Contraception

Please note to read the Wikipedia medical notice.

Contraception, contraception or birth control is any method or device to prevent unwanted pregnancy. Planning, provision and use of contraceptive methods is called family planning. Contraceptive methods have been used since ancient times, in the Petri papyrus of 1850 BC. Birth control prescriptions were already listed in C. and many other cultures did so in their own way throughout history, but effective and safe contraceptives were not available until the 20th century. Some cultures restrict or discourage access to birth control, as they consider it to be morally, religiously, or politically undesirable.

The most effective methods are sterilization by vasectomy in men and tubal ligation, intrauterine devices (IUDs), and subdermal contraceptives in women. This is followed by a number of hormonal contraceptives such as oral pills, patches, vaginal rings, billings, and injections. Less effective methods include barriers such as condoms, diaphragms, and contraceptive sponges, and fertility awareness methods. The least effective methods are spermicides and withdrawal from the male before ejaculation. Sterilization, while highly effective, is usually not reversible; all other methods are reversible, most immediately after stopping. Safe-sex practices, such as using male or female condoms, can also help prevent sexually transmitted infections. Other methods may not protect against infection of sexual transmission. Emergency contraception can prevent pregnancy in the first 72 to 120 hours after unprotected sex. Some argue that sexual abstinence is a method of birth control, but abstinence-only sex education may increase teen pregnancies when offered without contraceptive education due to non-compliance.

In adolescents, pregnancies are at greater risk of poor outcomes. Comprehensive sex education and access to contraceptive methods decrease the rate of unintended pregnancies in this age group. Although young people can generally use all forms of birth control, long-acting and reversible ones such as implants, IUDs, or vaginal rings are more successful in reducing teen pregnancy rates. After delivery, a woman who does not exclusively breastfeed can become pregnant again in as little as four to six weeks. Some contraceptive methods can be started immediately after birth, while others require a delay of up to six months. In lactating women, progestin-only methods are preferable to combined oral contraceptives. For women who have reached menopause, it is recommended that birth control continue until one year after the last period.

About 222 million women in developing countries who want to avoid pregnancy are not using modern contraception. Birth control in developing countries has decreased the number of maternal deaths by 40% (about 270 000 deaths prevented in 2008) and could prevent 70% if full demand were met. By lengthening the time between pregnancies, it can improve birth outcomes for adult women and the survival of their children. development the income, assets and weight of women and the schooling and health of their children improve with greater access to birth control. This increases economic growth due to fewer dependent children, increased female participation in the labor force and less consumption of scarce resources.

Methods

Birth control methods include barrier methods, hormonal contraceptives, intrauterine devices (IUDs), sterilization, and behavioral methods. These are used before or during sexual intercourse, while emergency contraceptives are effective for up to a few days after sex. Efficacy is usually expressed as the percentage of women who become pregnant using a given method in the first year, and sometimes as a lifetime failure rate among methods with high efficacy, such as tubal ligation.

The most effective methods are those that are long-lasting and do not require regular visits to a health facility. Both surgical sterilization, implantable hormones, and intrauterine devices have first-year failure rates of less than 1% Hormonal birth control pills, vaginal patches or rings, and the lactational amenorrhea (LAM) method, if used rigorously, can also have first-year (or for LAM, first semester) failure rates of less than 1 %. Through typical use these are considerably higher, at 9%, due to misuse. Other methods, such as condoms, diaphragms, and spermicides, have higher rates, even with perfect use. The American Academy of Pediatrics recommends long-acting and reversible contraception as first line for young people.

While all methods of birth control have some potential adverse effects, the risk is less than that associated with pregnancy. After stopping or stopping many methods of birth control, including oral contraceptives, IUDs, implants, and injections, the pregnancy rate during the subsequent year is the same as for those who did not use any contraceptive method.

In people with specific health problems, certain forms of birth control may require further investigation. In contrast, for healthy women, many methods do not require a medical examination, including oral, injectable, or implantable contraceptives and condoms Specifically, a pelvic exam, breast exam, or blood test before starting birth control pills do not seem to affect the results and are therefore not necessary. In 2009, the World Health Organization (WHO) published a detailed list of medical eligibility criteria for each type of birth control.

