Herstory Lesson

You may not like to think so, but the fact is, your grandparents had sex. And so did their grandparents. And theirs. So, what with all the hanky-panky going on since the dawn of time, it's not really too surprising that the invention of the birth control pill in the 1950s wasn't humanity's first foray into contraception. Of course, with all those years to think about what they really wanted out of an effective contraceptive, women have developed a pretty stringent laundry list of goals they'd like their birth control to meet. The story of contraception has really been all about getting closer and closer to hitting those marks for quality and convenience—and we aren't quite there yet.

Birth control B.C.

Some of the earliest birth control methods in the world date to ancient Egypt, where they were being used and written about as early as 1850 B.C. Egyptian women primarily focused on barrier methods, applying objects or pastes to the vagina and cervix in the hopes of blocking, killing—or,  ideally, blocking and killing—any sperm that tried to reach the uterus.

In concept, this isn't too far removed from the combination of diaphragm and spermicide that some women still use today. In practice, however, ancient Egyptian methods could be a lot less pleasant. "Balls of crocodile dung were one option," says Dr. Donnica Moore, a multimedia women's health educator. Barriers were also made from honey or from tampon-like wads of cotton soaked in fermented juice. Both these methods might have been somewhat effective, simply because the sugars in the juice and the honey would have broken down into lactic acid, which can have spermicidal qualities.

However, birth control was far from an exact science. Among other popular methods, people tried primitive versions of what's now known as natural family planning—condoms made from animal intestines and, later, vulcanized rubber; and the withdrawal method of sex. Most of these had major drawbacks and, while they may have slightly reduced your chances of conceiving, they weren't effective in any consistent or reliable way.

Pill popping

Enter the pill.

The idea of an oral contraceptive isn't a 20th century invention. People around the world, from the ancient Greeks to more recent Pacific Islanders, have used various local herbs and plants that were recommended to women who didn't want to be pregnant. Of these, many were probably useless. But not all. For instance, Sri Lankan women have long held the idea that a papaya a day keeps the babies away. Planned Parenthood reports that, in 1993, English researchers discovered that papayas were an excellent source of papain, an enzyme that offers some contraceptive benefits—though like the Egyptian honey, it wouldn't have been reliable.

Unfortunately, knowledge of methods like these was pretty much lost to Western medicine by the 20th century. Planned Parenthood founder Margaret Sanger provided a lot of the funding that pushed forward oral contraceptive research in the 1940s and 1950s, and the first birth control pills were sold in the U.S. in 1957. But this pill was very different from the hormonal contraceptives we use today. "The first pills had much, much higher doses of estrogen and progestin," Moore says. "They also had much higher rates of side effects and much higher rates of more serious complications like stroke, deep-vein thrombosis, and even some suspicion of hormonally induced cancers."

Clearly, the first challenge for this new generation of birth control was to lower the health risk associated with hormonal contraceptives. And, largely, birth control researchers have been successful at achieving that goal. Today's oral contraceptives use much lower doses of hormones, have fewer side effects, and are safer than their ancestors.

The pill has adapted in other ways as well. You can now get hormonal contraceptives delivered via intrauterine devices, rings, patches, shots, and implants, making birth control more convenient and harder to mess up. There are also contraceptives that contain only progestin, no estrogen, making them safe for nursing mothers and reducing certain side effects. And researchers have developed new types of progestins that are less likely to cause acne or weight gain than the first pills did.

To the future ... and beyond

There are still challenges to be met. The Population Council, a nonprofit dedicated to birth control research and promotion, has an ambitious set of goals. First off, women want systems that work longer and don’t require monthly trips to the pharmacy, says Dr. Regine Sitruk-Ware, the organization’s executive director of research and development. Hormone-containing IUDs and implants do this now, but these methods don’t meet the needs of all women, so the Population Council is working on developing a ring—similar to today's NuvaRing—that could be re-used for 13 menstrual cycles. "You'd use the same ring, three weeks in, one week out, for a full year," Sitruk-Ware says. This ring is in the third round of research trials and could be available as early as 2009 or 2010.

Making hormones used in birth control even safer for women is another important goal. Right now, most birth control is made with ethinyl estradiol. In rare cases, this synthetic estrogen can modify some of the proteins the liver produces, raising the risk of blood clots. Sitruk-Ware says that one way to reduce this risk even further is to switch to an estrogen called estradiol. She says that there are several pharmaceutical companies working on this right now and the first oral pills with estradiol might be available as soon as next year.

Finally, Sitruk-Ware says that even though “male contraception is a field where there’s really very little available right now,” the future of birth control will likely involve men. And, she says, both women and men want at least a couple of birth control options that would put men in the driver's seat. One way to do this might be with an androgen implant. Androgen is a potent male hormone that, when released into the body, has been shown to lower sperm count to almost zero; the numbers reverse soon after the implant is removed. Another method would use molecules to target the proteins that help sperm mature, turning off that ability so that the sperm would be incapable of fertilizing anything.

Unfortunately, it's hard to know how soon these male-centric methods will become available. "Very few private companies are working on male contraception," Sitruk-Ware says. "But this is a field that is very important to nonprofits like the Population Council." She estimates that it could be between five to 15 years before a male contraceptive is ready for the public.