Birth control 4271 225836168 2008-07-15T16:57:50Z Zodon 6424546 /* Physical methods */ rearrange sections - moved EPC between Hormonal and IUD since is a mix of those two (assume order same as BC template) {{otheruses}} [[Image:Familyplanningmalaysia.jpg|right|thumb|250px|A family planning facility in Kuala Terengganu, [[Malaysia]].]] '''Birth control''', sometimes synonymous with '''contraception''', is a regimen of one or more actions, devices, or [[medication]]s followed in order to deliberately prevent or reduce the likelihood of [[pregnancy]] or [[childbirth]]. Contraception may refer specifically to mechanisms which are intended to reduce the likelihood of the [[fertilization]] of an [[ovum]] by a [[spermatozoon]]. Birth control is commonly used as part of [[family planning]]. The history of birth control began with the discovery of the connection between [[Sexual intercourse|coitus]] and pregnancy. The oldest forms of birth control included ''[[coitus interruptus]]'', [[pessary|pessaries]], and the [[Herbalism|ingestion of herbs]] that were believed to be contraceptive or [[abortifacient]]. The earliest record of birth control use is an [[Ancient Egypt]]ian set of instructions on creating a contraceptive pessary. Different methods of birth control have [[Comparison of birth control methods|varying characteristics]]. [[Condom]]s, for example, are the only methods that provide significant protection from sexually transmitted diseases. [[#Religious and cultural attitudes|Cultural and religious attitudes on birth control]] vary significantly. ==History== [[Image:VictorianPostcard.jpg|right|thumb|250px|"And the villain still pursues her." Humorous Victorian era postcard.]] Probably the oldest methods of contraception (aside from sexual abstinence) are ''[[coitus interruptus]]'', lactational, certain [[barrier contraception|barrier methods]], and herbal methods ([[emmenagogue]]s and [[abortifacients]]). ''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 began to use this technique. This is not a particularly reliable method of contraception, as few men have the self-control to correctly practice the method at every single act of sexual intercourse.<ref name="kippley">{{cite book | first=John | last=Kippley | coauthors=Sheila Kippley | year=1996 | title=The Art of Natural Family Planning | edition=4th addition | publisher=The Couple to Couple League | location=Cincinnati, OH | id=ISBN 0-926412-13-2 | pages=p.146 }}, which cites:<br> :{{cite journal |last=Guttmacher Institute |title=Choice of Contraceptives | journal = The Medical Letter on Drugs and Therapeutics | volume = 34 |pages=111–114 |year=1992 | doi = 10.1016/j.<a | doi_brokendate = 2008-06-25 }}<br> {{cite book | first=RA | last=Hatcher | coauthors=Trussel J, Stewart F, et al | year=1994 | title=Contraceptive Technology | edition=Sixteenth Revised Edition | publisher=Irvington Publishers | location=New York | id=ISBN 0-8290-3171-5 }}</ref> Although it is commonly believed that [[pre-ejaculate]] fluid can cause pregnancy, modern research has shown that pre-ejaculate fluid does not contain viable sperm.<!-- --><ref name="HIV study">{{cite journal |title=Researchers find no sperm in pre-ejaculate fluid | journal = Contraceptive Technology Update | volume = 14 | issue = 10 |pages=154–156 |year=October 1993 | pmid = 12286905 }}</ref><!-- --><ref name="pre-e study">{{cite journal |last=Zukerman |first=Z. | coauthors = Weiss D.B. Orvieto R. |title=Short Communication: Does Preejaculatory Penile Secretion Originating from Cowper's Gland Contain Sperm? | journal = Journal of Assisted Reproduction and Genetics | volume = 20 | issue = 4 |pages=157–159 |year=April 2003 | pmid = 12762415 |doi = 10.1023/A:1022933320700 }}</ref> There are historic records of [[Egyptians|Egyptian]] women using a [[pessary]] (a vaginal [[suppository]]) made of various [[acid]]ic substances and lubricated with honey or oil, which may have been somewhat effective at killing sperm.<ref>{{cite web |url=http://www.mnsu.edu/emuseum/prehistory/egypt/dailylife/midwifery.htm |title =Ancient Egyptian Midwifery and Childbirth |accessdate=2007-09-01 |publisher=[[Minnesota State University]]}}</ref> However, it is important to note that the sperm [[cell (biology)|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. [[Asia]]n women may have used oiled paper as a [[cervical cap]], and [[Europe]]ans 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 them were effective, some were not; those that were most effective also had major [[Adverse drug reaction|side effects]]. One abortifacient reported to have low levels of side effects — [[silphium]] — was harvested to extinction around the 1st century.<!-- --><ref name="silphium">Tatman, John. [http://ancient-coins.com/articles/silphium/silphium2.htm ''Silphium: Ancient Wonder Drug?''] Accessed December 21, 2005</ref> The ingestion of certain [[poison]]s by the female can disrupt the [[reproductive system]]; women have drunk solutions containing [[mercury (element)|mercury]], [[arsenic]], or other toxic substances for this purpose. The Greek [[gynaecologist]] [[Soranus (Greek Physician)|Soranus]] in the 2nd century suggested that women drink water that [[blacksmith]]s had used to cool [[metal]]. The herbs [[tansy]] and [[pennyroyal]] are well-known in folklore as [[abortion|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 perilously damage the [[liver]], [[kidney]]s, and other organs. 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. Some [[herbal medicine|herbalists]] claim that [[black cohosh]] tea will also be effective in certain cases as an abortifacient.<!