diaphragm with spermicide have typical use first-year failure rates of 18% and 12%, respectively. With perfect use condoms are more effective with a 2% first-year failure rate versus a 6% first-year rate with the diaphragm. Condoms have the additional benefit of helping to prevent the spread of some sexually transmitted infections such as HIV/AIDS, however, condoms made from animal intestines do not.
Contraceptive sponges combine a barrier with a spermicide. Like diaphragms, they are inserted vaginally before intercourse and must be placed over the cervix to be effective. Typical failure rates during the first year depend on whether or not a woman has previously given birth, being 24% in those who have and 12% in those who have not. The sponge can be inserted up to 24 hours before intercourse and must be left in place for at least six hours afterward. Allergic reactions and more severe adverse effects such as toxic shock syndrome have been reported.
Evidence supports effectiveness and safety in adolescents and those who have and have not previously had children. IUDs do not affect breastfeeding and can be inserted immediately after delivery.
They may also be used immediately after an abortion. Once removed, even after long term use, fertility returns to normal immediately.While copper IUDs may increase menstrual bleeding and result in more painful cramps, hormonal IUDs may reduce menstrual bleeding or stop menstruation altogether. Cramping can be treated with painkillers like NSAIDs. Other potential complications include expulsion (2–5%) and rarely perforation of the uterus (less than 0.7%). A previous model of the intrauterine device (the Dalkon shield) was associated with an increased risk of pelvic inflammatory disease; however, the risk is not affected with current models in those without sexually transmitted infections around the time of insertion. IUDs appear to decrease the risk of ovarian cancer.
Surgical sterilization is available in the form of tubal ligation for women and vasectomy for men. Tubal ligation decreases the risk of ovarian cancer. Short term complications are twenty times less likely from a vasectomy than a tubal ligation. After a vasectomy, there may be swelling and pain of the scrotum which usually resolves in one or two weeks.
Chronic scrotal pain associated with negative impact on quality of life occurs after vasectomy in about 1–2% of men. With tubal ligation, complications occur in 1 to 2 percent of procedures with serious complications usually due to the anesthesia. Neither method offers protection from sexually transmitted infections. Sometimes, salpingectomy is also used for sterilization in women.Non-surgical sterilization methods have also been explored. FahimFahim, M. S., et al. "Heat in male contraception (hot water 60°C, infrared, microwave, and ultrasound)." Contraception 11.5 (1975): 549–562.Fahim, M. S., et al. "Ultrasound as a new method of male contraception." Fertility and sterility 28.8 (1977): 823–831.Fahim, M. S., Z. Fahim, and F. Azzazi. "Effect of ultrasound on testicular electrolytes (sodium and potassium)." Archives of andrology 1.2 (1978): 179–184. et al. found that heat exposure, especially high-intensity ultrasound, was effective either for temporary or permanent contraception depending on the dose, e.g. selective destruction of germ cells and Sertoli cells without affecting Leydig cells or testosterone levels. Chemical, e.g. drug-based methods are also available, e.g. orally-administered LonidamineLonidamine analogues for fertility management, WO2011005759A3 WIPO (PCT), Ingrid Gunda GeorgeJoseph S. TashRamappa ChakrsaliSudhakar R. JakkarajJames P. Calvet for temporary, or permanent (depending on the dose) fertility management. BorisUnited States Patent US3934015A, Oral male antifertility method and compositions provides a method for chemically inducing either temporary or non-reversible sterility, depending on the dose, "Permanent sterility in human males can be obtained by a single oral dosage containing from about 18 mg/kg to about 25 mg/kg".
The permanence of this decision may cause regret in some men and women. Of women who have undergone tubal ligation after the age of 30, about 6% regret their decision, as compared with 20–24% of women who received sterilization within one year of delivery and before turning 30, and 6% in nulliparous women sterilized before the age of 30. By contrast, less than 5% of men are likely to regret sterilization. Men who are more likely to regret sterilization are younger, have young or no children, or have an unstable marriage.
In a survey of biological parents, 9% stated they would not have had children if they were able to do it over again.Although sterilization is considered a permanent procedure, it is possible to attempt a tubal reversal to reconnect the fallopian tubes or a vasectomy reversal to reconnect the vasa deferentia. In women, the desire for a reversal is often associated with a change in spouse. Pregnancy success rates after tubal reversal are between 31 and 88 percent, with complications including an increased risk of ectopic pregnancy. The number of males who request reversal is between 2 and 6 percent. Rates of success in fathering another child after reversal are between 38 and 84 percent; with success being lower the longer the period between the vasectomy and the reversal. Sperm extraction followed by in vitro fertilization may also be an option in men.
