Contraception is a means of birth control. It comes in two varieties; natural and artificial. Artificial contraceptives are things like condoms, the pill, and various chemical injections. Many of these forms are not safe and can harm a woman's body. Natural methods like NFP, while requiring more effort than a condom, are a lot less expensive and are also very effective. And there is no latex, cream, or sponge between your skin.

Methods or preventing pregnancy:

Prevent union of sperm and egg
Reversible - Barrier contraceptives such as the condom (both male and female condom) and diaphragm prevent sperm from entering the vagina and thus prevent fertilization. Spermicidal agents increase the effectiveness of barrier contraceptives. The failure rate with barrier contraceptives is much higher than with the pill, mostly due to operator error.

Irreversible - A vasectomy is a tying of the vas deferens in the male, preventing sperm from being released in the ejaculate. Similarly, fallopian tube ligation prevents ova from ever meeting any sperm.

A hysterectomy would remove the uterus and leave the vagina as a blind passage. Not only would this prevent sperm and egg meeting but there would be no place for implantation to occur.

Preventing ovulation
With no egg present, barrier contraceptives are not necessary.

Through an oral contraceptive pill, the woman's body can be tricked into not ovulating. Also available as injections or norplant implants.

The most effective form of contraception available, with more than 99% efficacy.

Preventing fertilization
IUDs (Intra-uterine devices) are a piece of metal (usually copper), usually shaped into a T-shape, placed within the uterus. They work by either inhibiting sperm movement or by preventing the fertilized embryo from implanting.

The morning after pill
For the day after having unprotected sex. Also known as emergency contraception. Use of this is still controversial.

note: fallopian tube ligations and vasectomies are potentially reversible (but not with a high success rate). hysterectomies are definitely irreversible (at least until medical science advances quite a bit).

Conception occurs when a sperm gamete meets an ovum, usually within the fallopian tubes, and they successfully combine, creating a zygote.
The zygote moves down the fallopian tube and into the uterus where it becomes shallowly embedded in the endometrium which lines the uterine wall. (If this embedding does not take place both endometrium and zygote are lost at the woman’s next menstrual cycle without her being aware conception had occurred.)

Stopping a pregnancy occurring before this embeddment is called contraception, and can be effected in any of the following ways.

Barrier methods
Barrier methods of contraception do not allow the gametes to meet. A physical barrier is placed between the penis and the cervix, stopping the semen and sperm from entering the uterus and finding a ripe ovum. Barrier methods of contraception are most effective when used in conjunction with a spermicide, and include:
Condoms are latex (or more rarely lambskin) sheaths made to completely and snugly cover the penis during sexual intercourse. The ejaculate remains inside the condom after ejaculation and does not touch the woman at all. Condoms must be removed and disposed of directly after ejaculation.
Cervical caps
Cervical caps fit over the cervix allowing the penis to touch the vaginal walls directly, but making sure the sperm-containing ejaculate is kept from entering the uterus. A cervical cap must be fitted by a health care professional the first time, and must remain in place after ejaculation for 6 - 8 hours

Hormonal methods
The Pill
The Pill is actually a generic name for several different hormonal contraceptives. All types of the pill are made with progesterone and estrogen and fool the woman’s body into believing she is already pregnant and that there is no need to bring an ovum to ripeness. The woman taking the pill needs to take the same dose each day at the same time. Stomach upsets and antibiotics can disturb the effectiveness of the pill. If the pill is taken successfully, the woman does not ovulate, so there is no female gamete for the sperm to merge with, and the man can ejaculate into the woman without risk of pregnancy.
Injectable hormonal contraceptives include Depo Provera and Depo Ralovera. They are delivered intramuscularly at precisely thirteen week intervals and, like the pill, fool the woman’s body into believing it is already pregnant. Depo Provera does contain estrogen, but does not contain progesterone and is therefor something regular smokers could consider trying when looking for a hormonal contraceptive, although injectable contraceptives can take the body a long time to recover from.
One side effect of Depo Provera is that mestruation often ceases after the first two or three injections and does not recur until after the course of injections is stopped.
The morning after pill
Morning After pills are for emergency contraception, and must be taken within 72 hours of the unprotected sexual activity. The morning after pills contain estrogen, progesterone, or both hormones, and work by supressing ovulation, inducing menstruation and affecting the uterine lining in such a way that the zygote cannot become embedded and so is lost with the menstral flow. The morning after pill quite often causes nausea, vomiting, cramps, blood clots and breast soreness.

Physical and Surgical methods
Intra-Uterine-Devices are small pieces of copper and/or plastic fitted inside a woman’s uterus by a health care professional. Some remain for as long as the woman does not wish to concieve children and some (hormonally treated ones) must be replaced on a regular basis. The specific way in which the IUD works is unknown. There have been many cases of women with IUDs becoming ill in several different ways, including perforation of the uterus and infants being delivered with IUD-related damage.
Women who have not yet had children are likely to be advised against using an IUD.
A vasectomy is a fairly permanent form of contraception for males. An incision is made into the scrotum and the vas deferens (the tubes through which sperm is carried) are severed and tied off, stopping sperm ever reaching the penis. Some vasectomies have been successfully reversed, but these are in the minority. The surgery involved in a vasectomy is very minor and gives little discomfort.
Tubal ligation
Tubal ligation is the severing of the fallopian tubes in order to stop ova coming into the uterus and into contact with sperm. The ovaries continue to act in the normal manner, bringing ovum to ripeness monthly and releasing it, and releasing the hormones with govern the menstrual cycle.

