Family planning

A half century ago, a medicine was approval by US authorities that wasn't for sick people, but it's saved millions of lives. It has provoked so much discussion and altered the ways men and women related to themselves and the world, that in the end it simply became know as the Pill. A more generic name is hardly possible, but everyone knows what it is.

This small tablet has brought about striking changes in both the industrialized and developing worlds by giving women control over their own futures -- and in what appears to be such a simple way.

For a woman to avoid or delay pregnancy, she only has to swallow a small tablet and fears of an unwanted pregnancy are largely gone. According to the international Planned Parenthood Association, a family planning organization, fewer than one in 100 women will get pregnant if they take the pill as directed. It's a birth control method used by more than 100 million women around the world today.

Bad old days

While for many women of child-bearing age today, taking the Pill and avoiding unplanned pregnancies is almost a given, for their mothers or grandmothers things used to be very different.

"It was disastrous, it was destroying," said Ingar Brueggemann, a former director of Planned Parenthood who remembers the days before 1960 when access to birth control for most women was non-existent. Having sex then was akin to playing Russian Roulette, especially if a woman wasn't married.

"Of course the wrong people, because of one wrong night, got married," she told Deutsche Welle. "The pressure was enormous. I knew of young women who killed themselves because they got pregnant."

Some chose abortions, which were often unavailable, illegal and unsafe. If the women did have the child, her prospects for college or a career largely vanished.

But in 1960, the US Food and Drug Administration approved a pill for contraceptive use, Enovid, that worked by suppressing ovulation. Women rushed to the doctor for prescriptions, ready to gain control over their fertility and their lives.

It now meant that a woman could decide when she wanted children, and how many she wanted, which affected her work, family income, and a woman's health.

Crucial for development

The appearance of the Pill was a watershed moment for family planning in the United States and soon, Europe. But it has also had a lasting effect in developing countries, where family planning is a critical issue. However, family planning experts say the birth control revolution has still not arrived in every part of the developing world.

While birth rates in developed countries have fallen, sometimes to under replacement levels in countries like Germany, the population of the 49 least developed countries is still the fastest growing in the world. Africa's population is expected to double in the next 40 years. The average woman in sub-Saharan Africa has 5.3 children. One of our seven women die in childbirth in Niger, whereas in Sweden, the rate is one in 17,000.

"Fewer pregnancies is a health issue, and you have to think about empowering women to really decide on their future and not face unwanted pregnancies," said Klaus Brill, a vice- president at Bayer Schering Pharma, which produces an array of family planning products, including the Pill.

"If we can come down with the number, those young boys and girls will get the education they need, will be fed well, and have a better future."

According to the United Nations, contraception prevents almost three million infant deaths a year. Birth control reduces poverty, slows population growth and eases pressure on the environment.

Success or failure?

Family planning efforts in the developing world have seen success. In 1960 fewer than 10 percent of married women used contraception. By 2000, that number had jumped to over 60 percent. And the most popular temporary contraceptive method is the Pill.

Still, many woman in the developing world who do want to delay or avoid pregnancy are not using birth control, and for a lot of them, it's not by choice. In some male dominated societies, contraception is frowned upon by husbands who think they will be perceived as weak and lose status if their wives don't bear many children. For these women in these societies, said Ute Stahlmeister of the German Foundation for World Population, the Pill can be an especially good choice.

"She can use the Pill secretly and her husband or partner doesn't know she's using contraceptive," she said. "And, the Pill is one of the safest contraceptives she can use."

But there are downsides to the oral contraceptive that have less to do with the Pill itself than with a lack of information or erroneous beliefs. Many women in developing countries believe the Pill brings with it serious side effects and health risks, even though a large study released this March found women who use it are less likely to die from any cause, including cancer and heart disease.

According to Stahlmeister, one-fourth to one-half of those women in the developing world who don't use oral contraceptive don't use them because of misguided fears about side effects.

Statistics like this, as well as problems of making the Pill accessible to women who live far from clinics or pharmacies, cost and teaching women to correctly use the contraceptive have frustrated some family planning experts, who see a lot of unfilled potential.

"I would say 50 years of the pill has meant freedom in the West, and fifty years of failure in the developing world," said Ingar Brueggemann, the former Planned Parenthood director,

Most family planning advocates say continuing education is crucial – educating women and men about their bodies, reproduction, and the benefits of keeping the size of the family small. That remains a challenging task, especially in the light of a UN study that found fewer than 20 percent of sexually active young people in Africa use contraception.

"If you want developing world to develop, you definitely need the human right for family planning to be realized," said Stahlmeister. "A big part of that is the Pill."

Author: Kyle James
Editor: Anke Rasper