World Contraception Day :

The 26th of September is World Contraception Day, devoted to raising awareness and improving education about sexual and reproductive health, with a vision of a world where every pregnancy is wanted.  It is supported by a group of governments and international NGOs, including the Office of Populations Affairs, the Asian Pacific Council on Contraception, Centro Latinamericano Salud y Mujer, the European Society of Contraception and Reproductive Health, the German Foundation for World Population, the International Federation of Pediatric and Adolescent Gynecology, International Planned Parenthood Federation, the Marie International, Population Services International, the Population Council, the United States Agency for International Development (USAID), and Women Deliver.

Misconceptions :

There are a number of common misconceptions regarding sex and pregnancy.Douching after sexual intercourse is not an effective form of birth control. Additionally, it is associated with a number of health problems and thus is not recommended. 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.

Females :

Improvements of existing birth control methods are needed, as around half of those who get pregnant unintentionally are using birth control at the time. A number of 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. This vaginal ring appears to be effective for three or four months and is currently available in some areas of the world. For women who rarely have sex, the taking of the hormonal birth control levonorgestrel around the time of sex looks promising.

A number of methods to perform sterilization via the cervix are being studied. One involves putting quinacrine in the uterus which causes scarring and infertility. While the procedure is inexpensive and does not require surgical skills, there are concerns regarding long-term side effects. Another substance, polidocanol, which functions in the same manner is being looked at. A device called Essure, which expands when placed in the fallopian tubes and blocks them, was approved in the United States in 2002.

Males :

Methods of male birth control include condoms, vasectomies and withdrawal. Between 25 and 75% of males who are sexually active would use hormonal birth control if it was available for them. A number of hormonal and non-hormonal methods are in trials, and there is some research looking at the possibility of contraceptive vaccines.

A reversible surgical method under investigation is reversible inhibition of sperm under guidance (RISUG) which consists of injecting a polymer gel,  in dimethyl sulfoxide, into the vas deferens. An injection with sodium bicarbonate washes out the substance and restores fertility. Another is an intravas device which involves putting a urethaneplug into the vas deferens to block it. A combination of an androgen and a progestin seems promising, as do selective androgen receptor modulators. Ultrasound and methods to heat the testicles have undergone preliminary studies.

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 in a timely manner . First-year failure rates vary from 4% with perfect usage to 22% with typical usage. It is not considered birth control by some medical professionals.  There is little evidence regarding the sperm content of pre-ejaculatory fluid. While some tentative research did not find sperm, one trial found sperm present in 10 out of 27 volunteers. The withdrawal method is used as birth control by about 3% of couples.

This method is also has some drawbacks . male produces some lubricating fluid from his cowper glands before ejaculation. This fluid contains many sperms. A lapse in timing or willpower may result in late withdrawal and hence pregnancy .

Prevalence :

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. In the developing world overall, 35% of birth control is via female sterilization, 30% is via IUDs, 12% is via oral contraceptives, 11% is via condoms, and 4% is via male sterilization.

While less used in the developed countries than the developing world, the number of women using IUDs as of 2007 was more than 180 million. Avoiding sex when fertile is used by about 3.6% of women of childbearing age, with usage as high as 20% in areas of South America. As of 2005, 12% of couples are using a male form of birth control (either condoms or a vasectomy) with higher rates in the developed world. Usage of male forms of birth control has decreased between 1985 and 2009. Contraceptive use among women in Sub-Saharan Africa has risen from about 5% in 1991 to about 30% in 2006.

As of 2012, 57% of women of childbearing age want to avoid pregnancy (867 of 1520 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. Part of the reason that many women are without birth control is that many countries limit access due to religious or political reasons. while another contributor is poverty. Due to restrictive abortion laws in Sub-Saharan Africa, many women turn to unlicensed abortion providers for unintended pregnancy, resulting in about 2–4% obtaining unsafe abortions each year.

Modern methods :

In 1909, Richard Richter developed the first intrauterine device made from silkworm gut, which was further developed and marketed in Germany by Ernst Gräfenberg in the late 1920s. Gregory Pincus"Pincus and John Rock with help from the Planned Parenthood Federation of America developed the first birth control pills in the 1950s, such as mestranol / norethynodrel, which became publicly available in the 1960s. Medical abortion became an alternative to surgical abortion with the availability of prostaglandin analogs in the 1970s and mifepristone in the 1980s.

