Many villages in Africa do not have accurate sexual education available for their people. [ 26 ]  There are many misconceptions about contraception that include things such as; IUD's can enter your heart and cause death or that contraception will cause permanent infertility. [ 26 ]  Sometimes, these rumors stem from individuals' general distrust of the government. [ 26 ]  There are often negative social stigmas that are attached to the use or implantation of contraceptive devices which further discourages individuals from using them. [ 26 ]  Men are also discouraged from supporting contraceptive use as many believe that it will encourage their wives to be unfaithful. [ 26 ]


According to a study done in Sub-Saharan Africa, "about 13% of pregnancies end up in abortions and 97% of these are unsafe" (Bain, 2021). [ 25 ]  Many of these pregnancies occur in adolescent women, a time in their lives when childbearing has more complications, higher maternal mortality rates, and miscarriage. [ 28 ]


Although Europe is relatively receptive of contraception use, some countries in Europe differ on contraceptive accessibility, education, and usage. [ 29 ]  A study conducted by the International Health Foundation polled 6630 women from European countries including Germany, Poland, Denmark, and Italy which had shown that there was a relatively variable use of contraception from country to country. [ 29 ]  When reviewing what types of contraception were most common in each country, it was shown that IUDs (intrauterine devices) and oral contraceptives were most commonly used in Denmark, Germany, and Northern Italy. [ 29 ]  Poland more commonly adopts more traditional contraceptive techniques such as periodic abstinence and withdraw. [ 29 ]  Individuals also reported that voluntary sterilization (for both males and females) was most common among Germany, Spain, and Denmark. [ 29 ]


Another study done about natural family planning showed that only about 47% of married couples have used some for of contraception in Western Europe. [ 30 ]  Some barriers to access to contraceptives include inadequate sexuality education, nonoptimal family planning resources, and high cost as not all Western European countries cover contraceptives under their health insurance plans. [ 31 ]  Each country in Europe addresses accessibility to contraceptives differently. [ 32 ]


In Germany, various laws including the 1968 United Nations International Conference of Human Rights has made many things such as family planning services and access to contraception a human right. [ 33 ]  Germany requires a prescription for many of their contraceptives including IUD's and birth control. [ 34 ]  They have mandatory health insurance for woman under the age of 18, and these contraceptives are typically covered by that insurance (they typically only need to pay a 10% copay). [ 34 ]  In Romania, citizens are able to obtain contraceptives for free and citizens are required to contribute to a healthcare fund. [ 34 ]  This healthcare fund allows individuals access to things like family planning consultations, subsidized contraceptives, as well as social benefits. [ 34 ]  Although this healthcare fund is in place, a study has shown that accessibility to these services is increasingly difficult as they are not widely advertised and will not often be offered unless first requested. [ 35 ]  In Spain, condoms are widely available free of charge, and emergency contraception is required to be dispensed by law without a prescription or age limitations. [ 34 ]  In the UK, individuals are able to receive hormonal contraception for free if they have a prescription. [ 34 ]  Their goal is to reduce unplanned pregnancies, decrease abortion rates, and lower STD transmission. [ 34 ]  For most European countries, contraception seems to be mostly widely available and quite accessible to the typical individual. [ 34 ]


In Asian countries, such as  Pakistan , there are other factors that can influence one's openness to contraceptives, including social constraints and familial restraints. [ 36 ]  Pakistan follows a conservative cultural approach to family planning and views each child as a gift. [ 36 ]  This belief and society has made many families reluctant to use contraceptives. [ 36 ]  The decision to start using contraceptives depends on both partners and both sets of in-laws, which tends to be the greatest barrier for those intending on family planning. [ 36 ]


In a study conducted in the Philippines, it was found that the country complied with four of nine World Health Organization recommendations on family planning. Among the five recommendations that were not met were accessibility, availability, and informed-consent—all three of which may restrict contraceptive security. [ 37 ]  In the case of the Philippines, the availability recommendations were unmet due to the law that prohibits the use of emergency contraception in any government hospitals. [ 37 ]  Regarding accessibility, the reproductive health laws outline ways to provide contraceptives to those with lower-incomes; however, the main constraint that remains is that parental consent is required in the case of an adolescent requesting contraceptives. [ 37 ]


One motive to improve contraceptive accessibility in some countries is population control. In China, all forms of contraceptives are free in urban areas. [ 38 ]  China is currently working on improving woman's reproductive, maternal, newborn, child, and adolescent health (RMNCAH). [ 39 ]  In regards to contraceptive security, this movement includes utilizing contraceptives to appropriately space second pregnancies between 18 and 59 months after childbirth. [ 39 ]  This spacing of intervals is supported by an international study that found that more adverse events occurred during the perinatal period. [ 40 ]  These efforts are working toward improving reproductive and newborn health through the use of contraceptives. [ 39 ]


Decrement tables , also called  life table methods , are used to calculate the probability of certain events.


Life table  methods are often used to study birth control effectiveness.  In this role, they are an alternative to the  Pearl Index .


As used in birth control studies, a decrement table calculates a separate effectiveness rate for each month of the study, as well as for a standard period of time (usually 12 months). Use of life table methods eliminates time-related biases (i.e. the most fertile couples getting pregnant and dropping out of the study early, and couples becoming more skilled at using the method as time goes on), and in this way is superior to the Pearl Index.


Two kinds of decrement tables are used to evaluate birth control methods. Multiple-decrement (or competing) tables report net effectiveness rates.  These are useful for comparing competing reasons for couples dropping out of a study. Single-decrement (or noncompeting) tables report gross effectiveness rates, which can be used to accurately compare one study to another. [ 1 ]


The history of  birth control , also known as contraception and fertility control, refers to the methods or devices that have been historically used to prevent  pregnancy . [ 1 ]  Planning and provision of birth control is called  family planning . [ 2 ]  In some times and cultures,  abortion  had none of the stigma which it has today, making birth control less important. [ 3 ] [ 4 ]


Birth control and abortion are well documented in  Ancient Egypt . The  Ebers Papyrus  from 1550 BC and the  Kahun Papyrus  from 1850 BC have within them some of the earliest documented descriptions of birth control, the use of honey,  acacia  leaves and lint to be placed in the vagina to block sperm. [ 5 ] [ 6 ]  Another early document explicitly referring to birth control methods is the  Kahun Gynecological Papyrus  from about 1850 BC. It describes various contraceptive  pessaries , including  acacia gum , which recent research has confirmed to have  spermatocidal  qualities and is still used in contraceptive jellies. Other birth control methods mentioned in the papyrus include the application of gummy substances to cover the "mouth of the womb" (i.e. the  cervix ), a mixture of honey and  sodium carbonate  applied to the inside of the  vagina , and a pessary made from crocodile dung.  Lactation  (breast-feeding) of up to three years was also used for birth control purposes in ancient Egypt. [ 6 ]


The  Book of Genesis  references withdrawal, or  coitus interruptus , as a method of contraception when  Onan  "spills his seed" (ejaculates) on the ground so as to not father a child with his  deceased brother's wife   Tamar . [ 5 ]


Silphium , a species of  giant fennel  native to north Africa, may have been used as an oral contraceptive in  ancient Greece  and the  ancient Near East . [ 7 ] [ 8 ]  The plant only grew on a small strip of land near the coastal city of  Cyrene  (located in modern-day  Libya ) [ 7 ] [ 8 ]  and all attempts to cultivate it elsewhere resulted in failure. [ 7 ] [ 8 ]  Silphium was primarily used for culinary purposes and its use as a contraceptive is far less documented than its use as a seasoning. [ 8 ]  Accounts of silphium's contraceptive effectiveness are probably greatly exaggerated. [ 8 ]  Possibly due to its supposed effectiveness and thus desirability, by the first century AD, it had become so rare that it was worth more than its weight in silver and, by late antiquity, it was fully extinct. [ 7 ]   Asafoetida , a close relative of siliphion, was also used for its contraceptive properties. Other plants commonly used for birth control in ancient Greece include Queen Anne's lace ( Daucus carota ),  willow ,  date palm ,  pomegranate ,  pennyroyal ,  artemisia ,  myrrh , and  rue . Some of these plants are toxic and ancient Greek documents specify safe dosages. Recent studies have confirmed the birth control properties of many of these plants, confirming for example that Queen Anne's lace has post coital anti-fertility properties. Queen Anne's lace is still used today for birth control in  India . [ 6 ]


According to  Norman E. Himes , most methods of birth control used in antiquity were probably ineffective. [ 9 ]  The single most effective method of birth control known in antiquity was probably  coitus interruptus . [ 9 ]  The  ancient Greek  philosopher  Aristotle  ( c.  384–322 BC) recommended applying  cedar oil  to the womb before intercourse. [ 9 ]  Aristotle had no knowledge of how conception worked and he probably recommended this believing that the oil's smoothness would prevent conception. [ 9 ]  In actuality, this method may have sometimes been effective because the oil may have gummed up the  external os  and thereby reduced the motility of the sperm, [ 9 ]  but effectiveness would have been only occasional and highly variable. [ 9 ]  A  Hippocratic  text  On the Nature of Women  recommended that a woman who did not desire to conceive a child should drink a copper  salt  dissolved in water, which it claimed would prevent pregnancy for a year. [ 9 ]  This method is not only ineffective, but also dangerous, as the later medical writer  Soranus of Ephesus  ( c.  98–138 AD) pointed out. [ 9 ]  Soranus attempted to list reliable methods of birth control. [ 9 ]  He took a rational approach to this, rejecting the use of superstition and amulets and instead prescribing common-sense mechanical methods such as vaginal plugs and pessaries using wool as a base covered in oils or other gummy substances. [ 9 ]  According to Himes, many of Soranus's methods were probably also ineffective. [ 9 ]


In the 7th century BC, the Chinese physician Master Tung-hsuan documented both  coitus reservatus  and coitus obstructus, which prevents the release of  semen  during intercourse. However, it is not known if these methods were used primarily as birth control methods or to preserve the man's  yang . In the medieval Tang Dynasty,  Sun Simiao  documented the "thousand of gold contraceptive prescription" for women who no longer want to bear children. This prescription, which was supposed to induce sterility, was made of oil and quicksilver heated together for one day and taken orally. [ 10 ]


In India, Vatsyayana's classical text (2nd century AD) presented various contraceptive methods including coitus obstructus involving controlling the release of semen.


