Population Matters-USA – working for a sustainable world

There are three pieces of good news about birth control methods. One is very old, but never really studied, one is brand new and one futuristic.

I spent some time in Paris studying French when I was in college. I also learned about a male method of birth control from a research assistant for Dr. John Rock. Rock is best known for his work in developing “The Pill”, but he was also interested in other means of limiting fertility. He tested an idea based on the fact that testicles work best if they are cooler than core body temperature. His idea, which was never marketed, was an insulated athletic supporter. It was nicknamed the “Rock Strap”, of course.

Fast forward 60 years and researchers are still working on this idea. The physiology is clearly effective, but the long-term safety of heating testicles hasn’t been studied. Furthermore, persuading men to wear a warming codpiece doesn’t seem too practical.

Many governments have recognized that it is safer for women to take “The Pill” than to not use contraception. The relative safety is especially true in places with high maternal mortality—because preventing pregnancy also prevents maternal mortality. Oral contraceptives are available without prescription in over 100 countries—and, thanks to OPill®, now the USA is one of them! The FDA has finally recognized the safety of oral contraceptives.

The manufacturer and nonprofits that worked to make birth control pills available over the counter had several wishes that went along with the approval. The pill should be available to teens, it should not be too expensive, and that insurance should cover the medication even though it is available over-the-counter. After 20 years of work, they finally got their wishes! The FDA has very strict requirements. One of them is that the pills come with instructions on their proper usage that almost anyone can understand.

OPill® is a Progestin-Only Pill (POP). Unlike the majority of hormonal contraceptives, it does not have any estrogen. Blood clots, the most serious problems caused by birth control pills, are caused by estrogen; that is one reason the FDA finally gave their approval. There are minor problems with POPs, however, such spotting and needing to take OPill® at the same time of day, every day. Also, the unintended pregnancy rate may be a little higher than pills with estrogen.

Although I knew that sperm didn’t like heat, I didn’t know that they don’t like iron. An innovative contraceptive that is now the subject of research makes use of that fact. Ovaprene® is a diaphragm-like vaginal insert with a central mesh that is impregnated with an iron compound. Because it is a mesh, it is permeable to blood and cervical mucus, but the iron makes it lethal to sperm. The woman places it in her vagina as her period ends, being careful that her cervix is covered. The insert is left in place until her next period starts. It has the theoretical advantage of being nonhormonal, and providing month-long protection against pregnancy.

Ovaprene® appears to be ready for human testing. However, it is still years away from commercial availability, so don’t expect to find it in your pharmacy any time soon.

This brings up the challenges of developing a new family planning method. There are many contraceptive ideas that seem great at the start, but wind up in the trash. I know from personal experience. My idea for a rip-stop condom earned a patent (#4,881,553), but lost me a lot of money since no company was interested in buying the idea. This winnowing process explains, in part, why new methods are usually expensive.

©Richard Grossman MD, 2024

We were listening to Ann Patchett’s book of essays “These Precious Days” when “There are no children here” started. It is a remarkable essay in 23 parts, explaining why Patchett is not a mother.

One of the micro-essays upset me a bit. Patchett met a woman who had always known that she didn’t want children. The new friend said that it took her two years to find a doctor who would do her tubal ligation.

At age 37, Patchett decided she wanted a tubal ligation. She told her fiancé, a physician, and he told her “no”; she was doing well on birth control pills, and there is risk to surgery. She asked her gynecologist for a tubal and she also said “no”; the pill has benefits that help women. If Patchett had her tubes tied, there was a big chance that she’d go back on the pill in order to have milder periods.

I disagree with what her fiancé and doctor advised. The failure rate of the pill is higher than that of a tubal ligation, and (despite its safety), the risk of blood clots from the pill increases rapidly as women age.

I like what her friend said, referring to doctors who refused to do tubal ligations: “They think we don’t know our own mind when we decide to have an abortion, but we also don’t know our own mind when we decide to put ourselves in a position where we’ll never have to have an abortion.” Patchett wrote that the doctors who refused to do tubal ligations on request, considered women to be fools who couldn’t be trusted.

Common parlance distinguishes between women who want a child but are infertile, and those who are “childfree” by choice. The latter group has always existed, but is becoming more common now. Some of these women are so focused on their work that they don’t have the time or energy to parent. Others feel that they would not be good mothers. In addition, there is a new group—women who are concerned that the future is to bleak to subject a child to climate chaos, as well as those who realize that adding to the population will worsen the future of the planet.

There are women who did not have children—voluntarily or not—throughout history. Roman Catholic nuns take a vow of chastity. One well-known group were the Vestal Virgins, priestesses of the Roman goddess Vesta. They were chosen before puberty and could retire—and even marry—after 30 years. However, if one were caught breaking her vow of chastity, she would be executed.

The latest figures I could find show that about one in 6 women in the USA never gave birth. Of course, that could be either for reason of infertility or voluntary childlessness.

In most societies women experience pressure to get married and then have children. Although pressure for marriage seems to have decreased, women are still expected to have babies. Pronatalism is causing humans to reproduce at an untenable rate, thus increasing overpopulation and environmental damage.

There are many organizations for people who are considering being childfree, or have already made that decision. “The Notmom” (www.thenotmom.com) is unique because it supports women whether they are childless “by choice or by chance”. One nonprofit provides funding for sterilizations for both men and women. ChildFree by Choice (www.childfreebc.com) uses donations to help people of all genders avoid unplanned pregnancies.

If you would like to know more about pronatalism, I suggest Nandita Bajaj’s article: www.populationbalance.org/pronatalism. Recently she was recognized as an expert in the field by coauthoring an article in the preeminent journal, Science Progress: “World scientists’ warning: The behavioural crisis driving ecological overshoot”.

We live in an era where it is possible to have a loving, heterosexual relationship without fear of an unintended pregnancy. Now there are global as well as personal reasons to be childfree.