Legal positions :

Human rights agreements require most governments to provide family planning and contraceptive information and services. These include the requirement to create a national plan for family planning services, remove laws that limit access to family planning, ensure that a wide variety of safe and effective birth control methods are available including emergency contraceptives, make sure there are appropriately trained healthcare providers and facilities at an affordable price, and create a process to review the programs implemented. If governments fail to do the above it may put them in breach of binding international treaty obligations.

In America, Griswold v. Connecticut overturned a state law prohibiting dissemination of contraception information based on a constitutional right to privacy for marital relationships. In 1971, Baird extended this right to privacy to single people.

In 2010, the United Nations launched the Every Woman Every Child movement to assess the progress toward meeting women's contraceptive needs. The initiative has set a goal of increasing the number of users of modern birth control by 120 million women in the world's 69 poorest countries by the year 2020. Additionally, they aim to eradicate discrimination against girls and young women who seek contraceptives. The American Congress of Obstetricians and Gynecologists(ACOG) recommended in 2014 that oral birth control pills should be over the counter medications.

Religious views:

Religions vary widely in their views of the ethics of birth control. The Roman Catholic Church officially only acceptsnatural family planning in certain cases, 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 to allowing all methods of birth control. Views in Judaism range from the stricter Orthodox sect to the more relaxed Reformsect. Hindus may use both natural and artificial contraceptives. A common Buddhist view is that preventing conception is acceptable, while intervening after conception has occurred is not.

In Islam, contraceptives are allowed if they do not threaten health, although their use is discouraged by some. The Quran does not make any explicit statements about the morality of birth control, but contains statements encouraging having children. Muhammad also is reported to have said "marry and procreate".

The lactational amenorrhea method involves the use of a woman's natural postpartum infertility which occurs after delivery and may be extended by breastfeeding. This usually requires the presence of no periods, exclusively breastfeeding the infant, and a child younger than six months. The World Health Organization states that if breastfeeding is the infant's only source of nutrition, the failure rate is 2% in the six months following delivery. Six uncontrolled studies of lactational amenorrhea method users found failure rates at 6 months postpartum between 0% and 7.5%. Failure rates increase to 4–7% at one year and 13% at two years. Feeding formula, pumping instead of nursing, the use of a pacifier, and feeding solids all increase its failure rate. In those who are exclusively breastfeeding, about 10% begin having periods before three months and 20% before six months. In those who are not breastfeeding, fertility may return four weeks after delivery.

The total medical cost for a pregnancy, delivery and care of a newborn in the United States is on average $21,000 for a vaginal delivery and $31,000 for a Caesarean section as of 2012. In most other countries the cost is less than half. For a child born in 2011, an average US family will spend $235,000 over 17 years to raise them.

In the developing world, birth control increases economic growth due to there being fewer dependent children and thus more women participating in 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. These cost savings are related to preventing unplanned pregnancies and decreasing the spread of sexually transmitted illnesses. While all methods are beneficial financially, the use of copper IUDs resulted in the greatest savings.

The total medical cost for a pregnancy, delivery and care of a newborn in the United States is on average $21,000 for a vaginal delivery and $31,000 for a Caesarean section as of 2012. In most other countries the cost is less than half. For a child born in 2011, an average US family will spend $235,000 over 17 years to raise them.

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%. The evidence on which these estimates are based, however, is poor as the majority of people in trials stop their use early. Globally, they are used by about 3.5% of couples. If based on both basal body temperature and another primary sign, the method is referred to as symptothermal. Overall first-year failure rates of <2% to 20% have been reported in clinical studies of the symptothermal method. 

A split dose of two emergency contraceptive pills (most are now provided as one single-dose pill)

Emergency contraceptive methods are medications (sometimes misleadingly referred to as "morning-after pills") or devices used after unprotected sexual intercourse with the hope of preventing pregnancy. They work primarily by preventing ovulation or fertilization. A number of 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 might be a little more effective than levonorgestrel. Mifepristone is also more effective than levonorgestrel while copper IUDs are the most effective method. IUDs can be inserted up to five days after intercourse and prevent about 99% of pregnancies after an episode of unprotected sex (pregnancy rate of 0.1 to 0.2%). This makes them the most effective form of emergency contraceptive. In those who are overweight or obese levonorgestrel is less effective and an IUD or ulipristal is recommended.