-- --><ref name="abort_hist">{{cite book |last=Riddle |first=John M. |title=Eve's Herbs: A History of Contraception and Abortion in the West |year=1999 | location= Harvard MA | publisher=Harvard University Press |id=ISBN 0-674-27026-6}}</ref> Aside from abortifacients, herbal contraceptives in folklore have also included a few preventative measures. [[Hibiscus rosa-sinensis]], known in [[Ayurveda]] as a contraceptive, may have antiestrogenic properties.<ref>{{cite web | url=http://ecam.oxfordjournals.org/cgi/content/abstract/nem003v1 | author=Vasudeva | title=Post-Coital Antifertility Activity of Hibiscus rosa-sinensis Linn. roots | accessdate=2007-09-30 | publisher=Guru Jambheshwar University of Science and Technology}}</ref> [[Papaya]] seeds, rumored to be a male contraceptive, have recently been studied for their azoospermic effect on monkeys.<ref>{{cite journal |last=Lohiya |first=N. K. | coauthors = B. Manivannan, P. K. Mishra, N. Pathak, S. Sriram, S. S. Bhande, and S. Panneerdoss |year=2002 | month = March |title=Chloroform extract of ''Carica papaya'' seeds induces long-term reversible azoospermia in langur monkey | journal = Asian Journal of Andrology | volume = 4 |pages=17–26 | doi = |url=http://asiaandro.com/1008-682X/4/17.htm |accessdate=2006-11-18 |format={{dead link|date=June 2008}}{{ndash}} <sup>[http://scholar.google.co.uk/scholar?hl=en&lr=&q=author%3ALohiya+intitle%3AChloroform+extract+of+%27%27Carica+papaya%27%27+seeds+induces+long-term+reversible+azoospermia+in+langur+monkey&as_publication=Asian+Journal+of+Andrology&as_ylo=2002&as_yhi=2002&btnG=Search Scholar search]</sup> }}</ref> The fact that various effective methods of birth control were known in the ancient world sharply contrasts with a seeming ignorance of these methods in wide segments of the population of early modern [[Christian]] Europe. This ignorance continued far into the 20th century, and was paralleled by eminently high birth rates in European countries during the 18th and 19th centuries.<ref>see John M. Riddle: "Eve's Herbs: A History of Contraception and Abortion in the West", Princeton: Harvard University Press 1999, ISBN-10: 0674270266,esp. Chapter 6: "The Broken Chain of Knowledge"</ref> Some historians have attributed this to a series of coercive measures enacted by the emerging modern [[state]], in an effort to repopulate Europe after the population catastrophe of the [[Black Death]], starting in 1348. According to this view, the [[witch hunts]] were the first measure the modern state took in an attempt to eliminate knowledge about birth control within the population, and monopolize it in the hands of state-employed male medical specialists (gynecologists). Prior to the witch hunts, male specialists were unheard of, because birth control was naturally a female domain.<ref>see Gunnar Heinsohn/Otto Steiger: "Witchcraft, Population Catastrophe and Economic Crisis in Renaissance Europe: An Alternative Macroeconomic Explanation.", University of Bremen 2004{{PDFlink|[http://www.iksf.uni-bremen.de/publikationen/discussion/papers/dp31/31iksf-6heins-steiger.witchcraft.pdf (download)]|448&nbsp;[[Kibibyte|KiB]]<!-- application/pdf, 459662 bytes -->}}; John M. Riddle: "The Great Witch-Hunt and the Suppression of Birth Control: Heinsohn and Steiger's Theory from the Perspective of an Historian", Appendix to: Gunnar Heinsohn/Otto Steiger: "Witchcraft, Population Catastrophe and Economic Crisis in Renaissance Europe: An Alternative Macroeconomic Explanation.", University of Bremen 2004{{PDFlink|[http://www.iksf.uni-bremen.de/publikationen/discussion/papers/dp31/31iksf-6heins-steiger.witchcraft.pdf]|448&nbsp;[[Kibibyte|KiB]]<!-- application/pdf, 459662 bytes -->}}; also see John M. Riddle: "Eve's Herbs: A History of Contraception and Abortion in the West", Princeton: Harvard University Press 1999, ISBN-10: 0674270266, Chapters 5-7</ref> Presenters at a family planning conference told a tale of [[Arab]] traders inserting small stones into the uteruses of their camels in order to prevent pregnancy, a concept very similar to the modern [[IUD]]. Although the story has been repeated as truth, it has no basis in history and was meant only for entertainment purposes.<!-- --><ref name="camel">{{cite web |title=A History of Birth Control Methods |work=Planned Parenthood |year=June 2002 |url=http://www.plannedparenthood.org/news-articles-press/a-history-of-birth-control-methods.htm |accessdate=2006-09-02 }}, which cites:<br>Thomas, Patricia. (1988). ''Contraceptives'', Medical World News, 29(5) (14 March), 48</ref> The first interuterine devices (which occupied both the vagina and the uterus) were first marketed around 1900. The first modern intrauterine device (contained entirely in the uterus) was described in a [[Germany|German]] publication in 1909. The [[Gräfenberg ring]], the first IUD that was used by a significant number of women, was introduced in 1928.<!