The role of birth control in developing and developed countries

Birth control has played an important role in controlling fertility in developed and developing countries. My research questions will be exploring how birth control in developed countries compares to birth control in developing countries. The first section explains the history of technological advancements. The second section addresses the environmental impacts of birth control. The third section discusses the social changes that occurred in both societies with the integration of birth control.

Technological Development

Birth control has gone through many advancements both in medicine and technology in order to result in what forms we have today. There are many forms of contraceptive that have been developed over time. The formation of birth control methods focuses on how certain strategies used in developing countries were adopted by developed countries. Some of the technological milestones that have been used by developed and developing countries are condoms, oral hormonal contraceptives, the Intrauterine Device (IUD), and contraceptive vaccines.

One of the first methods of contraceptive would be the condom, and the first use of this method during sexual intercourse dates back to 12,000-15,000 years ago (Dexter & McCormick, 2012). The main purpose for the condom was to prevent semen from fertilizing an egg during sexual intercourse, preventing unwanted pregnancy as well as preventing sexually transmitted diseases. The oldest condoms were found in England dating back to 1640 (Dexter & McCormick, 2012). These condoms were made of animal gut. In the 18th century, Casanova wore condoms made of linen (Dexter & McCormick, 2012). The rubber condoms were mass-produced after 1843 (Dexter & McCormick, 2012). By 1924, the condom was the most commonly prescribed method of birth control, and by World War II it was highly encouraged for the soldiers to use condoms to prevent sexually transmitted infections (Dexter & McCormick, 2012). Similar to the male condom, there is also a female condom which is designed to prevent pregnancy by catching semen (Dexter & McCormick, 2012). Before this was available, women would use substances to prevent the uterus from absorbing semen (Dexter & McCormick, 2012). In South Africa, vegetable seedpods and plugs of grass and crushed roots were used; bundles of seaweed, moss, and bamboo were used in Japan, China, and South Sea Islands; and emptied pomegranates were used in ancient Greece (Dexter & McCormick, 2012). In 1994, a female condom developed by the Wisconsin Pharmacal Company called Reality was available in drugstores in the United States (Dexter & McCormick, 2012).

By the 1960s contraceptive methods were beginning to become more medically derived. The birth control pill was an important form of contraceptive which provided a hormonal method for women to take orally (Dexter & McCormick, 2012). Before this medical form was available, women in developing countries would ingest certain plants for their contraceptive benefits. Amongst these plants were pomegranate, pine, pennyroyal, and vitex (Dexter & McCormick, 2012). For generations, women in Africa, Asia, and the Americas used various fruits and plants for family planning (Dexter & McCormick, 2012). For example, women in India and Sri Lanka would eat a papaya a day in order to prevent pregnancy (Dexter & McCormick, 2012). For scientists in developed countries this sounded as an unlikely treatment, but in 1993 an English research team found that an enzyme in the fruit interacts with the hormone progesterone to prevent pregnancy (Dexter & McCormick, 2012). In the 1940s and 1950s, Planned Parenthood Federation of America founder Margaret Sanger advocated for birth control technology (Dexter & McCormick, 2012). In 1953, research scientist Gregory Pincus and Min Chueh were trying to produce an oral contraceptive based on synthetic progesterone (Dexter & McCormick, 2012). The first clinical trials for the birth control pill were done by Dr. John Rock, and in 1956 the trials were announced a success (Dexter & McCormick, 2012). The first oral contraceptive, Enovid, was approved by the U.S. Food and Drug Administration (FDA) for distribution (Dexter & McCormick, 2012). The formulation of the birth control pill could not have been done without the adoption of the developing world’s methods for contraceptive (Dexter & McCormick, 2012). One of the researchers, Russell Marker, found that Mexican women would eat wild yam as a form of contraceptive (Dexter & McCormick, 2012). Marker used these yams for progestin which was then combined with estrogen to formulate the first pill (Dexter & McCormick, 2012).