Many native plants were utilized and have thus been ingrained into Native American tradition as contraceptives.The  Hopi  and  Tewa  tribes are documented to have used the Indian paintbrush ( Castilleja linariifolia ) as a type of contraceptive. Many forms of the  Lithospermum  genus have been historically used by the  Navajo  and  Shoshoni  tribes. The bitter cherry plant ( Prunus emarginata ), corn lily ( Veratrum californicum ), and star-flowered lily-of-the-valley ( Maianthemum stellatum ) were used by a variety of different tribes as a form of contraceptive or sterility inducer. [ 11 ]


Cinnamon  has been used in ancient traditional Mexican medicine as an abortifacient and contraceptive. [ 12 ]   Nahua  women used parts of the plants in the  Bignonia  and  Hameilia  genera and those of the shaving brush tree ( Pseudobombax ellipticum ) in their medical practices as well. [ 13 ]


In the late 9th to early 10th century, the Persian physician  Muhammad ibn Zakariya al-Razi  documented  coitus interruptus , preventing ejaculation and the use of pessaries to block the  cervix  as birth control methods. He described a number of pessaries, including elephant dung,  cabbages  and  pitch , used alone or in combination. [ 14 ]  During the same period  Ali ibn Abbas al-Majusi (Persian)  documented the use of pessaries made of rock salt for women for whom  pregnancy  may be dangerous. In the early 10th century the Persian Polymath  Abu Ali al-Hussain ibn Abdallah ibn Sina (Persian) , known in Europe as Avicenna, included a chapter on birth control in his medical encyclopedia  The Canon of Medicine , listing 20 different methods of preventing conception. [ 10 ]  One such method of preventing contraception listed is otherwise identical to the ancient Egyptian method found in the  Papyrus Kahun  written 1,000 years earlier. However, it substitutes the ingredient of crocodile dug for that of elephant dug as he believed it to be of greater effectiveness. [ 15 ]


Indians used a variety of birth control methods since ancient times, including a potion made of powdered  palm leaf  and  red chalk , as well as pessaries made of  honey ,  ghee ,  rock salt  or the seeds of the palasa tree. A variety of birth control prescriptions, mainly made up of herbs and other plants, are listed in the 12th century  Ratirahasya  ("Secrets of Love") and in the 15th century  Ananga Ranga  ("The Stage of the God of Love"). [ 10 ]


In medieval western Europe, any efforts to halt or prevent pregnancy were deemed immoral by the  Catholic Church . [ 5 ]  Women of the time still used a number of birth control measures such as coitus interruptus, inserting lily root and rue into the vagina, and  infanticide  after birth. [ 16 ]


Historian  John M. Riddle  has advanced the hypothesis that women in classical antiquity, the  Middle Ages , and the  Early Modern period  used herbs to control fertility. [ 17 ] [ 18 ]  Historian Etienne van de Walle has quoted Riddle as stating that "most women" in the Middle Ages knew that certain herbs and herbal products could be taken to induce an abortion in the early stages of pregnancy and that this knowledge was primarily shared amongst women, thus affording them "more control over their lives than we thought possible". [ 19 ] [ 20 ]   Riddle has further hypothesized that "these drugs were perfected over centuries in a female culture of which males—who were doing the writing—had only a partial and imperfect understanding" [ 20 ]  and it is this shared  folk wisdom  amongst women that explains the relatively static population size in the West before the 18th century, rather than the high rate of  infant mortality . [ 18 ]   Several historians have taken issue with this hypothesis: Gary Ferngren has noted the circumstantial nature of Riddle's evidence and concluded that the ideas remained "unproved and unlikely," [ 21 ]  while  Helen King  has written that Riddle makes claims about modern  pharmacology  that are not supported by his source materials. [ 22 ]  Demographer Gigi Santow also takes issue with the proposition, writing that it overemphasizes the role of herbs and stating that Riddle seeks "not so much to persuade as to convert." [ 23 ]


On December 5, 1484, Pope  Innocent VIII  issued the  Summis desiderantes affectibus , a  papal bull  in which he recognized the existence of witches and gave full papal approval for the  Inquisition  to proceed "correcting, imprisoning, punishing and chastising" witches "according to their deserts". In the bull, which is sometimes referred to as the "Witch-Bull of 1484", the witches were explicitly accused of having "slain infants yet in the mother's womb" (abortion) and of "hindering men from performing the sexual act and women from conceiving" (contraception). [ 24 ]  Famous texts that served to guide the witch hunt and instruct magistrates on how to find and convict so-called "witches" include the  Malleus Maleficarum , and  Jean Bodin 's  De la Demonomanie des Sorciers . [ 25 ]  The  Malleus Maleficarum  was written by the priest  J. Sprenger  (born in  Rheinfelden , today Switzerland), who was appointed by Pope Innocent VIII as the General Inquisitor for Germany around 1475, and  H. Institoris , who at the time was inquisitor for  Tyrol ,  Salzburg ,  Bohemia  and  Moravia . The authors accused witches, among other things, of  infanticide  and having the power to steal men's penises. [ 26 ]


Barrier methods such as the  condom  have been around much longer, but were seen primarily as a means of preventing  sexually transmitted diseases , not pregnancy.  Casanova  in the 18th century was one of the first reported using "assurance caps" to prevent impregnating his mistresses. [ 27 ] [ 28 ] [ 29 ]  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. [ 30 ]


Birth control became a contested political issue in Britain during the 19th century.
 Thomas Malthus , an  Anglican  clergyman, statistician, and economist, argued in  An Essay on the Principle of Population  (1798) that population growth generally expanded exponentially in times and in regions of plenty until the size of the population quickly outstripped resources of subsistence. According to him, there were two types of checks that served to hold population within resource limits:  positive  checks, which raise the death rate; and  preventive  ones, which lower the birth rate. The positive checks include hunger, disease and war; the preventive checks, abortion, birth control, prostitution, postponement of marriage and celibacy. [ 31 ]  As a clergyman Malthus condemned birth control as "morally indefensible along with infanticide, abortion, and adultery." [ 32 ]
Malthus later elaborated his contention that human misery ( e.g. , hunger, disease, and war) was the principal limitation on population growth and would inevitably afflict society along with volatile boom-and-bust economic cycles. He suggested that paradoxically, efforts to alleviate poverty, such as workhouses, were futile and misguided since they would ultimately only result in subsequent growth in population. Instead Malthus recommended the preventive checks of sexual continence (chastity) and later marriages, which would produce both higher standards of living and greater economic stability without violating Christian morality. [ 33 ]


Malthus's ideas came to carry great weight in British political debate in the 19th century, and they heavily influenced the movement toward the adoption of  laissez-faire   liberal   capitalism .  Malthusians  were in favour of limiting population growth and began actively promoting birth control through a variety of groups. The term 'voluntary motherhood' was coined by  feminists  in the 1870s as a political critique of "involuntary motherhood" and as expressing a desire for women's emancipation. [ 34 ] [ 35 ]  Advocates for voluntary motherhood disapproved of contraception, arguing that women should only engage in sex for the purpose of  procreation  and advocated periodic or permanent  abstinence . [ 36 ]


In contrast, the birth control movement advocated for contraception so as to permit  sexual intercourse  as desired without the risk of  pregnancy . [ 37 ]  By emphasising "control", the birth control movement argued that women should have control over their reproduction - the movement was closely tied to the emerging  feminist  movement. The  Malthusian League  was established in 1877 and promoted the education of the public about the importance of  family planning  and advocated for the elimination of penalties against the promoters of birth control. [ 38 ]  It was initially founded during the "Knowlton trial" of  Annie Besant  and  Charles Bradlaugh  in July 1877. [ 39 ]  They were prosecuted for publishing  Charles Knowlton 's  Fruits of Philosophy  which explained various methods of birth control. [ 40 ]  Besant and Bradlaugh wrote that it was "...more moral to prevent the conception of children, than, after they are born, to murder them by want of food, air and clothing." [ 41 ]  The trial of Bradlaugh and Besant  counter-productively  triggered a wave of public interest in contraception, and book sales of Knowlton's book surged. [ 42 ]


Starting in the 1880s, birth rates began to drop steadily in the industrialized countries, as women married later and families in urban living conditions increasingly favoured having fewer children. This trend was particularly acute in the United Kingdom, where birth rates declined from almost 35.5 births per 1,000 in the 1870s to about 29 per 1,000 by 1900. While the cause is uncertain, the 29% decline within a generation shows that the birth control methods  Victorian women  used were effective. Many women were educated about contraception and how to avoid pregnancy. While the rhythm method was not yet understood, condoms and diaphragms made of  vulcanized rubber  were reliable and inexpensive. [ 43 ]


In the United States, contraception had been legal throughout most of the 19th century, but in the 1870s the  Comstock Act  and various state  Comstock laws  outlawed the distribution of information about  safe sex  and contraception and the use of contraceptives.


Margaret Sanger  and Otto Bobsein popularised the phrase "birth control" in 1914. [ 44 ] [ 45 ]  Sanger was mainly active in the United States, but had gained an international reputation by the 1930s. Sanger established a short lived birth control clinic in 1916, [ 46 ]  which was shut down just nine days later. Sanger was arrested for distributing contraceptives, and went on trial. [ 47 ]  Here as well, the publicity surrounding the arrest, trial, and appeal sparked birth control activism across the United States, and earned the support of numerous donors, who would provide her with funding and support for future endeavors. [ 48 ]  She went on to found the  first birth control league in America  in 1921.


