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4.4 CONTRACEPTION
The most obvious and most reliable way of avoiding pregnancy is complete abstinence from coitus. However, throughout history men and women have searched for means of contraception, i.e., for methods or devices that would allow them to engage in coitus without the risk of becoming parents. For thousands of years, such methods as were found remained crude and largely ineffective. Eventually, modern scientists discovered new and better methods (and improved the old ones), until they arrived at the present wide range of reasonable choices. Today, unwanted pregnancies can be prevented with almost complete certainty. Nevertheless, the search for even safer, simpler, and cheaper contraceptives goes on.
The development of reliable methods of contraception has had a profound effect on human sexual behavior. In the past, sex and procreation were inseparable. Sexual intercourse between men and women was restricted to coitus, and potentially it could always lead to the birth of children. Obviously, the interests of these children could best be protected by making sure that the parents stayed together to take care of them. The sexual morals of most societies therefore tried to prohibit sexual activity for everyone but married couples. Sex before and outside of marriage was considered immoral (and was sometimes severely punished). Within the institution of marriage itself, men and women were encouraged to produce as many children as possible. In fact, procreation was declared the true "nature" and only purpose of sex, and all forms of sexual expression that, by their very character, could not lead to pregnancy were called unnatural.
In the meantime, the factual basis of this morality has been all but destroyed by the modern, effective methods of contraception. They have broken the traditional link between sex, parenthood, and marriage. Now a married couple may very well decide to remain childless, or to have children only many years after the wedding. By the same token, fewer young couples are rushed into ill-considered marriages by unwanted pregnancies. As a result, the meaning of marriage itself is beginning to change. Parenthood may no longer be its primary goal. Indeed, love, companionship, professional cooperation, mutual support, or security may now be sufficient reasons to bring and to keep husband and wife together. At the same time, sexual intercourse inside and outside of marriage can be completely divorced from the purpose of procreation. Instead, it is acquiring a new importance as a means of communication.
A!! of this amounts to a fundamental change in human affairs. There is a new freedom of action and a new need for personal decisions and responsibilities. The challenges of this unprecedented situation cannot be met by prohibitive ethics, restrictive laws, or repressive policies aimed at protecting the people against themselves. On the contrary, they must now be given a chance to develop the capacity for self-determination and to make the right use of their new possibilities.
Nevertheless, the old beliefs and habits die hard. There are still many men and women who either remain blind to the consequences of this contraceptive revolution, or who are honestly afraid of them. For example, there is a widespread concern that the universal acceptance of contraception might lead to universal promiscuity and moral decay. On the other hand, more and more people are becoming alarmed about the dangers of overpopulation. Indeed, there can be no doubt that a further unchecked growth of the population would produce mounting misery in many parts of the world and, paradoxically, could even lead to the extinction of the human race by famine, disease, war, and environmental pollution.
In many countries, these conflicting concerns have produced ambiguous public policies. Certain governments favor the use of contraceptives by married couples, but not by single adults or minors. Some governments support the idea of contraception in order to eliminate the need for abortions which remain prohibited. Others see abortion simply as a welcome additional means of limiting the population. (Where contraception is made difficult, the number of abortions is bound to rise; where abortion is made easy, contraception may be neglected.) In some countries, both contraception and abortion are illegal. Still other countries hesitate to promote voluntary contraception among the general public, but have no scruples about forcing certain people to be sterilized. These sterilizations are usually carried out in order to prevent the transmission of severe genetic defects. (See "Genetic Defects.") However, sometimes forced sterilization has also been used for the purpose of social rather than medical control. (Healthy men and women are made infertile against their will because they are poor or otherwise "undesirable."
The very language in which different authorities speak about contraception often reveals their ideological standpoint. For example, many people today prefer to talk about "birth control". This is a term which includes abortion. (After all, an abortion also prevents a birth,) However, in most cases the issue is not the prevention of births, but of pregnancies, and therefore terms like "pregnancy control" or "conception control" ("contraception" for short) are more precise. Some people insist on using the phrase "family planning." This term implies that contraception is really nothing more than a method of determining the size of a family or, in other words, that it has its place only within marriage. A term like "pregnancy planning" would undoubtedly be more objective. Another term, "responsible parenthood", appeals to certain moral qualities in men and women who might be passive and fatalistic about possible pregnancies. A more neutral term, "planned parenthood" is used by a worldwide organization which offers contraception to all who seek it, whether they are married or not.
