History of Contraception

History of Contraception
Malcolm Potts and Martha Campbell
Vol. 6, Chp. 8, Gynecology and Obstetrics, 2002

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INTRODUCTION
The factors controlling human fertility and the development of rational therapies to limit births are not necessarily more difficult to understand than the isolation and cure of bacterial diseases. The surgery of voluntary sterilization or early abortion is intrinsically simpler than the treatment of appendicitis or the forceps delivery of a baby. Yet fertility regulation has diffused less rapidly through society than the means to cure disease and prevent death. This imbalance has generated an explosion in global population that is difficult to accommodate, and it has contributed to great inequalities in wealth and untold personal misery. Useful insights into current problems can be gained by looking at the history of contraceptive practice.
The aim of this chapter is to document the historical diapause between the acquisition and the application of relevant biologic knowledge to birth control; to analyze the historical factors affecting the delay; and to suggest that early 19th and 20th century attitudes toward contraception in the West are still palpable and
cast their shadows over global events in the 21st century.
IN THE BEGINNING
Homo sapiens evolved to be a slowing breeding animal. Prehistoric societies, like the few preliterate societies that remain, probably had total fertility rates of 4 to 6.1 Approximately half the children whowere born died before they could reproduce, and population grew slowly. Puberty was in the upper teens,babies were breastfed for 3 to 4 years, and pregnancies were therefore naturally spaced by long intervals of amenorrhea. With the first urban civilizations and settled agriculture, puberty began at an earlier age
and breastfeeding was often shortened or supplementary food introduced earlier than in hunter-gatherersocieties. Fertility went up. In the modern world, if a couple initiates sexual intercourse when the woman is 20 years old or younger and continues at least until her menopause, without artificially limiting fertility, she can expect to conceive and carry to term an average of 10 live-born children.2 Sooner or later, all human societies have to adopt restraints on family size.

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Contraception
Scattered references to fertility regulation exist in many historical records.3 Himes’s work is the prime referral text.4 Written records of contraceptive remedies and abortion techniques survive from the Egyptian Ebers Papyrus (1550 BC), the Latin works of Pliny the Elder (23 to 79 AD) and Dioscofides (De materia medica, c 58 to 64 AD), and the Greek writings of Soranus (Gynecology, c 100 AD). During the flowering of Arabic medicine in the 10th century, a variety of contraceptive recommendations were detailed, particularly in the works of Al-Razi (Rhazes, d 923 or 924 AD, Quintessence of Experience), All ibn Abbas (d 994 AD, The Royal Book), and Avicenna (Ibn Sina, d 1037 AD).
The methods to which the ancient scholars refer fall into three general categories: (1) those that seemed
reasonable at the time but are now known to be ineffective (e.g., wiping out the vagina after intercourse
[Soranus]); (2) the reasonable and perhaps effective (e.g., using honey, pepper, alum, or lactic acid as
pessaries and barriers [Ebers Papyrus, Dioscorides, and Soranus]); and (3) the unreasonable, manifestly
ineffective, such as the woman holding her breath at the time of ejaculation or jumping backward seven
times after coitus. The manufacture of vaginal pessaries from the dung of animals, such as crocodiles
(Petri Papyrus), elephants (Rhazes), or mice (Pliny), perhaps reflects Freudian more than pharmacologic
concerns, although as Himes points out, most animal dung is alkaline. Among descriptions that come close
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to certain modern methods of contraception are Jewish references to “cohabit with a sponge.”