Hormonal

Hormonal contraception is available in a variety of forms, including pills, implants under the skin, injections, patches, intrauterine devices, and vaginal rings. They are currently only available to women, although hormonal contraceptives for men have been and are being clinically tested. There are two types of oral contraceptive pills, combined oral contraceptive pills (containing estrogen and progesterone) and progestin-only pills (sometimes called mini-pills.) If taken during pregnancy, they do not increase the risk of miscarriage or cause birth defects. Both types of birth control pills prevent fertilization primarily by inhibiting ovulation and thickening the cervical mucosa. Their effectiveness depends on the user remembering to take the pills. They can also change the lining of the uterus and thus decrease implantation.

Combined hormonal contraceptives are associated with a slightly increased risk of venous and arterial thrombi. Venous thrombi, on average, increase from 2.8 to 9.8 per 10,000 women-years, which is still less than those associated with pregnancy. Due to this risk, they are not recommended in smokers older than 35 years.

The effect on sexual desire is varied, increasing or decreasing in some, but no effect in most. Combined oral contraceptives reduce the risk of ovarian cancer and endometrial cancer and do not change the risk of breast cancer. breast. They often reduce menstrual bleeding and menstrual pain. The lower doses of estrogens delivered by the vaginal ring may reduce the risk of breast pain, nausea, and headache associated with products with higher estrogen doses..

Progestin-only pills, injections, and intrauterine devices are not associated with an increased risk of blood clots and can be used by women with prior venous clots. In those with a history of arterial clots, hormonal methods are contraindicated. except for non-injectable progestin-only pills. Progestin-only pills can improve menstrual symptoms and can be used by women who are breastfeeding, as they do not affect milk production. Irregular bleeding can occur with progestin-only methods, and some users report missed periods. The progestins drospirenone and desogestrel minimize androgenic side effects, but increase the risks of blood clots and are therefore not first-line. first-year failure of perfect use of the injectable progestin Depo-Provera is 0.2%; while that of typical use is 6%.

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  Three varieties of birth control pills in a wrapper with a oriented calendar

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  Oral contraceptive

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  A transdermal birth control patch

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  A NuvaRing Vaginal Ring

Barrier

Barrier contraceptives are devices that attempt to prevent pregnancy by physically preventing semen from entering the uterus. This group includes male condoms, female condoms, cervical caps, diaphragms, and spermicidal contraceptive sponges.

Globally, condoms are the most common method of birth control. Male condoms are placed on the erect penis and physically block ejaculated semen from entering the sexual partner's body. Modern condoms they are mostly made of latex, but some are made of other materials such as polyurethane or lamb intestine. Female condoms, often made of nitrile, latex, or polyurethane, are also available. Male condoms have the advantage of being inexpensive., easy to use and have few adverse effects. Making condoms available to adolescents does not appear to affect the age of initiation of sexual activity or its frequency. In Japan about 80% of couples using contraception use condoms, while in Germany this number is about 25% and in the United States it is 18%.

Male condoms and the diaphragm with spermicide have first-year failure rates in typical use of 18% and 12%, respectively. With perfect use condoms are more effective at 2% vs. 6% of the diaphragm. Condoms have the added benefit of helping to prevent the spread of some sexually transmitted infections such as HIV/AIDS.

Contraceptive sponges combine a barrier with a spermicide. Like diaphragms, they are inserted vaginally before intercourse and must be placed over the cervix to be effective. Typical failure rates during first year depend on whether the woman has previously given birth (24%) or not (12%). The sponge can be inserted up to 24 hours before sex and left in place for at least six hours afterwards. Allergic reactions and more serious adverse effects such as toxic shock syndrome have been reported.

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  A masculline condom rolled.

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  A male latex condom developed

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  A female polyurethane condom

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  A Cervicovaginal diaphragm barrier, in his case next to an American room.

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  A birth control sponge within your open package.