The first permanent birth control clinic was established in Britain in 1921 by the birth control campaigner  Marie Stopes , in collaboration with the  Malthusian League . Stopes, who exchanged ideas with Sanger, [ 49 ]  wrote her book  Married Love  on birth control in 1918; - it was eventually published privately due to its controversial nature. [ 50 ]  The book was an instant success, requiring five editions in the first year  [ 51 ]  and elevating Stopes to a national figure. Its success was followed up with  Wise Parenthood: a Book for Married People , a manual on birth control, published later that year. [ 52 ]  She originally tried to publicize her message through the dissemination of pamphlets in the  slums  of  East London , but this approach failed to work, as the working class was too mistrustful of well-intentioned meddlers at the time. [ 53 ]


In 1921, after years of planning, Stopes and her husband  Humphrey Verdon Roe  opened the Mothers' Clinic in  Holloway ,  North London . [ 54 ]  The clinic, run by midwives and supported by visiting doctors, [ 55 ]  offered mothers birth control advice and taught them the use of a  cervical cap . Later in the same year, Stopes founded the  Society for Constructive Birth Control and Racial Progress , a support organization for the clinic. Her clinic made contraception acceptable during the 1920s by framing it in scientific terms and gained an international reputation. The Malthusian League opened up a second clinic shortly afterward, but admitted that Stopes clinic had been the first in the  British Empire , although the League emphasised that theirs was the first scientific clinic where birth control instruction was given under medical supervision (the medical officer was  Norman Haire ). [ 56 ]  These two clinics 'opened up a new period in the history of the movement aimed at the emancipation of women from their slavery to the reproductive function'. [ 57 ]  Although the clinic helped few patients in 1921 'the year was one of the most important in the whole history of birth control simply because of their very existence'. [ 58 ]


Throughout the 1920s, Stopes and other  feminist  pioneers, including  Dora Russell  and  Stella Browne , played a major role in breaking down  taboos  about sex and increasing knowledge, pleasure and improved reproductive health. Stopes was particularly influential in helping emerging birth control movements in a number of  British colonies  like India. [ 59 ]  In 1930 the National Birth Control Council was formed. Stella Browne's initial activism was limited to giving speaking tour across the country, providing information on birth control, women's health problems, problems related to puberty and sex education. [ 60 ] [ 61 ]  In 1929 began to openly call for the legalization of  abortion , during her lecture in front of the  World Sexual Reform Congress  in London. [ 62 ]  In April 1930 the Birth Control Conference assembled 700 delegates and was successful in bringing birth control and abortion into the political sphere - [ 63 ]  three months later,  HM Ministry of Health  allowed local authorities to give birth control advice in welfare centres.


In India, Mathematics Professor  Raghunath Dhondo Karve , elder son of  Maharshi Dhondo Keshav Karve , opened India's First Birth Control Clinic in 1921 in Mumbai (Bombay Presidency of British India), he also published a  Marathi  monthly magazine Samaj Swasthya (समाजस्वास्थ्य) starting from July 1927 until 1953.


The societal acceptance of birth control required the separation of sexual activity from procreation, making birth control a highly controversial subject in some countries at some points in the 20th century. [ 64 ]  Birth control also became a major theme in  feminist  politics; reproduction issues were cited as examples of women's powerlessness to exercise their rights. [ 65 ]  Starting in the 1930s and intensifying in the '60s and '70s, the birth control movement advocated for the legalisation of abortion and large scale education campaigns about contraception by governments. [ 64 ]  In a broader context birth control became an arena for conflict between  liberal  and  conservative values , raising questions about  family ,  personal freedom ,  state intervention , religion in politics,  sexual morality  and  social welfare . [ 65 ]


Gregory Pincus  and  John Rock , with help from the  Planned Parenthood Federation of America , developed the first birth control pills in the 1950s, which became publicly available in the 1960s. [ 66 ]


Medical abortion  became an alternative to surgical abortion with the availability of  prostaglandin analogs  in the 1970s and the availability of  mifepristone  in the 1980s. [ 67 ]


In 1965, the  Supreme Court of the United States  ruled in the case  Griswold v. Connecticut  that a  Connecticut  law prohibiting the use of contraceptives violated the constitutional "right to marital privacy". In 1972, the case  Eisenstadt v. Baird  expanded the right to possess and use contraceptives to unmarried couples.


In France, the  1920  Birth Law contained a clause that criminalized dissemination of birth-control literature. [ 68 ]  That law, however, was annulled in 1967 by the  Neuwirth Law , thus authorizing contraception, which was followed in 1975 with the  Veil Law . Women fought for reproductive rights and they helped end the nation's ban on birth control in 1965. [ 69 ]  In 1994, 5% of French women aged 20 to 49 who were at risk of unintended pregnancy did not use contraception. [ 70 ]


The availability of  contraception in the Republic of Ireland  was illegal in the  Irish Free State  (later the  Republic of Ireland ) from 1935 until 1980, when it was legalised with strong restrictions, later loosened. This reflected  Catholic teachings on sexual morality . In Italy women gained the right to access birth control information in 1970. [ 69 ]


In the  Soviet Union  birth control was made readily available to facilitate social equality between men and women.  Alexandra Kollontai , USSR commissar for public welfare, promoted birth control education for adults. In  Eastern Europe  and  Russia , natality fell abruptly after the  dissolution of the Soviet Union . [ 71 ]


A well-studied example of governmental restriction of birth control in order to promote higher birth rates is from 1998  Ceaușescu-era Romania . [ 72 ] [ 73 ]  The surge in births resulting from  Decree 770  led to great hardships for children and parents, matched by an increase in illegal abortions.


Although the scientific investigation of  male birth control  began in the 1930s, it was not until the 21 st century that the topic garnered increasing attention.


Human population planning  is the practice of managing the  growth rate of a human population . The practice, traditionally referred to as  population control , had historically been implemented mainly with the goal of increasing population growth, though from the 1950s to the 1980s, concerns about  overpopulation  and its effects on  poverty ,  the environment  and  political stability  led to efforts to reduce  population growth  rates in many countries. More recently, however, several countries such as  China ,  Japan , [ 1 ] [ 2 ]   South Korea , [ 3 ]   Russia , [ 4 ]   Iran ,  Italy , [ 4 ]   Spain ,  Finland , [ 5 ]   Hungary [ 6 ]  and  Estonia [ 7 ] [ 8 ]  have begun efforts to boost birth rates once again, generally as a response to looming demographic crises.


While population planning can involve measures that improve people's lives by giving them greater control of their  reproduction , a few programs, such as the Chinese government's " one-child policy  and  two-child policy ", have employed coercive measures.


Three types of population planning policies pursued by governments can be identified:


A number of ancient writers have reflected on the issue of population. At about 300 BC, the Indian  political philosopher   Chanakya  (c. 350-283 BC) considered population a source of political, economic, and military strength. Though a given region can house too many or too few people, he considered the latter possibility to be the greater evil. Chanakya favored the remarriage of  widows  (which at the time was forbidden in India), opposed taxes encouraging emigration, and believed in restricting  asceticism  to the aged. [ 9 ]


In  ancient Greece ,  Plato  (427-347 BC) and  Aristotle  (384-322 BC) discussed the best population size for Greek  city-states  such as  Sparta , and concluded that cities should be small enough for efficient administration and direct citizen participation in public affairs, but at the same time needed to be large enough to defend themselves against hostile neighbors. In order to maintain a desired population size, the philosophers advised that  procreation , and if necessary, immigration, should be encouraged if the population size was too small. Emigration to colonies would be encouraged should the population become too large. [ 10 ]  Aristotle concluded that a large increase in population would bring, "certain poverty on the citizenry and poverty is the cause of sedition and evil." To halt rapid population increase, Aristotle advocated the use of  abortion  and the exposure of newborns (that is,  infanticide ). [ 11 ]


Confucius  (551-478 BC) and other Chinese writers cautioned that, "excessive growth may reduce output per worker, repress levels of living for the masses and engender strife." Some Chinese writers may also have observed that "mortality increases when food supply is insufficient; that premature marriage makes for high infantile mortality rates, that war checks population growth." [ 10 ]  It is particularly noteworthy that Han Fei (281-233 BC), long before Malthus, had already noted the conflict between a population growing at the exponential rate and a food supply growing at the arithmetic rate.  [ 12 ]  Not only did he conclude that overpopulation was the root cause of the intensification of political and social conflict, but he also reduced traditional morality to an evolutionary product of material surplus rather than having any objective value. Nevertheless, during the Han Dynasty, the emperors enacted a large number of laws to encourage early marriage and childbirth.


Ancient Rome , especially in the time of  Augustus  (63 BC-AD 14), needed manpower to acquire and administer the vast  Roman Empire . A series of laws were instituted to encourage early marriage and frequent childbirth. Lex Julia (18 BC) and the Lex Papia Poppaea (AD 9) are two well-known examples of such laws, which among others, provided tax breaks and preferential treatment when applying for public office for those who complied with the laws. Severe limitations were imposed on those who did not. For example, the surviving spouse of a childless couple could only inherit one-tenth of the deceased fortune, while the rest was taken by the state. These laws encountered resistance from the population which led to the disregard of their provisions and to their eventual abolition. [ 9 ]


Tertullian , an early Christian author (ca. AD 160-220), was one of the first to describe famine and war as factors that can prevent overpopulation. [ 9 ]  He wrote: "The strongest witness is the vast population of the earth to which we are a burden and she scarcely can provide for our needs; as our demands grow greater, our complaints against Nature's inadequacy are heard by all. The scourges of pestilence, famine, wars, and  earthquakes  have come to be regarded as a blessing to overcrowded nations since they serve to prune away the luxuriant growth of the human race." [ 13 ]


Ibn Khaldun , a North African  polymath  (1332–1406), considered population changes to be connected to economic development, linking high birth rates and low death rates to times of economic upswing, and low birth rates and high death rates to economic downswing. Khaldoun concluded that high  population density  rather than high absolute population numbers were desirable to achieve more efficient division of labour and cheap administration. [ 13 ]


During the  Middle Ages  in Christian Europe, population issues were rarely discussed in isolation. Attitudes were generally pro- natalist  in line with the  Biblical  command, "Be ye fruitful and multiply." [ 13 ]


When Russian explorer  Otto von Kotzebue  visited the  Marshall Islands  in Micronesia in 1817, he noted that Marshallese families practiced  infanticide  after the birth of a third child as a form of population planning due to frequent  famines . [ 14 ]


European cities grew more rapidly than before, and throughout the 16th century and early 17th century discussions on the advantages and disadvantages of population growth were frequent. [ 15 ]   Niccolò Machiavelli , an Italian  Renaissance   political philosopher , wrote, "When every province of the world so teems with inhabitants that they can neither subsist where they are nor remove themselves elsewhere... the world will purge itself in one or another of these three ways," listing  floods ,  plague  and  famine . [ 16 ]   Martin Luther  concluded, "God makes children. He is also going to feed them." [ 16 ]


