From then to now: Contraception through the ages

By Hayley White

Reading time: 22 minutes

Humankind has been trying to control birth and fertility almost since the beginning of time - so long ago, in fact, there is no way to really know when contraception was first invented. The way women through the ages avoided pregnancy largely depended on religion, culture, and social status, and for the vast majority, contraception was based purely on superstition, magic, and plant remedies. Only a select few had access to contraceptive options that were rational and partially if not wholly effective.

Though there was never contraception as we know it today, preliterate tribal societies had their own ways of preventing pregnancy. For almost all preliterate tribes, unmarried girls who fell pregnant were looked down upon, so it was imperative they did everything possible to prevent it.

By Hayley White

Reading time: 22 minutes

Humankind has been trying to control birth and fertility almost since the beginning of time – so long ago, in fact, there is no way to really know when contraception was first invented. The way women through the ages avoided pregnancy largely depended on religion, culture, and social status, and for the vast majority, contraception was based purely on superstition, magic, and plant remedies. Only a select few had access to contraceptive options that were rational and partially if not wholly effective.

Though there was never contraception as we know it today, preliterate tribal societies had their own ways of preventing pregnancy. For almost all preliterate tribes, unmarried girls who fell pregnant were looked down upon, so it was imperative they did everything possible to prevent it.

Many different methods were used and while some were considered magic, others were reasonable and made biological sense. One of the most effective methods was coitus interruptus. Sometimes referred to as the “pull-out method”, coitus interruptus is essentially when the man pulls out his penis before he ejaculates.

Many civilisations believed in medicine as contraception, too – although in those days it would have been called magic. All over the world, various plants, tonics, potions, chants, spells, or even foods were understood to prevent pregnancy.

A method used by Yao tribeswomen was to find a person who knew about knot-tying. The person would go into the woods, gather two kinds of bark, and twist them into a cord. He would then rub the cord with egg yolk and tie into it three knots, saying with each tie: “tree you are called (name), and you (name). Out of you (egg) rises life, but from now on I want no more life.” The cord is worn by the woman until she decides to have more children, in which case she takes it off, unties the knots, puts it in water which she then drinks, and throws away the cord.

Weekly markets were held exclusively for women in some African tribes. “Magico-medico” stuff was sold at these markets as contraceptives and to induce abortions. The ingredients used to make this were unknown because the sale and possession of them was considered reason for divorce; some husbands might even kill their wives if they were caught going to these markets.

In West Africa, the most rational contraception method was the use of a crushed root inserted as a plug into the vagina. This is mirrored in Central Africa where women sealed their vaginas with rags or chopped grass as well as taking oral remedies. These techniques often caused medical issues like constipation and infection.

The medicine men of Indigenous North and South American tribes had a big part to play in women’s fertility and contraception. A lot of Native American contraceptives comprised natural herbs, plants, and roots. Cherokee women who wished to be sterile forever chewed cowbane (Cicula maculata) and Cora women consumed the internal scrapings of a male deer horn. South American tribes only had a handful of contraceptives. One such example was a vaginal wash made from the husk of a mahogany nut and lemon juice. Citric acid was considered a natural spermicide, and mahogany nuts were believed to have an astringent effect.

For many Native American people, the idea of contraception was absurd since children are considered a gift. As mentioned in Himes (1936), women who sought out contraceptive medicine had usually suffered numerous miscarriages or childbirth issues and were at risk with their next children.

Other tribes around the world had similar beliefs about contraception. If they did not completely outlaw it, then herbs and magic were used. Fijian women believed that large families were looked down upon and felt ashamed if they fell pregnant too many times, so they took local flora to prevent conception with varying success. The Australian Aboriginal tribes used two plants for contraception: tjarri or ka’atä (dioscorea saliva var. rotunda, a type of yam plant) and pi’alä (entada scandens, a type of bean plant). The aboriginals believed that a woman had no children because they had “shut themselves up” by eating medicine.