With more technologies available, more methods of contraceptives were being created. The Intrauterine Device (IUD) is a form of contraceptive that is placed within the uterus. The idea of a form of contraceptive being placed directly inside of the vagina was first thought of in the ninth century (Dexter & McCormick, 2012). In Persia they suggested to make this device with paper rolled tightly which was tied with a string and coated with ginger water (Dexter & McCormick, 2012). An official device to be placed inside of the uterus was invented in 1909 and were made of silkworm gut, yet they often caused infection (Dexter & McCormick, 2012). These infections were able to be cured with the use of penicillin, which was widely available in 1945 (Dexter & McCormick, 2012). A more advanced form of the device was later created 1926 by German physician Ernst Grafenberg (Dexter & McCormick, 2012). Grafenberg produced the G ring which was a ringed shaped IUD without a string to prevent build-up of bacteria in the uterus, thus causing infection (Dexter & McCormick, 2012). To prevent infection, the antiseptic technique for insertion of the IUD was used (Dexter & McCormick, 2012). In the late 1970s, the IUD took a step back from its advancements with the release of the Dalkon Shield (Dexter & McCormick, 2012). This IUD which brought back the string attached to the device, caused pelvic infection and also had a very low effective rate as many women became pregnant while using the Dalkon Shield (Dexter & McCormick, 2012). This IUD was discontinued for sale in 1974 as many people including the FDA and physicians requested its discontinuation (Dexter & McCormick, 2012). The Dalkon Shield is still used in developing countries, yet the World Health Organization deemed it safe for both developed and developing countries (Dexter & McCormick, 2012). The newest IUD now used was approved in 2000, and it delivers a small dose of progestin, levonorgestrel, directly into the uterus and is effective for up to five years (Dexter & McCormick, 2012).

Similar to the birth control pill, contraceptive vaccines are a form of medicalized birth control. Contraceptive vaccines have yet to be perfected yet it is the future of birth control methods. This vaccine will generate either humoral and/or cell-mediated immune response against hormones/proteins that have a critical role during reproduction (Gupta, Shrestha, & Minhas, 2013). The reaction to such vaccine will lead to the immune system to neutralize the biological activity, thus preventing fertility (Gupta, Shrestha, & Minhas, 2013). There are three categories of contraceptive vaccines. One category of vaccine focuses on preventing the production of gametes through the immune-mediated neutralization of gonadotropin releasing hormone (GnRH) which is secreted by the hypothalamus (Gupta, Shrestha, & Minhas, 2013). This hormone then leads to the secretion of luteinizing hormone (LH) and follicle stimulating hormone (FSH) (Gupta, Shrestha, & Minhas, 2013). When either the LH or FSH are immune-mediated neutralized, this will result in infertility (Gupta, Shrestha, & Minhas, 2013). For the second group of vaccines, the process involves facilitating immune response against spermatozoa- or oocyte specific proteins (Gupta, Shrestha, & Minhas, 2013). These proteins are important in the reproduction process so when they are removed it will prevent fertilization (Gupta, Shrestha, & Minhas, 2013). The third category of vaccine targets the immune-mediated neutralization of human chorionic gonadotropin (hCG) (Gupta, Shrestha, & Minhas, 2013). The hCG is secreted by growing blastocysts which is subsequently the placenta (Gupta, Shrestha, & Minhas, 2013). The infrastructure to give contraceptive vaccines exist mostly in developing countries since it is cost-efficient and free from the risk on improper usage (Gupta, Shrestha, & Minhas, 2013). In order for the use of contraceptive vaccines to be globalized it must improve its immunogenicity (Gupta, Shrestha, & Minhas, 2013). Immunogenicity is the degree to which an antigen can produce an immune response (Oxford Dictionary of Biology, 2016). Once this improvement is complete, the contraceptive vaccine can be truly perfected for usage.

Environmental Implications

Now with wider access to birth control around the world, people were curious about the ways in which pharmaceutical waste could cause any environmental repercussions. The contraceptive waste may be in the water supply, food chains, and landfills.

The fact that contraceptive waste might have an effect on the water supply proves to be a growing concern in both developed and developing countries. Pharmaceutical products and their metabolites contaminate wastewater and the environment at large through natural excretion by patients or inappropriate disposal of unused products (Zhang, et al., 2013). These contaminants will eventually leach into drinking water supplies if they escape degradation or capture during sewage water treatment. One study that was conducted found that when rodents were fed with fish contaminated with xenoestrogens or fish that was exposed to effluent wastewater containing estrogenic compounds it had a negative effect on the convoluted tubules of the testis where spermatogenesis occurs (Zhang, et al., 2013). In addition to xenoestrogens, other estrogenic substances such as Levonorgestrel and synthetic estrogen which are also used in contraceptives are found in effluent water and water systems (Parkkonen, et al., 2000). This effluent water then leads to a river or sea which proves to cause a greater concern. Pharmaceutical products do reach the environment through the water system and incomplete decontamination of wastewater. For Levonorgestrel, the concentration of this component was 4 to 5 times lower than results found in influent water (Pu, Wu, Yang, & Deng, 2008). These results show the importance of wastewater treatment.

