He was also convinced that there should be many more birth control clinics. “The best way to get a birth control program started,” he wrote, “is to put a field worker on the spot to get things organized and operating while I contribute the needed initial expense.” He hired Elsie Wulkop, a social worker whom he had known at Massachusetts General Hospital. She began work in Detroit in 1930 and during the next four years helped to open clinics in Michigan, Indiana, Missouri, Kansas, and Nebraska.

Throughout the late 1930s, always with an eye to strengthening the US birth control movement, Clarence Gamble urged the unification of Margaret Sanger’s Clinical Birth Control Research Bureau with the competing American Birth Control League. In 1939, the two organizations became the Birth Control Federation of America.

As he worked to expand access to birth control, Clarence followed a pattern of careful spending, making grants just sufficient to allow a clinic to open, and at the same time moving in response to local politics. He did not have a fortune the size of the Rockefellers; he was both unable to and uninterested in permanently subsidizing the impoverished. Working with a public often upset by birth control, he made sure that his fieldworkers educated the community to the point where members understood the importance of contraception, and would thus be willing and able to take over the work and its costs without further outside assistance. Clarence was then able to explore new frontiers and disseminate the workings of birth control more widely.

With his carefully calculated cash outlays, Clarence planted seeds that years later flourished. He funded early research for the Southeastern Pennsylvania League’s work to identify effective spermicidal jellies. After the American Medical Association (AMA) acknowledged in 1937 that contraception merited a physician’s attention, Gamble’s research became the basis of the AMA Standards Program for testing contraceptives—which was the measure of the AMA for endorsing contraceptive products, and finally the basis for state and federal legislation.

In 1937, he began to fund education and distribution of birth control supplies through the North Carolina State Board of Health, making North Carolina the first state to incorporate birth control in a public health program. This influenced five nearby states—South Carolina, Alabama, Florida, Mississippi, and Virginia—to incorporate birth control into their public health programs.

Throughout the 1930s, Clarence’s time was devoted to working with existing birth control organizations, often holding overlapping executive positions. He was president and delegate-at-large of the Pennsylvania Birth Control Federation; state delegate, one of five vice-presidents, and member of the Executive Committee of the Board of the American Birth Control League; medical field director of Margaret Sanger’s Birth Control Clinical Research Bureau; and treasurer and member of the board of Robert Dickinson’s National Committee on Maternal Health. By 1938, Clarence had left Philadelphia and the University of Pennsylvania. He purchased a house outside of Boston, Massachusetts, and funded eight field workers who were nurturing the beginnings of community-supported birth control clinics in Montana, Tennessee, Virginia, Florida, throughout the East Coast, and in the Midwest. During this decade, Clarence and his fieldworkers were responsible for helping to establish birth control clinics in 40 cities in 14 American states.

Dr. Gamble and his workers explained and promoted simple methods—not the expensive and often impractical diaphragm, but spermicidal jellies, foam powders, sponges to be dipped in salt or other inexpensive solutions—to women who otherwise would never have known of nor been able to afford contraceptives. At the same time, he recognized the need for scientific data to back his promotion of the simple methods, and he set up extensive clinical trials, with his visiting nurses collecting data that measured the effectiveness of the simple methods. Again and again, it was shown that birth rates were reduced by as much as two-thirds or more using these simple methods.

In Logan County, West Virginia, Clarence conducted the most thorough field trial of a chemical contraceptive that had ever been undertaken in the United States. The trial involved 1,345 women who used contraceptive jelly over a three-year period, from June 1936 to August 1939, and decreased their birth rate by 41 percent.

Adapted from the Wikipedia article Clarence Gamble, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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Contraceptives

Condoms, tubal ligation, and some intrauterine devices (IUDs) are available at no cost to a woman. Other forms of contraception that require a fee, such as other IUDs and chemical drugs (like the Depo shot), are available, but the woman does not need to get a prescription to obtain them.

Family Planning

In 1965, the Asociación Panameña para el Planeamiento de la Familia, or APLAFA, was founded to help women control the size of their families. A private family planning group, APLAFA has gone to great lengths not just to reduce the rate of teen pregnancy, but also to aid pregnant women with pre- and post-natal care for their unwanted pregnancies. The Panamanian government has also played a constructive role in the family planning movement. It offers services which teach couples about natural birth control methods (such as the ovulation method, the symptothermal method, and the rhythm method ), as well as modern methods, which many know as “the pill”, shots, patches, sterilization, and others.

