Birth control (also known as contraception and fertility control) is the use of methods or devices to prevent pregnancy. Birth control has been used since ancient times, but effective and safe methods became available only in the 20th century. The World Health Organization and United States Centers for Disease Control and Prevention provide guidance on the safety of birth control methods among women with specific medical conditions.
Birth Control
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| Category | Reproductive Health, Public Health |
| Research Fields | Obstetrics & Gynecology, Family Medicine, Epidemiology |
| Also known as: | Contraception, family planning |
| Pronunciation: | kon-truh-SEP-shuhn |
| Global users: | 851 million people use modern methods |
| Effectiveness range: | 85% to over 99% depending on method |
| Primary Applications: | Fertility regulation, maternal health, population policy |
| First documented use: | Ancient Egypt (1850 BC) |
| Modern development: | 20th century hormonal methods |
History
1800-1500 BC: Honey and Herbs as Early Contraceptives
The earliest documented birth control methods appear in ancient Egyptian papyri from 1850-1550 BC, describing vaginal suppositories made from honey, acacia leaves, and lint to block sperm. Ancient Greeks and Romans used silphium, a now-extinct plant that became worth more than its weight in silver due to its contraceptive properties. Aristotle recommended cedar oil applications, while Hippocratic texts suggested drinking copper salts—methods that were largely ineffective and sometimes dangerous.
1600s: Church Opposition and Secret Practices
Medieval Europe saw strong Catholic Church opposition to contraception, officially deeming pregnancy prevention immoral. Despite religious prohibitions, women secretly practiced withdrawal, used herbal preparations like lily root and rue, and wore superstitious items like weasel testicles. The oldest known condoms, made from animal intestines, date to 1640 and were found at Dudley Castle in England, likely used during the English Civil War to prevent sexually transmitted infections rather than pregnancy.
1870s: Malthusian League and Legal Challenges
The organized birth control movement began with the establishment of the Malthusian League in 1877 in the United Kingdom, advocating for family planning education and removal of legal penalties. This period saw the first systematic efforts to challenge restrictive laws and educate the public about contraception, setting the foundation for future reproductive rights activism.
1910s: Margaret Sanger and American Activism
Margaret Sanger and Otto Bobsein popularized the term “birth control” in 1914 in the United States. Sanger opened the first American birth control clinic in Brooklyn in 1916 with her sister Ethel Bryne, which was shut down after eleven days and led to her arrest. The publicity from her legal battles sparked nationwide birth control activism despite the restrictive Comstock Laws that made distributing contraceptive information illegal.
1920s: First Scientific Contraceptive Clinics
Marie Stopes established the first permanent birth control clinic in Britain in 1921, working with the Malthusian League to provide scientific contraceptive advice. Her clinic, staffed by midwives and visiting doctors, made contraception socially acceptable by presenting it in medical and scientific terms. Ernst Gräfenberg further developed Richard Richter’s intrauterine device using silkworm gut, laying groundwork for modern IUDs.
1950s: Hormonal Revolution and the Pill Development
Carl Djerassi synthesized progesterone from Mexican yams in 1951, creating the chemical foundation for hormonal contraceptives. Gregory Pincus and John Rock, with support from Planned Parenthood, developed the first birth control pills during this decade. Their research, partly funded by Margaret Sanger, led to extensive testing and preparation for what would become the most revolutionary contraceptive method.
1960s: FDA Approval and the Contraceptive Revolution
The FDA approved the first oral contraceptive pill, Enovid, in 1960, marking a turning point in reproductive control. This decade saw the pill become widely available, giving women unprecedented autonomy over their fertility. The contraceptive revolution coincided with broader social changes, including the women’s liberation movement and changing sexual attitudes, fundamentally altering family planning and women’s roles in society.
1970s: IUD Expansion and Legal Victories
Modern copper and hormonal IUDs became widely available during the 1970s, offering long-term reversible contraception. The Supreme Court case Eisenstadt v. Baird (1972) extended contraceptive access rights to unmarried individuals, building on the precedent set by Griswold v. Connecticut (1965). This decade also saw the development of prostaglandin analogs, providing new options for medical abortion.
1980s: Mifepristone and Emergency Contraception
The 1980s introduced mifepristone, revolutionizing medical abortion as an alternative to surgical procedures. Emergency contraception became more widely recognized and available during this period. Research continued on improving existing methods and developing new contraceptive technologies, while global family planning programs expanded significantly in developing countries.