-- --><ref name="IUD">{{cite journal |year=2000 | month = February |title=Evolution and Revolution: The Past, Present, and Future of Contraception | journal = Contraception Online (Baylor College of Medicine) | volume = 10 | issue = 6 | url=http://www.contraceptiononline.org/contrareport/article01.cfm?art=93}}</ref> The [[Calendar-based methods|rhythm method]] (with a rather high method failure rate of ten percent per year) was developed in the early 20th century, as researchers discovered that a woman only ovulates once per [[menstrual cycle]]. Not until the 1950s, when scientists better understood the functioning of the menstrual cycle and the [[hormone]]s that controlled it, were methods of [[hormonal contraception]] and modern methods of [[fertility awareness]] (also called [[#Fertility awareness methods|natural family planning]]) developed. [[Margaret Sanger]] was an American birth control activist and the founder of the [[American Birth Control League]] (which eventually became [[Planned Parenthood]]). She was instrumental in opening the way to access birth control. In 1960 the FDA approved the first form of [[hormonal birth control]], the [[combined oral contraceptive pill]]. ==Methods== {{seealso|Comparison of birth control methods}} ===Physical methods=== Physical methods may work in a variety of ways, among them: physically preventing sperm from entering the female reproductive tract; hormonally preventing ovulation from occuring; making the woman's reproductive tract inhospitable to sperm; or surgically altering the male or female reproductive tract to induce sterility. Some methods use more than one mechanism. Physical methods vary in simplicity, convenience and efficacy. ====Barrier methods==== [[Image:Kondom.jpg|thumb|right|200px|Condom (rolled-up).]] [[Barrier contraception|Barrier methods]] place a physical impediment to the movement of sperm into the female reproductive tract. The most popular barrier method is the male [[condom]], a latex or [[polyurethane]] sheath placed over the penis. The condom is also available in a female version, which is made of polyurethane. The [[female condom]] has a flexible ring at each end — one secures behind the [[pubic bone]] to hold the condom in place, while the other ring stays outside the vagina. Cervical barriers are devices that are contained completely within the vagina. The [[contraceptive sponge]] has a depression to hold it in place over the [[cervix]]. The [[cervical cap]] is the smallest cervical barrier. Depending on the type of cap, it stays in place by suction to the cervix or to the vaginal walls. The [[Diaphragm (contraceptive)|diaphragm]] fits into place behind the woman's pubic bone and has a firm but flexible ring, which helps it press against the vaginal walls. [[Spermicide]] may be placed in the vagina before intercourse and creates a chemical barrier. Spermicide may be used alone, or in combination with a physical barrier. ====Hormonal methods==== [[Image:Ortho tricyclen.jpg|thumb|left|225px|Ortho Tri-cyclen, a brand of oral contraceptive, in a dial dispenser.]] There are variety of delivery methods for [[hormonal contraception]]. Combinations of synthetic [[oestrogen]]s and [[progestin]]s (synthetic [[progestogen]]s) are commonly used. These include the [[combined oral contraceptive pill]] ("The Pill"), the [[Contraceptive patch|Patch]], and the [[NuvaRing|contraceptive vaginal ring]] ("NuvaRing"). Not currently available for sale in the United States is [[Combined injectable contraceptive| Lunelle]], a monthly injection. Other methods contain only a progestin (a synthetic progestogen). These include the [[progestogen only pill|progesterone only pill]] (the POP or 'minipill'), the injectables [[Depo Provera]] (a [[Injection (medicine)#Depot injection|depot formulation]] of [[medroxyprogesterone acetate]] given as an [[intramuscular injection]] every three months) and Noristerat ([[Norethindrone acetate]] given as an [[intramuscular injection]] every 8 weeks), and contraceptive [[Implant (medicine)|implant]]s. The progestin-only pill must be taken at more precisely remembered times each day than combined pills. The first contraceptive implant, the original 6-capsule [[Norplant]], was removed from the market in the United States in 1999, though a newer single-rod implant called [[Implanon]] was approved for sale in the United States on [[July 17]], [[2006]]. The various progestin-only methods may cause irregular bleeding during use. ====Ormeloxifene (Centchroman)==== [[Ormeloxifene]] (Centchroman) is a [[selective oestrogen receptor modulator]], or SERM. It causes ovulation to occur asynchronously with the formation of the uterine lining, preventing implantation of a zygote. It has been widely available as a birth control method in [[India]] since the early 1990s, marketed under the trade name Saheli. Centchroman is legally available only in India. ====Emergency contraception==== {{seealso|Emergency contraceptive availability by country}} Some combined pills and POPs may be taken in high doses to prevent pregnancy after a birth control failure (such as a condom breaking) or after unprotected sex. Hormonal [[emergency contraception]] is also known as the "morning after pill," although it is licensed for use up to three days after intercourse. Copper intrauterine devices may also be used as emergency contraception. For this use, they must be inserted within five days of the birth control failure or unprotected intercourse. Emergency contraception appears to work by suppressing ovulation.<ref name="Plan B Q&A">{{cite web |author=[[Food and Drug Administration|FDA]] |month=December 14, |year=2006 |title=Plan B: Questions and Answers, August 24, 2006, updated December 14, 2006 |url=http://www.fda.gov/cder/drug/infopage/planB/planBQandA20060824.htm |accessdate=2007-12-08}}</ref><!