Jean Bodin , a French  jurist  and  political philosopher  (1530–1596), argued that larger populations meant more production and more exports, increasing the wealth of a country. [ 16 ]   Giovanni Botero , an Italian priest and diplomat (1540–1617), emphasized that, "the greatness of a city rests on the multitude of its inhabitants and their power," but pointed out that a population cannot increase beyond its food supply. If this limit was approached, late marriage, emigration, and the war would serve to restore the balance. [ 16 ]


Richard Hakluyt , an English writer (1527–1616), observed that, "Through our longe peace and seldom sickness... we are grown more populous than ever heretofore;... many thousands of idle persons are within this realme, which, having no way to be sett on work, be either mutinous and seek alteration in the state, or at least very burdensome to the commonwealth." Hakluyt believed that this led to crime and full jails and in  A Discourse on Western Planting  (1584), Hakluyt advocated for the emigration of the surplus population. [ 15 ]  With the onset of the  Thirty Years' War  (1618–48), characterized by widespread devastation and deaths brought on by hunger and disease in Europe, concerns about depopulation returned. [ 17 ]


In the 20th century, population planning proponents have drawn from the insights of  Thomas Malthus , a British clergyman and economist who published  An Essay on the Principle of Population  in 1798. Malthus argued that, "Population, when unchecked, increases in a  geometrical  ratio.  Subsistence  only increases in an  arithmetical  ratio." He also outlined the idea of "positive checks" and "preventative checks." "Positive checks", such as  diseases ,  wars ,  disasters ,  famines , and  genocides  are factors which Malthus believed could increase the death rate. [ 18 ]
"Preventative checks" were factors which Malthus believed could affect the birth rate such as moral restraint, abstinence and  birth control . [ 18 ]  He predicted that "positive checks" on  exponential population growth  would ultimately save humanity from itself and he also believed that human misery was an "absolute necessary consequence". [ 19 ]  Malthus went on to explain why he believed that this misery affected the poor in a disproportionate manner.


There is a constant effort towards an increase in population which tends to subject the lower classes of society to distress and to prevent any great permanent amelioration of their condition…. The way in which these effects are produced seems to be this. We will suppose the means of subsistence in any country just equal to the easy support of its inhabitants. The constant effort towards population... increases the number of people before the means of subsistence are increased. The food, therefore which before supplied seven million must now be divided among seven million and a half or eight million. The poor consequently must live much worse, and many of them are reduced to severe distress. [ 20 ]


Finally, Malthus advocated for the education of the lower class about the use of "moral restraint" or voluntary abstinence, which he believed would slow the growth rate. [ 21 ]


Paul R. Ehrlich , a US biologist and environmentalist, published  The Population Bomb  in 1968, advocating stringent population planning policies. [ 22 ]  His central argument on population is as follows:


A cancer is an uncontrolled multiplication of cells; the population explosion is an uncontrolled multiplication of people. Treating only the symptoms of cancer may make the victim more comfortable at first, but eventually, he dies - often horribly. A similar fate awaits a world with a population explosion if only the symptoms are treated. We must shift our efforts from the treatment of the symptoms to the cutting out of cancer. The operation will demand many apparently brutal and heartless decisions. The pain may be intense. But the disease is so far advanced that only with radical surgery does the patient have a chance to survive.


In his concluding chapter, Ehrlich offered a partial solution to the "population problem",
"[We need] compulsory birth regulation... [through] the addition of temporary sterilants to water supplies or staple food. Doses of the antidote would be carefully rationed by the government to produce the desired family size". [ 23 ]


Ehrlich's views came to be accepted by many population planning advocates in the United States and Europe in the 1960s and 1970s. [ 24 ]  Since Ehrlich introduced his idea of the "population bomb", overpopulation has been blamed for a variety of issues, including increasing poverty, high unemployment rates,  environmental degradation , famine and genocide. [ 19 ]  In a 2004 interview, Ehrlich reviewed the predictions in his book and found that while the specific dates within his predictions may have been wrong, his predictions about climate change and disease were valid. Ehrlich continued to advocate for population planning and co-authored the book  The Population Explosion , released in 1990 with his wife Anne Ehrlich.


However, it is controversial as to whether human population stabilization will avert environmental risks. A 2014 study published in the  Proceedings of the National Academy of Sciences of the United States of America  found that given the "inexorable demographic momentum of the global human population", even mass mortality events and draconian one-child policies implemented on a global scale would still likely result in a population of 5 to 10 billion by 2100. Therefore, while reduced fertility rates are positive for society and the environment, the short term focus should be on mitigating the  human impact on the environment  through technological and social innovations, along with reducing  overconsumption , with population planning being a long-term goal. [ 25 ] [ 26 ]  A letter in response, published in the same journal, argued that a reduction in population by 1 billion people in 2100 could help reduce the risk of catastrophic climate disruption. [ 27 ]  A 2021 article published in  Sustainability Science  said that sensible population policies could advance social justice (such as by abolishing child marriage, expanding family planning services and reforms that improve education for women and girls) and avoid the abusive and coercive population control schemes of the past while at the same time mitigating the human impact on the climate, biodiversity and ecosystems by slowing fertility rates. [ 28 ]


Paige Whaley Eager argues that the shift in perception that occurred in the 1960s must be understood in the context of the demographic changes that took place at the time. [ 29 ]  It was only in the first decade of the 19th century that the world's population reached one billion. The second billion was added in the 1930s, and the next billion in the 1960s. 90 percent of this net increase occurred in developing countries. [ 29 ]  Eager also argues that, at the time, the  United States  recognised that these demographic changes could significantly affect global geopolitics. Large increases occurred in  China ,  Mexico  and  Nigeria , and demographers warned of a "population explosion", particularly in developing countries from the mid-1950s onwards. [ 30 ]


In the 1980s, tension grew between population planning advocates and women's health activists who advanced women's  reproductive rights  as part of a  human rights -based approach. [ 31 ]  Growing opposition to the narrow population planning focus led to a significant change in population planning policies in the early 1990s. [ further explanation needed ] [ 32 ]


Opinions vary among economists about the effects of population change on a nation's economic health. US scientific research in 2009 concluded that the raising of a child cost about $16,000 yearly ($291,570 total for raising the child to its 18th birthday). [ 33 ]  In the US, the multiplication of this number with the yearly population growth will yield the overall cost of the population growth. Costs for other developed countries are usually of a similar order of magnitude.


Some economists, such as  Thomas Sowell [ 34 ]  and  Walter E. Williams , [ 35 ]  have argued that poverty and famine are caused by bad government and bad economic policies, not by overpopulation.


In his book  The Ultimate Resource , economist  Julian Simon  argued that higher population density leads to more specialization and  technological innovation , which in turn leads to a higher standard of living. He claimed that human beings are the ultimate resource since we possess "productive and inventive minds that help find creative solutions to man’s problems, thus leaving us better off over the long run". [ 36 ]


Simon also claimed that when considering a list of  countries ranked in order by population density , there is no correlation between population density and poverty and starvation. [ citation needed ]  Instead, if a list of countries is considered according to corruption within their respective governments, there is a significant correlation between government corruption, poverty and famine. [ citation needed ]


As early as 1798,  Thomas Malthus  argued in his  Essay on the Principle of Population  for implementation of population planning. Around the year 1900, Sir  Francis Galton  said in his publication  Hereditary Improvement : "The unfit could become enemies to the State if they continue to propagate." In 1968, Paul Ehrlich noted in  The Population Bomb , "We must cut the cancer of population growth", and "if this was not done, there would be only one other solution, namely the 'death rate solution' in which we raise the death rate through war-famine-pestilence, etc.”


In the same year, another prominent modern advocate for mandatory population planning was  Garrett Hardin , who proposed in his landmark 1968 essay  Tragedy of the commons , society must relinquish the "freedom to breed" through "mutual coercion, mutually agreed upon." Later on, in 1972, he reaffirmed his support in his new essay " Exploring New Ethics for Survival ", by stating, "We are breeding ourselves into oblivion." Many prominent personalities, such as  Bertrand Russell ,  Margaret Sanger  (1939),  John D. Rockefeller ,  Frederick Osborn  (1952),  Isaac Asimov ,  Arne Næss [ 37 ]  and  Jacques Cousteau  have also advocated for population planning.
Today, a number of influential people advocate population planning such as these:


The head of the UN Millennium Project  Jeffrey Sachs  is also a strong proponent of decreasing the effects of overpopulation. In 2007, Jeffrey Sachs gave a number of lectures (2007  Reith Lectures ) about population planning and overpopulation. In his lectures, called " Bursting at the Seams ", he featured an integrated approach that would deal with a number of problems associated with overpopulation and  poverty reduction . For example, when criticized for advocating mosquito nets he argued that child survival was, "by far one of the most powerful ways", to achieve fertility reduction, as this would assure poor families that the smaller number of children they had would survive. [ 44 ]


Critics of human population planning point out that attempts to curb human population growth have resulted in violations of  human rights  such as  forced sterilization , particularly in  China  and  India . [ 45 ]  In the latter half of the twentieth century, India's population reduction program received substantial funds and powerful incentives from Western countries and international population planning organizations to reduce India's growing population. This culminated in "the Emergency," a period in the mid-1970's where millions of people were forcibly sterilized. Violent resistance to forced sterilization led to  police brutality  and some instances of  mass shootings  of civilians by police. [ 46 ]  Critics also argue that supposedly voluntary population planning is often coerced. [ 47 ]  Some also believe that the environmental problems caused by supposed overpopulation are better explained by other factors, and that the goal of human population reduction does not justify the threat to human rights posed by population planning policies. [ 48 ]


Other causes for opposition emerge from the feasibility of substantially impacting human population. According to some researchers, even rapid global adoption of a one-child policy would result in a world population exceeding 8 billion in 2050, and in a scenario involving catastrophic mass death of 2 billion people, world population would exceed 8 billion by 2100. [ 49 ]


The Catholic Church  has opposed abortion, sterilization, and artificial contraception  as a general practice but especially in regard to population planning policies. [ 50 ]   Pope Benedict XVI  has stated, "The extermination of millions of unborn children, in the name of the fight against poverty, actually constitutes the destruction of the poorest of all human beings." [ 51 ]  The reformed Theology pastor Dr.  Stephen Tong  also opposes the planning of human population. [ 52 ]


In 1946, Poland introduced a  tax on childlessness , discontinued in the 1970s, as part of natalist policies in the Communist government. From 1941 to the 1990s, the Soviet Union had a  similar tax  to replenish the population losses incurred during the Second World War.