Intrauterine devices

A T-shaped copper IUD with extraction threads.

Today's intrauterine devices (IUDs) are small devices that are inserted into the uterus, often in the shape of a 'T' and with copper or levonorgestrel content. It is a type of long-acting, reversible contraception and is one of the most effective types of reversible birth control. First-year failure rates with the copper IUD is about 0.8%, while the copper IUD is about 0.8%. of levonorgestrel is 0.2%. Among types of birth control, along with implants, they enjoy the highest user satisfaction. As of 2007, IUDs are the most widely used form of reversible contraception, with more of 180 million users worldwide.

Evidence supports efficacy and safety in adolescents and both those who have previously had children and those who have not. IUDs do not affect breastfeeding and can be inserted immediately after childbirth or abortion. A Once removed, even after prolonged use, fertility returns to normal immediately.

While copper IUDs can increase menstrual bleeding and cause more painful cramps, hormonal IUDs can reduce menstrual bleeding or stop menstruation altogether. Cramps can be treated with NSAIDs. Other potential complications include expulsion (2-5%) and rarely perforation of the uterus (less than 0.7%). An earlier model of the intrauterine device (the Dalkon shield) was associated with an increased risk of pelvic inflammatory disease, however, Current models do not pose the risk in those without sexually transmitted infections near the time of insertion.

Sterilization

Surgical sterilization is available in the form of tubal ligation for women and vasectomy for men. There are no significant long-term side effects, and tubal ligation decreases the risk of ovarian cancer. In the short term they are twenty times less likely with a vasectomy than with a tubal ligation. After a vasectomy, there may be swelling and pain in the scrotum that usually resolves within a week or two. With a tubal ligation, the Complications occur in 1–2% of procedures, with serious complications usually due to anesthesia. None of these methods offer protection against sexually transmitted infections.

This decision may cause regret in some people. Among women over the age of 30 who have undergone tubal ligation, around 5% regret their decision, compared with 20% of those under the age of 30. In contrast, less than 5% of men are likely to have their tubes tied. regret sterilization. Men most likely to regret sterilization are younger, have young or no children, or are in an unstable marriage. In a survey of biological fathers, 9% stated that they would not have had children if they were able to do so again.

Although sterilization is considered a permanent procedure, it is possible to try a tubal ligation reversal to reconnect the tubes or a vasectomy reversal to reconnect the vas deferens. The female desire for reversal is often associated with a change in spouse. Pregnancy success rates after tubal reversal are between 31 and 88%, with possible complications such as increased risk of ectopic pregnancy. The number of males requesting the reversal is between 2 and 6%. Success rates in fathering another child after the reversal are between 38 and 84%; whose success is less the longer the period of time between the original procedure and the reversal. Semen extraction followed by in vitro fertilization may also be an option for men.

Behavioral

Behavioral methods involve regulating the time or type of intercourse to prevent the introduction of semen into the female's reproductive tract, either always or only when an ovum may be present. first-year failure can be around 3.4%, however if they are misused the rate can be close to 85%.

Fertility Awareness

A CycleBeads, used to estimate day-based fertility since the last menstruation.

Fertility awareness or rhythm methods involve determining the most fertile days of the menstrual cycle and avoiding unprotected sex. Techniques for determining fertility include observing basal body temperature, secretions cervical or on cycle day. They have typical use first-year failure rates of 24%; in perfect use it depends on the method used and ranges from 0.4% to 5%. The evidence on which these estimates are based, however, is poor as most trial participants stop use early. Worldwide, they are used in about 3.6% of couples. If based on both basal body temperature and another primary sign, the method is known as symptothermal. Overall first-year failure rates of <2% to 20% have been reported in clinical studies of the symptothermal method.

Retreat

The withdrawal method (also known as coitus interruptus) is the practice of ending intercourse ("withdrawing") before ejaculation. The main risk of the withdrawal method is that the The male may not perform the maneuver correctly or in a timely manner. First-year failure rates range from 4% with perfect use to 22% with typical use. Some medical professionals do not consider it a method of control of the birth rate.