Along with disturbing water systems and food chains, pharmaceutical waste also is a concern for landfills and the leaching into water systems. In a study conducted by M.G.J Geurts et al., they were curious if the components of combined hormonal contraceptives including birth control pill, the patch and a vaginal ring, ethinyl estradiol, is found in landfills. Their study focused on the vaginal ring, specifically the product known as NuvaRing. These rings have specific instructions for safe disposal. The ring is supposed to be placed in the enclosable sachet in which the ring is provided in, and they then should be disposed of in normal household waste or returned to a pharmacist (Geurts, Boer, Graaf, & Ginkel, 2007). Since the household waste is incinerated or disposed of in landfills, the likelihood of the ethinyl estradiol contained inside of the contraceptive contaminating groundwater is high. In order to see if this is indeed true they used sandy soil and material from a landfill leached with artificial rainwater. The samples collected were filtered three times using three different filters with diameters of 47 mm (Geurts, Boer, Graaf, & Ginkel, 2007). This specific study was conducted in the Netherlands because of its high population density and its overall sales of contraceptives per capita (Geurts, Boer, Graaf, & Ginkel, 2007). Contraceptives are used by about 45% of the females aged 16 to 50 (Geurts, Boer, Graaf, & Ginkel, 2007). Once the contraceptive rings are disposed of in landfills they continue to release ethinyl estradiol, about 85% of the initial concentration (Geurts, Boer, Graaf, & Ginkel, 2007). The results showed that the sorption of ethinyl estradiol by soil bay actually prevent groundwater contamination because ethinyl estradiol is highly adsorptive (Geurts, Boer, Graaf, & Ginkel, 2007). Since ethinyl estradiol has low mobility in sand, this reduces the risk to groundwater disposed in household waste (Geurts, Boer, Graaf, & Ginkel, 2007).

There are new contraceptive methods as well as older methods under development for both women and men in order to ensure that contraceptives are completely ecofriendly. There are a still areas in which contraceptives cause ecotoxic effects that should be improved. One way to fix this right now would be to switch to methods that last longer such as vaginal rings or IUD (Blithe, 2016). A more long-term solution would be to reduce ecotoxic hormone levels without lowering the effectiveness of preventing pregnancy by adopting ecofriendly manufacturing techniques and to reduce waste products as much as possible (Blithe, 2016).

Social Implications

With more people using the plethora of contraceptive methods available, it created a lot of social issues in health care as well as social disputes in religious groups not supporting the use of such forms of birth control.

The American Social Hygiene Association fought hard to prohibit condom in the early 18th century since it was immoral and “unchristian” (Dexter & McCormick, 2012). Social hygienists did not have any sympathy towards the U.S soldiers who were fighting in World War I. With the denial of the use of condoms, the soldiers had high rates of sexually transmitted infections (Dexter & McCormick, 2012). Condoms were only allowed to be used by men to protect them from sexually transmitted infections such as syphilis and gonorrhea yet were unable to protect their wives from unwanted pregnancy (Dexter & McCormick, 2012). This is something the founder of Planned Parenthood, Margaret Sanger, faced while fighting for women’s right to use birth control in the 1940s and 1950s (Dexter & McCormick, 2012).

For the birth control pill, contraceptive knowledge was rare after the 13th century (Dexter & McCormick, 2012). Women who had the knowledge were at risk of being accused of witchcraft or heresy and the punishment for being caught included torture and death (Dexter & McCormick, 2012). Women in colonial America were offered contraceptive knowledge by Native Americans and their African-Carribean slaves (Dexter & McCormick, 2012).

In a 2010 study, Lynn Rosenberg, et al., found that oral contraceptive has had an effect on breast cancer risk for African American women. In general, there have been multiple studies completed at least two decades ago that have estimated a 25% increase in breast cancer among oral contraceptive users (Rosenburg, Boggs, Wise, Adams-Campbell, & Palmer, 2010). Women who used oral contraceptives were generally younger, had lower BMI, were more educated, have a later age at first birth, and drank alcohol (Rosenburg, Boggs, Wise, Adams-Campbell, & Palmer, 2010). In a study conducted by Lynn Rosenberg et al, they followed 53,848 Black Women’s Health Study participants to see if oral contraceptive used estrogen receptor-negative or estrogen receptor-positive breast cancer (Rosenburg, Boggs, Wise, Adams-Campbell, & Palmer, 2010). Most studies of oral contraceptive use and breast cancer have focused on white women, so the point of the study was to strengthen the results around African American women (Rosenburg, Boggs, Wise, Adams-Campbell, & Palmer, 2010). Their results found that the participants use of oral contraceptive was associated with estrogen receptor negative breast cancer than with estrogen receptor-positive (Rosenburg, Boggs, Wise, Adams-Campbell, & Palmer, 2010). This is alarming since estrogen receptor negative has a greater affect that estrogen receptor-positive cancer. These changes in the formulations of the oral contraceptive proves to be a threat for women to be diagnosed with breast cancer.