This policy springs from the realization that, in the long run, the use of contraception cannot remain restricted to selected groups or individuals. In fact, a growing number of men and women are now demanding full control
WORLD POPULATION GROWTH FROM 1750 TO 2050 IN BILLIONS
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high projection
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average projection
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developing countries
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developed countries
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Sources: Population Reference Bureau (PRB), Worldwatch Institute
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WORLD POPULATION GROWTH BY REGION, 1975 TO 2000 A.D.
OCEANIA N.AMERICA USSR EUROPE LAT.AMERICA AFRICA ASIA
THE "POPULATION EXPLOSION"
Over the last few hundred years the world's population has grown dramatically, and in the future an even more dramatic increase is to be expected. Furthermore,, as our graph illustrates, the greatest such increase is likely to take place in the poorest areas of the globe. In view of these developments., many governments have now begun to encourage contraception. (Tables courtesy of Population Reference Bureau, Inc., 1754 N Street, MW,/Washington D.C. 20036\
over their own reproductive lives as a basic human right. The recognition of this right will mean, one further step toward a more dignified and humane life. All couples will be able to have children by choice, not by chance, i.e., they will have them when they want them and as many as they want. Many people who know that they are sick, weak, or incompetent as parents will gladly decide not to have any children at all. Many others may postpone parenthood until they have matured emotionally or have achieved some success or financial security. Young people will no longer "get into trouble" or be "forced to marry". Every child will be a wanted child and thus have a better chance to grow up in a healthy environment.
While most people today look forward to this increase in human freedom, many have mixed feelings about the other side of the coin - there may be more sexual intercourse between unmarried couples (including the very young). For this reason, official sex education classes in schools, churches and youth organizations often shy away from the subject of contraception. Furthermore, while most educators have little difficulty explaining the facts of human reproduction, they are usually ill at ease describing the various contraceptive methods because they then have to discuss the details of sexual activity. Parents of teenagers also find themselves in a dilemma. If they provide their children with contraceptives, they seem to encourage sexual intercourse; if they ignore the problem, they may invite unwanted pregnancies.
The law in regard to contraception for minors is unclear. Actually, in the United States today there is a maze of many different, overlapping, and sometimes contradictory laws and court decisions which make it difficult to determine whether teenagers are legally entitled to contraception at all or, if that is the case, they still need the permission of their parents.
Still, there are now many public and private groups and organizations, such as Planned Parenthood or students' health services, which offer contraception to unmarried minors. Indeed, it seems that teenagers and young adults need such help more than anybody else. Although they are sexually mature, they often have to wait many years before they can get married and support a family. Many of them are still confused about their own feelings, needs, and objectives in life. Very often they do not know enough or do not care enough about contraception. Some young people actually like to gamble in the hope that nature will decide for them, and that a pregnancy, if it should occur, would somehow bring some purpose and order to their lives. They may secretly hope that a baby of their own may prove their independence from their parents, or that it may help them to "get even" with somebody else. Some girls deliberately deceive their boy friends and try to get pregnant in order to force them into marriage or at least a steady relationship. Most organizations that counsel teenagers about contraception are well aware of these problems. They are, therefore, not content with simply dispensing contraceptive devices, but try to spell out the alternatives and encourage responsible behavior. For this reason, they often invite boys and girls together for a personal discussion. This approach also makes it clear that contraception is always the responsibility of both sexual partners.
Remember:
• Every child should be a wanted child.
• Unwanted pregnancies can be prevented by the careful use ot contraception.
• Contraception is the responsibility of both sexual partners.
• Not every contraceptive method is equally effective or suitable for everyone.
• No contraceptive method can work unless used properly.
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