1990s: Long-Acting Methods and Global Access
The contraceptive implant gained popularity as a highly effective long-acting method. International efforts focused on improving contraceptive access in developing countries, recognizing family planning as essential for maternal health and economic development. This decade saw increased research into male contraceptives and continued refinement of existing hormonal methods.
2000s: Emergency Contraception Over-the-Counter
Emergency contraceptive pills became available over-the-counter in many countries, improving access to post-coital contraception. The Essure sterilization device was approved, offering non-surgical permanent contraception for women. Continued improvements in IUD design and hormonal formulations made these methods safer and more user-friendly, while telemedicine began expanding contraceptive access.
2010s: Healthcare Reform and Digital Innovation
The Affordable Care Act (2010) mandated insurance coverage for contraceptives in the United States, dramatically improving access. Smartphone apps for fertility tracking gained popularity, though with varying reliability. Long-acting reversible contraceptives (LARCs) became increasingly recommended by medical professionals as first-line options due to their superior effectiveness and user satisfaction rates.
2020s: Over-the-Counter Pills and Global Expansion
The FDA approved the first over-the-counter daily birth control pill (Opill) in 2023, marking a significant milestone in contraceptive accessibility. Countries like France and Ireland expanded free contraception programs for young women. Telemedicine further revolutionized contraceptive access, especially during the COVID-19 pandemic, while research continued on innovative male contraceptive methods and improved long-acting options.
Methods
Birth control methods include barrier methods, hormonal birth control, intrauterine devices (IUDs), sterilization, and behavioral methods. They are used before or during sex while emergency contraceptives are effective for up to five days after sex. Effectiveness is generally expressed as the percentage of women who become pregnant using a given method during the first year.
The most effective methods are long-acting and do not require ongoing health care visits. Surgical sterilization, implantable hormones, and intrauterine devices all have first-year failure rates of less than 1%. Hormonal contraceptive pills, patches or vaginal rings, and the lactational amenorrhea method (LAM), if adhered to strictly, can also have first-year failure rates of less than 1%. With typical use, first-year failure rates are considerably higher, at 9%, due to inconsistent use.
Hormonal
Hormonal contraception is available in a number of different forms, including oral pills, implants under the skin, injections, patches, IUDs and a vaginal ring. They are currently available only for women, although hormonal contraceptives for men have been and are being clinically tested. There are two types of oral birth control pills, the combined oral contraceptive pills (which contain both estrogen and a progestin) and the progestogen-only pills (sometimes called minipills).
Combined hormonal contraceptives are associated with a slightly increased risk of venous and arterial blood clots. Venous clots, on average, increase from 2.8 to 9.8 per 10,000 women years which is still less than that associated with pregnancy. Due to this risk, they are not recommended in women over 35 years of age who continue to smoke.
The effect on sexual drive is varied, with an increase or decrease in some but with no effect in most. Combined oral contraceptives reduce the risk of ovarian cancer and endometrial cancer and do not change the risk of breast cancer. They often reduce menstrual bleeding and painful menstruation cramps.
Barrier
Barrier contraceptives are devices that attempt to prevent pregnancy by physically preventing sperm from entering the uterus. They include male condoms, female condoms, cervical caps, diaphragms, and contraceptive sponges with spermicide.
Globally, condoms are the most common method of birth control. Male condoms are put on a man’s erect penis and physically block ejaculated sperm from entering the body of a sexual partner. Modern condoms are most often made from latex, but some are made from other materials such as polyurethane, or lamb’s intestine. Female condoms are also available, most often made of nitrile, latex or polyurethane.
Male condoms have the advantage of being inexpensive, easy to use, and have few adverse effects. Male condoms and the diaphragm with spermicide have typical use first-year failure rates of 18% and 12%, respectively. With perfect use condoms are more effective with a 2% first-year failure rate versus a 6% first-year rate with the diaphragm. Condoms have the additional benefit of helping to prevent the spread of some sexually transmitted infections such as HIV/AIDS.
Intrauterine devices
The current intrauterine devices (IUD) are small devices, often T-shaped, containing either copper or levonorgestrel, which are inserted into the uterus. They are one form of long-acting reversible contraception which is the most effective type of reversible birth control. Failure rates with the copper IUD is about 0.8% while the levonorgestrel IUD has a failure rates of 0.2% in the first year of use. Among types of birth control, they, along with birth control implants, result in the greatest satisfaction among users.