The hormones that are ingested through birth control also affects other parts of the body. Another study found that the amygdala is altered structurally and functionally in young adult women within the first months of hormonal contraceptive use. The finding indicates an association between amygdala structure and affect, in line with previously reported associations between smaller amygdala volumes and mood disorders (Lisofsky, Riediger, Gallinat, Lundenberger, & Kühn, 2016). Hormonal effects on amygdala functioning have been proposed as the neural underpinning for these observations, since fear extinction learning relates to amygdala function (Lisofsky, Riediger, Gallinat, Lundenberger, & Kühn, 2016). However, hormone-induced structural changes in the amygdala have not been connected to fear extinction learning and the association of structural and functional amygdala change via hormonal contraception has not been investigated in that context. A better understanding of hormone-induced structural brain changes and their potential impact on fear extinction learning would be clinically relevant, because impaired fear extinction learning has been associated with the development of anxiety disorders such as post-traumatic stress disorder (Lisofsky, Riediger, Gallinat, Lundenberger, & Kühn, 2016).Thus, hormonal contraceptive use might be a risk factor for PTSD and could influence the efficacy of PTSD therapies, as has been suggested previously (Lisofsky, Riediger, Gallinat, Lundenberger, & Kühn, 2016). The study also reported preliminary evidence suggesting that gray matter in the region showing structural alterations is associated with positive affect across individuals and may therefore be relevant for the psychological wellbeing of hormonal contraceptive users.

Developed Countries

For developed countries, the usage of contraceptives has brought more positive outcomes than negative. In the United States for instance, the risk of poor contraceptive use decreased 34% overall and 46% for individuals aged 15 to 17 years (Santelli, Lindberg, Finer, & Singh, 2007). More people are using birth control options such as the condom, oral contraceptives, and more methods, thus showing the decline in non-usage (Santelli, Lindberg, Finer, & Singh, 2007). The developments in contraceptive use overtime has helped prevent pregnancy by reducing the risk by 86% (Santelli, Lindberg, Finer, & Singh, 2007). For individuals aged 15 to 17 years these developments have reduced the risk of pregnancy by 77% (Santelli, Lindberg, Finer, & Singh, 2007). Although this information is from the United States, other developed countries have shown similar patterns with improved contraceptive use (Santelli, Lindberg, Finer, & Singh, 2007).
Developing Countries
For developing countries, there has been a substantial increase in the use of contraceptives by adolescent women over the last two decades (Blanc, Tsui, Croft, & Trevitt, 2009). There are now more adolescent women than older women using birth control methods and use is usually done by shorter time frames with consistent use, more contraceptive failure, and discontinuing usage for other reasons (Blanc, Tsui, Croft, & Trevitt, 2009). When looking at trends, it is predicted that the demand for contraceptive methods will be needed to challenge the preparedness, capacity and resources of existing family planning programs and providers (Blanc, Tsui, Croft, & Trevitt, 2009). Although there have been positive results there is still room for improvement for access and education of contraceptive and contraceptive use. In countries that have a low quantity of contraceptive available for access, it is important that they provide access to meet the demand for contraceptives and improve the quality of care (Williamson, Parkes, Wight, Petticrew, & Hart, 2009). For issues such as improving the quality of care, such as providing counseling for women to ensure that she is aware of what contraceptive she wants to use and how to use it correctly. This change will help countries avoid contraceptive discontinuation which is related to the patient’s needs as well as the patient becoming pregnant which could have been prevented with proper care (Williamson, Parkes, Wight, Petticrew, & Hart, 2009).
Contraceptives have played a substantial role in controlling fertility in developed and developing countries. With the technological advancements for contraceptives, it has allowed for higher access worldwide as well as higher effective rates. Through this developmental process, there has been some challenges with accepting the use of contraceptives and when it was accepted by the public, it was able to prevent infections and of course unwanted pregnancy. Although newer forms of birth control have had some negative effects on the environment, majority of the findings show no damage due to contraceptive waste. In fact, there are new developments in birth control that are being enhanced such as the eco-friendly options that were suggest in the Blithe reading. With such developments through history it has been a topic of controversy with some communities not accepting contraceptive use. These barriers are slowly but surely being broken down by individuals who see the benefits of birth control use both in developed and developing countries. There is still a lot of room for improvement with the access for contraceptives in developing countries and for the developed countries they should focus on perfecting birth control for the rest of the world.

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