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The history of contraception: From ancient egyptians to the "morning after"

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  • Casa di Cura Privata San Paolo
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Abstract

The term "contraception" refers to the set of contraceptive techniques, i.e., the means aimed to prevent or reduce the likelihood of a pregnancy. Some contraceptive methods are commonly used as a tool for family planning (FP). The requirements of a contraceptive are: security, ease of use, low incidence of undesirable side effects, harmless for the product of conception if the technique fails, acceptable cost, minimal interference with the dynamics of sexual intercourse, reversibility (i.e., fertility restoration in the event of suspension of the use). We consider traditional contraceptive methods all those practices that do not require help (contraceptive devices), and that reduce the chance that fertilization takes place: abstinence or sexual practices alternative to vaginal penetration, breast-feeding, or amenorrhea accompanying the phase of breast-feeding after delivery. Since ancient times, women had to find and invent methods of birth control, by the practices of the ancient Egyptian to the anti-fertility recipes of the Chinese. The first birth control methods date back to ancient Egypt. Four thousand years ago, doctors advised as a method of contraception mixtures of crocodile dung and honey or swabs of acacia honey to be left in the vagina for long periods. After the intercourse, it was also recommended a wine-, garlic-, or fennel-based lavender. In the Greek-Roman world, during the classical age, people frequently resorted to abortion, but the physician Hippocrates, in the 5th century, suggested as a contraceptive a mixture of iron sulphate and copper, while his colleague Dioscorides proposed pepper buffers and a cedar and alum rubber to be applied before intercourse. In Roman times, Plinius (100 B.C.), expressing on birth control, spoke in terms of prevention of conception. At that times, sacred amulets and condoms made from animal bladders were employed more than anything else. Subsequently, during the Middle Ages, with Christianity, we witness the spread in Western countries of a doctrine rigidly hostile to any contraceptive practice, so that contraceptive methods were banned. This will endure until the end of the Middle Ages. Their development was officially resumed only from the 18th century on. Nevertheless, contraceptive practices of all kinds continued to spread in Europe, to see the constitution, at the end of the 19th century, of the movement for the legalization of contraception by Margaret Sanger. Also in the 19th century, the first rubber condom and the diaphragm (invented by the Dutch physician Wilhelm Mesinga in 1883) were introduced. Then, the era in which even scientific research will deal with this topic came, starting in 1897 with Beard and in 1898 with Prenant, who observed as during pregnancy ovulation was suppressed and so, after Hermann and Stein showed in rats that ovarian extracts could inhibit ovulation, Haberlandt in 1924 suggested the use of the ovarian hormones for the control of fertility. For the discovery of the birth control pill used to date we had to wait a little longer, to arrive to about 50 years ago with Carl Dejerassi and Gregory Pincus, which marked the first stage of the sexual liberation of women and at the same time of the splitting between reproduction and sexual pleasure. In 1956, in fact, the American physician Gregory Pincus patented the first birth control pill. In the last century and especially in recent decades, many contraceptive methods which by technical, mechanical, or chemical aids, can reduce, even drastically, the possibility that fertilization occurs, have spread. These methods are distinguished in: hormonal contraceptives, mechanical barrier- methods, intrauterine methods, natural methods or of fertility awareness, and surgical methods or of sterilization. Today we continue in this direction in research and discoveries, coming to the latest news of a new generation of scientific findings, such as Implanon® (Schering-Plough, Kenilworth, New Jersey, United States [US]), who greeted the traditional birth control pills. Research on new methods of contraception is still ongoing, such as the use of ultrasound to induce temporary male sterility, or the use of high doses of melatonin to reduce female fertility.

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Article
PIP The history of sterilization dates back to the time of Hippocrates, when female sterilization was recommended for preventing hereditary mental diseases. James Blundell introduced surgical sterilization in 1823 for the prevention of high risk pregnancies. Vasectomy was first performed in the US at the end of the 19th century, mainly to prevent hereditary disorders. Male sterilization was a means of genocide during Nazi rule in Germany. Religious beliefs have the most powerful impact on the practice or nonpractice of family planning. In the teachings of Islam, Christianity, and Judaism, only sporadic references explicitly prohibit contraception, yet various religious edicts have interpreted these references too broadly by advocating prohibition of most contraceptive methods. Recently, the world community endorsed the basic right of couples to decide the number of children they want and the right to family planning with free informed choice. An integral part of a successful family planning program is voluntarism. In Europe and North America sterilization is legal, except in Italy, France, and Turkey. In Latin America sterilization is illegal in a number of countries; in Burma and Vietnam restrictions are in place; and in Africa fertility regulation is illegal in one-third of the countries. Informed consent before sterilization during counseling by a skilled, unbiased counselor is indispensable. All family planning services should be part of the national health care system including the voluntary contraception services. Incentives may compromise voluntarism. Most programs require a minimum age and a minimum number of children, marital status, and spousal consent. For sterilization, a waiting period of 1-30 days has been recommended. The exclusion of childless and single individuals has been challenged as a violation of human rights. For mentally retarded people parents or guardians provide consent. Major ethical issues in the future could emerge concerning novel fertility techniques: cryopreservation of sperm and intracytoplasmic sperm injection.