There is little data regarding the sperm content of pre-ejaculatory fluid. While some tentative research did not find sperm, one trial found sperm present in 10 out of 27 volunteers. The withdrawal method is used as birth control by about 3% of couples.
Deliberate non-penetrative sex without vaginal sex or deliberate oral sex without vaginal sex are also sometimes considered birth control. While this generally avoids pregnancy, 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 sperm can be deposited near the entrance to the vagina and can travel along the vagina's lubricating fluids.
Abstinence-only sex education does not reduce teenage pregnancy. Teen pregnancy rates and STI rates are generally the same or higher in states where students are given abstinence-only education, as compared with comprehensive sex education. Some authorities recommend that those using abstinence as a primary method have backup methods available (such as condoms or emergency contraceptive pills).
Levonorgestrel pills, when used within 3 days, decrease the chance of pregnancy after a single episode of unprotected sex or condom failure by 70% (resulting in a pregnancy rate of 2.2%). Ulipristal, when used within 5 days, decreases the chance of pregnancy by about 85% (pregnancy rate 1.4%) and is more effective than levonorgestrel. Mifepristone is also more effective than levonorgestrel, while copper IUDs are the most effective method. IUDs can be inserted up to five days after intercourse and prevent about 99% of pregnancies after an episode of unprotected sex (pregnancy rate of 0.1 to 0.2%). This makes them the most effective form of emergency contraceptive. In those who are overweight or obese, levonorgestrel is less effective and an IUD or ulipristal is recommended.
If pregnancy is a high concern, using two methods at the same time is reasonable. For example, two forms of birth control are recommended in those taking the anti-acne drug isotretinoin or anti-epileptic drugs like carbamazepine, due to the high risk of if taken during pregnancy.
Birth control also improves child survival in the developing world by lengthening the time between pregnancies. In this population, outcomes are worse when a mother gets pregnant within eighteen months of a previous delivery. Delaying another pregnancy after a miscarriage, however, does not appear to alter risk and women are advised to attempt pregnancy in this situation whenever they are ready.
Teenage pregnancies, especially among younger teens, are at greater risk of adverse outcomes including preterm birth, low birth weight, and infant mortality. In 2012 in the United States 82% of pregnancies in those between the ages of 15 and 19 years old were unplanned. Comprehensive sex education and access to birth control are effective in decreasing pregnancy rates in this age group.
Birth control methods, especially hormonal methods, can also have undesirable side effects. The intensity of side effects can range from minor to debilitating and varies with individual experiences. These most commonly include changes in menstruation regularity and flow, nausea, breast tenderness, headaches, weight gain, and mood changes (specifically an increase in depression and anxiety). Additionally, hormonal contraception can contribute to bone mineral density loss, impaired glucose metabolism, increased risk of venous thromboembolism. Comprehensive sex education and transparent discussion of birth control side effects and contraindications between healthcare provider and patient is imperative.
The total medical cost for a pregnancy, delivery, and care of a newborn in the United States is on average $21,000 for a vaginal delivery and $31,000 for a caesarean delivery as of 2012. In most other countries, the cost is less than half. For a child born in 2011, an average US family will spend $235,000 over 17 years to raise them.
]] Globally, as of 2009, approximately 60% of those who are married and able to have children use birth control. How frequently different methods are used varies widely between countries. The most common method in the developed world is condoms and oral contraceptives, while in Africa it is oral contraceptives and in Latin America and Asia it is sterilization. In the developing world overall, 35% of birth control is via female sterilization, 30% is via IUDs, 12% is via oral contraceptives, 11% is via condoms, and 4% is via male sterilization.
While less used in the developed countries than the developing world, the number of women using IUDs as of 2007 was more than 180 million. Avoiding sex when fertile is used by about 3.6% of women of childbearing age, with usage as high as 20% in areas of South America.
As of 2012, 57% of women of childbearing age want to avoid pregnancy (867 of 1,520 million). 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. This results in 54 million unplanned pregnancies and nearly 80,000 maternal deaths a year. Part of the reason that many women are without birth control is that many countries limit access due to religious or political reasons, while another contributor is poverty. Due to restrictive abortion laws in Sub-Saharan Africa, many women turn to unlicensed abortion providers for unintended pregnancy, resulting in about 2–4% obtaining each year.
