Contraception

Although contraceptive use involves an individual's decision to have safe sex and control fertility, trends at both global and local levels are greatly affected by culture, religion, gender relations, medicine, and state policy. Contraception, the deliberate use of various methods to prevent pregnancy as a consequence of sexual intercourse, has been practiced since ancient times. Yet it was not until the second half of the 20th century that contraception became an issue of global importance out of a concern for both overpopulation and reproductive health and rights. Easy access to safe, effective, and affordable contraceptive methods is a crucial part of reducing unintended pregnancies and unsafe abortions; it also has brought about the so-called sexual revolution.

Contraceptive methods range from natural ones like rhythm, withdrawal, vaginal douching, and prolonged lactation to artificial ones such as sterilization, the birth control pill, injectable/implant, intrauterine devices (IUDs), vaginal barrier methods, and condoms. In the 19th century, coitus interruptus was the most widely used, followed by vaginal douching. The condom, because of its original association with prostitutes, its rough material, and its costs, was not attractive to many couples at the time. Birth control movements led by feminists in the early 20th century advocated female methods to separate sex and pregnancy, ensuring women full control of their bodies. These early advocates circulated contraceptive information and set up clinics to [Page 287]provide their clients with diaphragms, spermicidal cream, and jelly, which were banned in some countries under obscenity laws or pronatalist policies, such as the United States and Japan, respectively. The well-known fruit of the movements—the pill (a female hormonal contraceptive)—was invented in 1960 by reproductive scientists based in the United States who received financial support from the famous birth control activists Margaret Sanger and Katharine McCormick as well as pharmaceutical companies like Syntex and Searle.

In the 1960s and 1970s, anxiety about unchecked world population growth was pervasive worldwide. Developed countries, the United States in particular, were concerned that “overpopulation” in poor countries could cause social turbulence and lead to dwindling natural resources, undermining geopolitical security and the environment. Developing countries worried that rapid population growth might hinder their economic development. Some governments, private foundations, and international organizations argued that reducing the fertility rate was necessary for sustainable development, yet some developing nations asserted that the real problem was underdevelopment rather than population growth. In 1974, at the World Population Conference in Bucharest, Romania, the delegates from Third World nations championed the idea that, with adequate international aid, development itself was the best contraceptive for poor countries. Despite these controversies, international funding poured in, supporting research in long-acting and permanent contraceptive methods—especially IUDs and female sterilization—and spreading them in the developing regions. The large-scale promotion of contraception through national family-planning projects emphasized efficacy, convenience, and cost-effectiveness. However, a lack of adequate medical counseling was not uncommon, and this often resulted in less attention to safety issues, thus compromising women's well-being.

It was not until the 1970s that the rise of the women's health movement brought women's reproductive health and choice into public discussions about population control and access to contraception. Women's health activists not only worked for stricter risk evaluation for female contraceptive methods, but they also pressured the World Health Organization (WHO) to invest research monies in male methods, such as “the male pill,” which is still under development. Through their advocacy in the International Population Conferences in 1984 in Mexico City, Mexico, and in 1994 in Cairo, Egypt, women's empowerment and reproductive health and rights gradually came to form the ground rules for both governments and nongovernmental organizations that were providing and assessing family-planning services. In addition to the women's health movement, the HIV/AIDS prevention and treatment programs around the world play a critical role in disseminating information about contraception and providing cheap or free contraceptives (usually condoms). Contraception has become an essential part of global public health policies.

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