Article
PIP Black fertility in the U. S. declined sharply in the latter part of the 19th century and continued declining up to 1940. Common expert opinion has held that this decline in fertility was not attributable to an increase in birth control practice. Instead, experts hypothesized that the fertility decline was due almost entirely to deleterious changes in health factors among blacks. The health hypothesis is faulty because those black groups with socioeconomic advantages most conducive to good health were the very groups with the lowest fertility rates. A number of recent fertility studies seem to show fairly widespread use of birth control among blacks during the 60 years up to 1940. This widespread use did not increase precipitously in the 1930s but grew gradually over the previous 1/2 century. Knowledge and acceptance levels of birth control were also high during those years among blacks. Similarly, the experts' beliefs that birth control, even if practiced among blacks, did not have much effect on black fertility because "infective" methods were used, birth control was not practiced "effectively," and blacks started birth control practice too late in their reproductive lives have been shown by studies to have no empirical bases.
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PIP During the Elizabethan era there was a considerable body of knowledge concerning birth control techniques including coitus interruptus, penis ointments, pessaries, purgatives, genital baths and bloodletting. Works were available describing the symptons and causes of abortion and reporting some abortifacients. The Puritans were aware of birth control techniques, but were opposed to them for several reasons: 1) it would go against the biblical injunction to be fruitful and multiply; 2) birth control frustrated the creation of what was in the image of God; 3) fecundity was a blessing and should not be thwarted; 4) the society of the elect should be increased; and 5) through childbirth a woman could atone for Eve's original sin. Although some Puritans recognized that marriage was for comfort and solace as well as for the bearing of progeny, birth control was frowned upon, the the Puritan clergy practiced what it preached. In a random sample of Puritan clergy there was an average of 6.8 children born per family, which was higher than the average to be found among English nobility of the same period.
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Modern contraception began early this century. In 1922, Mrs. Sanger of America came to China. Her theories of contraception and methods became the classical basis cited by Chinese workers on contraception. The Modern Women published since 1922 was the first professional publication in China, carrying many articles written by Chinese scholars. Monographs and translation of foreign works were also published. An institute for contraception was also founded in 1930. The Chinese Medical Association officially recognized contraceptive work as one of the public health works, marking the contraception, once lead by sociologists, under the category of the professional medical works.
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PIP The debate over causes of population change in Britain between the early 18th and mid-19th centuries has centered on the relative importance of changes in birth rates and death rates and whether demographic growth stemmed from economic or "fortuitous" origins, and the understanding of the process of fertility change during industrialization. Conventional wisdom, espoused by T.S. McKeown and R.G. Brown, stated that as long as mortality was high, an increase in the birth rate would have little effect on the population growth. Improvements in the environment (standards of living are the most acceptable explanation of the decline of mortality. This position is contradicted in Wrigley's study of Colyton, a village in Devon. Wrigley argues that restraint of fertility in Colyton is the result of a system of family limitation deliberate in that social or individual action caused fewer children to be born. There are many methods and versions of birth control. Coitus interruptus may have been the most important method in the 17th and early 18th centuries. The stereotype of a high birth rate, high death rate community with population size limited entirely by positive checks is inappropriate. Britain may have been in a state of homeostatic adjustment based on a high elasticity expedited by contraceptive practice and nuptiality patterns.