The ancient Greece philosopher Aristotle ( 384–322 BC) recommended applying cedar oil to the womb before intercourse, a method which was probably only effective on occasion. A Hippocrates text On the Nature of Women recommended that a woman drink a copper salt dissolved in water, which it claimed would prevent pregnancy for a year. This method was not only ineffective but also dangerous, as the later medical writer Soranus of Ephesus ( 98–138 AD) pointed out. Soranus attempted to list reliable methods of birth control based on rational principles. He rejected the use of superstition and amulets and instead prescribed mechanical methods such as vaginal plugs and pessaries using wool as a base covered in oils or other gummy substances. Many of Soranus's methods were probably also ineffective.
In medieval Europe, any effort to halt pregnancy was deemed immoral by the Catholic Church, although it is believed that women of the time still used some birth control measures, such as coitus interruptus and inserting lily root and rue into the vagina.
Women in the Middle Ages were also encouraged to tie weasel testicles around their thighs during sex to prevent pregnancy. The oldest condoms discovered to date were recovered in the ruins of Dudley Castle in England, and are dated back to 1640. They were made of animal gut, and were most likely used to prevent the spread of sexually transmitted infections during the English Civil War. Casanova, living in 18th-century Italy, described the use of a lambskin covering to prevent pregnancy; however, condoms only became widely available in the 20th century.
In the United States, Margaret Sanger and Otto Bobsein popularized the phrase "birth control" in 1914.
Sanger primarily advocated for birth control on the idea that it would prevent women from seeking unsafe abortions, but during her lifetime, she began to campaign for it on the grounds that it would reduce mental and physical defects. She was mainly active in the United States but had gained an international reputation by the 1930s. At the time, under the Comstock Law, distribution of birth control information was illegal. She jumped bail in 1914 after her arrest for distributing birth control information and left the United States for the United Kingdom. In the U.K., Sanger, influenced by Havelock Ellis, further developed her arguments for birth control. She believed women needed to enjoy sex without fearing a pregnancy. During her time abroad, Sanger also saw a more flexible diaphragm in a Dutch clinic, which she thought was a better form of contraceptive. Once Sanger returned to the United States, she established a short-lived birth-control clinic with the help of her sister, Ethel Bryne, based in the Brownville section of Brooklyn, New YorkThe increased use of birth control was seen by some as a form of social decay.
A decrease of fertility was seen as a negative. Throughout the Progressive Era (1890–1920), there was an increase of voluntary associations aiding the contraceptive movement. These organizations failed to enlist more than 100,000 women because the use of birth control was often compared to eugenics; however, women were seeking a community with like-minded women. The ideology that surrounded birth control started to gain traction during the Progressive Era due to voluntary associations establishing community. Birth control was unlike the Victorian Era because women wanted to manage their sexuality. The use of birth control was another form of self-interest women clung to. This was seen as women began to gravitate towards strong figures, like the Gibson Girl.The first permanent birth-control clinic was established in Britain in 1921 by Marie Stopes working with the Malthusian League.
The clinic, run by midwives and supported by visiting doctors, offered women's birth-control advice and taught them the use of a cervical cap. Her clinic made contraception acceptable during the 1920s by presenting it in scientific terms. In 1921, Sanger founded the American Birth Control League, which later became the Planned Parenthood Federation of America. In 1924 the Society for the Provision of Birth Control Clinics was founded to campaign for municipal clinics; this led to the opening of a second clinic in Greengate, Salford in 1926. Throughout the 1920s, Stopes and other feminism pioneers, including Dora Russell and Stella Browne, played a major role in breaking down about sex. In April 1930 the Birth Control Conference assembled 700 delegates and was successful in bringing birth control and abortion into the political sphere – three months later, the Ministry of Health, in the United Kingdom, allowed local authorities to give birth-control advice in welfare centres.The National Birth Control Association was founded in Britain in 1931 and became the Family Planning Association eight years later. The Association amalgamated several British birth control-focused groups into 'a central organisation' for administering and overseeing birth control in Britain. The group incorporated the Birth Control Investigation Committee, a collective of physicians and scientists that was founded to investigate scientific and medical aspects of contraception with 'neutrality and impartiality'.BCIC Memorandum on Proposed Re-organisation c.. Wellcome Library, Archives of the Eugenics Society (WL/SA/EUG/D/12/12.) Subsequently, the Association effected a series of pure science and Applied science product and safety standards that manufacturers must meet to ensure their contraceptives could be prescribed as part of the Association's standard two-part-technique combining 'a rubber appliance to protect the mouth of the womb' with a 'chemical preparation capable of destroying... sperm'. Between 1931 and 1959, the Association founded and funded a series of tests to assess chemical efficacy and safety and rubber quality. These tests became the basis for the Association's Approved List of contraceptives, which was launched in 1937, and went on to become an annual publication that the expanding network of FPA clinics relied upon as a means to 'establish facts about and to publish these facts as a basis on which a sound public and scientific opinion can be built'.Birth Control Investigation Committee Statement of Intent c.1927, Wellcome Library, Archives of the Family Planning Association (WL/SA/FPA), WL/SA/FPA/A13/5.
