A brief history of contraceptives

It is a truth universally acknowledged that the best form of contraception is complete abstinence. However, with human beings, complete abstinence is something of a miracle. Ever since we made the link between sperm and babies we've been looking for ways to ensure that we can stay up all night having fun, rather than stay up all night nursing infants. Although the contraceptive pill is regarded as the catalyst for the sexual revolution, there were other methods lying around well before the 1960s.

In the beginning (Or not, we're trying to avoid conception here, aren't we?)

So, humans have noticed that sperm can lead to pregnancy, in which case, it's best not to get any sperm inside a woman, right? Right. The obvious answer is to not have sex, but, that's not the aim of the game. In which case, we have to indulge in the next best thing: have sex, but don't let the sperm get anywhere near the target. Hence coitus interruptus comes along. Unfortunately, this is not the most reliable of methods; in fact, its failure rate is somewhere around 27%. With nearly a quarter of Ancient Egyptian couples becoming parents before they were ready, the women got desperate. You see, the favoured Ancient Egyptian method of contraception was to use a plug of crocodile dung, lubricated with honey. That sounds like desperation to me!

Soranus the Gynaecologist (Cough, cough)

Moving on a few centuries and their unplanned pregnancies, we come to the Greeks, and their legendary obs/gynae physician, Soranus. In addition to recommending that the infants of mothers who died in childbirth should be suckled by a goat, he also had some fairly interesting things to say about conception. Bless him, he knew that a woman ovulated, and around that time she'd be more fertile. Unfortunately, he decided that ovulation and menstruation occurred at the same time. Clearly, this wasn't a great move towards family planning. So that he might atone for his mistiming, he gave other contraceptive advice. He believed that drinking the water in which blacksmiths cooled iron, or jumping backwards seven times following intercourse could prevent conception. I'm beginning to think that abstinence is looking more appealing...

When in Rome...

...use a sea sponge soaked in lemon juice or vinegar. Now apart from the acid stinging a bit, this was probably a fairly effective method, what with acid being a spermicide. If a Roman lady didn't fancy banging on the door of the local brothel to ask if they had any spare sponges — or worse still, an abortion — she could always have opted for a barrier of beeswax or alum wax. However, after Augustus passed the leges Julia (18 BCE) and Papia Poppaea (9 BCE), discretion would have been imperative. He was so fearful for Rome's declining birthrate that he passed laws banning contraception and offering incentives for parents of more than three children.

For those not in Rome other barrier methods of contraception were favoured. Chinese women opted for something akin to the modern diaphragm, using oiled paper to cover the cervix.

Potions and Poisons

In addition to the various types of barrier methods and use of self-control, there have always been a selection of herbs and tinctures available to women trying not to conceive, or trying to induce abortion should they have conceived already. Unfortunately, just about all of these involved a high degree of risk given that they are toxic: arsenic, mercury, strychnine among them. The herbs pennyroyal and tansy are also known as abortifacients as they induce uterine bleeding. However, death is a very real prospect if using either of these as a contraceptive.

Silphium was a plant much-prized by the Greeks and Romans as a contraceptive. It was a member of the parsley family, and grew on a narrow strip of coastal land in Cyrenacia (modern-day Libya). However, the popularity of this giant-fennel-like plant and its restricted area of cultivation meant that it became extinct at some point in the First century CE. Back to the beeswax, then?

The rise of the condom (snigger)

Linen, leather, animal intestine, rubber? They've all been used to prevent conception, probably for around 1000 years. Now it is mostly down to latex. Go read the condom node. It's excellent. Beats the 17th century douche favoured by French prostitutes, or the half-lemon, which was another option. Of course, there is now also the female condom, which sits inside the vagina, rather than fitting over the penis.

Intrauterine Device (Or the Coil)

Legend has it that Arab camel traders discovered that placing stones inside the uteruses of their camels prevented them from conceiving. The story is slightly dubious, and the exact nature of an IUD's efficacy is unknown, but it is an efficient method of contraception: it has a failure rate of about 1%.

The first records of an entirely intrauterine device date from a 1909 German medical journal, although they didn't become widely used until about 1929, when the German doctor Ernst Grafenberg published his findings from trials using a silk suture device. The following year he determined that silver wire wrapping the ring improved its efficiency. World War II meant that work on the IUD was shelved, because the leading researchers were German or Japanese, where contraception was banned. Since then, though, information has been shared and improvements have been made to the IUD making it more comfortable, less likely to cause infection, and giving it greater efficiency.

Hormonal Birth Control

Pills, injections, patches, subcutaneous implants, intra-vaginal rings, emergency contraception, and some IUDs all rely on hormones to ensure that women don't get pregnant before they're ready. Essentially they work by preventing ovulation. There are two types: the combined pill, which is oestrogen and progesterone, or the progesterone-only pill. There may also be some thickening of the cervical mucus, which helps to stop sperm finding their goal, or thinning of the endometrium, thereby preventing a fertilised egg from emplanting.