The  Socialist Republic of Romania  under  Nicolae Ceaușescu  severely  repressed abortion , (the most common  birth control  method at the time) in 1966, [ 53 ] [ 54 ]  and forced gynecological revisions and penalties for unmarried women and childless couples.
The surge of the birth rate taxed the public services received by the  decreței 770  ("Scions of the Decree 770") generation. A consequence of Ceaușescu's natalist policy is that large numbers of children ended up living in  orphanages , because their parents could not cope. The vast majority of children who lived in the communist orphanages were not actually orphans, but were simply children whose parents could not afford to raise them. [ 55 ]  The  Romanian Revolution  of 1989 preceded a fall in population growth.


Nativity in the Western world dropped during the  interwar period . Swedish sociologists  Alva  and  Gunnar Myrdal  published  Crisis in the Population Question  in 1934, suggesting an extensive  welfare state  with universal healthcare and childcare, to increase overall Swedish birth rates, and level the number of children at a reproductive level for all social classes in Sweden.  Swedish fertility  rose throughout World War II (as  Sweden was largely unharmed by the war ) and peaked in 1946.


Australia  currently offers fortnightly Family Tax Benefit payments plus a free immunization scheme, and recently [ when? ]  proposed to pay all child care costs for women who want to work. [ 56 ]


The most significant population planning system in the world was China's  one-child policy , in which, with various exceptions, having more than one child was discouraged. Unauthorized births were punished by fines, although there were also allegations of illegal forced  abortions  and  forced sterilization . [ 57 ]  As part of China's planned birth policy, (work) unit supervisors monitored the fertility of married women and may decide whose turn it is to have a baby. [ 58 ]


The Chinese government introduced the policy in 1978 to alleviate the social and  environmental problems of China . [ 59 ]  According to government officials, the policy has helped prevent 400 million births. The success of the policy has been questioned, and reduction in fertility has also been attributed to the modernization of China. [ 60 ]  The policy is controversial both within and outside of China because of its manner of implementation and because of concerns about negative economic and social consequences e.g.  female infanticide . In Asian cultures, the oldest male child has responsibility of caring for the parents in their old age. Therefore, it is common for Asian families to invest most heavily in the oldest male child, such as providing college, steering them into the most lucrative careers, and so on. To these families, having an oldest male child is paramount, so in a one-child policy, daughters have no economic benefit, so daughters, especially as a first child, are often targeted for abortion or infanticide. China introduced several government reforms to increase retirement payments to coincide with the one-child policy. During that time, couples could request permission to have more than one child. [ 61 ]


According to  Tibetologist   Melvyn Goldstein , natalist feelings run high in China's  Tibet Autonomous Region , among both ordinary people and government officials. Seeing  population control  "as a matter of power and ethnic survival" rather than in terms of ecological  sustainability , Tibetans successfully argued for an exemption of  Tibetan people  from the usual  family planning  policies in China such as the  one-child policy . [ 62 ]


In November 2014, the Chinese government allowed its people to conceive a second child under the supervision of government regulation. [ 63 ]


On 29 October 2015, the ruling Chinese Communist Party announced that all one-child policies would be scrapped, allowing all couples to have two children. The change was needed to allow a better balance of male and female children, and to grow the young population to ease the problem of paying for the aging population. The law enacting the  two-child policy  took effect on 1 January 2016, and replaced the previous one-child policy. [ 64 ] [ 65 ]


In May 2021, the Chinese government allowed its people to conceive a third child, in a move accompanied by "supportive measures" it regarded "conducive" to improving its "population structure, fulfilling the country's strategy of actively coping with an ageing population and maintaining the advantage, endowment of human resources" after declining birth rates recorded in the  2020 Chinese census . [ 66 ]


During the  Second Orbán Government , Hungary increased its family benefits spending from one of the lowest rates in the  OECD  to one of the highest. [ 67 ]  In 2015, it amounted to nearly 4% of GDP. [ 68 ]


Only those with two or fewer children are eligible for election to a local government. [ 69 ]


Us two, our two  ("Hum do, hamare do" in Hindi) is a slogan meaning  one family, two children  and is intended to reinforce the message of family planning thereby aiding population planning.


Facilities offered by government to its employees are limited to two children. The government offers incentives for families accepted for sterilization. Moreover, India was the first country to take measures for family planning back in 1952. [ 70 ]


In the south west of India lies the long narrow coastal state of Kerala. Most of its thirty-two million inhabitants live off the land and the ocean, a rich tropical ecosystem watered by two monsoons a year. It's also one of India's most crowded states – but the population is stable because nearly everybody has small families…  At the root of it all is education. Thanks to a long tradition of compulsory schooling for boys and girls Kerala has one of the highest literacy rates in the World.  Where women are well educated they tend to choose to have smaller families…  What Kerala shows is that you don't need aggressive policies or government incentives for birthrates to fall. Everywhere in the world where women have access to education and have the freedom to run their own lives, on the whole they and their partners have been choosing to have smaller families than their parents.  But reducing birthrates is very difficult to achieve without a simple piece of medical technology, contraception.


In 2019, the  Population Control Bill, 2019  bill was introduced in the  Rajya Sabha  in July 2019 by  Rakesh Sinha . The purpose of the bill is to control the population growth of India.


After the  Iran–Iraq War ,  Iran  encouraged married couples to produce as many children as possible to replace population lost to the war. [ 71 ]


Iran succeeded in sharply reducing its birth rate from the late 1980s to 2010. [ 72 ] [ 73 ]  Mandatory contraceptive courses are required for both males and females before a marriage license can be obtained, and the government emphasized the benefits of smaller families and the use of contraception. [ 74 ]  This changed in 2012, when a major policy shift back towards increasing birth rates was announced. In 2014, permanent contraception and advertising of birth control were to be outlawed. [ 75 ]


In  Israel ,  Haredi  families with many children receive economic support through generous governmental child allowances, government assistance in housing young religious couples, as well as specific funds by their own community institutions. [ 76 ]  Haredi women have an average of 6.7 children while the average Jewish Israeli woman has 3 children. [ 77 ]


Japan  has experienced  a shrinking population  for many years. [ 78 ]  The government is trying to encourage women to have children or to have more children – many Japanese women do not have children, or even remain single. The population is culturally opposed to  immigration . [ citation needed ]


Some Japanese localities, facing significant population loss, are offering economic incentives.  Yamatsuri , a town of 7,000 just north of  Tokyo , offers parents $4,600 for the birth of a child and $460 a year for 10 years.


In  Myanmar , the Population planning Health Care Bill requires some parents to space each child three years apart. [ 79 ]  The Economist, in 2015, stated that the measure was expected to be used against the persecuted Muslim  Rohingyas  minority. [ 80 ]


Russian President  Vladimir Putin  directed Parliament in 2006 to adopt a 10-year program to stop the sharp decline in  Russia 's population, principally by offering financial incentives and subsidies to encourage women to have children. [ 81 ]


Singapore has undergone two major phases in its population planning: first to slow and reverse the  baby boom  in the  Post-World War II  era; then from the 1980s onwards to encourage couples to have more children as the  birth rate  had fallen below the  replacement-level fertility . In addition, during the  interim period ,  eugenics  policies were adopted. [ 82 ]


The  anti-natalist  policies flourished in the 1960s and 1970s: initiatives advocating small families were launched and developed into the  Stop at Two  programme, pushing for two-children families and promoting  sterilisation . In 1984, the government announced the  Graduate Mothers' Scheme , which favoured children of  more well-educated mothers ; [ 83 ]  the policy was however soon abandoned due to the outcry in the  general election of the same year . [ 84 ]
Eventually, the government became  pro-natalist  in the late 1980s, marked by its  Have Three or More  plan in 1987. [ 85 ]  Singapore pays $3,000 for the first child, $9,000 in cash and savings for the second; and up to $18,000 each for the third and fourth. [ 81 ]


In 2017, the government of Spain appointed  Edelmira Barreira , as "Government Commissioner facing the Demographic Challenge", in a pro-natalist attempt to reverse a negative population growth rate. [ 86 ]


In May 2012,  Turkey 's Prime Minister Recep Tayyip Erdogan argued that abortion is murder and announced that legislative preparations to severely limit the practice are underway. Erdogan also argued that abortion and  C-section deliveries  are plots to stall Turkey's economic growth. Prior to this move, Erdogan had repeatedly demanded that each couple have at least three children. [ 87 ]


Enacted in 1970,  Title X  of the  Public Health Service Act  provides access to contraceptive services, supplies and information to those in need. Priority for services is given to people with low incomes. The Title X Family Planning program is administered through the  Office of Population Affairs  under the Office of Public Health and Science.
It is directed by the  Office of Family Planning . [ 88 ]  In 2007, Congress appropriated roughly $283 million for family planning under Title X, at least 90 percent of which was used for services in family planning clinics. [ 88 ]  Title X is a vital source of funding for family planning clinics throughout the nation, [ 89 ]  which provide reproductive health care, including abortion.


The education and services supplied by the Title X-funded clinics support young individuals and low-income families. The goals of developing healthy families are accomplished by helping individuals and couples decide whether to have children and when the appropriate time to do so would be. [ 89 ]


Title X has made the prevention of  unintended pregnancies  possible. [ 89 ]  It has allowed millions of American women to receive necessary reproductive health care, plan their pregnancies and prevent abortions. Title X is dedicated exclusively to funding family planning and reproductive health care services. [ 88 ]


Title X as a percentage of total public funding to family planning client services has steadily declined from 44% of total expenditures in 1980 to 12% in 2006. Medicaid has increased from 20% to 71% in the same time. In 2006, Medicaid contributed $1.3 billion to public family planning. [ 90 ]


In the early 1970s, the United States Congress established the Commission on Population Growth and the American Future (Chairman  John D. Rockefeller III ), which was created to provide recommendations regarding population growth and its social consequences. The Commission submitted its final recommendations in 1972, which included promoting contraceptives and liberalizing abortion regulations, for example. [ 91 ]


In a 2004  editorial  in  The New York Times ,  David Brooks  expressed the opinion that the relatively high birth rate of the United States in comparison to Europe could be attributed to social groups with "natalist" attitudes. [ 92 ]  The article is referred to in an analysis of the  Quiverfull  movement. [ 93 ]  However, the figures identified for the demographic are extremely low.