In 1936, the United States Court of Appeals for the Second Circuit ruled in United States v. One Package of Japanese Pessaries that medically prescribing contraception to save a person's life or well-being was not illegal under the Comstock Laws. Following this decision, the American Medical Association Committee on Contraception revoked its 1936 statement condemning birth control. A national survey in 1937 showed 71 percent of the adult population supported the use of contraception. By 1938, 374 birth control clinics were running in the United States despite their advertisement still being illegal. First Lady Eleanor Roosevelt publicly supported birth control and family planning.
The restrictions on birth control in the Comstock laws were effectively rendered null and void by Supreme Court decisions Griswold v. Connecticut (1965)"Griswold v. Connecticut: Landmark Case Remembered", by Andi Reardon. NY Times, May 28, 1989 and Eisenstadt v. Baird (1972)."Catherine Roraback, 87, Influential Lawyer, Dies" by Dennis Hevesi Oct. 20, 2007. In 1966, President Lyndon B. Johnson started endorsing public funding for family planning services, and the Federal Government began subsidizing birth control services for low-income families. The Affordable Care Act, passed into law on March 23, 2010, under President Barack Obama, requires all plans in the Health Insurance Marketplace to cover contraceptive methods. These include barrier methods, hormonal methods, implanted devices, emergency contraceptives, and sterilization procedures.
In the United States, the 1965 Supreme Court decision Griswold v. Connecticut overturned a state law prohibiting the dissemination of contraception information based on a constitutional right to privacy for marital relationships. In 1972, Eisenstadt v. Baird extended this right to privacy to single people.
In 2010, the United Nations launched the Every Woman Every Child movement to assess the progress toward meeting women's contraceptive needs. The initiative has set a goal of increasing the number of users of modern birth control by 120 million women in the world's 69 poorest countries by 2020. Additionally, they aim to eradicate discrimination against girls and young women who seek contraceptives. The American Congress of Obstetricians and Gynecologists (ACOG) recommended in 2014 that oral birth control pills should be over the counter medications.
Since at least the 1870s, American religious, medical, legislative, and legal commentators have debated contraception laws. Ana Garner and Angela Michel have found that in these discussions men often attach reproductive rights to moral and political matters, as part of an ongoing attempt to regulate human bodies. In press coverage between 1873 and 2013 they found a divide between institutional ideology and real-life experiences of women.
In the United Kingdom contraception can be obtained free of charge via contraception clinics, sexual health or GUM (genitourinary medicine) clinics, via some GP surgeries, some young people's services and pharmacies.
In September 2021, France announced that women aged under 25 in France will be offered free contraception from 2022. It was elaborated that they "would not be charged for medical appointments, tests, or other medical procedures related to birth control" and that this would "cover hormonal contraception, biological tests that go with it, the prescription of contraception, and all care related to this contraception".
From August 2022 onwards contraception for women aged between 17 and 25 years will be free in the Republic of Ireland.
A number of methods to perform sterilization via the cervix are being studied. One involves putting quinacrine in the uterus which causes scarring and infertility. While the procedure is inexpensive and does not require surgical skills, there are concerns regarding long-term side effects. Another substance, polidocanol, which functions in the same manner is being looked at. A device called Essure, which expands when placed in the fallopian tubes and blocks them, was approved in the United States in 2002. In 2016, a black boxed warning regarding potentially serious side effects was added, and in 2018, the device was discontinued.
Several novel contraceptive methods based on hormonal and non-hormonal mechanisms of action are in various stages of research and development, up to and including , including gels, pills, injectables, implants, wearables, and oral contraceptives.
Recent avenues of research include and required for male fertility. For instance, the serine/threonine-protein kinase 33 (STK33) is a Testicle-enriched kinase that is indispensable for male fertility in humans and mice. An inhibitor of this kinase, CDD-2807, has recently been identified and induced reversible male infertility without measurable toxicity in mice. Such an inhibitor would be a potent male contraceptive if it passed safety and efficacy tests.
Birth control is also being considered as an alternative to hunting as a means of controlling overpopulation in wild animals. Contraceptive vaccines have been found to be effective in a number of different animal populations. goat herders fix a skirt, called an olor, to male goats to prevent them from impregnating female goats.
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