-- --><ref name="Plan B patient pamphlet">{{cite web |author=[[Barr Pharmaceuticals|Duramed Pharmaceuticals]] |month=September |year=2006 |title=Plan B Patient Pamphlet |url=http://www.go2planb.com/PDF/PatientPamphlet.pdf |pages=p. 3 |accessdate=2007-12-08|format=PDF}}</ref> However, because it might prevent a fertilized egg from implanting, some people consider it a form of abortion. The details of the possible methods of action are still being studied. ====Intrauterine methods==== [[Image:IUDCPCopperT380A.gif|thumb|right|200px|An intrauterine device.]] These are contraceptive devices which are placed inside the [[uterus]]. They are usually shaped like a "T" — the arms of the T hold the device in place. There are two main types of intrauterine contraceptives: those that contain copper (which has a spermicidal effect), and those that release a [[progestogen]] (in the US the term [[progestin]] is used). The terminology used for these devices differs in the [[United Kingdom]] and the United States. In the US, all devices which are placed in the uterus to prevent pregnancy are referred to as [[Intrauterine device|intra-uterine devices]] (IUDs) or intra-uterine contraceptive devices (IUCDs). In the UK, only [[copper]]-containing devices are called IUDs (or IUCDs), and hormonal intrauterine contraceptives are referred to with the term [[IntraUterine System|Intra-Uterine System]] (IUS). This may be because there are seven types of copper IUDs available in the UK, compared to only one in the US. ====Induced abortion==== [[Abortion]] can be done with surgical methods, usually [[suction-aspiration abortion]] (in the first trimester) or [[dilation and evacuation]] (in the second trimester). [[Medical abortion]] uses drugs to end a pregnancy and is approved for pregnancies where the length of gestation has not exceeded 8 weeks. Some herbs are believed to cause abortion (abortifacients). The efficacy of these plants as such has never been studied in humans. Some [[animal testing|animal studies]] have found them to be effective on other species.<ref name="riddle1">Riddle, John M. (1992). ''Contraception and Abortion from the Ancient World to the Renaissance.'' Cambridge, MA: Harvard University Press.</ref><ref name="abort_hist" /> The use of herbs to induce abortion is not recommended due to the risk of serious side effects. Abortion is subject to [[Ethical aspects of abortion|ethical debate]]. ====Sterilization==== [[Sterilization (surgical procedure)|Surgical sterilization]] is available in the form of [[tubal ligation]] for women and [[vasectomy]] for men. In women, the process may be referred to as "tying the tubes," but the fallopian tubes may be tied, cut, clamped, or blocked. This serves to prevent sperm from joining the unfertilized egg. The non-surgical sterilization procedure, [[Essure]], is an example of a procedure that blocks the tubes. Sterilization should be considered permanent. ===Behavioral methods=== Behavioral methods involve regulating the timing or methods of intercourse to prevent the introduction of sperm into the female reproductive tract, either altogether or when an egg may be present. ====Fertility awareness==== Symptoms-based methods of [[fertility awareness]] involve a woman's observation and charting of her body's fertility signs, to determine the fertile and infertile phases of her cycle. Most methods track one or more of the three primary fertility signs:<!-- --><ref name="tcoyf">{{cite book | first=Toni | last=Weschler | year=2002 | title=Taking Charge of Your Fertility | pages=p.52 | edition=Revised Edition | publisher=HarperCollins | location=New York | id=ISBN 0-06-093764-5 }}</ref> changes in [[basal body temperature]], in cervical mucus, and in cervical position. If a woman tracks both basal body temperature and another primary sign, the method is referred to as ''symptothermal''. Some fertility monitoring devices use urinalysis to follow the levels of [[estrogen]] and [[luteinizing hormone]] throughout a woman's menstrual cycle. Other bodily cues such as [[mittelschmerz]] are considered secondary indicators. [[Calendar-based methods]] such as the rhythm method and Standard Days Method are dissimilar from symptoms-based fertility awareness methods, in that they do not involve the observation or recording of bodily cues of fertility. Instead, calendar-based methods estimate the likelihood of fertility based on the length of past menstrual cycles. These methods are less accurate than symptoms-based fertility awareness methods, and are considered by many fertility awareness teachers to have been obsolete for at least 20 years. Charting of the menstrual cycle may be done by the woman on paper or with the assistance of [[software]]. The calendar-based methods may use a device such as CycleBeads. Symptoms-based methods may be assisted by fertility monitoring devices that accept and interpret temperature readings, information from home [[urinalysis]] tests, or both. To avoid pregnancy with fertility awareness, unprotected sex is restricted to the least fertile period. During the most fertile period, barrier methods may be availed, or she may abstain from intercourse. The term ''[[natural family planning]]'' (NFP) is sometimes used to refer to any use of FA methods. However, this term specifically refers to the practices which are permitted by the [[Roman Catholic Church]] — [[#Lactational|breastfeeding infertility]], and periodic [[abstinence]] during fertile times. FA methods may be used by NFP users to identify these fertile times. ====Coitus interruptus==== ''[[Coitus interruptus]]'' (literally "interrupted sex"), also known as the withdrawal method, is the practice of ending sexual intercourse ("pulling out") before ejaculation. The main risk of coitus interruptus is that the man may not perform the maneuver correctly, or may not perform the maneuver in a timely manner. Although concern has been raised about the risk of pregnancy from sperm in [[pre-ejaculate]], several small studies<ref name="HIV study" /><ref name="pre-e study" /> have failed to find any viable sperm in the fluid. ====Avoiding vaginal intercourse==== The risk of pregnancy from non-vaginal sex, such as [[outercourse]] (sex without [[sexual penetration|penetration]]), [[anal sex]], or [[oral sex]] is virtually zero. (A very small risk comes from the possibility of [[semen]] leaking onto the [[vulva]] (with anal sex) or coming into contact with an object, such as a hand, that later contacts the vulva.) ====Abstinence==== [[Sexual abstinence]] is the practice of refraining from all sexual activity. ====Lactational==== Most breastfeeding women have a period of infertility after the birth of their child. The [[lactational amenorrhea method]], or LAM, gives guidelines for determining the length of a woman's period of breastfeeding infertility. ===Methods in development=== ====For females==== * Praneem is a polyherbal vaginal tablet being studied as a [[spermicide]], and a [[microbicide]] active against HIV.