INTRODUCTION
With the chapters in this
volume that address specific contraceptive methods and issues, this
introductory chapter provides an overview of the overall benefits of
birth control, details contraceptive practices (particularly among US
women), and concludes by comparing the efficacy, costs, and benefits of
existing as well as emerging reversible contraceptives.
By
reducing unintended pregnancies and abortions, and facilitating family
planning/spacing of births, effective contraception provides both
health and social benefits to mothers and their children. According to
worldwide estimates, some 600,000 women die each year of
pregnancy-related causes, and 75,000 die following unsafe abortions.1 At least 200,000 of these maternal deaths are attributable to the failure or lack of
contraceptive services.2
In addition to preventing mortality, effective contraception improves
maternal health. Data from the well-controlled Intergenerational Panel
Study of Mothers and Children, a 31-year longitudinal survey of 1113
mother-child pairs, indicate that unwanted births can lead to
nonpsychotic major depression (postpartum depression), feelings of
powerlessness, increased time pressures, and a reduction in overall
physical health.3
Finally, effective contraception improves the social and economic role
of women and enables them to participate in society fully.4, 5
Infants
and children also derive benefits from effective contraception. As
modern contraceptive methods have become more widely available
throughout the world, infant mortality has decreased from approximately
150 deaths per 1000 live births in the 1950s to 80 deaths per 1000 live
births in the 1990s.4
In developing countries, 53% of married women plan family size, and 90%
of them use modern birth control methods such as female sterilization,
oral contraceptives (OCs), and intrauterine devices (IUDs).4
According to Population Action International, infant mortality in
developing countries could be decreased by one third by increasing the
spacing between births to 2–4 years.1
The health status of infants and children is also improved as the
result of effective contraception. In the 31-year mother-child survey,
unwanted children had more health problems, such as lower birth weight
and higher mortality, than those who had been wanted.3
Mothers who had an unwanted birth also had a poorer quality
relationship with all their children, tending to spank them more and
spend less leisure time with them.3 In addition, evidence indicates that children from large families generally receive less education.1
| Major Events in Birth Control In The United States | ||||||||||||||||||||||||||||||||||||||||
| Key events in the availability of modern contraceptive in the United States are summarized in Table 1.4, 6
Although many refer to these events as the contraceptive revolution,
Diczfalusy recently observed that "many scientists wonder whether or
not contraception is still a revolution or rather a normal way of
life—with significantly improved quality of life—for a billion couples".7
Condoms have been available for hundreds of years, yet most major
advances in contraception have occurred since the 1960s and 1970s.6
OCs and IUDs were introduced in the early 1960s, and both had become
highly popular methods of contraception by the 1970s, as use of the
diaphragm and male condom waned.6, 8 However, the 1980s saw a dramatic decrease in IUD use as the result of concerns about intrauterine infections.4, 8 Today, only 0.8% of US women use IUDs compared with nearly 100 million women worldwide.6
Major changes occurred during the 1990s as condom use among adolescents
increased, probably because of public health efforts to increase
awareness about the risks of human immunodeficiency virus infection and
other sexually transmitted diseases (STDs), and OC use decreased
slightly.4, 9
Additionally, approval of levonorgestrel implants and the depot
medroxyprogesterone acetate (DMPA) contraceptive injection provided
methods that offered excellent protection in less user-dependent forms.6 In fact, the decline in teen pregnancies seen in the last decade has been attributed largely to increased use of DMPA.10
READ MORE ON CONTRACEPTION
|
| Year | Event |
| 1925 | First manufacture of diaphragms in United States |
| 1937 | American Medical Association endorses birth control |
| 1942 | Planned Parenthood Federation of America established |
| 1960 | Birth control pill approved by Food and Drug Administration (FDA) |
| 1960 | Intrauterine device approved by FDA |
| 1970 | Family Planning Services and Population Research Act creates Title X of Public Health Service Act |
| 1972 | Medicaid funding for family planning services authorized |
| 1983 | Contraceptive sponge approved for sale in the United States |
| 1990 | Public service announcements for condoms appear on national television for the first time |
| 1990 | Norplant approved by FDA |
| 1992 | Depo-Provera approved by FDA |
| 1993 | Reality female condom (vaginal pouch) approved by FDA |
| 1995 | Contraceptive sponge withdrawn from market by manufacturer; condom use reaches new high levels |
| 1997 | Emergency use of oral contraceptive pills approved by FDA |
| 2000 | Lunelle monthly injection and Mirena IUD approved by FDA |