Birth control is the practice of preventing or reducing the probability of pregnancy without abstaining from sexual intercourse; the term is also sometimes used to include abortion, the ending of an unwanted pregnancy, or abstinence. The term family planning is sometimes used as well, especially for thoughtful and premeditated selection of a birth control technique or set of techniques. Employing techniques to avoid pregnancy resulting from intercourse is called contraception (literally, against conception).
Birth control is a controversial political and ethical issue in many countries and religions. Opponents promote abstinence from sexual intercourse as an alternative, but supporters consider this an inadequate replacement for the full array of birth control techniques.
History of birth control
Probably the oldest methods of contraception are coitus interruptus, barrier methods, herbal abortifacients, and attempts to arrange intercourse to coincide with a woman's non-fertile times, colloquially known as the "rhythm method". While it seems like the rhythm method would have been a good choice, scientists did not figure out the details of the human menstrual cycle until the early 20th century.
Coitus interruptus (withdrawal of the penis from the vagina prior to ejaculation) probably predates any other form of birth control. Once the relationship between the emission of semen into the vagina and pregnancy was known or suspected, some men probably managed to think through the haze of passion and withdraw in time. This is not a particularly reliable method of contraception, as the small amount of fluid secreted prior to ejaculation (pre-ejaculate or "Cowper's fluid") can still contain sperm (this is explained below). However it requires no equipment and is still better than nothing.
Folklore has suggested douching immediately following intercourse as a contraceptive method, and while it seems like a sensible idea to try to wash the ejaculate out of the vagina, it does not work due to the nature of the fluids and the structure of the female reproductive tract -- if anything, douching spreads semen further towards the uterus. Some slight spermicidal effect may occur if the douche solution is particularly acidic, but overall it is not an effective method.
The reason both withdrawal and douching are usually not very effective is that the male ejaculate typically consists of approximately 5ml (1 teaspoon) of fluid carrying in excess of 500,000,000 sperm, of which only 1 is needed to cause reproduction. Thus even a tiny amount of ejaculate can be more than enough.
Additionally, prior to ejaculation, a man typically releases small amounts of seminal fluid and sperm ("pre-ejaculate") as a result of becoming sexually aroused, during the erection, and while the penis is being stimulated by the vagina during sexual intercourse. It is theorized that pre-ejaculate is in part an attempt by the penis to assist in lubricating the vagina, and as an attempt to ameliorate the acidity of the female vagina and the male urethra (acidity caused by the usual use of the penis to excrete urine). These small amounts of pre-ejaculate can contain more than 30,000 sperm in each drop, and again, only one sperm is needed to cause impregnation.
There are historic records of Egyptian women using a pessary (a vaginal suppository) made of various acidic substances (crocodile dung is alleged) and lubricated with honey or oil, which may have been somewhat effective at killing sperm. However, it is important to note that the sperm cell was not discovered until Anton van Leeuwenhoek invented the microscope in the late 17th century, so barrier methods employed prior to that time could not know of the details of conception. Oriental women may have used oiled paper as a cervical cap, and Europeans may have used beeswax for this purpose. The condom appeared sometime in the 17th century, initially made of a length of animal intestine. It was not particularly popular, nor as effective as modern latex condoms, but was employed both as a means of contraception and in the hopes of avoiding syphilis, which was greatly feared and devastating prior to the discovery of antibiotic drugs.
Various abortifacients have been used throughout human history. Some of these were effective, some were not; those that were most effective also had major side effects. The ingestion of certain poisons by the female can disrupt the reproductive system; women have drunk solutions containing mercury, arsenic, or other toxic substances for this purpose. The Greek gynaecologist Soranus in the 2nd century AD suggested that women drink water that blacksmiths had used to cool metal. The herbs tansy and pennyroyal are well-known in folklore as abortive agents, but these also "work" by poisoning the woman. Levels of the active chemicals in these herbs that will induce a miscarriage are high enough to damage the liver, kidneys, and other organs, making them very dangerous. However, in those times where risk of maternal death from postpartum complications was high, the risks and side effects of toxic medicines may have seemed less onerous. It is also believed that black cohosh tea will also be effective in certain cases as an abortifacient.
There are references in Arabic history to traders inserting a small stone into the uterus of a camel in order to prevent it from conceiving, a concept very similar to the modern IUD, but it seems unlikely that this was used as a contraceptive method for humans since knowledge of the female reproductive tract was very limited until the 20th century, and surgical techniques were poor.