<!-- --><ref>{{cite journal |author=Joshi S, Katti U, Godbole S, Bharucha K, B K, Kulkarni S, Risbud A, Mehendale S |title=Phase I safety study of Praneem polyherbal vaginal tablet use among HIV-uninfected women in Pune, India. | journal = Trans R Soc Trop Med Hyg | volume = 99 | issue = 10 |pages=769–74 |year=2005 | pmid = 16084547 | doi = 10.1016/j.trstmh.2005.01.007}}</ref> * BufferGel is a spermicidal gel being studied as a microbicide active against HIV.<!-- --><ref name="reprotect">{{cite web |title=BufferGel |publisher=ReProtect Inc. |date=[[2006-10-24]] |url=http://www.reprotect.com/products.shtml |accessdate=2007-05-19 }}</ref> * Duet is a disposable diaphragm in development that will be pre-filled with BufferGel.<!-- --><ref name="cbas diaphragm">{{cite web |title=Diaphragms |work=Cervical Barrier Advancement Society |date=2000 |url=http://www.cervicalbarriers.org/information/diaphragms.cfm |accessdate=2006-10-18 }}</ref> It is designed to deliver [[microbicide]] to both the cervix and vagina. Unlike currently available diaphragms, the Duet will be manufactured in only one size and will not require a prescription, fitting, or a visit to a doctor.<ref name="reprotect" /> * The [[SILCS diaphragm]] is a [[silicone]] barrier which is still in clinical testing. It has a finger cup molded on one end for easy removal. Like the Duet, the SILCS is novel in that it will only be available in one size. * A [[vaginal ring]] is being developed that releases both estrogen and progesterone, and is effective for over 12 months.<!-- --><ref name="nccring">{{cite journal |title=New Contraceptive Choices | journal = Population Reports, INFO Project, Center for Communication Programs | volume = M | issue = 19 |publisher=The Johns Hopkins School of Public Health |year=April 2005 |url=http://www.infoforhealth.org/pr/m19/ |accessdate=2006-07-14 }} [http://www.infoforhealth.org/pr/m19/m19chap2.shtml Chapter 2: Vaginal Rings]</ref> * Two types of progestogen-only vaginal rings are being developed. Progestogen-only products may be particularly useful for women who are breastfeeding.<ref name="nccring" /> The rings may be used for four months at a time.<!-- --><ref>{{cite journal |author=Massai R, Quinteros E, Reyes MV, Caviedes R, Zepeda A, Montero JC, Croxatto HB |title=Extended use of a progesterone-releasing vaginal ring in nursing women: a phase II clinical trial |journal=Contraception |volume=72 |issue=5 |pages=352–7 |year=2005 |pmid=16246661 |doi=10.1016/j.contraception.2005.05.004}}</ref> * A progesterone-only contraceptive is being developed that would be sprayed onto the skin once a day.<ref>New Contraceptive Choices. [http://www.infoforhealth.org/pr/m19/m19chap3.shtml Chapter 3: Transdermal contraception]</ref> * [[Quinacrine]] sterilization and the Adiana procedure are two permanent methods of birth control being developed.<!-- --><ref> [http://www.infoforhealth.org/pr/m19/m19chap10.shtml Chapter 10: Transcervical sterilization].</ref> ====For males==== {{main|Male contraceptive}} Other than condoms and withdrawal, there are currently no available methods of reversible contraception which males can use or control. Several methods are in [[research and development]]: *As of 2007, a chemical called [[Adjudin]] is currently in Phase II human trials as a [[male oral contraceptive]].<ref>{{cite journal | title=Male Contraceptive Methods Are in the Pipeline |author=Robert Finn |journal=Ob.Gyn. News 42:28, May 1, 2007}} [http://www.obgynnews.com/article/PIIS0029743707703956/fulltext Full text] {{PDFlink|[http://download.journals.elsevierhealth.com/pdfs/journals/0029-7437/PIIS0029743707703956.pdf PDF]|114&nbsp;[[Kibibyte|KiB]]<!-- application/pdf, 116954 bytes -->}}</ref> * [[RISUG]] (Reversible Inhibition of Sperm Under Guidance), is an experimental injection into the [[vas deferens]] that coats the walls of the vas with a spermicidal substance. The method can potentially be reversed by washing out the vas deferens with a second injection. * Experiments in [[vas-occlusive contraception]] involve an implant placed in the [[vasa deferentia]]. * Experiments in [[heat-based contraception]] involve heating a man's testicles to a high temperature for a short period of time. ==Misconceptions== Modern misconceptions and [[urban legend]]s have given rise to a great deal of false claims: * The suggestion that [[douche|douching]] with any substance immediately following intercourse works as a contraceptive is untrue. While it may seem like a sensible idea to try to wash the ejaculate out of the vagina, it is not likely to be effective. Due to the nature of the fluids and the structure of the female reproductive tract{{ndash}} 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 scientifically observed to be a reliably effective method. * It is a myth that a female cannot become pregnant as a result of the first time she engages in sexual intercourse. * While women are usually less fertile for the first few days of menstruation,<!