"Natural" methods
"Natural" methods of contraception rely on observing one’s own reproductive cycle and having sexual contact only at those points in the cycle during which one is unlikely to ovulate. They include
The rhythm method uses a calendar and a thermometer to establish when a woman ovulates - one’s temperature rises measurably on ovulation - and predicting the dates of future ovulations from the pattern discovered.
The Billings method of contraception involves feeling the vaginal secretions each day to see how viscous (or not) they are, and establishing from this at what point in her reproductive cycle the woman is, and avoiding sex on day she is likely to be close to ovulation.

A brief history of contraceptives

It is a truth universally acknowledged that the best form of contraception is complete abstinence. However, with human beings, complete abstinence is something of a miracle. Ever since we made the link between sperm and babies we've been looking for ways to ensure that we can stay up all night having fun, rather than stay up all night nursing infants. Although the contraceptive pill is regarded as the catalyst for the sexual revolution, there were other methods lying around well before the 1960s.

In the beginning (Or not, we're trying to avoid conception here, aren't we?)

So, humans have noticed that sperm can lead to pregnancy, in which case, it's best not to get any sperm inside a woman, right? Right. The obvious answer is to not have sex, but, that's not the aim of the game. In which case, we have to indulge in the next best thing: have sex, but don't let the sperm get anywhere near the target. Hence coitus interruptus comes along. Unfortunately, this is not the most reliable of methods; in fact, its failure rate is somewhere around 27%. With nearly a quarter of Ancient Egyptian couples becoming parents before they were ready, the women got desperate. You see, the favoured Ancient Egyptian method of contraception was to use a plug of crocodile dung, lubricated with honey. That sounds like desperation to me!

Soranus the Gynaecologist (Cough, cough)

Moving on a few centuries and their unplanned pregnancies, we come to the Greeks, and their legendary obs/gynae physician, Soranus. In addition to recommending that the infants of mothers who died in childbirth should be suckled by a goat, he also had some fairly interesting things to say about conception. Bless him, he knew that a woman ovulated, and around that time she'd be more fertile. Unfortunately, he decided that ovulation and menstruation occurred at the same time. Clearly, this wasn't a great move towards family planning. So that he might atone for his mistiming, he gave other contraceptive advice. He believed that drinking the water in which blacksmiths cooled iron, or jumping backwards seven times following intercourse could prevent conception. I'm beginning to think that abstinence is looking more appealing...

When in Rome...

...use a sea sponge soaked in lemon juice or vinegar. Now apart from the acid stinging a bit, this was probably a fairly effective method, what with acid being a spermicide. If a Roman lady didn't fancy banging on the door of the local brothel to ask if they had any spare sponges — or worse still, an abortion — she could always have opted for a barrier of beeswax or alum wax. However, after Augustus passed the leges Julia (18 BCE) and Papia Poppaea (9 BCE), discretion would have been imperative. He was so fearful for Rome's declining birthrate that he passed laws banning contraception and offering incentives for parents of more than three children.

For those not in Rome other barrier methods of contraception were favoured. Chinese women opted for something akin to the modern diaphragm, using oiled paper to cover the cervix.

Potions and Poisons

In addition to the various types of barrier methods and use of self-control, there have always been a selection of herbs and tinctures available to women trying not to conceive, or trying to induce abortion should they have conceived already. Unfortunately, just about all of these involved a high degree of risk given that they are toxic: arsenic, mercury, strychnine among them. The herbs pennyroyal and tansy are also known as abortifacients as they induce uterine bleeding. However, death is a very real prospect if using either of these as a contraceptive.

Silphium was a plant much-prized by the Greeks and Romans as a contraceptive. It was a member of the parsley family, and grew on a narrow strip of coastal land in Cyrenacia (modern-day Libya). However, the popularity of this giant-fennel-like plant and its restricted area of cultivation meant that it became extinct at some point in the First century CE. Back to the beeswax, then?

The rise of the condom (snigger)

Linen, leather, animal intestine, rubber? They've all been used to prevent conception, probably for around 1000 years. Now it is mostly down to latex. Go read the condom node. It's excellent. Beats the 17th century douche favoured by French prostitutes, or the half-lemon, which was another option. Of course, there is now also the female condom, which sits inside the vagina, rather than fitting over the penis.

Intrauterine Device (Or the Coil)

Legend has it that Arab camel traders discovered that placing stones inside the uteruses of their camels prevented them from conceiving. The story is slightly dubious, and the exact nature of an IUD's efficacy is unknown, but it is an efficient method of contraception: it has a failure rate of about 1%.