There are few data regarding the sperm content of the pre-ejaculatory fluid. Although some tentative investigations did not find it, one test found sperm present in 10 of the 27 volunteers. The withdrawal method is used for contraception by 3 % of couples.

Abstinence

Although some groups advocate total sexual abstinence, by which they mean avoiding all sexual activity, in the context of birth control the term generally means abstinence from vaginal sex. Abstinence is 100% effective to prevent pregnancy; however, not everyone who intends to be abstinent refrains from all sexual activity and in many populations there is a significant risk of pregnancy from non-consensual sex.

Abstinence-only sex education does not reduce teen pregnancy. Teen pregnancy rates are higher for students who received abstinence-only education, compared with comprehensive sex education. Some authorities recommend that those who who use abstinence as their primary method have a backup method(s) available (such as condoms or emergency contraceptive pills). Non-penetrative sex or oral sex, deliberately without vaginal sex, are also sometimes considered a control method. While they generally prevent pregnancy, pregnancy can still occur with intercrural sex and other forms of sex with the penis near the entrance to the vagina (genital rubbing and penile exit in anal intercourse) with which semen can be deposited near the entrance to the vagina and travel through the lubricating fluids of the vagina.

Breastfeeding

The lactational amenorrhea method involves the use of natural female infertility that occurs after childbirth and can be extended by breastfeeding. This normally requires no period at all, exclusive breastfeeding of the baby and a child under six months of age. The World Health Organization states that if breastfeeding is the sole source of nutrition for the infant, the failure rate is 2% in the six months postpartum. Six uncontrolled studies of Lactational amenorrhea found failure rates at six months postpartum between 0% and 7.5%. These increase to 4.7% at one year and 13% at two years. instead of breastfeeding, the use of a pacifier and solid foods all increase your failure rate. In women who are exclusively breastfeeding, about 10% start having periods before three months and 20% before six months. In which it is not are breastfeeding, fertility may return four weeks after delivery.

Emergency

A dose of two emergency birth control pills.

Emergency contraceptive methods are medications (sometimes misnamed "morning-after pills") or devices used after unprotected sex in the hope of preventing pregnancy. They work primarily by preventing ovulation or fertilization. There are several options: high-dose birth control pills, levonorgestrel, mifepristone, ulipristal, and IUDs. Providing women with emergency contraceptive pills in advance does not affect rates of sexually transmitted infections, condom use, pregnancy rates, or sexual risk behavior. All emergency methods have minimal side effects.

Levonorgestrel pills, when used within three days, decrease the chances of pregnancy after a single episode of unsafe sex or condom failure by 70% (resulting in a pregnancy rate of 2. 2%). Ulipristal, when used within five days, decreases the chance of pregnancy by nearly 85% (1.4% pregnancy rate) and may be slightly more effective than levonorgestrel. mifepristone is also more effective than levonorgestrel, while copper IUDs are the most effective method. IUDs can be inserted up to five days after intercourse and prevent 99% of pregnancies after one episode of unsex. protection (0.2% pregnancy rate), making them the most effective form of emergency contraception. In women who are overweight or obese, levonorgestrel is less effective and an IUD or ulipristal is recommended.

Double protection

Dual protection is the use of methods that prevent both sexually transmitted infections and pregnancy. It is provided by condoms, either alone or with another method of contraception, or abstinence from penetrative sex. If the pregnancy is a high concern it is reasonable to use two methods simultaneously, as well as recommended in users of the anti-acne isotretinoin, due to the high risk of birth defects if taken during pregnancy.

Effects

Health

Maternal Mortality Index (2010).

Use of contraceptives and fertility rate by region.

Contraceptive use in developing countries is estimated to have decreased the number of maternal deaths by 40% (about 270,000 deaths prevented in 2008) and could prevent 70% of deaths if the full demand for birth control. These benefits are achieved by reducing the number of unwanted pregnancies that subsequently lead to unsafe abortions and by preventing pregnancies in high-risk women.