Former US Senator  Rick Santorum  made natalism part of his platform for his  2012 presidential campaign . [ 94 ]    Many of those categorized in the General Social Survey as "Fundamentalist Protestant" are more or less natalist, and have a higher birth rate than "Moderate" and "Liberal" Protestants. [ 95 ]  However, Rick Santorum is not a Protestant but a practicing Catholic.


It is reported that  Uzbekistan  has been pursuing a policy of forced sterilizations, hysterectomies and IUD insertions since the late 1990s in order to impose population planning. [ 96 ] [ 97 ] [ 98 ] [ 99 ] [ 100 ] [ 101 ] [ 102 ]


{{ Infobox birth control }}  contains a consistent style within which to summarise some key points about a particular method of  Birth control . Don't worry about trying to fill in all the fields -- even if you can only get one or two, that still can be useful and many do not apply to all methods.


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Male contraceptives , also known as  male birth control , are methods of preventing  pregnancy  by interrupting the function of sperm. [ 1 ]  The main forms of male  contraception  available today are  condoms ,  vasectomy , and  withdrawal , which together represented 20% of global contraceptive use in 2019. [ 2 ] [ 3 ] [ 4 ] [ 5 ]   New forms of male contraception are in  clinical  and  preclinical  stages of  research and development , but as of 2024, none have reached  regulatory approval  for widespread use. [ 6 ] [ 7 ] [ 8 ] [ 9 ]


These new methods include topical creams, daily pills, injections, long-acting implants, and external devices, and these products have both hormonal and non-hormonal mechanisms of action. [ 6 ] [ 10 ] [ 11 ] [ 12 ] [ 13 ] [ 14 ] [ 15 ]   Some of these new contraceptives could even be  unisex , or usable by any person, because they could theoretically incapacitate mature sperm in the man's body before  ejaculation , or incapacitate sperm in the body of a woman after  insemination . [ 16 ] [ 17 ]


In the 21st century, surveys indicated that around half of men in countries across the world have been interested in using a variety of novel contraceptive methods, [ 18 ] [ 19 ] [ 20 ] [ 21 ]  and men in clinical trials for male contraceptives have reported high levels of satisfaction with the products. [ 12 ] [ 22 ]   Women worldwide have also shown a high level of interest in new male contraceptives, and though both male and female partners could use their own contraceptives simultaneously, women in long-term relationships have indicated a high degree of trust in their male partner's ability to successfully manage contraceptive use. [ 18 ] [ 23 ] [ 24 ]


A modelling study from 2018 suggested that even partial adoption of new male contraceptives would significantly reduce  unintended pregnancy  rates around the globe, [ 25 ]  which remain at nearly 50%, even in developed countries where women have access to modern contraceptives. [ 26 ] [ 27 ] [ 28 ]   Unintended pregnancies  are associated with negative socioeconomic, educational, and health outcomes for women, men, and the resulting children (especially in historically marginalized communities), [ 27 ] [ 29 ] [ 30 ] [ 31 ] [ 32 ] [ 33 ] [ 34 ]  and 60% of unintended pregnancies end in  abortions , [ 35 ] [ 36 ]  many of which are  unsafe  and can lead to women's harm or death. [ 37 ] [ 38 ] [ 39 ] [ 40 ]   Therefore, the development of new male contraceptives has the potential to improve racial, economic, and gender equality across the world, advance  reproductive justice  and  reproductive autonomy  for all people, and save lives.


Vasectomy is surgical procedure for permanent male  sterilization  usually performed in a physician's office in an outpatient procedure. [ 41 ]  During the procedure, the  vasa deferentia  of a patient are severed, and then tied or sealed to prevent sperm from being released during ejaculation. [ 42 ]  Vasectomy is an effective procedure, with less than 0.15% of partners becoming pregnant within the first 12 months after the procedure. [ 43 ]  Vasectomy is also a widely reliable and safe method of contraception, and complications are both rare and minor. [ 44 ] [ 45 ]   Vasectomies can be reversed, though rates of  successful reversal  decline as the time since vasectomy increases, and the procedure is technically difficult and often costly. [ 42 ] [ 46 ] [ 41 ]


A condom is a  barrier device  made of  latex  or thin plastic film that is rolled onto an erect  penis  before intercourse and retains ejaculated  semen , thereby preventing pregnancy. [ 47 ]  Condoms are less effective at preventing pregnancy than vasectomy or modern methods of female contraception, with a real-world failure rate of 13%. [ 43 ]  However, condoms have the advantage of providing protection against some  sexually transmitted infections  such as  HIV/AIDS . [ 48 ] [ 49 ]  Condoms may be combined with other forms of contraception (such as  spermicide ) for greater protection. [ 50 ]


The withdrawal method, also known as  coitus interruptus  or pulling out, is a behavior that involves halting penile-vaginal intercourse to remove the penis out and away from the  vagina  prior to ejaculation. [ 51 ] [ 52 ]  Withdrawal is considered a less-effective contraceptive method, with typical-use failure rates around 20%. [ 41 ] [ 43 ]  However, it requires no equipment or medical procedures. [ 51 ]


Researchers have been working to generate novel male contraceptives with diverse mechanisms of action and possible delivery methods, including  long-acting reversible contraceptives  (LARCs), daily  transdermal gels , daily and on-demand oral pills, monthly  injectables , and  implants. [ 53 ] [ 54 ] [ 55 ]  Efforts to develop male contraceptives have been ongoing for many decades, but progress has been slowed by a lack of funding and industry involvement. As of 2024, most funding for male contraceptive research is derived from government or philanthropic sources. [ 56 ] [ 57 ] [ 58 ] [ 59 ]


Novel male contraceptives could work by blocking various steps of the  sperm development process , blocking sperm release, or interfering with any of the sperm functions necessary to reach and fertilize an egg in the female reproductive tract. [ 60 ]   Advantages and disadvantages of each of these approaches will be discussed below, along with relevant examples of products in development.


These methods work by preventing the testes from producing sperm, or interfering with sperm production in a way that leads to the production of nonfunctional sperm. [ 61 ]   This approach can be accomplished by either  hormonal  or nonhormonal small-molecule drugs, or potentially by thermal methods.  The effectiveness of contraceptives in this group can be easily assessed microscopically, by measuring sperm count or abnormalities in sperm shape, but because  spermatogenesis  takes approximately 70 days to complete, [ 62 ]  these methods are likely to require approximately three months of use before they become effective, and approaches that halt sperm production at an early stage of the process may result in reduced testicular size. [ 63 ]  Methods have been suggested in the 1980s. [ 64 ]


Hormonal contraceptives for men work similarly to  hormonal female methods , using  steroids  to interrupt the  hypothalamic-pituitary-gonadal axis  and thereby block sperm production. Administering external  androgens  and  progestogens  suppresses secretion of the  gonadotropins   LH  and  FSH , which impairs  testosterone  production and sperm generation in the testes, leading to reduced sperm counts in ejaculates within 4–12 weeks of use. [ 65 ]  However, since the contraceptives contain testosterone or related androgens, the levels of androgens in the blood remain relatively constant, thereby limiting side effects and maintaining masculine  secondary sex characteristics  like muscle mass and hair growth. [ 65 ]


Multiple methods of male hormonal contraception have been tested in  clinical trials  since the 1990s, and although one trial was halted early, leading to a large amount of press attention, [ 66 ] [ 67 ] [ 68 ] [ 69 ] [ 70 ]  most hormonal male contraceptives have been found to be effective, reversible, and well-tolerated. [ 71 ] [ 72 ] [ 73 ] [ 74 ] [ 75 ] [ 76 ]


As of 2024 [update] , the following hormonal male contraceptive products are in clinical trials:


Some anabolic steroids may exhibit suppressive effects on spermatogenesis, but none are being investigated for use as a male contraceptive. [ 84 ]


Non-hormonal contraceptives for men are a diverse group of molecules that act by inhibiting any of the many  proteins  involved in sperm production, release, or function.  Because sperm cells are highly specialized, they express many proteins that are rare in the rest of the human body. [ 85 ] [ 86 ] [ 87 ]   This suggests the possibility that non-hormonal contraceptives that specifically block these sperm proteins could have fewer side effects than hormonal contraceptives, since sex steroid receptors are found in tissues throughout the body. [ 88 ]   Non-hormonal contraceptives can work by blocking spermatogenesis, sperm release, or mature sperm function, resulting in products with a wide variety of usage patterns, from slow onset to on-demand usage. [ 89 ]   Contraceptives targeting mature sperm functions could even be taken by both sperm-producing and egg producing people. [ 17 ] [ 16 ]   Challenges of non-hormonal contraceptive development include  bioavailability  and delivery past the  blood-testis barrier . [ 90 ]


As of 2024 [update] , the following non-hormonal male contraceptive product is in clinical trials:


As of 2024 [update] , the following non-hormonal male contraceptive products are in  preclinical development :


Prolonged testicular heating had been shown to reduce sperm counts in 1941, [ 115 ]  considered as a method of birth control after 1968 and in the 1980s [ 116 ] [ 117 ]  No modern clinical trials have demonstrated the safety, contraceptive effectiveness, or reversibility of this approach. Various devices are in early preclinical stages of development, and as of 2017 some approaches have been used by men through  self-experimentation . [ 14 ] [ 118 ]   As of 2015, the mechanism by which heating disrupts spermatogenesis was still not fully understood. [ 119 ]  There have been theoretical  concerns that prolonged heating could increase the risk of  testicular cancer  since the inborn birth defect of  cryptorchidism  carries a risk of testicular cancer [ 120 ]  or that heating could damage sperm DNA, resulting in harm to potential offspring. [ 121 ]


These approaches work by either physically or chemically preventing the emission of sperm during ejaculation, and are likely to be effective on-demand.


α1-adrenoceptor antagonists  and  P2X1  antagonists have been shown to inhibit  smooth muscle  contractions in the  vas deferens  during ejaculation, and therefore prevent the release of semen and sperm while maintaining the sensation of  orgasm . [ 122 ] [ 123 ] [ 124 ]  Various molecules in these categories are under consideration as possible on-demand male contraceptives.


Vas-occlusive contraception  is a form of male  contraception  that blocks  sperm  transport in the  vas deferens , the tubes that carry sperm from the  epididymis  to the  ejaculatory ducts .


