- Fertility & Reproductive Systems
The History of Contraception
The History of Contraception
Contraception of one form and another has probably been in existence for as long as human babies have been born, and maybe longer. In the beginning it was rituals and witch doctors and it has slowly developed into more reliable methods. Actually, some of the earlier methods are not unlike the more recent ones and of course very few of them are completely reliable.
It was the ancient Greeks who first realised that male and female union caused pregnancy and since then many methods have been used with varying degrees of success. A wide range of products have been used as barriers such as lemon juice and essence from mahogany husks, acacia tree and honey, oil of cedar and lead ointment, frankincense and olive oil, salt, cabbage or willow leaves, onion juice, peppermint oil and, soft wool. Since most of these are either quite acidic or quite alkaline, it is quite likely that they all offered some degree of protection, in fact it is quite surprising how effective some of them could have been, although they would not have been as reliable as the methods that we use today. The first suppository that was commercially produced was developed in England by Walter Rendell, it was made of cocoa butter and quinine sulphate. Pessaries, suppositaries and spermicides are still in use today, unfortunately they are not the best forms available partly because they need to be inserted as near the time of intercourse as possible, this is not always easy to judge. However, they are often used in conjunction with other methods, particularly the diaphragm and as such prove quite useful. Vaginal douches have been used after intercourse since the 1600s, however, they do not seem to be at all effective.
In the Middle Ages Serbian women would dip their fingers in the first bathwater of the infant, the number of fingers which were dipped in would equal the number of years of sterility. Brides in the Baltic Island of Öland touched the cervix with as many fingers as they would like to have children. Other methods used were holding breath at ejaculation, inducing sneezing, weight gain, the use of amulets, the woman jumping backwards seven times, the woman spitting three times in the mouth of a frog, the woman eating bees and the woman remaining passive during intercourse.
A wide range of pills and potions were also recommended. Indian women used a combination of seeds, leaves and roots and quotations such as "one tola of powdered palm leaf and red chalk taken with cold water on the fourth day makes a woman sterile with certainty" are found in ancient literature. The literature of the ancient Hebrews includes a mixture described as, "Alexandrian gum, liquid alum and garden crocus, each in the weight of a denar, are mixed together. Three cups of wine with this medicine are good for gonorrhoea, and do not sterilise. Two cups of beer with this medicine cure jaundice and sterilise".
Abortion is one of the earliest forms of birth control. Obviously the methods were crude and often with fatal results for the mother. Generally though, even as long ago as the tenth century it was only accepted with good reason generally if the mother's health was at risk or the pregnancy had been the result of rape. Nowadays an abortion is a fairly straightforward outpatient process where the woman is just given a local anaesthetic. These days it is not uncommon for people to try such things as jumping down the stairs, having hot baths and eating hot curry in the hope that this may trigger a spontaneous miscarriage, admittedly I don't think they usually hold up much hope with this though. Some people also use herbal formulations to start an abortion, these are not necessarily without the side effects of the conventional abortion process but are less invasive. There are two sets of herbs used for this procedure, emmenagogues which encourage pelvic area blood circulation and menstruation and oxytocic herbs which encourage uterine contractions and release prostaglandin hormones. These tend to be used together. Emmenagogues include vitamin C, ginger and pennyroyal, oxytocic herbs include blue cohosh root and angelica. These processes seem to be more effective when the period is actually due.
Prolonged lactation is another method that has been in use for many thousands of years. Women realised that when they were breast feeding they were much less likely to become pregnant. Since this was also the easiest way to feed a child in the early days it was very popular. Research suggests that amenorrhea (no periods) lasted about two months when the child was not breastfed and up to nine months during lactation. Although women can conceive even though they do not menstruate, it is less likely. In third world countries where there is very little available as contraception, this method is still very widely practised.
Coitus interruptus is mentioned in the bible and is still used today. It is obviously not very reliable but certainly better than nothing. The Roman Catholic Church considers this method wrong with the same feeling as they do with any other forms of contraception. It can also have a certain amount of emotional effect since it is something that has to be on the mind during the whole sexual act. It also just might be forgotten.
There are pictures of a sheath covering a penis going on a tablet dating 1350-1200BC although it is not quite clear what the function of it was. Also a helmet of tortoiseshell was used in Japan in ancient times. However condoms were used in the early days as protection against venereal disease. During the Renaissance condoms were made of sausage skins and later a linen sheath. By the 18th century condoms were commonplace. Gabriello Fallopius, the Italian discoverer of the Fallopian tubes developed a linen condom which was popular for many years. In 1843 Goodyear developed rubber and this led to a big development in the production of condoms. In the 1930s latex was used for them and then by 1997 polyurethane was used which was stronger and less affected by external conditions such as heat, humidity and spermicides. Some of the brands also have a spermicide added to give extra protection. Nowadays, condoms come in a wide range of colours, styles and even flavours! It is still the most popular form of contraceptive internationally.The effectiveness of the condom can vary quite considerably, the best figure given being 97% effective.