Birth control also improves child survival in the developing world by lengthening the time between pregnancies. In this population, outcomes are worse when a mother becomes pregnant within eighteen months of a previous birth. However, delaying another pregnancy after miscarriage does not appear to alter the risk, and women are advised to attempt pregnancy in this situation when they are willing.

Teen pregnancies, especially among the very young, are at increased risk of adverse outcomes, including preterm birth, low birth weight, and infant death. In the United States, 82% of teen pregnancies between the ages of 15 and and 19 years are unplanned. Comprehensive sexual education and access to contraceptive methods are effective in decreasing pregnancy rates in this age group.

Finances

Countries per fertility index (2012). Number of children:

7-8 6-7 5-6 4-5

3-4 2-3 1-2 0-1

In the developing world, birth control increases economic growth because there are fewer dependent children and thus more women participating in the labor force. Income, assets, and unemployment rate Women's body mass (BMI) and their children's schooling and BMI all improve with increased access to contraception. Family planning through the use of modern contraceptive methods is one of the most cost-effective health interventions. For every dollar spent on it, the United Nations estimates that between two and six dollars are saved. These cost savings are related to preventing unintended pregnancies and decreasing the spread of sexually transmitted diseases. all methods are economically beneficial, the use of copper IUDs results in the greatest savings.

The total medical cost for pregnancy, delivery, and newborn care in the United States is, on average, $21,000 for a vaginal delivery and $31,000 for a C-section in 2012. In most the other countries the cost is less than half. For a child born in 2011, the average American family will spend $235,000 over 17 years to raise them.

Prevalence

Percentage of women using a modern contraceptive method in 2010.

6 % 12 % 18 % 24 % 30% 36 %

42 % 48 % 54 % 60% 66 % 72 %

78 % 84 % 86 % No data

Globally, as of 2009, approximately 60% of those who are married and able to have children control birth control. How often different methods are used varies widely between countries. The most common methods in the In the developed world it is condoms and oral contraceptives, while in Africa it is oral contraceptives and in Latin America and Asia it is sterilization. In the developing world, the preferred methods in descending order are female sterilization (35%), IUDs (30%), oral contraceptives (12%), condoms (11%), and male sterilization (4%).

Although it is used less in developed countries than the developing world, the number of women using IUDs in 2007 was more than 180 million. Avoiding intercourse while fertile is used by around 3.6% of women of childbearing age, with use as high as 20% in parts of South America. By 2005, 12% of couples are using a male form of birth control (either condom or vasectomy) with higher rates in the developed world. Male forms have declined between 1985 and 2009. Contraceptive use among women in sub-Saharan Africa has increased from about 5% in 1991 to about 30% in 2006.

By 2012, 57% of women of childbearing age want to avoid pregnancy (867 out of 1.52 billion). Yet 222 million women cannot access contraception, 53 million of whom are in sub-Saharan Africa and 97 million in Asia. This translates to 54 million unplanned pregnancies and almost 80,000 maternal deaths each year. Part of the reason many women lack birth control is that many countries limit its access due to for religious or political reasons, while another contributor is poverty. Due to restrictive abortion laws in sub-Saharan Africa, many women turn to unauthorized abortion providers. This translates to 18-39 out of every 1,000 women having an unsafe abortion each year.

History

Early history

Cirene's ancient silver coin that represents a silium heel.

The Egyptian Ebers Papyrus from 1550 B.C. C. and the Kahun papyrus from 1850 BC. contain some of the oldest documented descriptions of birth control: the use of acacia honey, leaves, and fluff placed in the vagina to block semen. Silphium is believed to have been used as a contraceptive that, due to its efficacy and thus convenience, was harvested to extinction.

In medieval Europe, any effort to stop pregnancy was considered immoral by the Catholic Church, although it is believed that women at the time still used various birth control measures, such as coitus interruptus and inserting orris root and rue into the vagina. In the Middle Ages women were encouraged to tie weasel testicles around their thighs during sex to prevent pregnancy. Discoveries were recovered from the ruins of Dudley Castle in England and date back to 1640. These were made from animal guts and were most likely used to prevent sexually transmitted diseases during the English Civil War. Casanova, Italian of the 18th century, described wearing a lambskin covering to prevent pregnancy; however, condoms only became widely available in the 20th century.

