Contraception

Contraceptive Methods

With the exception of the male condom, male sterilization (vasectomy), and withdrawal (coitus interrup-tus), contraceptive methods rely primarily upon the female partner's high motivation, and women generally assume most of the responsibility for their successful use. Contraceptive methods available for women vary widely and range in terms of ease of access and availability, reliability, and level of medical intervention. They consist of behavioral methods such as abstinence, fertility awareness (practices that revolve around ovulation cycles, including periodic abstinence, calendar charting, cervical mucus monitoring, basal body temperature reading, and cervical observation), and the lactational amenorrhea method (used solely by women who have recently given birth and are breastfeeding); surgical methods such as female sterilization (involving surgery in the form of either tubal libation or the considerably more invasive hysterectomy); and mechanical and chemical methods, such as vaginal barriers (diaphragm, cervical cap, sponge) inserted prior to intercourse and requiring the use of a spermicide (a chemical that kills or immobilizes sperm), intrauterine devices (IUDs) (variously shaped objects medically inserted into the uterus to alter its lining and prevent conception), and hormonal methods (the contraceptive patch or implant, oral contraception, and the vaginal ring), which work through the addition of synthetic hormones to interrupt the process of ovulation.

The female condom, a barrier contraceptive controlled by women created as an alternative to the male condom, exists as the only female-initiated means to prevent both pregnancy, sexually transmitted infections (STIs), and the human immunodeficiency virus (HIV). Lauded as a method that would provide women with greater control over their own sexuality, health, and fertility, the female condom developed from a broader understanding of gender-based inequalities that often make it difficult for women to negotiate (much less insist on) male condom use. Approved by the Food and Drug Administration (FDA) in the United States in 1993 (and revamped to a “new and improved” version in 2005), worldwide adoption of this barrier method has been slow in part because of its higher learning curve and elevated cost.

Introduced in North America in the 1960s, the oral contraceptive pill (commonly known as simply “the Pill”) had enormous social impact. Utilizing a combination of one or two hormones (both estrogen and progesterone together or in the case of the “mini-pill” progesterone alone), it prevented ovulation and was considered to be 95% to 99% effective if used correctly. Initially made (legally) available to married women only, it was considered to be the most effective method of contraception to date, and it was promoted as a “worry-free” way for couples to determine the size and spacing of their offspring and to help them preserve (or improve) their standards of living. For women, it provided unprecedented control over their fertility, and its management was separate from sexual activity, effectively eliminating the difficulties [Page 161]of negotiation with a male partner and allowing for spontaneity. However, its most significant impact lay in the public understanding of a contraceptive method that successfully divorced reproduction from sexual activity. The Pill's enormous popularity and rapid adoption in the Western world amplified debates surrounding women's sexuality, promiscuity, and the moral ramifications of premarital sex.

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