Birth control is the practice of preventing or reducing the probability of pregnancy without abstaining from sexual intercourse; the term is also sometimes used to include abortion, the ending of an unwanted pregnancy, or abstinence. The term family planning is sometimes used as well, especially for thoughtful and premeditated selection of a birth control technique or set of techniques. Employing techniques to avoid pregnancy resulting from intercourse is called contraception (literally, against conception).
Birth control is a controversial political and ethical issue in many countries and religions. Opponents promote abstinence from sexual intercourse as an alternative, but supporters consider this an inadequate replacement for the full array of birth control techniques.
__History of birth control__
Probably the oldest methods of contraception are coitus interruptus, barrier methods, herbal abortifacients, and attempts to arrange intercourse to coincide with a woman's non-fertile times, colloquially known as the "rhythm method". While it seems like the rhythm method would have been a good choice, scientists did not figure out the details of the human menstrual cycle until the early 20th century.
Coitus interruptus (withdrawal of the penis from the vagina prior to ejaculation) probably predates any other form of birth control. Once the relationship between the emission of semen into the vagina and pregnancy was known or suspected, some men probably managed to think through the haze of passion and withdraw in time. This is not a particularly reliable method of contraception, as the small amount of fluid secreted prior to ejaculation (pre-ejaculate or "Cowper's fluid") can still contain sperm (this is explained below). However it requires no equipment and is still better than nothing.
Folklore has suggested douching immediately following intercourse as a contraceptive method, and while it seems like a sensible idea to try to wash the ejaculate out of the vagina, it does not work due to the nature of the fluids and the structure of the female reproductive tract -- if anything, douching spreads semen further towards the uterus. Some slight spermicidal effect may occur if the douche solution is particularly acidic, but overall it is not an effective method.
The reason both withdrawal and douching are usually not very effective is that the male ejaculate typically consists of approximately 5ml (1 teaspoon) of fluid carrying in excess of 500,000,000 sperm, of which only 1 is needed to cause reproduction. Thus even a tiny amount of ejaculate can be more than enough.
Additionally, prior to ejaculation, a man typically releases small amounts of seminal fluid and sperm ("pre-ejaculate") as a result of becoming sexually aroused, during the erection, and while the penis is being stimulated by the vagina during sexual intercourse. It is theorized that pre-ejaculate is in part an attempt by the penis to assist in lubricating the vagina, and as an attempt to ameliorate the acidity of the female vagina and the male urethra (acidity caused by the usual use of the penis to excrete urine). These small amounts of pre-ejaculate can contain more than 30,000 sperm in each drop, and again, only one sperm is needed to cause impregnation.
There are historic records of Egyptian women using a pessary (a vaginal suppository) made of various acidic substances (crocodile dung is alleged) and lubricated with honey or oil, which may have been somewhat effective at killing sperm. However, it is important to note that the sperm cell was not discovered until Anton van Leeuwenhoek invented the microscope in the late 17th century, so barrier methods employed prior to that time could not know of the details of conception. Oriental women may have used oiled paper as a cervical cap, and Europeans may have used beeswax for this purpose. The condom appeared sometime in the 17th century, initially made of a length of animal intestine. It was not particularly popular, nor as effective as modern latex condoms, but was employed both as a means of contraception and in the hopes of avoiding syphilis, which was greatly feared and devastating prior to the discovery of antibiotic drugs. (time references and more details pending)
Various abortifacients have been used throughout human history. Some of these were effective, some were not; those that were most effective also had major side effects. The ingestion of certain poisons by the female can disrupt the reproductive system; women have drunk solutions containing mercury, arsenic, or other toxic substances for this purpose. The Greek gynaecologist Soranus in the 2nd century AD suggested that women drink water that blacksmiths had used to cool metal. The herbs tansy and pennyroyal are well-known in folklore as abortive agents, but these also "work" by poisoning the woman. Levels of the active chemicals in these herbs that will induce a miscarriage are high enough to damage the liver, kidneys, and other organs, making them very dangerous. However, in those times where risk of maternal death from postpartum complications was high, the risks and side effects of toxic medicines may have seemed less onerous. It is also believed that black cohosh tea will also be effective in certain cases an an abortifacient.
There are references in Arabic history to traders inserting a small stone into the uterus of a camel in order to prevent it from conceiving, a concept very similar to the modern IUD, but it seems unlikely that this was used as a contraceptive method for humans since knowledge of the female reproductive tract was very limited until the 20th century, and surgical techniques were poor.
Oral contraceptives did not appear until the mid-20th century, when scientists better understood the process of conception and advances in biochemistry allowed for the isolation (and later synthesis) of the hormones controlling the cycle.