Vas-occlusive contraception  provides a contraceptive effect through physical blockage of the  vas deferens , the  duct  connecting the  epididymis  to the  urethra . While a  vasectomy  excises, or removes, a piece of each vas deferens and occludes the remaining open ends of the duct, vas-occlusive methods aim to block the duct while leaving it intact.  Vas-occlusive methods generally aim to create  long-acting reversible  options, through a second procedure that removes the blockage. [ 138 ]   However, full reversibility remains questionable, since animal and human studies have shown sperm abnormalities, incomplete recovery of sperm parameters, and the development of fertility-impairing  antibodies  against one's own sperm after blockage removal. [ 111 ] [ 139 ] [ 140 ] [ 141 ] [ 142 ] [ 143 ]


As of 2024 [update] , the following vas-occlusive male contraceptive products are in clinical trials:


As of 2024 [update] , the following vas-occlusive male contraceptive products are in preclinical development:


Research into new, more acceptable designs of condoms is ongoing. [ 164 ] [ 165 ]


These approaches work by blocking functions that mature sperm need in order to reach and fertilize an egg in the female reproductive tract, such as  motility ,  capacitation , semen liquification, or  fertilization .  Drugs or devices that target mature sperm are likely to be effective on-demand (taken just before intercourse), and could even be delivered either in sperm-producing or egg-producing bodies, leading to unisex contraceptives. [ 17 ] [ 16 ]


As of 2024 [update] , the following non-hormonal male contraceptive approaches are in  preclinical  or early development:


Although some people question whether men would be interested in managing their own contraceptives [ 188 ]  or whether women would trust their male partners to do so successfully, [ 189 ]  studies consistently show that men around the world have significant levels of interest in novel forms of male contraception [ 18 ] [ 23 ] [ 190 ] [ 19 ] [ 191 ] [ 192 ]  and that women in committed relationships would generally trust their male partners to manage the contraceptive burden in the relationship. [ 23 ]   Additionally, males participating in various contraceptive clinical trials have reported high satisfaction with the products they were using. [ 81 ] [ 12 ] [ 22 ]


Studies on potential uptake indicate that in most countries, more than half of men surveyed would be willing to use a new method of male contraception. [ 18 ] [ 20 ] [ 190 ] [ 193 ] [ 194 ] [ 195 ]   Interestingly, some of the highest rates were reported in low-income countries like Nigeria and Bangladesh where 76% of men surveyed indicated that they would be willing to use a new method within the first 12 months that it is available. [ 18 ]  This is particularly compelling, since it has been estimated that a mere 10% uptake of new male contraceptive methods could avert nearly 40% of unintended pregnancies in Nigeria. [ 25 ]   Across the world, many young and middle-aged men especially want the ability to control their own fertility, and are not well-served by existing family planning programs. [ 196 ]


Although a phase II trial for an injectable male contraceptive was halted in 2011 by an independent data safety monitoring board due likely to rare adverse effects experienced by some participants, [ 197 ] [ 67 ]  leading many popular articles to suggest men could not tolerate side effects similar to those that many women endure on hormonal birth control, [ 70 ] [ 198 ]  in reality more than 80% of the study's male participants stated at the end of the trial that they were satisfied with the contraceptive injection, and would be willing to use the method if it were available. [ 199 ]   Subsequent hormonal male contraceptive clinical trials have progressed successfully, showing high levels of efficacy and acceptability among the participants. [ 12 ] [ 22 ] [ 81 ] [ 200 ]


It is sometimes assumed that women won’t trust men to take contraceptives, since women would bear the consequences of a male partner's missed dose or misuse. [ 189 ]   Of course, male contraceptive options would not have to replace female contraceptives, and in casual sexual encounters both partners may prefer to independently control their own contraceptive methods.  On the other hand, some long-term couples might want only one partner to bear the contraceptive burden. Indeed, there is evidence that a large proportion of women in relationships in many countries around the world would trust their partners to take a potential male method, [ 24 ] [ 18 ]  and many women want more male partner involvement in their own reproductive health services. [ 201 ]   Further, current contraceptive use data show that more than a quarter of women worldwide already rely on male-controlled methods for contraception (such as condoms and vasectomy), [ 202 ]  and this figure could grow as more male contraceptive methods become available.


Despite the fact that modern female pharmaceutical contraception has been on the market since the 1960s, [ 203 ]  40-50% of pregnancies are still  unintended  worldwide, leading to an approximate total of 121 million  unintended pregnancies  annually. [ 204 ] [ 205 ] [ 206 ]   Importantly, most studies on unintended pregnancies only measure women's intentions about the pregnancy, and so pregnancies that were unintended by men are understudied and may be under-reported. [ 207 ]   Unintended pregnancies have been shown to be linked with a wide variety of negative outcomes on mental and physical health, as well as educational and socioeconomic attainment in both parents and the children born of unintended pregnancies. [ 27 ] [ 29 ] [ 30 ] [ 32 ] [ 33 ] [ 34 ]


Surprisingly, although the rate of unintended pregnancies (per 1000 women of childbearing age) is higher in  developing countries , [ 205 ] [ 208 ] [ 209 ]  the percentage of pregnancies that are unintended is actually higher in  developed countries , since a lower proportion of women in developed countries are intending to conceive at any given time. [ 205 ]   Research indicates that unmet need for modern contraception is the cause of 84% of unintended pregnancies in developing countries. [ 210 ]   In the United States, which has a higher unintended pregnancy rate than many other developed nations, [ 211 ]  one important reason that women cite for nonuse of contraceptives is concerns about the side effects of existing products. [ 212 ]   Taken together, these statistics suggests that the current suite of contraceptives is insufficient to meet the fertility planning needs of people across the world, and therefore the introduction of new male contraceptives is likely to decrease the stubbornly high global rates of unintended pregnancy. [ 25 ]


International market research indicates that 49% of men in the United states and 76% of men in Nigeria would try a novel male contraceptive within the first year of its existence. [ 18 ]   Independent modelling predicts that even if real-world usage is only 10% as high as the market research suggests, the introduction of a male contraceptive would avert roughly 200,000 unintended pregnancies per year in the USA and Nigeria each. [ 25 ]


Fathers with unintended births report lower proportions of happiness than in fathers with intentional births [ 213 ]  and unintended fatherhood for men in their early 30's is associated with a significant increase in depressive symptoms. [ 214 ]   In addition, men in insecure financial situations are more likely to report a recent unintended pregnancy, [ 207 ]  and supporting and raising a child brings significant costs that can exacerbate financial insecurity. [ 215 ] [ 216 ]   More broadly, access to effective and reliable contraception would advance men's ability to "maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities" in accordance with the principles of  Reproductive Justice . [ 217 ]


Family planning has been found to be associated with overall well-being and is one of the most efficient tools for women's empowerment. [ 218 ] [ 219 ] [ 220 ]  Positive outcomes of effective birth control include improvements in women's health, self-agency, education, labor force participation, financial stability, as well as decreases in pregnancy-related deaths, [ 221 ] [ 222 ] [ 223 ]  and these positive social and health impacts may be further realized by the addition of novel male and unisex methods. [ 25 ] [ 18 ]  New male contraceptive options would not come at the expense of women’s reproductive autonomy, since women would still be able to take advantage of all of the contraceptive methods available to them, choose to have both partners use their own contraceptive methods at the same time, or rely solely on their male partners’ form of contraception.


Interventions encouraging male engagement in couples' reproductive health and decisionmaking have shown positive outcomes related to promoting more equitable gender norms in the context of family planning, [ 224 ]  and increased joint decision making in couples. It is reasonable to assume from these data that increasing male involvement as contraceptive users will further improve gender equity. [ 225 ]


While this article has used the term "male" contraception for clarity, these contraceptives are most accurately described as "sperm-targeting" contraceptives, since they would work effectively in any body that produces sperm, regardless of that person's gender identity or external genitalia. [ 17 ]   Importantly, contraceptives that block functions of mature sperm could be delivered in a  unisex  manner, incapacitating sperm before ejaculation in sperm-producing people, or after sperm arrives in the body of egg-producing people. [ 16 ] [ 17 ]


Transgender ,  nonbinary , and  intersex  people are underserved by current contraceptive options.  For example, many trans men can become pregnant (both intentionally and unintentionally), [ 226 ]  but may prefer not to use  estrogen - or  progestin -containing hormonal birth control (both because of the social classification of these hormones as "female sex hormones" and because of a fear they will interfere with  masculinizing hormone therapy , although the American College of Obstetricians and Gynecologists states that these hormonal contraceptives have little effect on masculinization.) [ 227 ] [ 228 ] [ 229 ]  Trans women who have not had  gender-affirming genital surgery  may have similar unmet contraceptive needs as those of  cisgender  men, since gender-affirming hormonal therapy is not effective contraception. [ 229 ]   Nonbinary and intersex people may be less likely to use current methods of birth control, since they are popularly categorized by the labels "male" and "female", which may not match an individual's gender identity or may invoke feelings of  gender dysphoria . [ 228 ]   This dynamic may contribute to the higher rates of unintended pregnancies seen in the  LGBTQ+  community as compared to  heterosexual  peers, [ 230 ] [ 231 ] [ 232 ]  which could in theory be ameliorated by the introduction of  unisex  contraceptives.


Novel male contraceptive options are predicted to reduce the incidence unintended pregnancies, [ 25 ] [ 18 ]  and being the product of an intended rather than unintended pregnancy has been shown to correlate with improved health and wellbeing outcomes in children. [ 31 ] [ 222 ] [ 233 ] [ 234 ]   Additionally, reduced family size correlates with improved educational outcomes, [ 235 ]  and children born after the introduction of family planning programs in the USA experienced a reduction in poverty rates, both in childhood and adulthood. [ 236 ]


Unintended pregnancies rates increase as income decreases, both between countries [ 36 ]  and between socioeconomic and racial groups within a given country. [ 211 ] [ 237 ]   Women of color, especially Black women, in the United States and other developed countries have dramatically higher rates of  death during and after birth  and worse maternal health outcomes, due in part to  systemic discrimination . [ 238 ] [ 222 ]   Since unintended pregnancies can have negative effects on an individual's physical and mental health, educational attainment, and economic prospects, these higher unintended pregnancy rates likely contribute to the persistent socioeconomic gaps within and between societies. [ 27 ] [ 29 ] [ 30 ] [ 31 ] [ 32 ] [ 33 ] [ 34 ]     It’s therefore possible that the introduction of new male contraceptives would not only mitigate gender inequities, as discussed above, but racial and income inequities as well, by providing more ways for individuals to avoid unintended pregnancies. [ 25 ]


In addition to the personal financial savings of avoiding unintended pregnancy mentioned above, on a societal level, contraceptives are a public health intervention with a high return on investment: for every dollar the United States government spends on family planning programs, it saves $7.09, for a total of over $13 billion per year. [ 239 ]   Unintended pregnancies in the United States are estimated to cause $4.5 billion in direct medical costs. [ 34 ] [ 32 ]   New male contraceptives are likely to prevent some unintended pregnancies [ 25 ]  and therefore reduce these costs.