The first records of an entirely intrauterine device date from a 1909 German medical journal, although they didn't become widely used until about 1929, when the German doctor Ernst Grafenberg published his findings from trials using a silk suture device. The following year he determined that silver wire wrapping the ring improved its efficiency. World War II meant that work on the IUD was shelved, because the leading researchers were German or Japanese, where contraception was banned. Since then, though, information has been shared and improvements have been made to the IUD making it more comfortable, less likely to cause infection, and giving it greater efficiency.

Hormonal Birth Control

Pills, injections, patches, subcutaneous implants, intra-vaginal rings, emergency contraception, and some IUDs all rely on hormones to ensure that women don't get pregnant before they're ready. Essentially they work by preventing ovulation. There are two types: the combined pill, which is oestrogen and progesterone, or the progesterone-only pill. There may also be some thickening of the cervical mucus, which helps to stop sperm finding their goal, or thinning of the endometrium, thereby preventing a fertilised egg from emplanting.

Work on the idea of an oral contraceptive began in the early part of the twentieth century, mostly owing to the campaigning of Margaret Sanger. She dreamed of an efficient, easily administered method of birth control. Her work, in combination with the research skills of Gregory Pincus and the financial backing of Katherine McCormick, led to the first trials of oral contraceptives in Puerto Rico, in 1956. Initially, the doses were far too high, which led to side-effects of dizziness, nausea, and bloodclots. However, the dosage was adjusted and by 1959 the Pill was being prescribed in America. Although British women had access to the Pill around this time, it wasn't until the Family Planning Act of 1967 that it became freely available. With 99% effectiveness, the Pill is one of the most widely used methods of birth control, and research has been conducted for some time into the possibility of a male pill. Not quite there yet, though.

Oh, and don't forget that a woman who is lactating can't conceive, either. Well, it's slightly more complicated than that, as has been pointed out. If the baby is less than six months old, the mother is breastfeeding exclusively, and she hasn't experienced any vaginal bleeding since the birth, conception rates are about 2%. As a general rule, doctors and midwives will recommend some form of postnatal birth control, often an IUD.

Permanent Measures

For people who have decided that they never want children, or have definitely had enough, sterilisation is an option. For a woman, this would involve having her fallopian tubes ligated, or ligated and cut. A man would undergo a vasectomy. A vasectomy can be reversed, although the results aren't guaranteed, whilst female sterilisation is regarded as permanent.

Not so permanent measures (And probably not so effective, either.)

For couples who are perhaps religious, or are not so keen on interfering with nature, there are methods of contraception that rely on the observation of a woman's monthly cycle to determine when she is ovulating, and when having intercourse is 'safe'. It requires the daily taking of temperatures, examining a woman's vaginal discharge, and noting the dates and length of her period. It is about a woman getting to know her body and her cycle, and very much an individual method, as explained in fertility awareness. This sort of approach is favoured by Catholic families who perhaps do want some control over their lives, but are not so keen on the idea of obviously flouting the Church's doctrine on contraception.

Persona is a method of contraception that monitors the hormone levels in a woman's urine, indicating when she should refrain from intercourse. It's recommended for women who are in monogamous relationships, and have cycles between 23 and 35 days long. It's non-invasive, but does involve peeing on a stick every day, and is 94% effective.

Cultural and religious attitudes to contraception (Oh G-d, here we go...)

I was taught not to discuss politics or religion at the dinner table, so I hope nobody's eating right now. If sex is taboo, then contraception is probably even more so. Until 1930, contraception faced disapproval from Catholics and Protestants alike. Then, the Anglican community allowed it, and steadily other Protestant churches followed suit. For Catholics, of course, it remains forbidden.

Although Muslim couples are expected to procreate, the Qu'ran does not specifically prohibit contraception. Consequently, it is a widely accepted part of life, and might even have been performed by the prophet Muhammad. Similarly, Hindus are expected to have children, but contraception is not forbidden; this seems to be an attitude shared with Sikh teaching.

Two Jews, three opinions. Essentially, the Bible dictates that humans should be fruitful and multiply, and that man should should not 'spill his seed'. Crudely put: Jewish couples are expected to have children, barrier methods of contraception are frowned upon, and men shouldn't masturbate. The concept of niddah, or ritual family purity appears to have been devised to positively encourage conception. A couple cannot lie with each other whilst a woman has her period, nor for seven days following. By the time that they can have sex again, she's going to be ovulating. However, contraception would be allowed if a woman's life or mental health were to be endangered by conception, or if the family would suffer as a result of a child. In these circumstances, the Pill would be the favoured method of contraception. And that's just in Orthodox circles. Moving into more Conservative Judaism it is still expected for couples to have children, but that it should be on their terms. As for Progressive Judaism, it is the choice of the individual. Then there is the Jewish Aids Trust, which encourages the use of condoms, because Jewish people contract sexually transmitted infections, too.

So, who's for joining a convent, then?

Prevention is better than cure:

  • Teaching Year 9 PSE
  • Bowker, DE: (2002) Aims, Methods, Results, Conclusions: Parenthood in Rome, 100 BCE - 100 CE, (Bristol, unpublished).

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