Oral contraceptives did not appear until the mid-20th century, when scientists better understood the process of conception and advances in biochemistry allowed for the isolation (and later synthesis) of the hormones controlling the cycle.
Traditional birth control methods
Modern birth control methods
Condoms and herbal birth control methods existed before the modern era. The herbal methods were of various degrees of efficacy, and were available in China and Europe.
Religious and cultural attitudes to birth control
Christianity in general has had mixed opinions towards contraception and its role in society over the years. Prior to the 20th century, contraception was generally condemned by all the major branches of Christianity, including by major reformers like Luther and Calvin. This condemnation was relaxed by the Episcopalian Church at the 1930 Lambeth Conference, and most Protestant groups followed suit over the course of the 20th century, though some individual Protestants adhere to the traditional view that contraception is wrong.
Among Protestant Christianity, the sizeable ELCA, which includes a large number of US Lutheran and Episcopalian churches, makes the following statement:
- When [having children] is not their intention, the responsible use of safe, effective contraceptives is expected of the male and the female. Respect and sensitivity should also be shown toward couples who do not feel called to conceive and/or rear children, or who are unable to do so.
This is a fairly overt acceptance of modern contraceptives. The other major Lutheran and Presbyterian associations, as well as other Protestant groups in general, may take other positions.
Like pre-20th century Protestantism, the Catholic Church has been morally opposed to contraception and orgasmic acts outside of the context of non-contracepted intercourse as far back as one can historically trace. For instance, the 2nd century Epistle of Barnabas takes it for granted that oral sex is immoral.
The official position of the Catholic Church regarding birth control is expressed very clearly in Pope Pius XI's 1930 encyclical entitled Casti Connubii. It was written in response to the Episcopalian then-recent approval of artificial means of contraception when used in cases of grave necessity.
- Since, therefore, openly departing from the uninterrupted Christian tradition some recently have judged it possible solemnly to declare another doctrine regarding this question, the Catholic Church, ... in order that she may preserve the chastity of the nuptial union from being defiled by this foul stain, ... proclaims anew: any use whatsoever of matrimony exercised in such a way that the act is deliberately frustrated in its natural power to generate life is an offense against the law of God and of nature, and those who indulge in such are branded with the guilt of a grave sin.
In 1968 Pope Paul VI released a document called Humanae Vitae, which again forbade chemical and barrier methods but suggested natural methods such as the rhythm method or natural family planning might be considered in cases of necessity, a suggestion some see implicit in Casti Connubii as well. These methods are known as "periodic abstinence" and are argued to be morally different from positively modifying the couple's fertility, since the modus operandi is abstinence, albeit not all the time.
Couples seeking marriage in the Catholic Church are required to undergo counseling by a Catholic priest. In the past priests led couples seeking to delay children to rhythm, today they are instructed to point new couples toward the more effective natural family planning.
Roman Catholic opposition to birth control has been criticized as adding to overpopulation, poverty and destitution. Others also argue that their refusal to allow missionaries to discuss condoms in Africa has added to the AIDS epidemic there. When information regarding condoms is given to African congregations by church leaders it is often factually incorrect stating, for example, that latex is riddled with millions of invisible holes which allow the HIV virus to pass through.  (http://news.bbc.co.uk/2/hi/health/3176982.stm)
In response, many in the Church claim that there are enough food and other resources on the planet for everyone, and that there is no correlation between population density and wealth or poverty. Some of the richest countries in the world have the densest populations, and vice versa. Supporters of birth control argue that economic growth which allows for a high population density without poverty is a direct function of the availability of birth control, as it leads to smaller families (as is the case in all nations which allow birth control), which in turn have more purchasing power to support themselves and provide their children with education, which is universally recognized as necessary for sustainable growth.
While many people in third world countries regard children as their only defense against destitution, supporters of birth control argue that the dependency on child labor is a vicious circle. A higher availability of children as labor forces pushes down wages; more children require more food, which in turn requires the employment of children to bring in the food.
The Church has repeatedly stated its position that condoms are not adequate prevention for sexually transmitted diseases like AIDS, claiming that they are expensive, fallible and liable to provide a false sense of security. Instead the Church argues for sexual abstinence and non-promiscuous sexual relationships. Many scientists dispute the Church's position on condom security, and argue for a mixed approach of preventive measures instead. Some utterly reject sexual abstinence education as misleading (see sex education, sexual abstinence).
In addition to the argument from the essentially unanimous pre-20th century Christian tradition prohibition contraception, Catholic philosophers have proposed three types of philosophical arguments. These arguments are not official Church teaching, but attempts to give a philosophical argument for what might also be accepted on faith.