-- --><ref>{{cite book | first=John | last=Kippley | coauthors=Sheila Kippley | year=1996 | title=The Art of Natural Family Planning | edition=4th addition | publisher=The Couple to Couple League | location=Cincinnati, OH | id=ISBN 0-926412-13-2 | pages=108-111,148 }}, which cites: :{{cite journal | author=Wade ME, McCarthy P, Braunstein GD, et al | title= A randomized prospective study of the use-effectiveness of two methods of natural family planning | journal=American journal of obstetrics and gynecology | year=October 1981 | volume=141 | issue=4 | pages=368–376 | pmid=7025639 }} :{{cite journal | author=Barbato M, Bertolotti G | title= Natural methods for fertility control: A prospective study — first part | journal=International Journal of Fertility | year=1988 | volume=33 Suppl | pages=48–51 | pmid=2902027 }} :{{cite journal |last=Roetzer |first=J |title=Sympto-thermal method — Ten years of change | journal = Linacre Quarterly | volume = 45 |pages=358–374 |date=1979 | pmid = 12309198}}</ref><!-- The PMID for the Roetzer ref is actually a different publication, but it appears to be the same information (i.e. just re-published in the other journal) --> it is a myth that a woman absolutely cannot get pregnant if she has sex during her [[menstrual cycle|period]]. * Having sex in a hot tub does not prevent pregnancy, but may contribute to vaginal infections. * Although some [[sex positions]] may encourage pregnancy, no sexual positions prevent pregnancy. Having sex while standing up or with a woman on top will not keep the sperm from entering the uterus. The force of ejaculation, the contractions of the uterus caused by [[prostaglandins]]{{Fact|date=February 2007}} in the semen, as well as ability of sperm to swim overrides gravity. * Urinating after sex does not prevent pregnancy and is not a form of birth control, although it is often advised anyway to help prevent [[urinary tract infections]].<ref>{{cite web |last=Rosenthal |first=M. Sara |title=Urinary Tract Health |work=The Gynecological Sourcebook |publisher=WebMD |year=2003 |url=http://www.webmd.com/content/article/85/98735.htm?UID=%7BEBD5D25E-A89F-4C28-AFF9-F02F4FFE0E90%7D |accessdate=2007-06-27 }}</ref> * Toothpaste cannot be used as an effective contraceptive<ref name="FCAU">{{Cite web|url =http://www.abc.net.au/foreign/stories/s1000575.htm|title=Sex & the Holy City |accessdate=2006-11-21|publisher=Foreign Correspondent|format=htm}}</ref> ==Effectiveness== :<span class="boilerplate seealso">''See also the table at: [[Comparison of birth control methods#Effectiveness of various methods|Comparison of birth control methods]]''</span> Effectiveness is measured by how many women become pregnant using a particular birth control method in the first year of use. Thus, if 100 women use a method that has a 12 percent first-year failure rate, then sometime during the first year of use, 12 of the women should become pregnant. The most effective methods in typical use are those that do not depend upon regular user action. Surgical sterilization, Depo-Provera, implants, and intrauterine devices (IUDs) all have first-year failure rates of less than one percent for perfect use. Sterilization, implants, and IUDs also have ''typical'' failure rates under one percent. The typical failure rate of Depo-Provera is disagreed upon, with figures ranging from less than one percent up to three percent.<!-- --><ref name="Trussell 1998">{{cite book |author=Trussell, James |year=1998 |editor=Hatcher, Robert A. et al. (eds.) |chapter=Contraceptive Efficacy |title=Contraceptive Technology |edition=17th ed. |location=New York |publisher=Ardent Media |id=ISBN 0-966-49020-7}}</ref><!-- --><ref>{{cite web |author=[[Food and Drug Administration|FDA]] |year=2005 |title=Depo-Provera U.S. Prescribing Information |url=http://www.fda.gov/cder/foi/label/2005/020246s013lbl.pdf |accessdate=2007-06-12}}</ref> Other methods may be highly effective if used consistently and correctly, but can have typical use first-year failure rates that are considerably higher due to incorrect or ineffective usage by the user. Hormonal contraceptive pills, patches or rings, fertility awareness methods, and the lactational amenorrhea method (LAM), if used strictly, have first-year (or for LAM, first-6-month) failure rates of less than 1%.<!-- --><ref>Ecochard, R.; Pinguet, F.; Ecochard, I.; De Gouvello, R.; Guy, M.; and Huy, F. (1998) "Analysis of natural family planning failures. In 7007 cycles of use", ''Fertilite Contraception Sexualite'' 26(4):291-6</ref><!-- --><ref name="creighton2">Hilgers T.W. and Stanford J.B. (1998) "Creighton Model NaProEducation Technology for avoiding pregnancy. Use effectiveness", ''Journal of Reproductive Medicine'' 43(6):495-502</ref><!-- --><ref name="billings">[http://www.woomb.org/omrrca/bulletin/vol27/no4/chinaEvaluation.html Evaluation of the Effectiveness of a Natural Fertility Regulation Programme in China]: Shao-Zhen Qian, et al. Reproduction and Contraception (English edition), in press 2000.</ref><!-- --><ref name="creighton">Howard, M.P. and Stanford, J.B. (1999) "Pregnancy probabilities during use of the Creighton Model Fertility Care System", ''Archives of Family Medicine'' 8(5):391-402</ref> In one survey, typical use first-year failure rates of hormonal contraceptive pills (and by extrapolation, patches or rings) were as high as five percent per year. Fertility awareness methods as a whole have typical use first-year failure rates as high as 25 percent per year; however, as stated above, perfect use of these methods reduces the first-year failure rate to less than 1%.