The history of contraception
“Throughout history, man has sought to control fertility and to plan births. Ancient peoples such as the Chinese, Indians, Egyptians, used, two thousand years before Christ, different contraceptive techniques, including the coitus interruptus and vaginal tampons impregnated with spermicidal substances. Egyptian papyrus (Kahn Papyrus, Ebers Papyrus, IV Ramasseum Papyrus, Berlin Papyrus), more than 3000 years old, refer to procedures dedicated to prevent women from conceiving. Greek and Roman recipes are plentiful, and some of them are surprising. They consist mostly of potions that provoke temporary sterility (for one year), pessaries and local spermicides. Coitus interruptus was also used, as well as anal intercourse, qualified as ‘against the mores’. As for condoms, they are also a very ancient invention. For three millennia, pig bladders, lamb gut, caeca of rabbits, fish swim bladders, have been used to avoid sexually transmitted diseases. The idea of using an intra-uterine device in order to prevent or interrupt pregnancy has also been known since antiquity: it is said that the Arabs and the Turks introduced pebbles in the uterus of she-camels to prevent them from getting pregnant during their long journeys across the desert. The will to separate sexuality from procreation is therefore not new. But in Antiquity and Mediaeval times, it was more frequent to resort to abortion, infanticide and, especially, abandoning newborn babies”.
Modern contraception:
- 17th century: use of the male condom begins.
- 1880: Wilhelm Mensinga develops a diaphragm to serve as a pessary (female mechanical condom).
- 1909: the first intra-uterine device is designed by a German physicist, Richard Richter. It was made of silkworm intestines and was shaped like a ring.
- 1928: Ernest Gräfenberg, a Berlin doctor, invents the coil. At first “he used silkworm intestines sutured together in the shape of a star to make his devices. As these were too easily expulsed, Gräfenberg later developed coils made out of silver, or of an alloy of copper, zinc and nickel. These ‘Gräfenberg rings’ were used extensively in the 1930s. However, the rings frequently caused pain and bleeding, and were liable to be expelled or to perforate the uterus. The main complication was the development of endometritis and salpingitis (inflammation of the Fallopian tubes), severe and recurrent, in numerous patients, and several deaths ensued. For this reason, Gräfenberg’s work was condemned by obstetricians and gynaecologists and by the medical profession as a whole”.
- 1937: the American Medical Association Committee on Contraceptive Practices expressed “its total opposition to contraception using intrauterine methods. Intrauterine devices were condemned in Europe, but continued to be used in Japan”.
1950s:
- 1958: introduction of the famous oestroprogestogenic pill by Gregory Pincus, marking the beginning of “modern” contraception. Contraception, which had been almost exclusively mechanical until then, becomes massively medical.
- 1959: first reports testifying to the safety and effectiveness of the coil arrive from Israel and Japan. The Population Council in New York embarks on an intensive research programme resulting in the development of the modern coil, relatively well-anchored in the uterine cavity and well-tolerated”.
1960s:
- 1960: the pill is introduced for sale in the United States under the brand name Enovid. Modified in 1962 to make it more acceptable to patients, by 1963 there were already more than a million users throughout the world.
- 1964: development of the modern coil owing to the discovery of plastic materials: “intrauterine devices made of these flexible and elastic materials could be folded and introduced through a tube into the uterus, and expand once in the uterus. ‘Margulies coils’ (1964) and ‘Lippes loops’ (1965) were the first polyethylene coils to be manufactured”.
- 1966: the World Population Council develops the notion of subcutaneous progestogen implants in response to “a demand from population control policies advocates who, dramatically emphasizing the dangers of global ‘overpopulation’, were looking for a contraceptive that could be used on a massive scale in developing countries, in the context of “governmental reproductive health programmes”.
- 1966: first clinical study on emergency contraception.
- 1967: contraception is legalized in France (Neuwirth law).
1970s:
- 1971: two scientific studies introduce the notions of “post-coital contraception” and “interceptive” methods to designate the agents capable of preventing a pregnancy from developing by acting before the implantation of the embryo.
- 1974: the Population Council begins clinical tests of implants under the name Norplant.
1980s:
- 1982: Etienne-Emile Beaulieu, of the pharmaceutical laboratory Roussel-Uclaf, presents the abortive pill RU 486 to the Academy of Sciences in France. Roussel-Uclaf signs a deal with the WHO in 1983, followed by a deal with the US Population Council.
- 1983: Finland, where Norplant had been produced, is the first country to approve it. It is subsequently approved in Sweden (1985), Indonesia, Ecuador, the Dominican Republic and Thailand (1987), before being registered and distributed in numerous countries (currently 60). The use of Norplant was approved in the United States in 1990. The product has been distributed in Great Britain since 1993.
- 1984: first time that a product for post-coital “contraception” obtains its license and is marketed in the UK.
- 1988: the abortive pill (RU 486/Mifepristone) is authorized in France. It will later be approved in Great Britain (1991) and Sweden (1992).
1990s:
- 1999: authorization of the commercialization of Norlevo in France.
- 2000: France becomes the first country to approve prescription-free emergency contraception (Norlevo).