Birth Control Movement

"And the villain still pursues it," a Victorian satirical postcard.

The birth control movement developed during the 19th century and early XX. The Malthusian League, based on the ideas of Thomas Malthus, was established in 1877 in the United Kingdom to educate the public about the importance of planning and advocate for the removal of penalties for promoting birth control. It was founded during the "Knowlton trial" of Annie Besant and Charles Bradlaugh, who were indicted for posting about various methods of birth control.

In the United States, Margaret Sanger and Otto Bobsein popularized the phrase "birth control" in 1914. Sanger was active primarily in the United States, but had built an international reputation by the 1930s. then, under the Comstock Act, the distribution of birth control information was illegal. She fled on bail in 1914 after being arrested for distributing contraceptive information, and migrated from the United States to the United Kingdom, returning in 1915. Sanger established a short-lived birth control clinic in 1916, which closed after eleven days and which caused his arrest. Publicity surrounding the arrest, trial, and appeal ignited birth control activism in the United States.

The first permanent birth control clinic was established in Britain in 1921 by Marie Stopes with the Malthusian League. The clinic, run by midwives and supported by visiting doctors, offered women advice on birth control. birth control and taught them how to use a cervical cap. Her clinic made contraception acceptable during the 1920s by presenting it in scientific terms. In 1921, Sanger founded the American Birth Control League, which later became the American Federation of Planned Parenthood. In 1924, the Society for the Supply of Birth Control Clinics was founded to fight for municipal clinics; this led to the opening of a second clinic in Greengate, Salford, in 1926. Throughout the 1920s, Stopes and other pioneering feminists, such as Dora Russell and Stella Browne, played important roles in breaking down taboos. about sex. In April 1930, the Birth Control Conference gathered 700 delegates and succeeded in bringing birth control and abortion into the political sphere. Three months later, the UK Ministry of Health allowed local authorities to give birth control counseling in welfare centres.

In 1936 the United States court ruled in U.S. v. One Package that the prescription of contraceptives to save human life or health was not illegal under the Comstock Act. Following the decision, the American Medical Association Committee on Contraception reversed its 1936 statement condemning birth control. The following year a national poll showed that 71% of the adult population supported the use of contraception. By 1938, 347 birth control clinics were operating in the country despite the fact that their promotion was still illegal. First Lady Eleanor Roosevelt publicly supported birth control and family planning. In 1966, President Lyndon B. Johnson began supporting public funding of family planning services, and the federal government began subsidizing birth control services. for low-income families. The The Affordable Care Act, passed March 23, 2010 under President Barack Obama, requires all plans on the Health Insurance Marketplace to cover birth control. These include barrier, hormonal, implantable devices, emergency, and sterilization procedures.

Modern Methods

In 1909, Richard Richter developed the first intrauterine device made from silkworm intestine, which was improved and commercialized in Germany by Ernst Gräfenberg in the late 1920s. In 1951, Mexican chemist Carl Djerassi made hormones of the progesterone pill using sweet potatoes. Djerassi had chemically created the pill but did not have the means to distribute it to patients. Meanwhile, Gregory Pincus and John Rock with the help of the American Federation for Planned Parenthood developed the first birth control pills in the 1950s, such as mestranol/norethynodrel, which became publicly available in the 1960s with FDA approval. FDA under the name Enovid. Medical abortion became an alternative to surgical abortion with the availability of prostaglandin analogues in the 1970s and mifepristone in the 1980s.

Society and culture

Legal Situations

Human rights agreements require most governments to provide family planning and contraceptive information and services. These include the obligation to create a national plan for family planning services, remove laws that limit access, ensure the availability of a wide variety of safe and effective contraceptive methods, including emergency contraceptives, ensure that health providers are available qualified personnel and facilities at an affordable price and create a process to review implemented programs. Failure by governments to do so can put them in violation of binding international treaty obligations.