Evidence supports effectiveness and safety in adolescents and those who have and have not previously had children. IUDs do not affect breastfeeding and can be inserted immediately after delivery. They may also be used immediately after an abortion. Once removed, even after long term use, fertility returns to normal immediately.
While copper IUDs may increase menstrual bleeding and result in more painful cramps, hormonal IUDs may reduce menstrual bleeding or stop menstruation altogether. Other potential complications include expulsion (2–5%) and rarely perforation of the uterus (less than 0.7%).
Sterilization
Surgical sterilization is available in the form of tubal ligation for women and vasectomy for men. Tubal ligation decreases the risk of ovarian cancer. Short term complications are twenty times less likely from a vasectomy than a tubal ligation. After a vasectomy, there may be swelling and pain of the scrotum which usually resolves in one or two weeks. With tubal ligation, complications occur in 1 to 2 percent of procedures with serious complications usually due to the anesthesia. Neither method offers protection from sexually transmitted infections.
The permanence of this decision may cause regret in some men and women. Of women who have undergone tubal ligation after the age of 30, about 6% regret their decision, as compared with 20–24% of women who received sterilization within one year of delivery and before turning 30. By contrast, less than 5% of men are likely to regret sterilization.
Behavioral
Behavioral methods involve regulating the timing or method of intercourse to prevent the introduction of sperm into the female reproductive tract, either altogether or when an egg may be present. If used perfectly the first-year failure rate may be around 3.4%; however, if used poorly first-year failure rates may approach 85%.
Fertility awareness
Fertility awareness methods involve determining the most fertile days of the menstrual cycle and avoiding unprotected intercourse. Techniques for determining fertility include monitoring basal body temperature, cervical secretions, or the day of the cycle. They have typical first-year failure rates of 24%; perfect use first-year failure rates depend on which method is used and range from 0.4% to 5%.
Withdrawal
The withdrawal method (also known as coitus interruptus) is the practice of ending intercourse (“pulling out”) before ejaculation. The main risk of the withdrawal method is that the man may not perform the maneuver correctly or on time. First-year failure rates vary from 4% with perfect usage to 22% with typical usage. There is little data regarding the sperm content of pre-ejaculatory fluid.
Abstinence
Sexual abstinence may be used as a form of birth control, meaning either not engaging in any type of sexual activity, or specifically not engaging in vaginal intercourse, while engaging in other forms of non-vaginal sex. Complete sexual abstinence is 100% effective in preventing pregnancy. However, among those who take a pledge to abstain from premarital sex, as many as 88% who engage in sex, do so prior to marriage.
Lactation
The lactational amenorrhea method involves the use of a woman’s natural postpartum infertility which occurs after delivery and may be extended by breastfeeding. For a postpartum woman to be infertile (protected from pregnancy), their periods have usually not yet returned (not menstruating), they are exclusively breastfeeding the infant, and the baby is younger than six months. If breastfeeding is the infant’s only source of nutrition and the baby is less than 6 months old, 93–99% of women are estimated to have protection from becoming pregnant in the first six months.
Emergency
Emergency contraceptive methods are medications or devices used after unprotected sexual intercourse with the hope of preventing pregnancy. Emergency contraceptives are often given to victims of rape. They work primarily by preventing ovulation or fertilization. Several options exist, including high dose birth control pills, levonorgestrel, mifepristone, ulipristal and IUDs.
Levonorgestrel pills, when used within 3 days, decrease the chance of pregnancy after a single episode of unprotected sex or condom failure by 70% (resulting in a pregnancy rate of 2.2%). Ulipristal, when used within 5 days, decreases the chance of pregnancy by about 85% (pregnancy rate 1.4%) and is more effective than levonorgestrel. Copper IUDs are the most effective method and can be inserted up to five days after intercourse and prevent about 99% of pregnancies after an episode of unprotected sex.
Effects
Health
Contraceptive use in developing countries is estimated to have decreased the number of maternal deaths by 40% (about 270,000 deaths prevented in 2008) and could prevent 70% of deaths if the full demand for birth control were met. These benefits are achieved by reducing the number of unplanned pregnancies that subsequently result in unsafe abortions and by preventing pregnancies in those at high risk.