61% of unintended pregnancies end in  abortion , [ 35 ]  whereas only 20% of all pregnancies end in abortion. [ 240 ]  Interestingly, unintended pregnancy rates are higher in countries where abortion is illegal than those where abortion is legal, yet the incidence of abortion is similar between these groups of countries. [ 35 ] [ 241 ]   Illegal abortions are more likely to be  unsafe , and there are an estimated 25 million unsafe abortions globally each year, leading to 50,000 - 70,000 yearly deaths and 5 million people with long-term health consequences. [ 37 ] [ 38 ] [ 39 ] [ 40 ]    Importantly, increases in the prevalence and uptake of modern contraceptives have been shown to decrease unintended pregnancy and abortion rates when fertility rates are constant. [ 242 ] [ 243 ] [ 244 ]   This suggests that the introduction of new forms of male contraception could prevent a significant number of abortions, save lives, and avoid unnecessary suffering.


A variety of plant extracts have been used throughout history in attempts to prevent pregnancy, though most were used by women, and the efficacy and safety of these methods is questionable. [ 245 ] [ 246 ] [ 247 ]


Condoms  made of animal organs or fabric have been in documented use since at least the 16th century, [ 248 ]  and various types of penile coverings have been depicted and referenced in materials from cultures around the world as early as 3000  BCE , though it is not always clear that these coverings were used for birth control or protection from sexually transmitted infections. [ 249 ]   The 1800's saw the development of thick reusable rubber condoms, [ 248 ] [ 249 ]  and thinner disposable latex rubber condoms entered production in the 1920s. [ 250 ] [ 251 ] [ 252 ]


Vasectomy  was first performed in humans in the late 1800s, but not initially as a method of voluntary birth control.  Instead, it was first used as an attempted treatment (later proved to be ineffective) for  enlarged prostates , and within a few years, one-sided vasectomy became popular as a supposed method of sexual rejuvenation in older men. [ 253 ] [ 254 ]   Although this rejuvenation treatment was ineffective  pseudoscience  and any perceived effects were likely due only to the  placebo effect , many prominent men, such as Sigmund Freud and W.B. Yeats, sought out the procedure. [ 255 ]   In the early 1900s, the use of vasectomy took a darker turn, and it became widely promoted and practiced as a means of  eugenic  involuntary sterilization. [ 254 ] [ 253 ]   It was not until the 1950s that vasectomy became widely used as a method for voluntary sterilization and family planning. [ 254 ] [ 253 ]   Since then, vasectomy has undergone extensive technical improvements and innovations, such that it is no longer a single procedure, but a  family of related procedures . [ 253 ] [ 256 ]


In the 1990s, and into the early 2000s, major pharmaceutical companies  Organon ,  Wyeth , and  Schering  were pursuing preclinical and clinical development of various male contraceptive products, but in 2006, all three companies ceased development of these products within a short time of each other, for reasons that have not been publicly released. [ 257 ] [ 110 ]


In 2013, the Male Contraceptive Initiative was founded with the goal of funding and supporting the development of new male contraceptives. [ 258 ] [ 259 ]


In 2020,  Dr. Polina Lishko  was awarded the  MacArthur "Genius" Fellowship  for her contributions to the understanding of sperm physiology, with the award specifically noting her work on "opening up new avenues in ... the development of male-specific or unisex contraceptives." [ 260 ]


Many researchers have attempted to develop male contraceptive products over the last hundred years.  A selection of these efforts (that are no longer in development as of 2024) are listed below.


Married Love or Love in Marriage  is a book by British academic  Marie Stopes . It was one of the first books openly to discuss  birth control .


The book begins by stating that "More than ever to-day are happy homes needed. It is my hope that this book may serve the State by adding to their number. Its object is to increase the joys of marriage, and to show how much sorrow may be avoided." [ 1 ]


The preface states that it was geared toward teaching married couples how to have a happy marriage, including 'great sex' [ 2 ]  – and it was thus offering a service to 'the State' by reducing the number of people affected by failed marriages.


The central question is how can the "desire for freedom" [ 1 ]  and "physical and mental exploration" be balanced with the limits of monogamy and raising a family. [ 2 ] [ 3 ]  The answer is not "in the freedom to wander at will" but a "full and perfected love". In Stopes'  lexicography  love means sex and "access to the knowledge of how to cultivate it". [ 2 ]


Stopes had already published books based upon her work as a research scientist.  However, the publishers – both academic and mainstream – she approached for  Married Love  felt the subject matter too controversial and turned it down. [ 4 ]  Its publication was finally financed by  Humphrey Roe , a Manchester businessman and birth control campaigner, who Stopes would later marry. [ 5 ]  Roe paid the £200 required by the small publishing firm Fifield & Co. who published  Married Love  in March 1918. [ 6 ]


It rapidly sold out, and was in its sixth printing within a  fortnight .


The  US Customs Service  banned the book as obscene until April 6, 1931, when Judge  John M. Woolsey  overturned that decision. Woolsey was the same judge who in 1933 would lift the ban on  James Joyce 's  Ulysses , allowing for its publication and circulation in the United States of America.


It was the first book to note that women's sexual desire coincides with  ovulation  and the period right before  menstruation . The book argued that marriage should be an equal relationship between partners. Although officially scorned in the UK, the book went through 19 editions and sales of almost 750,000 copies by 1931.


In 1935 a survey of American academics said  Married Love  was one of the 25 most influential books of the previous 50 years, ahead of  Relativity  by  Albert Einstein ,  Interpretation of Dreams  by  Sigmund Freud ,  Mein Kampf  by  Adolf Hitler  and  The Economic Consequences of the Peace  by  John Maynard Keynes . [ 7 ]


The book was the basis for a 1923 British silent film adaptation  Married Love  directed by  Alexander Butler . [ 8 ]


Contraception  is typically considered safer than pregnancy, especially in patients with  medical conditions  such as  high blood pressure  or  diabetes . However, people with medical conditions may need to have contraceptive options tailored around their specific needs. [ 1 ]  Resources exist for patients and providers to help tailor methods. One example of a resource is the Medical Eligibility Criteria for Contraceptive Use (MEC), [ 2 ] [ 3 ]  which exists in multiple formats.


In 1996, the  World Health Organization  created a set of guidelines called "medical eligibility criteria for contraceptive use" for  family planning  and reproductive health programs and providers in order to guide provision of contraceptive care worldwide. [ 2 ]  The guidelines are based on systematic reviews of the medical literature and expert opinion where evidence is lacking. [ 3 ]  The intent of these recommendations was to allow public health programs in individual countries to tailor contraceptive safety guidance to their particular populations. Subsequently, in 2010, the  Centers for Disease Control and Prevention  created recommendations for contraceptive provision in the United States. [ 3 ]  These references may be used by medical providers as well as patients to assess their eligibility to use individual contraceptives like  birth control pills ,  intrauterine devices , and  implants .


The MEC categorizes methods using a numerical system. Category 1 conditions have no restrictions on use of a contraceptive method. Category 2 indicates method use may require closer follow-up. For a Category 3 condition, use of that method "usually is not recommended unless other more appropriate methods are not available or acceptable. The severity of the condition and the availability, practicality, and acceptability of alternative methods should be considered, and careful follow-up is required". [ 3 ]   Category 4 conditions have an unacceptable level of risk if the method is used. [ 3 ]


Medical Eligibility Criteria exist in multiple formats described below to encourage greater use and access by medical professionals. [ 4 ]


Print version: The full print document of the US Medical Eligibility Criteria is intended to describe in further detail the medical evidence for each recommendation.


Summary chart: A summary chart that is color coded, with green used for category 1 and 2 methods and pink/red used for category 3 and 4 methods, exists to provide reference to select methods and their categories.


Summary wheel: A summary wheel exists that details categories in a slightly different format than the summary chart. [ 4 ]


App: A free app has been created by the CDC to offer easier access to the guidelines for medical providers.


Medieval contraception  is a debated topic among historians, though methods of contraception have been developed not just in modern times. In ancient times, women attempted to protect themselves from unwanted pregnancy with various means and practices, as evidenced by ancient records. Ancient and medieval manuscripts provide glimpses into diverse birth control practices.


As the first official record of contraception, an Egyptian spermicidal recipe from the period around 1525 BC was to "mix grated Acacia leaves and honey and soak a gauze bandage to be inserted into the vagina." [ 1 ]  This type of contraceptive tampon could have had a spermicidal effect due to the acacia lactic acid contained in the sap which is proven effective as a spermicide.


Most of the indigenous peoples around the world, as well as from European antiquity all the way to the  Middle Ages , contain linkages to point to the use of plant based oral contraceptives. This type of contraception is currently regaining attention in some scientific and historian circles. [ 2 ] [ 3 ]  Plant-based contraceptives and abortifacient drugs may have been widely used in antiquity and the Middle Ages, but much knowledge about ancient forms of medicinal contraception appears to have vanished. [ 4 ]  Because of this, plant-based oral contraception in history is often contested, though archaeological and written record shows evidence that drugs were a reliable way to prevent conception or even induce early-term abortions. [ 5 ]  Their absence from many historical texts could be due to their likely presence in anti-fertility lore which was almost exclusively limited to midwives as professionals. These bits of folklore, combined with archaeological written records, allude to what was likely a “thriving oral culture of contraception.” [ 6 ]   Silphium  was a plant that grew in the hills near the Greek city-state of  Cyrene, Libya , located in  North Africa . This plant was one example of an oral contraceptive in ancient times, based partly on Pliny's statement that it could be used "to promote the menstrual discharge." [ 7 ]