Adapted from the Wikipedia article Abortion in Panama, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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Abstinence, be faithful, use a condom, also known as the ABC strategy or abstinence-plus sex education, also known as abstinence-based sex education, is a sex education policy based on harm reduction which modifies the approach of abstinence-only sex education by including education about safe sex and birth control methods. Abstinence-only sex education is strictly to promote the sexual abstinence until marriage, and does not teach about safe sex or contraceptives. The abstinence-based sex education program is meant to stress abstinence and include information on safe sex practices. In general terms, this strategy of sex education is a compromise between abstinence-only education and comprehensive sex education. The ABC approach was developed in response to the growing epidemic of HIV/AIDS in Africa, and to prevent the spread of other sexually transmitted diseases.

Abstinence-based sex education can include issues of human relationships, the basic biology of human reproduction, safe sex methods and contraceptives, HIV/AIDS information, and masturbation in place of sex. It recommends sexual abstinence outside marriage as an ideal, having only a single long-term sexual partner. The use of condoms and other safe sex practices is advocated only if it is not possible to remain with a single sexual partner. Advocating this ideal, whilst pragmatically dealing with the fact that abstinence only sex education is ineffective by itself, has made the ABC approach more palatable to many African governments and relief agencies.

The ABC approach has notably been used in African countries like Uganda.

Adapted from the Wikipedia article Abstinence, be faithful, use a condom, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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Compared to the other common reversible methods of contraception such as IUDs, hormonal contraceptives and male condoms, coitus interruptus is less effective at preventing pregnancy. As a result, it is also less cost-effective than many more effective methods: although the method itself has little direct cost, users have a greater chance of incurring the risks and expenses of either abortion or pregnancy and child-birth. Only models that assume all couples practice perfect use of the method find cost savings associated with the choice of withdrawal as a birth control method.

The method is largely ineffective in the prevention of STDs, like HIV, since pre-ejaculate may carry viral particles or bacteria which may infect the partner if this fluid comes in contact with mucous membranes. However, a reduction in the volume of bodily fluids exchanged during intercourse may reduce the likelihood of disease transmission compared to using no method due to the smaller number of pathogens present.

The method may be difficult for some couples to use. The interruption of intercourse may leave some couples sexually frustrated or dissatisfied.

Masters and Johnson considered withdrawal as a means to developing sexual problems, e.g. premature ejaculation and erectile dysfunction.

Adapted from the Wikipedia article Coitus interruptus, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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In three large clinical trials involving a total of 3,330 women using the Ortho Evra / Evra patch for up to one year, 12% of users discontinued the patch because of adverse events. The most frequent adverse events leading to patch discontinuation were: nausea and/or vomiting (2.4%), application site reaction (1.9%), breast discomfort, engorgement or pain (1.9%), headache (1.1%), and emotional lability (1.0%).

The most frequent adverse events reported while using the Ortho Evra / Evra patch were: breast discomfort, engorgement or pain (22%), headache (21%), application site reaction (17%), nausea (17%), upper respiratory tract infection (10%), menstrual cramps (10%), and abdominal pain (9%).

Breakthrough bleeding and/or spotting while using the Ortho Evra / Evra patch was reported by: 18% in cycle 1, 12% in cycle 3, 8% in cycle 6 and cycle 13. Breakthrough bleeding (requiring more than one pad or tampon per day) was reported by: 4% in cycle 1, 3% in cycle 3 and cycle 6, and 1% in cycle 13.

Additional side effect information is provided in the Ortho Evra label information and the Evra SPC and PIL.

Thromboembolic risks

All combined hormonal birth control products have a very small increased risk of serious or fatal thromboembolic events. There is ongoing research into the thromboembolic risks of Ortho Evra as compared to combined oral contraceptive pills. A recent study found that users of the contraceptive patch may have a twofold increased risk for non-fatal venous thromboembolic events compared with women who took a norgestimate-containing oral contraceptiv

In studies with oral contraceptives, the risk for cardiovascular disease (such as thromboembolism) is significantly increased in women over the age of 35 years who also smoke tobacco. Hence, Ortho-Evra’s package insert states: “Women who use hormonal contraceptives, including ORTHO EVRA, should be strongly advised not to smoke.”

According to the manufacturer, the patches introduce a 60% higher level of estrogen into the bloodstream as compared to oral contraceptives; however, the clinical significance of this difference is unknown.