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PIP: Malthusianism in France in the years before the 1st world war was quickly transformed by the socialist ideology and presented to the working class as a revolutionary theory which might help the masses toward the goal of social revolution. However, the original appeal to moral restraint only (late marriage, sexual abstinence) in avoiding unwanted pregnancies was refused, and contraception was advertised vigorously. The 1st militant neomalthusian organization, The Malthusian League, was created in 1877, and was ideologically linked to anglo-saxon social reformism. At the beginning ot the 20th century Malthusianism in France began to assume a different character under the influence of a leading militant revolutionary, Paul Robin, who emphasized the Malthusian doctrine as an indispensable strategic tool of the proletariat's success, when coupled with better education. The Malthusian League published 2 magazines, Regeneration, and, later, Le Malthusien. Most French Neomalthusians belonged to the anarchist movement and gathered around its publication, Libertaire. However, the so called pure anarchists and the communists were against it, and strong opposition also came from the labor unions and from at least some of the socialist press. In 1911 the Federation of Neomalthusian Working Groups was founded; within it socialist groups with different ideologies debated the Malthusian theory. Notwithstanding the Federation's efforts to link Neomalthusianism with the workers' movement, this link was never really established. The Federation had to fight against the dominant bourgeois ideology, against other revolutionary groups, and against those who wanted to save France from the danger of underpopulation and the immigration of increasing numbers of workers from less civilized countries. Birthrate began declining in France at the end of the 18th century, but the greatest decline began between 1890-1900. It is very difficult to determine whether Neomalthusianism affected the reproductive behavior of the French people.
Article
Concern for contraception played a significant role in precipitating the appearance of psychoanalysis. In Vienna at the turn of the century middle class couples attempted to control family size, often by coitus interruptus. Freud was concerned by the anxiety which this practice caused. Rubber condoms were also available. Freud found the condom the more desirable method but also productive of anxiety. Freud describes the woman's use of a sponge as a contraceptive method, and when all else failed, abortion. The far reaching effects of birth control and family planning were envisioned by Freud, but he deliberately chose to deal with the individual anxieties caused by "Malthusian" practices. Coitus interruptus became increasingly alarming as a cause of neurosis; he asserted that fear of an unwanted pregnancy played little part. He also stated that masturbation caused nervous debility. To Freud contraception undermined the argument that civilization is based on self control and discipline. If couples could have sexual intercourse with no fear of repercussions, what force would be strong enough to drive men and women back to their highest callings?
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Medieval and Renaissance tales are remarkable for their frank discussion of sexual practices, including birth control. Italian and French writings are the most explicit. Contraception and abortions are often treated as 'secrets', esoteric practices acquired from experts. The concealment of pregnancy is presented as an alternative form of birth control, often used after the others have failed. In the narratives, the use of birth control is mostly confined to premarital relations, although contraception by married women appears at the end of the period in a few French examples.
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In the Fall of 1997 the leading Swedish newspaper, Dagens Nyheter, created a media hype over the Swedish policy of compulsory sterilisation that had been in operation between 1935 and 1975. In the discussion that followed, the moral condemnation of our medical past was unanimous. However, the reasons for rejecting what had gone on were varied and mutually inconsistent. Three strands of criticism were common: the argument from autonomy, the argument from caution, and the argument from biological scepticism. In the paper it is argued that what point of departure you choose in your criticism of the past should be of consequence also for your ideas about present and future medical practice. In particular, if you rely on the argument from autonomy, you should be prepared to accept a liberal (present and future) use of reproductive techniques.
Article
Birth control techniques were widely available in 19th-century Canada, despite the fact that they were illegal. Most physicians remained silent about contraception, with a small minority vocally opposed to the practice of birth control. Canadian physicians were influenced by the social, economic, legal, and political values of their time, and their support of birth control initially lagged far behind public interest and need. At later points in Canadian medical history, physicians actively supported increased access to contraceptive services, and played a significant role in the legalization of contraception in this country. The Canadian birth control movement made tremendous strides in the 1930s with the dissemination of contraceptive information to the public and the opening of the first public birth control clinic. The Canadian Medical Association supported contraceptive practice as part of preventive medicine in the 1930s, and the legalization of contraception in the early and mid 1960s. Contraception was formally legalized in Canada in 1969 and has become a significant aspect of medical practice. In Canada, current medical controversies in contraception include issues of public education, advertising, contraceptive research, and the integration of contraception with other aspects of reproductive and sexual health in medical practice.
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Despite its 100 years old history, intrauterine contraception is still regarded as a modern method. Moreover, one could have witnessed its renewal in recent years. New devices have been introduced, which are not only simple modifications of the earlier ones in material, size and format, but were developed by quite new ideas and conceptions. These include the hormone-containing, the frameless and the Hungarian devices containing alloy (copper-silver, copper-gold) in their metal part. Another line of progress is marked by the new ways of applications, which are open both for the new and for the old types of devices. One of these possibilities is emergency contraception. The other one goes beyond contraception; it is intrauterine local hormonal treatment. The author presents these novelties by using partly international study results, but mainly personal data based on his own clinical experiences.
