Introductory Chapter: Family Planning: Past, Present, and Future

1. Background

Going back to the old world, the history of family planning covers methods that were used by ancient civilizations and cultures to prevent conception or to terminate pregnancies that were already established [1, 2].

The ancient societies of Egypt, Greece, and Rome practiced birth control methods as, in general, they preferred small family sizes [1].

2. The past

In ancient Egypt, family planning is documented on the Elbers papyrus of 1550 BC and the Kahun papyrus of 1850 BC. These papyri describe various methods of family planning, such as the placement of lint, honey, and acacia leaves pessaries in the vagina to impede the function of seminal fluid [3, 4].

These methods have been tested in recent times and have been shown to be effective spermicidal agents. In addition, other modalities have been advocated in ancient Egypt, such as the application of honey and sodium bicarbonate in the vagina or acacia gum to the cervix. Of interest is the fact that lactational amenorrhea was known to the ancient Egyptians and was advocated as a method of family planning [5].

Coitus interruptus was anciently referenced as a means of family planning as it was practiced by a minor biblical person in the Book of Genesis. This person spills his seed on the ground as a method of contraception with his deceased brother’s wife [5].

Generally, ancient cultures viewed the application of family planning as being the responsibility of the women, such as the use of pessaries and emulets [5].

Historians cite the legend of Minos in 150 AD which suggests that the condom was used in ancient times when he used the bladder of a goat to protect his partner from the serpents and scorpions contained in his semen [5].

In the ancient Near East and Greece, the rare silphium plant was used as an oral contraceptive, the effectiveness of which was greatly exaggerated. Other plants used for the same purpose include Queen Anne’s lace, date palm, and willow [6].

In addition to the application of cedar oil in the female genitals, coitus interruptus was practiced during the times of Aristotle and Hippocrates [7].

Other than coitus interruptus, coitus reservatus and coitus obstructus were known to the ancient Chinese and Indians, in addition to the use of oral mixtures of oil and quicksilver [8].

In the medieval period, Middle Eastern and Indian civilization in general, the medical polymaths, Al Razi and Avicenna greatly influenced the advancement of medical science. Contraceptive issues were described by them in the form of coitus interruptus and the use of pessaries of various components that included elephant dung and various plants [8, 9].

In contrast, medieval Europe was influenced by Catholicism, where contraception was deemed immoral [5].

These practices went on until the political issues of “voluntary motherhood” and women’s emancipation movement of more recent centuries. It was in the very late eighteenth century when Thomas Malthus advocated chastity and late marriages that would result in greater economic stability and improve the standards of living without affecting Christian morality [10].

The birth control movement of the nineteenth century in Britain resulted in the reduction of the birth rate from 35.5 per 1000 in the 1870s to 29 per 1000 within 20 years [11].

The Graafian follicle was discovered and widely published in the second half of the eighteenth century. Even after van Leeuwenhoek discovered sperm around the same time (1677), about 200 years passed before it was clear to scientists how conception and early embryology worked. It was no surprise that the rhythm method was not yet understood. On the other hand, condoms and diaphragms made of vulcanized rubber were available [11].

In the United States, there had been few social and legal ramblings throughout most of the nineteenth century. This culminated in the foundation of the first birth control league in America. In synchrony, Marie Stopes clinic, the first birth control clinic in Britain was established in 1921 [12].

In the twentieth century birth control faced the issue of having to separate sexual activity from family planning, in addition to it becoming related to the feminist movement. Furthermore, there was a clash between the liberal and the conservative camps in relation to issues related to personal freedom, welfare, traditions, values, morality, religious beliefs, family size, politics, and state intervention [13].

Late in the twentieth century the combined oral contraceptive pill was developed in the United States and became commercially available in the 1960s. For termination of unplanned pregnancies, prostaglandin analogs became available in the 1970s and mifepristone in the 1980s [14].

The birth control pill literature, and the birth control pill were met with considerable legal bans in France and the Republic of Ireland as met in France, 1960s, and 1980s, respectively [15].

3. The present

Currently, among women of reproductive age worldwide, the vast majority need family planning. Women that have an unmet need for contraception greatly outnumber these using contraceptive methods [16, 17].

Access to contraceptive methods advances health and other social benefits, especially when births are separated by 2 years or more [18].

The demand for family planning has been on the increase. It is estimated that over one billion women are current users with a contraceptive prevalence rate of about 50% [19].

There has been a slow increase in the proportion of women of reproductive age who have their need for family planning satisfied by modern contraceptive methods. Reasons for this include various barriers such as difficulty accessing services by the young and poor, limited choice of methods, fear of side effects, bias against some methods, cultural or religious opposition, poor quality, and limited access to services [19].

The various methods of contraception are classified by their effectiveness as commonly used by the number of pregnancies per 100 women as very effective (0–0.9), effective (1–9), moderately effective (10–19), and less effective (20 or more), as follows [20]:

Combined oral contraceptives	7
Progestogen-only pills	7
Implants	0.1
Progestogen only injectables	4
Monthly injectables or combined injectable	3
Combined contraceptive patch and combined contraceptive vaginal ring (CVR)	7 (for contraceptive vaginal ring)
Intrauterine copper device	0.8
Intrauterine levonorgestrel device	0.7
Male condoms	13
Female condoms	21
Male sterilization (vasectomy)	0.15
Female sterilization (tubal ligation)	0.5
Lactational amenorrhea method (LAM)	2 (in 6 months)
Standard days method (SDM)	12
Basal body temperature (BBT) method	No reliable data
Two day method	14
Sympto-thermal method	2
Emergency contraception pills	1–2
Calendar method or rhythm method	15
Coitus interruptus	20

4. The future

The future of family planning is highlighted by the fact that it is an important component of national health promotion and disease prevention programs. Research on improving family planning service delivery is closely related to the broader research effort that relates to the betterment of the general quality of health care that would inform practitioners about best practices. It is, therefore, necessary to foster research that results in improving family planning’s effective and timely dissemination of information to service providers.

The future of family planning revolves around the prediction that methods would become 100% effective, especially those used a day after coitus, and producing vaginal spermicides that are bactericidal and virucidal against sexually transmitted infections. Albeit, the advancement of contraceptive pills or injections for men would be influenced by the reluctance of men from certain cultures and societies to adopt such methods.

As with the health care system as a whole, the family planning future agenda should include some key aspects that relate to safety, effectiveness, patient-centered care, efficiency, and equity of health care.