St. Thomas Aquinas believed that it was wrong to perform a positive act that deliberately frustrates the primary purpose of a human organ. If the sexual organs have reproduction as their primary purpose, then it follows that contraception is wrong. Opponents of this argument claim that not all frustration of the primary purpose of an organ is wrong or that the sexual organs have interpersonal union as a co-primary purpose.
As a defense of the teaching of Humanae Vitae, Catholic thinkers John Finnis and Germain Grisez gave a new argument. They considered what it is that is wrong about killing people, and concluded that what is wrong about murder is that one is acting directly and positively against the value of human life. Since birth control when it is done by a positive act such as swallowing a pill or putting on a condom (but not when it is "done" in a negative way, i.e., through abstinence), is directly aimed at preventing the formation of life, it is an act directly and positively against the value of human life, and hence wrong. The Finnis and Grisez argument appears to have the consequence that use of non-abortifacient contraception in cases of danger of rape is also wrong, a consequence that is not taught by the Catholic Church since Humanae Vitae never addresses the case of rape.
Finally, a number of thinkers of the "personalist school", most notably Karol Wojtyla, who was to become Pope John Paul II, argued that contraception is contrary to the interpersonal union that sexual intercourse should cement. The most popular form of this argument asserts that sexual union should involve total mutual bodily self-giving if it is not to be a form of self-deceit. Contraception holds back something significant, namely fertility, and hence is argued to be objectively anti-unitive, even if the couple subjectively feels united (that something is held back is clearest in the case of barrier methods, but it is argued that other methods still involve holding something back from giving). But to act anti-unitively is, it is argued, to act against marital love, and this is wrong.
A variant version of this argument states that non-contracepted intercourse makes the couple a biological unit. What makes them a biological unit is that their organs are working together, biologically striving for reproduction, even if the intercourse is at a time when reproduction is biologically impossible. But to deliberately and positively act to make reproduction impossible is to set one's will directly against the activity of the organs that are putatively uniting the couple, and hence against the union of the two persons. Some Catholic thinkers have also employed versions of this biological unit account of intercourse to argue against orgasmic homosexual activity.
The Qur'an does not make any explicit statements about the morality of contraception (nor does the Bible unless the text about Onan at Genesis 38:9 counts), but contains statements encouraging procreation (similar to those found in the Bible). Various interpretations have been set forth over time, and at the time of this writing, discussions on the web can be found easily that take various positions. Early Muslim literature discusses various contraceptive methods, and a study sponsored by the Egyptian government concluded that not only was azl (coitus interruptus) acceptable from a moral standpoint, but any similar method that did not produce sterility was also acceptable. However, there are several schools of thought on this as well as other issues concerning Islamic morality.
Active prevention of pregnancy is in violation of the commandment "be fruitful and multiply" (Genesis 1:22). Rabbinic authorities further consider the possibility (generally not accepted) that a union that by definition cannot lead to pregnancy would amount to "spilling seed", the sin of Onan (Genesis 38:9).
The option of contraception is raised by the Talmud (tractate Yevamot 12b), where the use of a pessary is discussed for women who are too young to get pregnant, presently pregnant, or nursing. In each case either the woman or her child is at risk for serious complications, and this is the basis for many rabbinic authorities permitting contraception in situations where pregnancy would seriously harm the woman. In those cases, the most "natural" method is preferred; as the use of a condom or pessary creates a physical barrier, "the pill" (or and intrauterine device) is preferred by most authorities.
Contraceptive measures that lead to sterility, especially male sterility (e.g. through vasectomy), are problematic, and a sterilised man may have to separate from his wife (based on Deuteronomy 23:2).
When Orthodox Jewish couples contemplate the use of contraceptives, they generally consult a rabbi who evaluates the need for the intervention and which method is preferrable from a halachic point of view.
A remarkable use of the contraceptive pill in Judaism is by young brides. The laws of family purity state that intercourse cannot take place while a woman is menstruating (see niddah). In order to decrease the chance of menstruation occurring just before (or on) the wedding night, many brides briefly regulate their periods in the months leading up to their wedding.
Generally, the introduction of oral contraceptives has not caused the stir in Jewish circles that it caused in other religious groups. It was followed by a number of responsa from rabbinic decisors (poskim) which outlined the proper approach to the new phenomenon. There has been surprisingly little talk of the potential risk of increased promiscuity (z'nut).