In the United States, Griswold v. Connecticut struck down state law that prohibited the release of contraceptive information based on the constitutional right to privacy in marital relationships. In 1971 Einstady v. Baird extended the right to privacy to single people.

In 2010, the United Nations launched the Every Woman, Every Child movement to assess progress toward meeting women's contraceptive needs. The initiative has set itself the goal of increasing the number of users of modern contraceptives to 120 million women in the 69 poorest countries in the world by the year 2020. In addition, they aspire to eradicate discrimination against girls and adolescents who seek control of birth control. The American Congress of Obstetricians and Gynecologists (ACOG) in 2014 recommended that oral contraceptive pills should be listed as over-the-counter medications.

Religious postures

Religions vary widely in their ethical views on birth control. Officially, the Catholic Church only accepts natural family planning, although large numbers of Catholics in developed countries accept and use modern birth control methods. of birth control. Among Protestants there is a wide range of opinions from the absolute rejection of allowing all methods of birth control. In Judaism they range from the most strict orthodox sect to the most relaxed reformist. Hinduism they can use both natural and artificial contraceptives. A common Buddhist opinion is that prevention of conception is acceptable, but intervening after conception has occurred is not. In Islam, contraceptives are permitted if they do not threaten health, although some advise against them.

World Contraception Day

September 26 is World Contraception Day, dedicated to raising awareness and improving education about sexual and reproductive health, with a vision of a world where every pregnancy is wanted. It is supported by a group of governments and international NGOs, including the Office of Populations Affairs, the Asia-Pacific Council on Contraception, the Latin American Center for Health and Women, the European Society for Contraception and Reproductive Health, the German Foundation for World Population, the International Federation of Pediatric and Adolescent Gynecology, the International Federation of Planned Parenthood, Marie Stopes International, Population Services International, the Population Council, the United States Agency for International Development (USAID) and Women Deliver.

Misconceptions

There are several common misconceptions about sex and pregnancy. Douching after sex is not an effective method of birth control. Additionally, it is associated with various health problems and is therefore not recommended. Women can get pregnant the first time they have sex and in any sexual position. It is possible, but not very likely, to get pregnant during menstruation.

Lines of research

Women

Existing methods of contraception need to be improved, as around half of women who become pregnant unintentionally were using a contraceptive method. Several modifications to existing methods are being studied, including an improved female condom and diaphragm, a progestin-only patch, and a long-acting progesterone vaginal ring. The latter appears to be effective for three to four months and is now available in some areas of the world. For women who rarely have sex, taking of levonorgestrel near the sex appears promising.

Various methods of performing sterilization through the cervix are being studied. One is to place quinacrine in the uterus which causes scarring and infertility. While the procedure is inexpensive and requires no surgical skills, there are concerns about long-term side effects. Polidocanol, another substance that works in the same way, is also being investigated. A device called Essure, which expands when it is placed into the fallopian tubes and blocks them was approved in the United States in 2002.

Men

Male methods of contraception include condoms, vasectomies, and coitus withdrawal. Between 25 and 75% of men who are sexually active would use hormonal contraception if it were available to them. Various hormonal and non-hormonal methods are in clinical trials and there is some research exploring the possibility of birth control vaccines.

As for hormonal approaches, a combination of an androgen and a progestin appears promising, as do selective androgen receptor modulators. Recent experiments with dimendrolone undecanoate, a drug known as DMAU, have shown preliminary results that researchers have been deemed "satisfactory". These results, obtained by a group from the University of Washington Medical Center and UCLA Harbor Medical Center, were presented at the American Endocrine Association Annual Meeting in March 2018. It is a combination of testosterone undecanoate and progestin and its operation is similar to that of the female pill. The study, conducted with 100 patients who used the drug for 28 days, showed "marked suppression" of testosterone levels among those who ingested doses of 400 mg. Very few patients reported symptoms of testosterone deficiency. These results are considered very promising, although longer-term studies with larger numbers of people are still needed.