Work on the idea of an oral contraceptive began in the early part of the twentieth century, mostly owing to the campaigning of Margaret Sanger. She dreamed of an efficient, easily administered method of birth control. Her work, in combination with the research skills of Gregory Pincus and the financial backing of Katherine McCormick, led to the first trials of oral contraceptives in Puerto Rico, in 1956. Initially, the doses were far too high, which led to side-effects of dizziness, nausea, and bloodclots. However, the dosage was adjusted and by 1959 the Pill was being prescribed in America. Although British women had access to the Pill around this time, it wasn't until the Family Planning Act of 1967 that it became freely available. With 99% effectiveness, the Pill is one of the most widely used methods of birth control, and research has been conducted for some time into the possibility of a male pill. Not quite there yet, though.

Oh, and don't forget that a woman who is lactating can't conceive, either. Well, it's slightly more complicated than that, as has been pointed out. If the baby is less than six months old, the mother is breastfeeding exclusively, and she hasn't experienced any vaginal bleeding since the birth, conception rates are about 2%. As a general rule, doctors and midwives will recommend some form of postnatal birth control, often an IUD.

Permanent Measures

For people who have decided that they never want children, or have definitely had enough, sterilisation is an option. For a woman, this would involve having her fallopian tubes ligated, or ligated and cut. A man would undergo a vasectomy. A vasectomy can be reversed, although the results aren't guaranteed, whilst female sterilisation is regarded as permanent.

Not so permanent measures (And probably not so effective, either.)

For couples who are perhaps religious, or are not so keen on interfering with nature, there are methods of contraception that rely on the observation of a woman's monthly cycle to determine when she is ovulating, and when having intercourse is 'safe'. It requires the daily taking of temperatures, examining a woman's vaginal discharge, and noting the dates and length of her period. It is about a woman getting to know her body and her cycle, and very much an individual method, as explained in fertility awareness. This sort of approach is favoured by Catholic families who perhaps do want some control over their lives, but are not so keen on the idea of obviously flouting the Church's doctrine on contraception.

Persona is a method of contraception that monitors the hormone levels in a woman's urine, indicating when she should refrain from intercourse. It's recommended for women who are in monogamous relationships, and have cycles between 23 and 35 days long. It's non-invasive, but does involve peeing on a stick every day, and is 94% effective.

Cultural and religious attitudes to contraception (Oh G-d, here we go...)

I was taught not to discuss politics or religion at the dinner table, so I hope nobody's eating right now. If sex is taboo, then contraception is probably even more so. Until 1930, contraception faced disapproval from Catholics and Protestants alike. Then, the Anglican community allowed it, and steadily other Protestant churches followed suit. For Catholics, of course, it remains forbidden.

Although Muslim couples are expected to procreate, the Qu'ran does not specifically prohibit contraception. Consequently, it is a widely accepted part of life, and might even have been performed by the prophet Muhammad. Similarly, Hindus are expected to have children, but contraception is not forbidden; this seems to be an attitude shared with Sikh teaching.

Two Jews, three opinions. Essentially, the Bible dictates that humans should be fruitful and multiply, and that man should should not 'spill his seed'. Crudely put: Jewish couples are expected to have children, barrier methods of contraception are frowned upon, and men shouldn't masturbate. The concept of niddah, or ritual family purity appears to have been devised to positively encourage conception. A couple cannot lie with each other whilst a woman has her period, nor for seven days following. By the time that they can have sex again, she's going to be ovulating. However, contraception would be allowed if a woman's life or mental health were to be endangered by conception, or if the family would suffer as a result of a child. In these circumstances, the Pill would be the favoured method of contraception. And that's just in Orthodox circles. Moving into more Conservative Judaism it is still expected for couples to have children, but that it should be on their terms. As for Progressive Judaism, it is the choice of the individual. Then there is the Jewish Aids Trust, which encourages the use of condoms, because Jewish people contract sexually transmitted infections, too.

So, who's for joining a convent, then?

Prevention is better than cure:

  • Teaching Year 9 PSE
  • Bowker, DE: (2002) Aims, Methods, Results, Conclusions: Parenthood in Rome, 100 BCE - 100 CE, (Bristol, unpublished).
  • http://home.snu.edu/~dwilliam/f97projects/contraception/history.htm
  • http://en.wikipedia.org/wiki/Birth_control
  • http://en.wikipedia.org/wiki/Intrauterine_device
  • http://en.wikipedia.org/wiki/Oral_contraceptive
  • http://www.mum.org/contrace.htm
  • http://www.allaboutsikhs.com/mansukh/124.htm
  • http://www.unipath.com/Persona.cfm