__Traditional birth control methods__
* celibacy, or sexual abstinence (these may be more properly called alternatives to birth control)
* non-procreative sex, such as
** sex without penetration ("outercourse")
** anal sex or oral sex
* coitus interruptus
* the rhythm method
__Modern birth control methods__
* Barrier methods
** condom
** female condom
** diaphragm
** cervical cap
* Chemical methods
** oral contraceptives ("The Pill")
** implants (such as Norplant)
** male pill
** Depo Provera
** spermicides
** morning-after pill
* Other methods
** herbal contraception
** Intrauterine Device
** Natural family planning
** surgical sterilization, including vasectomy for men and tubal ligation for women
** chemical or surgical abortion (not considered by some to be birth control, since pregnancy occurs)
Condoms and herbal birth control methods existed before the modern era. The herbal methods were of various degrees of efficacy, and were available in China and Europe.
__Religious and cultural attitudes to birth control:__
__Christianity__
Christianity in general has had mixed opinions towards contraception and its role in society over the years. The sizeable ELCA, which includes a large number of US Lutheran and Episcopalian churches, makes the following statement:
"When (having children) is not their intention, the responsible use of safe, effective contraceptives is expected of the male and the female. Respect and sensitivity should also be shown toward couples who do not feel called to conceive and/or rear children, or who are unable to do so."
This is a fairly overt acceptance of modern contraceptives. The other major Lutheran and Presbyterian associations, as well as other Protestant groups in general, may take other positions.
__Catholicism__
The official position of the Catholic Church regarding birth control is expressed very clearly in Pope Pius XI's encyclical entitled Casti Connubii. It was written in response to the Episcopalian approval of artificial means of contraception when used in cases of grave necessity.
"Since, therefore, openly departing from the uninterrupted Christian tradition some recently have judged it possible solemnly to declare another doctrine regarding this question, the Catholic Church, ... in order that she may preserve the chastity of the nuptial union from being defiled by this foul stain, ... proclaims anew: any use whatsoever of matrimony exercised in such a way that the act is deliberately frustrated in its natural power to generate life is an offense against the law of God and of nature, and those who indulge in such are branded with the guilt of a grave sin."
In 1968 Pope Paul VI released a document called Humanae Vitae, which again forbade chemical and barrier methods but suggested natural methods such as the rhythm method or natural family planning might be considered in cases of necessity. The public response to this suggestion was immediate and overwhelming. There is dissent however. Some priests and theologians accept only abstinence as moral and there are also those who assert abstinence within a marriage can be immoral.
Couples seeking marriage in the Catholic Church are required to undergo counseling by a Catholic priest. In the past priests led couples seeking to delay children to rhythm, today they are instructed to point new couples toward the more effective natural family planning.
__Islam__
The Qur'an does not make any explicit statements about the morality of contraception (nor does the Bible), but contains statements encouraging procreation (similar to those found in the Bible). Various interpretations have been set forth over time, and at the time of this writing, discussions on the web can be found easily that take various positions. Early Muslim literature discusses various contraceptive methods, and a study sponsored by the Egyptian government concluded that not only was azl (coitus interruptus) acceptable from a moral standpoint, but any similar method that did not produce sterility was also acceptable. However, there are several schools of thought on this as well as other issues concerning Islamic morality.
__Judaism__
Active prevention of pregnancy is in violation of the commandment "be fruitful and multiply" (Genesis 1:22). Rabbinic authorities further consider the possibility (generally not accepted) that a union that by definition cannot lead to pregnancy would amount to "spilling seed", the sin of Onan (Genesis 38:9).
The option of contraception is raised by the Talmud (tractate Yevamot 12b), where the use of a pessary is discussed for women who are too young to get pregnant, presently pregnant, or nursing. Is each case either the woman or her child is at risk for serious complications, and this is the basis for many rabbinic authorities permitting contraception in situations where pregnancy would seriously harm the woman. In those cases, the most "natural" method is preferred; as the use of a condom or pessary creates a physical barrier, "the pill" (or and intrauterine device) is preferred by most authorities.
Contraceptive measures that lead to sterility, especially male sterility (e.g. through vasectomy), are problematic, and a sterilised man may have to separate from his wife (based on Deuteronomy 23:2).
When Orthodox Jewish couples contemplate the use of contraceptives, they generally consult a rabbi who evaluates the need for the intervention and which method is preferrable from a halachic point of view.
A remarkable use of the contraceptive pill in Judaism is by young brides. The laws of family purity state that intercourse cannot take place while a woman is menstruating. In order to decrease the chance of menstruation occurring just before (or on) the wedding night, many brides briefly regulate their periods in the months leading up to their wedding.
Generally, the introduction of oral contraceptives has not caused the stir in Jewish circles that it caused in other religious groups. It was followed by a number of responsa from rabbinic decisors (poskim) which outlined the proper approach to the new phenomenon. There has been surprisingly little talk of the potential risk of increased promiscuity (z'nut).