Providing emergency contraceptive pills to women in advance does not affect rates of sexually transmitted infections, condom use, pregnancy rates, or sexual risk-taking behavior. All methods have minimal side effects.

Dual protection is the use of methods that prevent both sexually transmitted infections and pregnancy. This can be with condoms either alone or along with another birth control method or by the avoidance of penetrative sex. If pregnancy is a high concern using two methods at the same time is reasonable, and two forms of birth control is recommended in those taking the anti-acne drug isotretinoin, due to the high risk of birth defects if taken during pregnancy.

See also: Maternal 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. Delaying another pregnancy after a miscarriage however does not appear to alter risk and women are advised to attempt pregnancy in this situation whenever they are ready.

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 the United States 82% of pregnancies in those between 15 and 19 are unplanned. Comprehensive sex education and access to birth control are effective in decreasing pregnancy rates in this age group.

Providing emergency contraceptive pills to women in advance does not affect rates of sexually transmitted infections, condom use, pregnancy rates, or sexual risk-taking behavior. All methods have minimal side effects.

The birth control movement developed during the 19th and early 20th centuries. The Malthusian League, based on the ideas of Thomas Malthus, was established in 1877 in the United Kingdom to educate the public about the importance of family planning and to advocate for getting rid of penalties for promoting birth control. It was founded during the "Knowlton trial" of Annie Besant and Charles, who were prosecuted for publishing on various methods of birth control.

In the United States, Margaret Sanger and Otto Bobsein popularized the phrase "birth control" in 1914. Sanger was mainly active in the United States but had gained an international reputation by the 1930s. At the time, under the Comstock Law, distribution of birth control information was illegal. She jumped bail in 1914 after her arrest for distributing birth control information and left the United States for the United Kingdom to return in 1915. Sanger established a short-lived birth-control clinic in 1916, which was shut down after eleven days and resulted in her arrest. The publicity surrounding the arrest, trial, and appeal sparked birth control activism across the United States.

The first permanent birth-control clinic was established in Britain in 1921 by Marie working with the Malthusian League. The clinic, run by midwives and supported by visiting doctors, offered women's birth-control advice and taught them the use of a cervical cap. Her clinic made contraception acceptable during the 1920s by presenting it in scientific terms. In 1924 the Society for the Provision of Birth Control Clinics was founded to campaign for municipal clinics; this led to the opening of a second clinic in Greengate, Salford in 1926. Throughout the 1920s, Stopes and other feminist pioneers, including Dora Russell and Stella Browne, played a major role in breaking down taboos about sex. In April 1930 the Birth Control Conference assembled 700 delegates and was successful in bringing birth control and abortion into the political sphere - three months later, the Ministry of Health, in the United Kingdom, allowed local authorities to give birth-control advice in welfare centres.

Though some groups advocate total sexual abstinence, by which they mean the avoidance of all sexual activity, in the context of birth control the term usually means abstinence from vaginal intercourse. Abstinence is 100% effective in preventing pregnancy; however, not everyone who intends to be abstinent refrains from all sexual activity, and in many populations there is a significant risk of pregnancy from nonconsensual sex.

Abstinence-only sex education does not reduce teenage pregnancy. Teen pregnancy rates are higher in students given abstinence-only education, as compared with comprehensive sex education. Some authorities recommend that those using abstinence as a primary method have backup method(s) available (such as condoms or emergency contraceptive pills). Deliberate non-penetrative sex without vaginal sex or deliberate oral sex without vaginal sex are also sometimes considered birth control. While this generally avoids pregnancy, pregnancy can still occur with intercrural sexand other forms of penis-near-vagina sex (genital rubbing, and the penis exiting from anal intercourse) where sperm can be deposited near the entrance to the vagina and can travel along the vagina's lubricating fluids. 

Sterilization :

Surgical sterilization is available in the form of tubal ligation for women and vasectomy for men . There are no significant long-term side effects, and 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 a week or two.  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.