In the land of the kama sutra, , contraceptive techniques from the ancient Indian Sanskrit texts and poems were created between the 10th and 16th centuries. These are almost all ritualistic or magical, with some being semi rational. Most of the recommendations for birth control rely on taking medicines or potions or using magic. One text titled the Ananga Ranga, or the Stage of the God of Love written by Kalyana Malla says that a woman who drinks the roots of an angi tree (semecarpus anacardium, plumbago zeylanica or citrus acida) cooked in sour rice water for three days straight after her period ends will be barren. The Pancasayaka by Jyotirisvara Kavisekhara says that a woman must choose a lucky day to drink palasa (butea frondose) and the fruits and flowers of the salmali tree (salmalia malabarica) together with melted butter to become unfruitful. Other more rational methods included smearing the vagina with honey and ghee; a vaginal medication of rock salt dipped in oil; and a tampon soaked with ajwain seed, rock salt, and oil.

A couple of ancient Egyptian papyruses discuss various contraceptives. In the Petri or Kahun Papyrus dated 1850 BC, there are three main prescriptions: the first is a vaginal pessary made from crocodiles’ dung and paste; the second is a vaginal plug made from honey and natron (native sodium carbonate); and the third talks about some kind of gum-like substance for insertion into the vagina. The Ebers Papyrus dated 1550 BC is a collection of medical writings that mention the first-ever use of a contraceptive acacia gum and honey-infused lint tampon. In the Berlin Papyrus dated 1300 BC, there are eight sections that discuss contraception, sterility, and pregnancy. The main contraceptive from this papyrus recommends fumigating the vulva with a drug; then, for four days after, cooking and swallowing a concoction of grease, m’alel herb, and sweet ale.

The Greek and Roman beliefs and practices around contraception, both magical and medical, are extensive. Aristotle, Plato, and Hesiod all had something to say about population control but the philosopher whose influence carried well into the Middle Ages was Soranos of Ephesus. His techniques were the most rational and provided options for both contraception and abortion, making him the greatest gynaecologist in antiquity. In one of his texts, he lists a number of methods, like wiping the semen out of the vagina, packing soft wool into the mouth of the uterus or smearing the mouth of the uterus with sour oil, honey, or cedar gum. In his recommendations, he mentions one thing that his predecessors never did: the side effects of birth control, including vomiting, indigestion, and a heavy head.

Ancient world Islamic cultures have quite possibly the most reasonable approach to birth control. The Islamic civilisation was heavily influenced by the Greek culture, so of course a lot of their medicine was also carried over. An interesting thing about the Islamic religion compared to the Christian is that the foetus is not seen as a human being until it has a distinctly human form. Because of this, abortion and birth control are allowed. One of the most well-regarded doctors in Islam, and even arguably in the Middle Ages according to Himes (1936), was Persian physician Abū Bakr Muḥammad bin Zakariyyāʾ al-Rāzī (known also by his Latin name Rhazes). According to whom, the most efficient form of birth control is the pull-out method, or officially coitus interruptus.

Other more popular techniques were the use of pessaries or suppositories made of various substances and attempts to expel semen from the vagina. All Islamic physicians agree that a woman should jump backwards seven or nine times after intercourse because these are magic numbers and should somehow work towards preventing pregnancy. Physician ‘Ali ibn al-‘Abbas al-Majusi made very clear that contraceptives should only be available to ‘trustworthy’ women who have small uteruses or who have a disease that would make childbirth fatal. They were very explicit that these methods should not be made available for sexually promiscuous women.

In the Western Middle Ages, any knowledge of contraception gathered by old civilisations was mostly forgotten. Perhaps the beliefs of the Roman Catholic Church had something to do with that. One of the most interesting things during this time is that contraception was religiously forbidden and seen as a sin in the Catholic Church. The views of St. Thomas Aquinas (1225–1274) were held throughout the Roman Catholic Church and had a massive impact on the general population as a result. Aquinas condemned birth control on the grounds that it was against nature and therefore wrong; “hence, after the sin of homicide, by which human nature actually existing is destroyed, this kind of sin, by which the generation of human nature is impeded, seems to hold second place,” (Aquitas as cited in Himes, 1936).