<!-- --><ref name="Trussell 1998" /> Condoms and cervical barriers such as the diaphragm have similar typical use first-year failure rates (14 and 20 percent, respectively), but perfect usage of the condom is more effective (three percent first-year failure vs six percent) and condoms have the additional feature of helping to prevent the spread of [[sexually transmitted disease]]s such as the [[HIV virus]]. The withdrawal method, if used consistently and correctly, has a first-year failure rate of four percent. Due to the difficulty of consistently using withdrawal correctly, it has a typical use first-year failure rate of 19 percent,<!-- --><ref name="Trussell 1998" /> and is not recommended by some medical professionals.<!-- --><ref name="skouby">Skouby, SO. The European Journal of Contraception and Reproductive Health Care (2004) "Contraceptive use and behavior in the 21st century: a comprehensive study across five European countries." 9(2):57-68</ref> ===Protection against sexually transmitted infections=== {{seealso|safe sex}} Not all methods of birth control offer protection against [[sexually transmitted infections]]. Abstinence from all forms of [[Human sexual behavior|sexual behavior]] will protect against the ''sexual'' transmission of these infections. The male latex condom offers some protection against some of these diseases with correct and consistent use, as does the female condom, although the latter has only been approved for [[vaginal sex]]. The female condom may offer greater protection against sexually transmitted infections that pass through skin to skin contact, as the outer ring covers more exposed skin than the male condom, and can be used during anal sex to guard against sexually transmitted infections. However, the female condom can be difficult to use. Frequently a woman can improperly insert it, even if she believes she is using it correctly.{{Fact|date=February 2007}} The remaining methods of birth control do not offer significant protection against the sexual transmission of these diseases. However, so-called sexually transmitted infections may also be transmitted '''non-sexually''', and therefore, abstinence from sexual behavior does not guarantee 100 percent protection against sexually transmitted infections. For example, HIV may be transmitted through contaminated needles which may be used in [[intravenous drug use]], [[tattoo]]ing, [[body piercing]], or [[Injection (medicine)|injections]]. Health-care workers have acquired HIV through occupational exposure to accidental injuries with needles.<!-- --><ref name="HIV">{{cite journal | author=Do AN, Ciesielski CA, Metler RP, Hammett TA, Li J, Fleming PL | title=Occupationally acquired human immunodeficiency virus (HIV) infection: national case surveillance data during 20 years of the HIV epidemic in the United States | journal=Infect Control Hosp Epidemiol | year=2003 | pages=86–96 | volume=24 | issue=2 | pmid=12602690 | doi=10.1086/502178}} </ref> ==Religious and cultural attitudes== ===Religious views on birth control=== {{main|Religious views on birth control}} Religions vary widely in their views of the [[ethics]] of birth control. In [[Christianity]], the [[Roman Catholic Church]] accepts only [[Natural Family Planning]],<ref name="pope1">{{Cite web|url=http://www.vatican.va/holy_father/paul_vi/encyclicals/documents/hf_p-vi_enc_25071968_humanae-vitae_en.html|title=Humanae Vitae: Encyclical of Pope Paul VI on the Regulation of Birth, July 25, 1968|accessdate=2006-10-01|publisher=The Vatican|format=html}}</ref> while [[Protestants]] maintain a wide range of views from [[Quiverfull|allowing none]] to very lenient.<ref name="rainey_ref_2">{{Cite web|url=http://www.familylife.com/fltoday/default.asp?id=5868&page=72&search=&strMonth=&strDay=&strYear=&guests=&keywords=&showType=|title="The Value of Children" (11 July 2002 FamilyLife Today Radio Broadcast)|accessdate=2006-09-30|publisher=FamilyLife Today|year=2002|author=Dennis Rainey|format=Transcript of radio broadcast}}</ref> Views in [[Judaism]] range from the stricter [[Orthodox Judaism|Orthodox]] sect to the more relaxed [[Reform Judaism|Reform]] sect.<ref name="jew_BC">{{cite book | title=Birth Control in Jewish Law| last=Feldman| first=David M.| date=1998| publisher=Jason Aronson| location=Lanham, MD| id=ISBN 0-7657-6058-4}}</ref> In [[Islam]], contraceptives are allowed if they do not threaten health or lead to sterility, although their use is discouraged.<ref name="Islam_BC">{{cite journal | author=Khalid Farooq Akbar| title="Family Planning and Islam: A Review"| journal=Hamdard Islamicus|volume=XVII| issue=No. 3| url=http://muslim-canada.org/family.htm}}</ref> [[Hinduism|Hindus]] may use both natural and artificial contraceptives.<ref name="hindu_BC">{{Cite web|url=http://www.healthsystem.virginia.edu/internet/chaplaincy/hindu.cfm|title="Hindu Beliefs and Practices Affecting Health Care"|accessdate=2006-10-06|publisher=University of Virginia Health System|format=html}}</ref> A common [[Buddhism|Buddhist]] view of birth control is that preventing conception is ethically acceptable, while intervening after conception has occurred or may have occurred is not.