Birth Control

The practice of birth control prevents

conception, thus limiting reproduction. The term

birth control, coined by Margaret SANGER in

1914, usually refers specifically to methods of

contraception, including STERILIZATION. The

terms family planning and planned parenthood

have a broader application. METHODS OF

BIRTH CONTROL Attempts to control fertility

have been going on for thousands of years.

References to preventing conception are found in

the writings of priests, philosophers, and

physicians of ancient Egypt and Greece. Some

methods, though crude, were based on sound

ideas. For example, women were advised to put

honey, olive oil, or oil of cedar in their vaginas to

act as barriers. The stickiness of these substances

was thought to slow the movement of sperm into

the uterus. Wads of soft wool soaked in lemon

juice or vinegar were used as tampons, in the

belief that they would make the vagina sufficiently

acidic to kill the sperm. The Talmud mentions

using a piece of sponge to block the cervix, the

entrance to the uterus. Sperm Blockage Several

modern methods of birth control are practiced by

creating a barrier between the sperm and the egg

cell. This consists of the use of a chemical foam, a

cream, or a suppository. Each contains a

chemical, or spermicide that stops sperm. They

are not harmful to vaginal tissue. Each must be

inserted shortly before COITUS. Foams are

squirted from aerosol containers with nozzles or

from applicators that dispense the correct amount

of foam and spread it over the cervix; creams and

jellies are squeezed from tubes and held in place

by a diaphragm or other device; and

suppositories--small waxy pellets melted by body

heat--are inserted by hand. More effective at

keeping sperm and egg apart are mechanical

barriers such as the diaphragm and cervical cap

(both used with a spermicide), the sponge, and the

condom. A diaphragm is a shallow rubber cup that

is coated with a spermicide and positioned over

the cervix before intercourse. Size is important;

women need to have a pelvic examination and get

a prescription for the proper diaphragm. The

cervical cap, less than half the size but used in the

same way, has been available worldwide for

decades. It was not popular in the United States,

however, and in 1977 it failed to gain approval by

the Food and Drug Administration (FDA); in

1988, the FDA again permitted its sale. The

contraceptive sponge, which keeps its spermidical

potency for 48 hours after being inserted in the

vagina, was approved in 1983. Like the

diaphragm and cervical cap, the sponge has an

estimated effectiveness rate of about 85%. The

devices only rarely produce side effects such as

irritation and allergic reactions and, very rarely,

infections. The condom, a rubber sheath, is rolled

onto the erect penis so that sperm, when

ejaculated, is trapped but care must be taken so

that the condom does not break or slip off. A

fresh condom should be used for each sexual act.

Condoms also help protect against the spread of

VENEREAL DISEASES, and, unlike other

barrier devices, condoms made of latex do

provide some protection--but not

foolproof--protection against AIDS (see AIDS).

Another method of preventing the sperm from

reaching the egg is withdrawal by the man before

ejaculation. This is the oldest technique of

contraception and, because of the uncertainty of

controlling the ejaculation, is considered one of the

least effective. Altering Body Functions Even in

ancient times, attempts were made to find a

medicine that would prevent a woman\'s body from

producing a baby. Only within the last century,

however, have methods been developed that

successfully interrupt the complex reproductive

system of a woman\'s body. The first attempt,

made in the 19th century, was based on a legend

that camel drivers about to go on long journeys in

the desert put pebbles in the wombs of female

camels to keep them from becoming pregnant.

Researchers tried to find something that would

work similarly in a woman\'s cervix. The earliest

such objects were made of metal and were held in

by prongs. Later, wire rings were placed beyond

the cervix, in the uterus itself, thus giving rise to the

term intrauterine device, or IUD. IUDs appear to

work by altering the necessary environment in the

uterus for the fertilized egg. It was only with the

introduction of modern plastics such as

polyethylene, however, that IUDs were widely

accepted. Their pliability led to simpler insertion

techniques, and they could be left in place until

pregnancy was desired unless a problem arose

with their use. Copper-containing IUDs, and those

that slowly released the hormone progesterone,

had to be replaced periodically. Some users of

IUDs, however, complained increasingly of the

side effects of the devices. The most common

problem was bleeding, and the devices could also

cause uterine infections. More dangerous was the

possible inducement of pelvic inflammatory

disease (see UROGENITAL DISEASES), an

infection that may lead to blockage of