Article
The control of fertility constitutes a global health issue, since overpopulation and unintended pregnancy have both major personal and societal impact. Although some regions of the world are seeing neutral or negative population growth, many developing countries are seeing explosive growth of their populations and these population changes will affect the entire globe. It is estimated that in a decade, the largest cohort of young women worldwide in human history will reach adolescence thus necessitating the need for a wide range of contraceptive options that can be used by both females and males. The contraceptive revolution that occurred in the 1960s with the development of the hormonal-based oral contraceptive for women has subsequently made a significant impact on societal dynamics in several cultures, yet there has been virtually no innovation in this field since that time. This lack of innovation contrasts dramatically with the vast enhancement of our knowledge base of the basic processes of reproduction. The genomic and proteomic revolutions have provided new tools and new targets for contraceptive development, and the results of such approaches have identified gene products that play critical roles in female and male reproduction, thus expanding the array of targets for novel and innovative female- and male-based contraceptives. This normally would herald a renaissance in contraceptive development, yet the commitment of industry to this endeavor is limited to a few firms due to the economics of contraceptive development. This chapter will consider the types of targets being considered in the development of new generations of contraceptives and will also focus on the challenges that industry has in meeting these goals.
Article
In the 1940s there occurred an ethical conflict in the Women's Hospital of Basle. It arose in the context of a shortage of nurses, the introduction of the Swiss national criminal law, the change of the hospital director, the increase of abortion and the nursing ideal of obedience and serving. The conflict showed the social change towards measures of birth control such as abortion and sterilisation. Different political opinions and strong convictions clashed. The paper is focusing on denominationally affiliated nurses, the deaconesses of Riehen, who were standing between the religious conviction to protect unborn life and the professional principle of unconditional nursing. Finally they decided to leave the hospital.
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H.G. Wells called her 'that unforgettable heroine'. But she was forgotten, most particularly in New Zealand, where she was banned from mention in the newspapers under the War Regulations for her 'safe sex' work during the First World War - a very hypocritical move as it happened just as her work was officially taken on by the army. For this work she was dubbed the 'guardian angel of the ANZACs' by a French venereal disease specialist and awarded the Reconnaissance Franaise by the French. After the war she settled in London, marrying her long-time friend and wartime colleague, physical culturist Fred Hornibrook. Rout went on with her venereal disease prophylaxis campaign after the war. She also entered the birth control movement in the 1920s, playing a major role in the last big birth control court case, a role often attributed to Dora Russell, while Rout again is 'forgotten'. In her books, like the best selling Safe Marriage, a safe sex guide (which was banned in New Zealand), she encouraged women to own their own bodies and take responsibility for their own sexual health. She linked exercise and sex, arguing in books like Sex and Exercise, that exercise would enhance women's sex lives. She and Hornibrook, who wrote a best-selling book entitled The Culture of the Abdomen, presaging the current obsession with rocklike 'abs', made a pair, teaching fitness techniques, holding 'native dance' evenings, and being hailed as modern dance proponents. Rout also wrote books on vegetarianism, wholemeal cookery and Maori culture. The word most commonly used by people describing her throughout her life was 'energy'. She herself was very fit. But she did not fit in. Once her marriage to Hornibrook was over, in 1936, she returned to New Zealand, was rebuffed by former friends. She sailed for Rarotonga and died there, of a self-administered overdose of quinine that September. As she had remarked to H.G. Wells, 'It is a mixed blessing to be born too soon'. She anticipated many of the enthusiasms of our own time - in diet, in dance, in ideas about exercise and sexuality. But because she was so far ahead of her own time in her 'safe sex' campaign, she became persona non grata in her own country. With the advent of AIDS her contribution snaps into focus - and the AIDS clinic in the city of Christchurch where she used to live has been named after her.
This paper focuses on the relations between a liberal group of sex reformers, consisting of writers and literary critics, and physicians from the Polish Eugenics Society in interwar Poland. It illustrates the paradoxes of the mutual co-operation between these two groups during the 1930s and analyses the reason why compulsory sterilisation was rejected by politicians. From the early 1930s two movements began to forge an alliance in Poland: the sexual reform movement which advocated freedom of the individual, and eugenics, which called for limiting the freedom of the individual for the collective good. This paper draws attention to several issues which emerged as part of this collaboration: population politics, the relationship between reformers, eugenicists and state institutions, and the question of how both movements--eugenics and sexual reform--perceived the question of sexuality, birth control and abortion. It will also focus on those aspects of their thinking that led to mutual co-operation.