<ref name="buddhist_BC">{{Cite web|url=http://web.singnet.com.sg/~alankhoo/MoreQA.htm#Abortion|title="More Questions & Answers on Buddhism: Birth Control and Abortion"|accessdate=2008-06-14|publisher=Alan Khoo|format=html}}</ref> ===Birth control education=== Many teenagers, most commonly in developed countries, receive some form of [[sex education]] in school. What information should be provided in such programs is hotly contested, especially in the United States and Great Britain. Possible topics include reproductive anatomy, human sexual behavior, information on sexually transmitted diseases (STDs), social aspects of sexual interaction, negotiating skills intended to help teens follow through with a decision to remain abstinent or to use birth control during sex, and information on birth control methods. One type of sex education program used mainly in the United States is called [[abstinence-only education]], and it promotes [[sexual abstinence]] until [[marriage]]. The programs do not encourage birth control, often provide inaccurate information about contraceptives and sexuality<ref> {{cite news |first= Ceci |last= Connolly|authorlink= |coauthors= |title= Some Abstinence Programs Mislead Teens, Report Says |url=http://www.washingtonpost.com/wp-dyn/articles/A26623-2004Dec1.html |work= The Washington Post |publisher= |page=A01|date= 2004-12-02|accessdate=2008-05-23 }}</ref>, stress failure rates of condoms and other contraceptives, and teach strategies for avoiding sexually intimate situations. Advocates of abstinence-only education believe that the programs will result in decreased rates of teenage pregnancy and STD infection. In a non-random, [[Internet]] survey of 1,400 women who found and completed a 10-minute [[multiple choice|multiple-choice]] [[online questionnaires|online questionnaire]] listed in one of several popular [[Web search engine|search engine]]s, women who received sex education from schools providing primarily abstinence information, or contraception and abstinence information equally, reported fewer unplanned pregnancies than those who received primarily contraceptive information, who in turn reported fewer unplanned pregnancies than those who received no information.<!-- --><ref>{{cite journal |author=Williams MT, Bonner L |title=Sex Education Attitudes and Outcomes Among North American Women | journal = Adolescence | volume = 41 | issue = 161 |pages=1–14 |year=2006 | pmid = 16689438 |url=http://www.brainphysics.com/research/SexEd_Williams2006.pdf}}</ref> However, [[randomized controlled trial]]s demonstrate that abstinence-only sex education programs increase the rates of pregnancy and STDs in the teenage population.<!-- --><ref>{{cite journal |author=DiCenso A, Guyatt G, Willan A, Griffith L |title=Interventions to reduce unintended pregnancies among adolescents: systematic review of randomised controlled trials. | journal = BMJ | volume = 324 | issue = 7351 |pages=1426 |year=2002 | pmid = 12065267 | doi = 10.1136/bmj.324.7351.1426}}</ref><!-- --><ref>{{cite press release |title=Based on the research, comprehensive sex education is more effective at stopping the spread of HIV infection, says APA committee |publisher=American Psychological Association |date=[[February 23]] [[2005]] |url=http://www.apa.org/releases/sexeducation.html |accessdate=2006-08-11 }}</ref> Professional medical organizations, including the [[American Medical Association|AMA]], [[American Academy of Pediatrics|AAP]], [[American College of Obstetricians and Gynecologists|ACOG]], [[American Public Health Association|APHA]], and [[Adolescent medicine|Society for Adolescent Medicine]], support comprehensive sex education (providing abstinence and contraceptive information) and oppose the sole use of abstinence-only sex education.<!-- --><ref>{{cite web |author=Kaplan, David W. |year=2002 |title=Prepared Statement. Hearing on Welfare Reform: A Review of Abstinence Education and Transitional Medical Assistance |publisher=U.S. House of Representatives Subcommittee on Health |url=http://republicans.energycommerce.house.gov/107/hearings/04232002Hearing541/Kaplan933print.htm |accessdate=2007-06-22}}</ref><!-- --><ref>{{cite journal |author=Santelli J, Ott MA, Lyon M, Rogers J, Summers D |year=2006 |title=Abstinence-only education policies and programs: a position paper of the Society for Adolescent Medicine |journal=J Adolesc Health |volume=38 |issue=1 |pages=83–7 |pmid=16387257 |url=http://www.adolescenthealth.org/PositionPaper_Abstinence_only_edu_policies_and_programs.pdf |doi=10.1016/j.jadohealth.2005.06.002|format=PDF}}</ref> ==See also== * [[Population control]] * [[One-child policy]] * [[Childless by choice]] * [[Reproductive Health]] * [[Natalism]], promoting childbirth ==References== {{reflist|2}} ==External links== {{Commonscat|Contraception}} * [http://www.ingenious.org.uk/See/Medicineandhealth/Obstetricsgynaecologyandcontraception/ Ingenious]: an archive of historical images related to obstetrics, gynaecology, and contraception. * [http://www.fphandbook.org Family Planning: A Global Handbook for Providers] USAID, WHO, Johns Hopkins INFO Project, 2007 {{Template group |list = {{Birth control methods}} {{Environmental technology}} {{Sex}} }} [[Category:Birth control| ]] [[Category:Environmental technology]] [[Category:Sustainability]] {{Link FA|pt}} {{Link FA|sl}} [[ar:تحديد النسل]] [[bs:Kontrola rađanja]] [[ca:Contracepció]] [[cs:Antikoncepce]] [[da:Prævention]] [[de:Empfängnisverhütung]] [[es:Método anticonceptivo]] [[eo:Kontraŭkoncipilo]] [[fa:پیشگیری از بارداری]] [[fr:Contraception]] [[ko:피임]] [[id:Keluarga Berencana]] [[is:Getnaðarvörn]] [[it:Contraccezione]] [[he:פיקוח ילודה]] [[lt:Kontracepcija]] [[mk:Надзор на раѓање]] [[ms:Kawalan kelahiran]] [[nl:Anticonceptie]] [[ja:避妊]] [[no:Prevensjon]] [[nn:Prevensjon]] [[nrm:Contraception]] [[pl:Antykoncepcja]] [[pt:Contracepção]] [[ru:Контрацепция]] [[simple:Birth control]] [[sk:Antikoncepcia]] [[sl:Nadzor rojstev]] [[sr:Контрола рађања]] [[sh:Kontrola rađanja]] [[fi:Ehkäisy]] [[sv:Preventivmedel]] [[ta:கருத்தடை]] [[th:การคุมกำเนิด]] [[tr:Doğum kontrolü]] [[uk:Контрацептиви]] [[zh:生育控制]]