The calculation of the efficiency of a contraceptive is worked out on the likelihood of getting pregnancy during a year. For instance if a method is said to be 85% effective it means that 15 out of every 100 women who use it are likely to get pregnant within a year. The efficiency of many of the methods used is dependent on the correct procedures being used and therefore inexperience or laziness can have a big effect on the reliability.
Female condoms were also used, they were first available commercially in the early 1900s. In 1992 they became more popular when the first polyurethane ones were produced. African women used to make them out of okra pods which had been hollowed out and Roman women used goat's bladders. Some people even used gold balls inserted into the vagina. It is also mentioned that Minos, who was the King of Crete around the beginning of the first century AD used the bladder of a goat inserted into his wife's vagina as a female condom.
Fredrick Adolph Wilde designed the cap in about 1838. It was a rubber device designed to fit over the cervix. He said that these would have to be individually moulded as the size of the cervix varies quite considerably. The cap would be worn as a semi permanent arrangement, only being removed when the woman's period began. The diaphragm was designed a little later by Mensinga. This covers the cervix and fits on the pubic bone and it is still a very popular form of contraception. Although it was designed by a German it soon became very popular in Holland due to the fact that it was recommended by Aletta Jacobs who opened the first ever birth control clinic there in 1882. This is where it got the name of the Dutch cap. Prior to this various other items have been used in a similar function, including lemons, which probably would have been particularly effective due to the acidic nature of lemon juice. Research is now underway to develop diaphragms made of polyurethane. It is considered to be up to 98% effective. A new version of the cap has been available in America since 1988 which is smaller and fits much more closely and therefore can be worn for longer than the diaphragm and needs less spermicide.
Surprisingly, knowledge of the basic principles of the intrauterine device seems to go back many hundreds of years, it is known that the Greeks used a similar device. In 1868 a product was made that partially went through the vagina. Then in 1909 Dr R Richter produced the first real IUD, further research into this was made in the 1920s by Ernst Grafenberg. They were initially made of silkworm gut and then later out of a silver ring. More lately they have been made out of plastic and copper. In 1996 IUDs were made that produced hormones as well. The IUD is still popular as a form of contraception. It is about an inch across and is inserted into the vagina, a very simple procedure for a doctor to perform. If an IUD is inserted no more than five days after ovulation, then this will also probably prevent a pregnancy due to recent intercourse. Certain problems such as pelvic inflammatory disease have been linked with the use of the IUD but there have been many improvements since this discovery. They are considered to be about 96% effective.
It has long been accepted that women have fertile times and infertile times in their menstrual cycle, even Hippocrates wrote about it. However initially the period which we now know as being fertile was considered relatively safe. In the 1840s, two separate scientists, a German called Bischoff and a Frenchman called Pouchet realised that women produced an egg once a month and also that this meant that their most fertile time was in the middle of the cycle, not just before the period as it was previously considered to be. The research into this began in the 1930s. It has also been discovered that the basal temperature of the women rises when she is ovulating and the texture of the cervical mucous changes. This led to the development of the Billings method which is based on these changes. These factors have helped both those trying to conceive and those who do not want to use any "unnatural" form of birth control. More recently an electronic gadget has become available which will tell you when you are fertile and when you are not. This method of contraception is the only one which is recognised by the Roman Catholic church. This method can be up to 98% effective but obviously very great care has to be taken to ensure that the necessary checks are made properly.
Sterilisation is also something that has been going on much longer than might be expected, but we know that eunuchs were not uncommon in ancient times and in fact ovariectomies we also not uncommon and happened as far back as 63BC. The Aborigines and those in the South Pacific used to cut a slit from the urethral meatus to the scrotum, which meant that the semen would leak out before reaching the woman's vagina. As medical procedures have improved and become safer and people feel more need to limit the size of their families this method of contraception has become increasingly popular. Although the only method that is completely reliable, it does have the disadvantage of usually being irreversible. The first reference to vasectomies as such was in 1775 and further research was undertaken by Sir Astley Copper in 1830. In 1907 sterilisation was compulsory in America for those at risk of passing on what were considered to be serious hereditary conditions. This later gave cause for concern and in 1934 sterilisation for these reasons was allowed to be taken voluntarily, but was not compulsory. By the 1960s improvement in surgical procedures and promotion by the Simon Population Trust made male sterilisation better understood and therefore more popular. By 1972 the NHS started provided vasectomies free as with other contraceptive services. Since then further research has taken place and now vasectomy is a very simple outpatient operation or even just performed in the doctor's surgery.