The European Middle Ages were full of religious taboo and superstition, and so contraception was magical, mostly based around amulets and talismans. There was a belief that a woman could not get pregnant if she held a piece of Jasper in her hands during sex, or if she wore the heart of a salamander on her knees; and if she held a certain number of fingers underneath her during sex then that number of years will go by without her getting pregnant. All of this was folklore.

When exactly the condom was first created is a bit of a question mark. A number of civilisations used condoms throughout history; some were found in ancient Egypt, Rome, and Greece. According to legend, at around 3000 BC, King Minos of Crete was said to have serpents and scorpions in his semen because many of his mistresses were dying after sex. To protect himself and his partners, a goats-bladder condom was introduced that protected the women from disease. Instead of animal bladders, the ancient Egyptians used linen condoms and were said to wear coloured ones to distinguish social status. Ancient Romans used both linen and animal bladders and intestines. They mostly used condoms to prevent disease, unaware that contraception was another side effect.

Ancient China and Japan also used condoms, though theirs were markedly different. Instead of linen, silk was used because it was so readily available. Silk paper applied with oil lubrication was common use for sex in China as disease and illness spread from trade with the East and Central Europe. The Chinese also saw value in smaller families so sought contraception to help reduce numbers. In Japan, the Kabuta-Gata was designed: condoms made from tortoise shells and occasionally leather. The Kabuta-Gata was sometimes used for erectile dysfunction (Khan, Mukhtar, Dickinson, & Sriprasad, 2013).

Kabuta-Gata

In 16th century Europe, Italian anatomist Fallopius claimed to have made a linen sheath that protected against syphilis. He tested this sheath on 1100 men and none of them became infected. In his memoirs, Casanova also mentioned wearing condoms for contraception. He would often blow them up to amuse women and test them for holes. By the 18th century, the condom – also known as armour or a preservative machine – flourished and major developments were made through to the 19th century when in 1844 Hancock and Goodyear began making rubber condoms. Plastic condoms became available during World War 2; the first coloured condom was made by Japan in 1949; the first ever condom with lubrication was made in the 1950s; and in 1975, condoms coated with spermicide were made. Today, condoms remain the most effective form of protection against sexually transmitted infections (STIs) and are almost 98 per cent effective in preventing pregnancy when used correctly and without any other birth control (Family Planning, n.d.).

Other more modern-day contraceptives descended from ancient practices, too. The Intrauterine device (IUD) evolved from pessaries and was developed in the early 20th century. IUDs were made from wood, glass, bone, rubber, and various metals. In Germany in 1909 the first literary paper for the IUD was published by Dr. Richard Richter detailing a ring made of silkworm gut being inserted into the uterus. Twenty years later, the effectiveness of a silver intrauterine ring, known as the Graffenberg Ring, was presented by Ernst Graffenberg and gave the IUD its first exposure, scientific identity, and credibility.

The development of the Ota Ring by Tenrei Ota in Japan was a modified version which replaced the silver wire of the Graffenberg Ring with gold-plated silver, gold, or plastic. It’s known as the grandfather of modern IUDs. These two devices were initially rejected by the medical community who claimed they were ineffective and dangerous. This prevented the IUD from widespread use for another 20-30 years until a study in Japan proved their safety (Hutchings, Benson, Perkin, & Soderstrom, 1985).

After a myriad of IUDs became available, the copper and the hormonal IUDs are the two most widely used today. There are multiple variations on hormonal IUDs: the Mirena, Jaydess, Liletta, Kyleena, and Skyla. All have the synthetic hormone progestin, made to replicate the natural hormone progesterone. This hormone prevents pregnancy and helps to treat heavy and painful periods. Some IUDs have more hormones than others and can last anywhere from three (Jaydess) to five years (Mirena).

