“The Best Offense Is a Good Defence” – especially when it comes to the human reproduction.
Given the current global scenario encompassing war, recession, and environmental degradation, one would think that contraception is perhaps the only sustainable and pragmatic answer to the plagues of the modern world.
The modern methods of contraception have been nothing less than a milestone in reproductive biology, and have been hailed by the feminists all over. However, the rocky road to safe birth control has been paved with hilarious, and often tragic milestones!
Tales of yore:
The earliest evidence of birth control dates back to 1850 BC in Egypt and Mesopotamia. Crocodile dung was used as one of the earliest forms of contraceptive by the ancient Egyptians in 1850 BC. Archaeologists have found documentation on the Papyrus scrolls describing how prolonged breastfeeding may delay the next pregnancy. Other scrolls have held detailed instructions on how to make birth control ‘sponges’ or ‘cervical caps’ at home using honey, acacia leaves, wool, or lint. These were believed to prevent sperm from entering the womb during intercourse. Interestingly, many Indian women have been using a vinegar-soaked sponge with a similar purpose until as recently as the 1980s. In the medieval Europe, a silphium plant extract was often used as a contraceptive and was incredibly popular. Over-cultivation of the plant in fact led to its eventual extinction (Shall we call this a birth control paradox?).
The Middle Ages were perhaps the most ‘experimental’ when it came to birth control. The legendary Casanova reportedly asked his lovers to use lemon halves like a cervical cap – believing that the high levels of acidity could kill semen. The fact that the ladies would even consider this option should be a testimony to his ‘male prowess’. At other times, couples were advised to opt for curious birth control methods ranging from the amulets made of mule’s earwax, weasel’s testicles, and a bone taken from the right side of a black cat.
It was in 1838 that medical science finally started to see some sense. A German doctor, Friedrich Wilde, offered patients a small cervical cap to cover the cervix between menstrual periods. This method though never widely adopted, was to be the precursor to the modern diaphragm which is in use even today.
The post world War I era was difficult. The desperation to not breed (and to avoid being sexually assaulted) led to the women seeking desperate measures. Lo and behold, thus was born an Iron chastity belt in the 1800s. Fashion magazines advised this uncomfortable contraception made of iron spikes as underpants that functioned as a defence against rape in the working women. Men sometimes wanted their mates to wear them to prevent cheating; the blatant advertising for this contraption continued till finally it was banned sometime in 1930s.
A bitter “Pill” to swallow:
For those who think of the contraceptive pill as a tool to women emancipation, hear this – The story of the birth control pill development is a tale of conflicting ideologies and medical exploitation.
In the 1950s, two Harvard professors tested the prototype ‘birth control pills’ on mentally ill Massachusetts women and low-income Puerto Rican women, raising questions about research practices at Harvard and beyond. Furthermore, the reports by the trial subjects regarding the side effects of the pill were dismissed as ‘psychogenic’ in origin. The scientists relied on invasive tests and shaky medical consent as the Pill was developed during a relatively unregulated period of scientific history. The Nuremberg Code of 1947, which established the importance of informed consent, was not legally binding, additionally were The Kefauver-Harris Drug Amendments of 1962 and the Belmont Report of 1979, which required proof of drug safety and “respect, beneficence, and justice” throughout all human trials, not yet written. The American researchers took no informed consent (which lead to legal ramification years later).
Luckily, the FDA helped refine the formulation and approved the first oral contraceptive for women in 1960. The pill was initially however exclusively marketed for “cycle control” only. Even in the 1960s, the contraception was a legal, social and political taboo. In the United States (US), the Comstock Law prohibited public discussion and research about contraception, some calling it obscene and essentially lumping contraception with pornography. In fact in the 1960s, the United States was the only western nation to enact laws criminalizing birth control. (Given the current state of affairs in US, it seems like we have come to a full circle!). It was not until 1969, when the Canadian parliament finally decided to decriminalize contraception, that parts of the West followed the suit.
Within 2 years of its initial distribution, 1.2 million American women were using the birth control pill, in spite of vehement opposition from all religious institutions. The first oral contraceptive preparation contained 100 to 175 µg of estrogen and 10 mg of progesterone. After multiple studies, it was discovered that significant adverse effects, including an increased risk for venous thromboembolism were common at high hormonal doses. The modern pill contains only 30 to 50 µg of estrogen and 0.3 to 1 mg of progesterone eradicating many of the adverse effects. Today, a higher dose estrogen-progesterone preparation is prescribed as a ‘morning after pill’ or as emergency contraception.
Emergency contraception:
In the Mid-1960s, doctors would prescribe a high dose of estrogen as a method to prevent a potential pregnancy resulting from a sexual assault. Though effective, it was also found to result in a lot of side effects like an increased risk of thrombotic events, severe migraines as well as irregular periods. The Yuzpe regimen introduced in the late 1960s consisted of a combination hormone formula and replaced the high-dose estrogen emergency contraception with some progesterone-containing preparations. These came with their own share of side effects, mostly in the form of acne and premenstrual symptoms. Later, the copper IUD became a popular method of non-hormonal emergency contraception due to its safety and relative lack of systemic side effects. The problem here was an increased expulsion rate in the first 6 weeks of insertion and a higher incidence of pelvic inflammatory disease, especially in those with multiple sexual partners.
