How the 20th-century gave birth to birth control

Following a century of rapid advances in contraception, we are getting better at preventing unintended pregnancies.

How the birth control pill works.
Video By National Geographic

How the 20th-century gave birth to birth control

Following a century of rapid advances in contraception, we are getting better at preventing unintended pregnancies.

How the birth control pill works.
Video By National Geographic

A single sperm penetrates an egg and a spark of new life is created. Every year, there are more than 200 million pregnancies worldwide; around 40 percent are unintended. Unsurprisingly, countries with the most effective birth control have the lowest rates of abortion.

Despite the risks it poses to mothers, we are very good at making babies. Normally, a woman is fertile for about 35 years, in which time she could have 15 pregnancies leading to perhaps 13 deliveries and as many children. This abundance of fertility is both a blessing and a curse: For many, it can lead to poverty and suffering. Which is why humans have long searched for an effective method of contraception that would enable them to take control of their fertility and decide if, when, and how often they become pregnant.

For thousands of years, efforts were made to reduce the potency of sperm and to stop it from reaching the egg. Apart from abstinence, coitus interruptus was probably one of the earliest attempts to prevent pregnancy. Since ancient times, leaves, lemons, and sponges served as vaginal barriers; and there is evidence the ancient Greeks used a form of intrauterine device, or IUD. For millennia women inserted fruit acids into their vaginas, perhaps observing the sharply acid environment’s effect on sperm, while douches would attempt to wash away semen after intercourse. Willow shoots, bees, and the scrapings of stag horns were all tried as an oral contraceptive, and when everything else failed, crude methods of abortion were a desperate last resort.

By the start of the 20th century, condoms were made of vulcanized rubber, spermicidal jelly was being commercially produced, IUDs were being developed, and the diaphragm had contributed to the emancipation of women by giving them control over a relatively effective method of contraception. Then, in 1929, a real breakthrough was made when research by Drs. Kyusaku Ogino in Japan and Hermann Knaus in Austria established when ovulation occurs. This crucial knowledge was used to accurately calculate a woman’s menstrual cycle and determine on what days she might become pregnant, eventually becoming known as the calendar or rhythm method. Advances in contraception accelerated with latex condoms, female condoms, smaller IUDs, and early experiments into implants and injections. But a major leap was made in 1960 with the arrival of the birth control pill.

Releasing synthetic hormones that mimic estrogen and progestin, the birth control pill prevents ovulation by tricking the body into thinking that it is already pregnant. It was the brainchild of Margaret Sanger, an American champion of women’s rights who first coined the phrase “birth control.” To build on research that proved hormones could suppress ovulation, in 1951 Sanger persuaded the provocative endocrinologist Gregory Pincus to develop a birth control pill for women. He teamed up with gynecologist John Rock, and in 1956 controversial large-scale clinical trials in Puerto Rico, which had no anti-birth control laws, reported success. In 1957 the FDA approved the prescription of the pill—but only for menstrual disorders. With unusually large numbers of women reporting menstrual disorders, the FDA approved the pill as a contraceptive in 1960. Despite controversy, within two years more than a million American women were taking the pill, and by 1965 it was the most popular form of birth control in the United States. Today, a safer and less potent version is up to 99 percent effective in preventing unintended pregnancies.

The pill is widely regarded as the turning point in humankind's struggle to control fertility. The two most common forms of contraception until 1960, the condom and coitus interruptus, relied entirely on the man, but the pill put women in charge of preventing pregnancy and gave them effective control of their own fertility. As adoption of the pill increased, unintended pregnancies decreased, infant mortality rates dropped, and the natural cycle of womanhood was transformed. Throughout history, a woman’s fertile years were often dominated by pregnancy and breastfeeding; now, those 35 years were interrupted by only one or two pregnancies on average. This has had a profound impact on millions of women. However, despite the UN’s stance that access to contraception is a basic human right, more than 200 million unwanted pregnancies occur every year.

Overall, Africa has far fewer women using birth control than anywhere else, due in part to limited access but also caused by cultural, religious, and gender-based barriers. A recent surge in the popularity of injectable contraceptives in Africa has been ascribed to their convenience and discretion that enables their use to be hidden from disapproving partners, family, and friends. However big a breakthrough the pill has been, contraception will continue to evolve to better meet the needs of women, becoming easier, safer, more effective, and more long-term.

Today, we are on the brink of microchip implants that could release contraceptive hormones over many years and be switched on and off as needed. Apps are being developed to monitor key fertility indicators in a woman’s body, and the long-promised male pill may yet make an appearance—though perhaps as a spray or cream that uses a protein to slow down sperm production. We have come a long way in a very short time, but while the 20th century could justifiably be called the century of contraception, perhaps the irony is that in the 50 years since the pill became available, world population has more than doubled. As humanity breeds itself toward eight billion and beyond, the story of contraception is far from over.

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