T-shaped intrauterine birth control device on pink background

The copper IUD (ParaGard) damages or kills sperm and affects the lining of the uterus so a fertilised egg cannot grow. The copper IUD can usually last for five years – like the hormonal Mirena. IUDs are typically considered more than 99 per cent effective (Health Navigator, n.d.).

The initial idea that hormones could prevent pregnancy was typically something applied to animals rather than humans. However, it was thanks to this effectiveness in animals that scientists realised hormones could be used for contraception in humans too. This was how the birth control pill was created. It was only in 1961 that the first contraceptive pill, Enovid, was approved and another ten years before unmarried women in the US were allowed access.

It took a lot of playing around with different kinds of hormones before medical scientists eventually fine-tuned the pill, and especially in a way that reduced side effects for women. The original pill and current forms of oral contraception are vastly different and now there is a wide range available.

The combined pill, simply known as “the pill”, is an oral contraceptive that has both progestogen and oestrogen. There is also a progestogen-only pill but this is less commonly used.

The combined pill is taken every day at the same time – otherwise the effectiveness drops. It works by stopping ovulation (eggs being released from the ovaries) and is used to treat heavy periods and painful cramps by thinning the lining of the uterus. There is a range of different brands – all come with various potential side effects. While taking the pill, there is the option to induce a period at the end of every month by taking the seven non-hormone sugar pills. If used correctly, the pill is considered 99 per cent effective (Health Navigator, n.d.).

Other birth control options that have taken a bit longer to develop but are just as effective include the implant (the rod), the diaphragm, and the Depo-Provera® (the jab/injection). The implant is made up of two small matchstick-sized rods inserted under the skin in the arm. These slowly release progestogen and work for up to five years with over 99 per cent effectiveness (Family Planning, n.d.), and can be removed anytime.

The diaphragm is a silicone dome held in place by the vaginal muscles and which covers the cervix as a physical barrier against sperm entering the uterus. The recommended use is to apply spermicide to the inside of the diaphragm and insert before intercourse. Kept in place for at least six hours afterwards and used properly, the diaphragm can be 94 per cent effective (Family Planning, n.d.).

The Depo-Provera® is an intramuscular injection that contains the hormone medroxyprogesterone. It is given every 13 weeks, or every three months. It stops ovulation and changes the lining of the uterus so that it is less likely to take a fertilised egg. Used properly, the jab can be more than 99 per cent effective (Health Navigator, n.d.). The longer Depo-Provera® is used, the longer it takes for fertility to resume, the average time being between six months to one year.

One of the really exciting things to come to light in the last couple of months is the positive development of a male birth control pill. Found to be more than 99 per cent effective in mice, students at the University of Minnesota have created a non-hormonal pill that prevents pregnancy in mice without any obvious side effects (1 News, 2022). Unlike other male birth control studies, this pill does not target any male hormones such as testosterone. Lowering testosterone levels can have side effects like weight gain and depression which is why all previous attempts at clinical trials have led nowhere. The students at the University of Minnesota are hoping to start human clinical trials in the second half of 2022.

The history of birth control is a long one. Fraught with magic and superstition in the early days, scientific research into the female reproductive system over the following centuries has led to this powerhouse discovery that has changed the lives of women (and maybe men in the future) everywhere.

 

 

Sources: 1. Male contraceptive pill 99% effective in mice trial, 1news 2. Combined oral contraceptive pill; 3. Condoms; 4. Contraceptive implant; 5. Diaphragms, Family Planning 6. Depo-provera®; 7. Intrauterine devices (IUD) for contraception, Health navigator NZ 8. Medical history of contraception, Waverly Press, Inc. 9. The IUD after 20 years: A review, Family Planning Perspectives 10. The story of the condom, IJU: Journal of the Urological Society of India 11. Non-hormonal IUDs, Planned Parenthood 12. The history of the condom. Journal of the Royal Society of Medicine, ncbi.nlm.nih.gov/pmc

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