Since the world is world, humanity has sought methods to control conception. According to Ana Martos in his book Brief history of the condom and contraceptive methods , already in the fourth century BC Aristotle spoke of "recipes to kill sperm." Some of them consisted of "smearing the area of the uterus with cedar or olive oils, mixed with incense or with lead ointment". Although we do not know its efficacy and its health, it could be considered one of the first contraceptive methods.
The methods to avoid pregnancies that are currently used are varied, although we could group them into three types: barrier (preservatives), hormonal (pills, patches, injections ...) and natural methods (basal temperature control or the Billings method, among others). This article, entitled "How many contraceptive methods do you know? There are more than 15 ...", offers a good summary of all available options, as well as their respective percentages of effectiveness in contraception.
Although in Spain access to these methods is quite widespread, the decriminalization of contraceptives was not approved until 1978, as this chronicle of El País of that time tells. Forty years later, the 2018 National Survey on Contraception in Spain showed that 5.67% of women of childbearing age did not use any contraceptive method in their sexual relationships with risk of unwanted pregnancy. Usually the lack of use is due to misconceptions, excuses or myths. The classics "that is not going to happen to me", "I trust the other person" or "it was a moment of passion" are still arguments among young people not to use a condom.
Among Spaniards who do use a contraceptive method, the most commonly used is the external condom, with 38% according to the survey cited. The second place is taken by the contraceptive pill, with 26%, although its use is decreasing among millennials for, among other reasons, its side effects and cost. The list is followed by male sterilization (primarily vasectomy), with 12%, and female sterilization (basically tubal ligation), with 9%.
These percentages, which seem so logical to Spanish (and European) readers, since the use of the external condom is the most widespread in the region with an average of 17.8%), will not be so much for readers of other regions, since that the economic situation, the cultural context, the implementation of pharmaceuticals and public policies condition the most popular methods in each country, as analyzed by this complete study of Medicamentalia.
For example, the one-child policy in China, in force until 2015 and preventing women from having more than one child, caused many women to have an intrauterine device mandatory after their first birth. This caused 40.6% of women of childbearing age to use the IUD, according to statistics published by the UN in 2017. Another example would be North Korea, where that percentage rises to 74%, according to the same statistics. The British newspaper The Guardian published an article about sexuality in the Asian country in which a North Korean citizen explained: "Condoms are very difficult to find, vasectomies are not an option and the only form of birth control is intrauterine devices ".
The opposite case would be found in many countries in sub-Saharan Africa. Arantza Abril, responsible for Reproductive Sexual Health of Doctors Without Borders, explained in this other article that in many of these countries "there is practically no professional trained to place an IUD." This fact, according to the expert, has caused the number of users of subcutaneous implants to grow as a contraceptive method: "They are comfortable, their placement does not cause pain, it works in the long term, it is economical, it has few side effects and the male does not notice it "he commented.
In another context, Canada draws attention to its high number of men who opt for vasectomy: while in the neighboring United States only 10% of couples who use some mechanism to control births turn to vasectomy, in Canada that percentage It rises to 22%. A doctor explained this peculiarity to a Canadian journalist talking about the high cultural acceptance of the procedure and its good coverage by public health services.
Although we have already seen that the variations between countries are enormous, we can say that, in global terms and according to the UN, the most used methods are female sterilization, with 24% (blocking or ligation of the fallopian tubes), followed for the external condom (21%), the IUD (17%) and the pill (16%). 45.2% use permanent or long-lasting methods (such as sterilization, IUD or implants), 46.1% use short-acting methods (such as external condom or pill) and 8.7% use traditional methods (such as reverse gear or those centered on the calendar). However, because the regional differences are so pronounced, these figures only offer a partial picture and it is convenient to use other statistics to complete the table.
A change of perspective
Historically, when they talked about family planning, international organizations used to do it from a demographic perspective: how many children per family did we need for the world population to remain at acceptable levels. However, in 1994, 179 governments approved an action program that changed the approach to another based on human rights, needs, aspirations and circumstances of each woman.
From this perspective, international organizations estimate that there are 1.9 billion women of reproductive age (between 15 and 49 years old). Of that amount, there are 1,100 million with family planning needs and, therefore, interested in the use of contraceptive methods. Within this last figure, there are 842 million who use modern methods (which include almost all those mentioned at the beginning of this article), 190 million without access to contraceptive methods (although they did not want children or would like to further space the birth between them) and 80 million using traditional methods (despite their poor reliability).
If we take a look at the map of how these statistics are distributed, we find that the use of contraceptive methods illustrates the inequality between countries. "In 2019, most countries with a high proportion of women of reproductive age who do not want pregnancies but do not use contraceptive methods are in sub-Saharan Africa," we read in this United Nations report. The lack of access to contraceptive methods, neither modern nor traditional, exceeds 20% in up to 15 countries in that region. Only Haiti and Samoa reach those percentages in other continents. Along the same lines, the three countries that most resort to traditional methods are Chad, Somalia and South Sudan, coinciding quite accurately with the map of countries with less income.
That so many people remain without access to these have repercussions in different fields, such as unplanned pregnancies, maternal and infant mortality, abortions at risk or sexually transmitted diseases. Thus, what are the causes that drive so many women away from access to contraceptive methods?
The Guttmacher Institute, an American NGO founded in 1968 and that promotes reproductive health, published a study entitled "Needs not covered in the use of contraceptive methods in developing countries: examining women's reasons for not using them" . The study mentions that surveys conducted in 52 countries between 2005 and 2014 revealed that, among the reasons most cited by women, were fear of health risks and opposition to the use of these methods, both of women Respondents as their surroundings.
A study by The Pew Research Center, an American think tank founded in 2004, showed that more than 50% of the population in Pakistan, Nigeria and Ghana believed that the use of contraceptives (outside the type of outpatient) was immoral. In Spain the percentage of people who found him immoral, according to the same study, is 2%. And in Mexico, 14%.
Many women, in addition, are forced to assume the weight of contraception for the relevance in their countries of mistaken beliefs or taboos. For example, the Ugandan television network New Vision TV explained in a story that some Ugandan men had refused to participate in a campaign that promoted vasectomies for fear that their virility would be affected. The statistics handled by the UN confirm that the prevalence of male sterilization in Uganda is 0%.
That is why the governments of some countries are taking action in this regard. For example, Ethiopia has formed a broad network of community health workers, who offer information and also contraceptives. And some governments, such as Ghana's, collaborate with NGOs to promote knowledge of contraception alternatives. These local initiatives, coupled with other international ones, such as the provision of contraceptives from the United Nations Population Fund, have brought some favorable results in recent years. One of the latest reviews of these initiatives showed that, between 2012 and 2019, 53 million women had begun using modern methods of contraception in the 69 poorest countries in the world.
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