Another molecule currently under study is 11-beta-methyl-19-nortestosterone dodecylcarbonate, or 11-beta-MNTDC, a modified testosterone that also has the combined actions of a male hormone (androgen) and progesterone, so that sperm production decreases while preserving libido. The drug has already successfully passed a Phase 1 trial in 40 healthy men conducted at LA BioMed and the University of Washington. Ten of the participants received a placebo capsule daily for 28 days and the other thirty took 11-beta-MNTDC in different doses: 14 of them received 200 milligrams and the other 16, 400 milligrams. Those who took the study compound reported lower levels of testosterone and the hormones needed to produce sperm compared to placebo. Some patients showed mild side effects such as fatigue, acne, or headache; five showed a slight decrease in sexual desire; and two others described mild erectile dysfunction. But in no case was sexual activity reduced. The study's principal investigator, Christina Wang, plans to conduct further studies to assess the effectiveness of the compound. In addition, two other oral drugs are being developed in parallel to find the compound with fewer side effects and greater effectiveness.

One reversible surgical method under investigation is reversible inhibition of sperm under guidance (RISUG), which involves injecting a polymer gel, styrene maleic anhydride in dimethyl sulfoxide, into the vas deferens. An injection with sodium bicarbonate removes the substance and restores fertility. Another is an intravasal device that involves placing a urethane plug in the vasa deferens to block them.

Ultrasonography and methods of heating the testicles have undergone preliminary studies.

Molecular condom.

This is a potential new birth control method being developed by UC Berkeley researchers. All of their findings have been published in the "Proceedings of the National Academy of Sciences" Filed November 24, 2020, at the Wayback Machine. This contraceptive method is effective for both men and women and has no hormonal side effects. To achieve the contraceptive effect, it uses a combination of two chemical substances of plant origin: lupeol and pristimerin. The molecular condom is still being tested and is still too expensive, so it still cannot be counted on as a contraceptive method.

In animals

Neutering, which involves the removal of some of the reproductive organs, is often performed as a method of birth control in domestic animals. Many animal shelters require these procedures as part of adoption agreements. In large animals the surgery is known as neutering. Birth control is also being considered as an alternative to hunting as a means of controlling overpopulation of animals. contraceptive vaccines have been shown to be effective in a number of diverse animal populations. Kenyan goat herders put a skirt called a scent on the males to prevent them from fertilizing the females.

Access to contraceptives by country

This field reports the percentage of people of reproductive age (18-49) who are married or in union and are using, or whose sexual partner is using, a contraceptive method as of the date of the most recent available data. The contraceptive prevalence rate is an indicator of health services, development and women's empowerment. It is also useful for understanding past, present, and future birth trends, especially in developing countries.

Further reading

• Speroff, Leon; Darney, Philip D. (22 November 2010). A clinical guide for contraception (5th ed.). Philadelphia, Pa.: Lippincott Williams & Wilkins. ISBN 978-1-60831-610-6.
• Stubblefield, Phillip G.; Roncari, Danielle M. (December 12, 2011). "Family Planning", pp. 211-269. In Berek, Jonathan S. (coordinator) Berek & Novak's Gynecology, 15th ed. Philadelphia: Lippincott Williams & Wilkins, ISBN 978-1-4511-1433-1.
• Jensen, Jeffrey T.; Mishell, Daniel R. Jr. (March 19, 2012). "Family Planning: Contraception, Sterilization, and Pregnancy Termination", pp. 215-272. In Lentz, Gretchen M.; Wolf, Rogerio A.; Gershenson, David M.; Katz, Vern L. (eds.) Comprehensive Gynecology, 6th ed. Philadelphia: Mosby Elsevier, ISBN 978-0-323-06986-1.
• Gavin, L; Moskosky, S; Carter, M; Curtis, K; Glass, E (Apr 25, 2014). «Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs». Godfrey, E; Marcell, A; Mautone-Smith, N; Pazol, K; Tepper, N; Zapata, L; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control 63 (RR-04): 1-54. PMID 24759690.