On November 10, 2005 Ortho McNeil, in conjunction with the FDA, revised the label for Ortho Evra, including a new bolded warning about higher exposure to estrogen for women using the weekly patch compared to taking a daily birth control pill containing 35& µg of estrogen, noting that higher levels of estrogen may put some women at increased risk for getting blood clots. The label was again revised in September 2006, and on January 18, 2008, the FDA again updated the label to reflect study results. “The FDA believes that Ortho Evra is a safe and effective method of contraception when used according to the labeling, which recommends that women with concerns or risk factors for serious blood clots talk with their health care provider about using Ortho Evra versus other contraceptive options.”

Adapted from the Wikipedia article Contraceptive patch, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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The commission produced a report in 1966, proposing that artificial birth control was not intrinsically evil and that Catholic couples should be allowed to decide for themselves about the methods to be employed. According to the majority report, use of contraceptives should be regarded as an extension of the already accepted cycle method:

The acceptance of a lawful application of the calculated sterile periods of the woman–that the application is legitimate presupposes right motives–makes a separation between the sexual act which is explicitly intended and its reproductive effect which is intentionally excluded. The tradition has always rejected seeking this separation with a contraceptive intention for motives spoiled by egoism and hedonism, and such seeking can never be admitted. The true opposition is not to be sought between some material conformity to the physiological processes of nature and some artificial intervention. For it is natural to man to use his skill in order to put under human control what is given by physical nature. The opposition is really to be sought between one way of acting which is contraceptive and opposed to a prudent and generous fruitfulness, and another way which is, in an ordered relationship to responsible fruitfulness and which has a concern for education and all the essential, human and Christian values.

Adapted from the Wikipedia article Pontifical Commission on Birth Control, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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Individuals who wish to use a cervical cap are screened by a health care provider to determine if a cervical cap, or one brand of cap, is appropriate for them. If a cap is determined to be appropriate, the provider will determine the proper size. The user must be refitted after any duration of pregnancy, whether the pregnancy is aborted, miscarried, or carried to term through vaginal childbirth or caesarean section.

Several factors may make a cap inappropriate for a particular woman. Women who have given birth may have scar tissue or irregularly shaped cervixes that interfere with the cap forming a good seal. For some women, available sizes of cervical caps do not provide a correct fit. Also, cavity rim caps are not recommended for women with an anteflexed uterus.

Obtaining a fitting appointment may be difficult for some women. A 1997 survey in the United States found that most family medicine residents had no experience with prescription methods of birth control other than oral contraceptives. In some countries, some devices (such as the Lea’s Shield) are available without a prescription.

Adapted from the Wikipedia article Cervical cap, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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There are a number of ways to reduce or eliminate the risk of ovarian cancer. Pregnancy before the age of 25 as well as breastfeeding provides some reduction in risk. Tubal ligation and hysterectomy reduce the risk and removal of both tubes and ovaries (bilateral salpingo-oophorectomy) dramatically reduces the risk of not only ovarian cancer but breast cancer also. The use of oral contraceptives (birth control pills) for five years or more decreases the risk of ovarian cancer in later life by 50%.

Tubal ligation is believed to decrease the chance of developing ovarian cancer by up to 67% while a hysterectomy may reduce the risk of getting ovarian cancer by about one-third. Moreover, according to some studies, analgesics such as acetaminophen and aspirin seem to reduce one’s risks of developing ovarian cancer. Yet, the information is not consistent and more research needs to be carried on this matter.

Adapted from the Wikipedia article Ovarian cancer, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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In the years since people first became aware of the AIDS epidemic, Japan like most industrialized nations has not suffered the high rates of disease and death that characterize, for example, some nations in Africa, some nations in Southeast Asia, etc. In 1992, the government of Japan justified its continued refusal to allow oral contraceptives to be distributed in Japan on the fear that it would lead to reduced condom use, and thus increase transmission of AIDS. As of 2004, condoms accounted for 80% of birth control use in Japan, and this may explain Japan’s comparably lower rates of AIDS.

Adapted from the Wikipedia article Sexuality in Japan, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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The Jewish view on birth control currently varies between the Orthodox, Conservative, and Reform branches of Judaism. Among Orthodox Judaism, use of birth control has been considered only acceptable for use in certain circumstances, for example, when the couple already has two children. Conservative Judaism, while generally encouraging its members to follow the traditional Jewish views on birth control has been more willing to allow greater exceptions regarding its use to fit better within modern society. Reform Judaism has generally been the most liberal with regard to birth control allowing individual followers to use their own judgment in what, if any, birth control methods they might wish to employ.

When Orthodox Jewish couples contemplate the use of contraceptives, they generally consult a rabbi who evaluates the need for the intervention and which method is preferable from a ”halachic” point of view.

Adapted from the Wikipedia article Religious views on birth control, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki

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