A full description of the procedures used for performing female sterilisation in 1834 was produced by Von Blundell and not surprisingly it was a very major operation taking months to recover. Much later it was realised that this procedure could be better done through the vagina rather than cutting open the abdomen and later still the fallopian tubes were clipped rather than cut. This leads to the possibility that this sort of contraception could be reversible. The procedure now most commonly used requires a very small incision near the naval and involves either clipping or burning the tubes
The sponge is another form of contraception that has been used for many hundreds of years and is still in use now. It used to be recommended that the sponge was about one inch square and soaked in brandy (as a spermicide) before use and have a silk cord or a twisted thread attached for easy removal. A tailor by the name of Francis Place decided that it was his job to tell the working class public about the role of the sponge. He circulated many handbills around London ensuring that they would reach the people who he felt really needed them. These days the sponge is usually made of polyurethane foam and have spermicides added and it is not reusable. This method can also protect against venereal disease and HIV. It is considered at best to be 87% effective.
The history of the pill dates back to when research was first done on the levels of hormones in women's bodies. However, the first contraceptive pill was produced for the general public in 1960. Since then a lot more research has been done and although there were possible bad side effects with the earlier ones, they are much safer now. One thing that made people consider the fact that something could be taken internally to reduce conception was the outbreak of clover disease in Australia in the 1940s. It was realised that when sheep were kept in fields with a large amount of clover they produced many fewer lambs than when they did not. It is now known that clover has a high level of natural oestrogen in it and this would have lead to this result. From this a man called Professor Russell Marker put a great deal of research into finding plant supplies of progesterone and following on from this research was the invention of the contraceptive pill by Dr Gregory Pincus. Various plant sources of oestrogen and progesterone are also very much used now in complementary medicine, not for contraception but for a wide range of menstrual disorders. In 1957 certain hormonal tablets were approved in America for using with menstrual disorders and three years later large clinical trials took place in Britain to test the effectiveness of the pill for contraception. Finally in 1961 oestrogen only pills were produced for contraceptive purposes in Great Britain. Research steadily continued on this and in 1981 we saw the introduction of contraceptive pill which provided hormones in sequence depending on the time of the menstrual cycle. In 1969 progestrogen (syntheitc progesterone) only pills were produced for the first time in Britain. The combination pill which contains both oestrogen and progestrogen stops ovulation and is about 99% effective, the mini pill (progestrogen only) reduces the chances of conception by effecting certain chances to the cervix and uterus and is about 97% effective.
Some research is being done into using wild carrot seed as a herbal contraceptive. It is believed to work by making the uterine lining unsuitable for implantation of the young foetus. However there is much more work to be done on this at the moment.
The morning after pill soon followed on from the contraceptive pill, this is a tablet, or more usually a series of tablets, that can be taken up to 12 hours after possible conception. The first ones of these were used in the 1960s and they required the taking of high doses of oestrogen for five days. In 1983 a new procedure was started using a combination of oestrogen and progestrogen. Progestrogen only contraceptive pills can also be used for this purpose. This procedure is not recommended though since it is usually unpleasant (about half the women who use it feel sick, and many vomit) and also it isn't that completely reliable.
Contraception by injection was first produced in the 1950s. This was discovered by Dr K Junkman who realised that by mixing alcohol with a progestrogen, the drug would have a long lasting contraceptive effect. After this a lot of research took place but it wasn't until 1974 that Depo-Provera was finally licensed for contraceptive use, and then it was only to be used for short periods of time. In 1984, it was allowed for long term use but only in cases where other methods were not considered to be suitable.
Contraceptive implants were first developed in America in 1967. These were capsules that could be implanted under the skin and which were filled with hormones. In 1995 Norplant was released in the United Kingdom. This consisted of six rods inserted under the skin which released progestrogens.
More recent methods are the injectable contraception, hormonal vaginal rings, skins patches and gels, nasal sprays, contraceptive vaccines and the male pill. Obviously research still goes in many areas and presumably always will do unless the population starts to rapidly decline and there is an ever increasing range of options available which are also getting safer and more reliable. Despite this, many of the methods that have been used for many hundreds of years are still very popular and presumably will continue to be so.