Further formulations resulted in the scientists perfecting the ratio of estrogen to progesterone required for emergency contraception. However, the availability of emergency pills or the ‘morning after pill over the counter and without prescription was another long-complicated battle between the pharma industry and the FDA. It was in 2009 that the FDA approved the OTC sale of ‘Next Choice’, the generic form of Plan B or morning-after pills, to all those age 17 or older for contraception. Those aged 16 and younger still need a prescription to obtain the same in some countries.
The IUCD:
Once upon a time, centuries ago, the middle eastern traders used to prevent pregnancy in their camels by inserting pebbles into their uteri. Clearly emboldened by this ‘brilliant’ idea, some hu’man’ decided to load the uterine cavity. In 1909 Dr. Richard Richter reported on his insertions of a uterine ring made of silkworm gut. In Germany, a certain Herr Graefenberg made a similar model, but in order to be able to identify the position of the ring in the uterus on an x-ray, he attached a silver wire to it. The pregnancy rate of this device was reported to be 3%. Unexpectedly, the silver turned the women’s gums bluish-black (gingival argyrosis). Then he improvised and used an alloy of copper and silver with a lowest ever pregnancy rate 1.6 % with constant use. Shortly after, Dr. Jaime Zipper in Chile discovered that insertion of a copper wire in one horn of the uterus of a rabbit protected that horn from pregnancy while it did not protect the other horn. Thus, the contraceptive effect of intrauterine copper was discovered, and a copper T was born.
In 1970, Dr. Antonio Scommegna devised a T shaped device made of plastic with an embedded progesterone in a semi permeable capsule. It was approved by the FDA for use for one year and was on the market until the early 2000. Subsequently, the concept was refined and the third-generation IUCD was born.
The love glove:
The first mention of a condom dates back to 3000 B.C to King Minos of Crete (from Homer’s Illiad). Aside from his delusions of grandeur (he believed his sperms contained serpents and scorpions), his intentions to protect his wife from his semen were honorable. He used the bladder of a goat to protect his wife from his semen. The ancient Romans were not far behind. They used animal intestines, and occasionally the muscles of their slain combatants as condoms.
In Asia, early documentation speaks of glans condoms (condoms that only cover the head of the penis) . Sometimes, these were made of tortoise shell or animal horns (Ouch!)
Fast forward a few thousand years and things started to improve thanks to the Egyptians, who used linen sheath condoms dyed in different colours to distinguish between classes of people (though one should wonder if one could make out all those colours, while one ‘made out’!)
Back then, syphilis killed a lot more people every year, and the government realized, that there was a considerable expense treating the troops posted overseas. The US military jumped distributed condoms to soldiers during the WWII. Britain created the very first lubricated condom, produced by (you guessed it right) Durex in 1957.
With the dawn of AIDS in 1980s and the eventual realization that the use of condoms could prevent HIV spread was when the condoms soared in popularity and continue to be the most beloved rubber item ever produced.
The male pill: Because it is better to unload the gun than shoot at a bulletproof vest
Though the idea is attractive, looks better on paper, most studies in this field have been prematurely terminated, either due to side effects, men finding ‘dry’ orgasms emasculating or the drug induced permanent sterility.
The history of coerced vasectomies and forced tubectomies:
The post world war era was fraught with famine and poverty. The subsequent years saw many countries attributing the low GDP and diseases to the expanding population and resorted to forced permanent birth control measures.
The Emergency in India from 1975 and 1977 resulted in gross misuse of power and human rights violations by the government. On August 6, 1976, Maharashtra became the first governmental unit to enact legislation mandating compulsory sterilization of men and women after the birth of a third child, passing the Family (Restrictions on Size) Bill on its third reading and sending it to the President of India. The President approved it and suggested amendments that would be necessary for enactment, but before the measure could be passed, new elections were called and the legislation stalled.
In these infamous times, Sanjay Gandhi, son of the then-Prime Minister Indira Gandhi, was largely responsible for what turned out to be a failed program sterilization program where young males were caught, and forced to undergo vasectomies in what is an extreme assault on human rights. In fact, in 1976, the program started with program monetary incentives to impoverished male citizens to get sterilized. The government promised land, housing, and money or loans to those who agreed. The scheme was not well received in the population. This ‘plea for sterilization’ soon snowballed into a draconian act with the reports of officials blocking off villages, kidnapping men and dragging them to surgical centers for vasectomies, often resulting in deaths due to improper sanitation and substandard surgical techniques.
This resulted in a strong mistrust of family planning initiatives, the effect of which continued into 21st-century India. A few reports suggest that the sterilization policies are still enforced in India, targeting mostly indigenous and lower-class women who are herded into the sterilization camps, the most recent case of abuse being the death of 15 lower-class women in a sterilization center in Chhattisgarh in 2014. Surprisingly, In spite of its history, permanent sterilization is still the highest used method of birth control in India (39 Percent).
The history has had its share of hiccoughs when it comes to birth control, but the mankind never gave up! We have definitely come a long way since dungs and amulets, but socially as well as medically, we have a lot to surmount. What is important though, is as long as one doesn’t give up on sex, one must not give up on contraception either.
Reference:
https://journalofethics.ama-assn.org/article/history-oral-contraception/2000-06
https://www.webmd.com/sex/birth-control/ss/slideshow-birth-control-history.
https://www.thecrimson.com/article/2017/9/28/the-bitter-pill/
https://www.pbs.org/wgbh/americanexperience/features/pill-timeline/
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