Birth control also improves child survival in the developing world by lengthening the time between pregnancies. In this population, outcomes are worse when a mother gets pregnant within eighteen months of a previous delivery.
Teenage pregnancies, especially among younger teens, are at greater risk of adverse outcomes including early birth, low birth weight, and death of the infant. In 2012 in the United States 82% of pregnancies in those between the ages of 15 and 19 years old were unplanned. Comprehensive sex education and access to birth control are effective in decreasing pregnancy rates in this age group.
Finances
In the developing world, birth control increases economic growth due to there being fewer dependent children and thus more women participating in or increased contribution to the workforce. Women’s earnings, assets, body mass index, and their children’s schooling and body mass index all improve with greater access to birth control. Family planning, via the use of modern birth control, is one of the most cost-effective health interventions. For every dollar spent, the United Nations estimates that two to six dollars are saved.
Prevalence
Globally, as of 2009, approximately 60% of those who are married and able to have children use birth control. How frequently different methods are used varies widely between countries. The most common method in the developed world is condoms and oral contraceptives, while in Africa it is oral contraceptives and in Latin America and Asia it is sterilization.
As of 2012, 57% of women of childbearing age want to avoid pregnancy (867 of 1,520 million). About 222 million women, however, were not able to access birth control, 53 million of whom were in sub-Saharan Africa and 97 million of whom were in Asia. This results in 54 million unplanned pregnancies and nearly 80,000 maternal deaths a year.
Society and culture
Legal positions
Human rights agreements require most governments to provide family planning and contraceptive information and services. In the United States, the 1965 Supreme Court decision Griswold v. Connecticut overturned a state law prohibiting the dissemination of contraception information based on a constitutional right to privacy for marital relationships. In 1972, Eisenstadt v. Baird extended this right to privacy to single people.
Religious views
Religions vary widely in their views of the ethics of birth control. The Roman Catholic Church re-affirmed its teachings in 1968 that only natural family planning is permissible, although large numbers of Catholics in developed countries accept and use modern methods of birth control. Among Protestants, there is a wide range of views from supporting none, such as in the Quiverfull movement, to allowing all methods of birth control. Views in Judaism range from the stricter Orthodox sect, which heavily restricts the use of birth control, to the more relaxed Reform sect, which allows most. In Islam, contraceptives are allowed if they do not threaten health, although their use is discouraged by some.
Misconceptions
There are a number of common misconceptions regarding sex and pregnancy. Douching after sexual intercourse is not an effective form of birth control. Women can become pregnant the first time they have sexual intercourse and in any sexual position. It is possible, although not very likely, to become pregnant during menstruation. Contraceptive use, regardless of its duration and type, does not have a negative effect on the ability of women to conceive following termination of use and does not significantly delay fertility.
Research directions
Improvements in existing birth control methods are needed, as around half of those who get pregnant unintentionally are using birth control at the time. Many alterations of existing contraceptive methods are being studied, including a better female condom, an improved diaphragm, a patch containing only progestin, and a vaginal ring containing long-acting progesterone.
Despite high levels of interest in male contraception, progress has been stymied by a lack of industry involvement. Several novel contraceptive methods based on hormonal and non-hormonal mechanisms of action are in various stages of research and development, including gels, pills, injectables, implants, and oral contraceptives for men.
FAQs
What type of birth control is best?
The “best” method depends on individual needs, but IUDs and implants are most effective (over 99%) and longest-lasting. For STI protection, condoms are essential. Combined methods offer maximum protection. Consult healthcare providers to determine what’s best for your health, lifestyle, and preferences.
Can he come in me if I’m on the pill?
Birth control pills are 93% effective with typical use when taken correctly daily. While highly effective at preventing pregnancy, pills provide no protection against sexually transmitted infections. For maximum protection against both pregnancy and STIs, use condoms alongside hormonal contraception.
Does birth control stop your period?
Some methods can stop periods: hormonal IUDs may reduce or eliminate bleeding, continuous-use pills can skip periods, and implants may cause irregular bleeding or no periods. Copper IUDs typically make periods heavier. Period changes are normal and usually not harmful with hormonal contraception.
Is birth control stronger than condoms?
Hormonal methods like pills, IUDs, and implants are more effective at preventing pregnancy than condoms (93-99% vs 87%). However, only condoms protect against sexually transmitted infections. For comprehensive protection, many people use hormonal contraception plus condoms for dual protection against pregnancy and STIs.