Although sterilization is considered a permanent procedure, it is possible to attempt a tubal reversal to reconnect the fallopian tubes or a vasectomy reversal to reconnect the vasa deferentia. In women the desire for a reversal is often associated with a change in spouse. Pregnancy success rates after tubal reversal are between 31 and 88 percent, with complications including an increased risk of ectopic pregnancy. The number of males who request reversal is between 2 and 6 percent. Rates of success in fathering another child after reversal are between 38 and 84 percent; with success being lower the longer the time period between the original procedure and the reversal. Sperm extraction followed by in vitro fertilization may also be an option in men.This decision may cause regret in some men and women. Of women aged over 30 who have undergone tubal ligation, about 5% regret their decision, as compared with 20% of women aged under 30. By contrast, less than 5% of men are likely to regret sterilization. Men more likely to regret sterilization are younger, have young or no children, or have an unstable marriage. In a survey of biological parents, 9% stated they would not have had children if they were able to do it over again.

1. the process of rendering an individual incapable of sexual reproduction, by castration,vasectomy, salpingectomy, or some other procedure. Endoscopic techniques for female sterilization that can be performed outside of a hospital without general anesthesia includeculdoscopic, hysteroscopic, and laparoscopic sterilization .

2. the process of destroying all microorganisms and their pathogenic products. It can beaccomplished by any of various methods, including heat (usually wet steam under pressure at121°C for 15 minutes), gas plasma, irradiation, or a bactericidal chemical compound such asethylene oxide, peracetic acid, or aqueous glutaraldehyde. The probability that a given processhas made something sterile is known as its sterility 

In sterilizing objects or substances, the high resistance of bacterial spore cells must be takeninto account. Most dangerous bacteria are destroyed at a temperature of 50° to 60°C, so thatpasteurization of fluid, which is the application of heat at about 60°C, destroys disease-causingbacteria. However, temperatures almost twice as high are usually required to destroy the sporecells.

The discovery that heat, in the form of flame, steam, or hot water, kills bacteria made possiblethe advances of modern surgery, which is based on freedom from microorganisms, or asepsis,and prevention of contamination. Sterilization of all equipment used during operations and otherprocedures, and of anything that in any way may touch an operative field, is carried outscrupulously. Health care providers all wear sterile clothing. Instruments are sterilized by boiling,by chemical antiseptics, or by use of an autoclave.

culdoscopic sterilization use of an endoscope to visualize the fallopian tubes and ovaries forthe purpose of preventing conception. The endoscope is inserted through an incision in theposterovaginal cervix. After the fallopian tubes are located, each tube is drawn out through thevaginal incision and severed. The major advantage of this procedure is that it can be done on anoutpatient basis. A disadvantage is the complication of infection, a very real possibility owing tothe unsterile nature of the vagina.

Gamma sterilization uses the radioisotope cobalt 60 as the energy source to sterilize somemedical supply products. It has the advantages of penetrating all types of packaging, decreasingquarantine time, requiring fewer personnel, and allowing for bulk processing.

flash sterilization sterilization of unwrapped equipment at 132°C for three to ten minutes usingsteam.

gas sterilization sterilization by means of a bactericidal gas, frequently used for items that areheat and moisture sensitive. Ethylene oxide is the gas most often used; it is highly explosiveand flammable in the presence of air, but these hazards are reduced by diluting it with carbondioxide or fluorinated hydrocarbons. Gas sterilization is a chemical process resulting fromreaction of chemical groups in the bacterial cell with the gas. Factors influencing gas sterilizationinclude time of exposure, gas concentration, penetration of the gas, and temperature andhumidity in the sterilizing chamber. Automatically controlled ethylene oxide sterilizers areusually heated to a temperature of 54°C (130°F). A humidity level of 35 to 70 per cent isrecommended.

terminal sterilization the final sterilization of instruments and equipment following use, therebyrendering them safe for handling.

hysteroscopic sterilization use of an endoscopic instrument to visualize the interior of theuterus and fallopian tubes for the purpose of preventing conception. The hysteroscope is insertedthrough the dilated cervix and on through the uterine cavity to the point at which each tube joinsthe uterus. A cautery is then used to electrocoagulate each tube. Occlusion of the tubes isaccomplished by scar tissue that forms at the sites of cauterization.

laparoscopic sterilization that which employs an endoscope to visualize the fallopian tubesand surrounding structures for the purpose of occluding the tubes. The instrument is guided intothe abdominal cavity through a small puncture made by a trocar inserted immediately below theumbilicus. A second small puncture is made in the lower abdomen through which cauteryforceps are inserted. The forceps are applied approximately 2 cm from the point at which each ofthe tubes joins the uterus.