Sixty years ago, one of the most consequential events of the past century occurred: the first sale of a drug called Enovid. At the time, it was illegal to use any form of contraception in Massachusetts, where Enovid was developed. But soon everyone just called Enovid the Pill.
A review of “Sex Before the Sexual Revolution: Intimate Life in England 1918–1963” by Simon Szreter and Kate Fisher.
As a young obstetrician in London in the 1960s, who had just moved into a house built in the 1920s, I began talking to my two neighbors, literally over the garden fence. They were both widows in their 80s and we soon wandered into conversations about the role of contraception in their married lives half a century earlier. Looking out on the sexual revolution of the 1960s, they were almost eager to talk about intimate details of their younger lives.
The fifth Millennium Development Goal has brought critical attention to the unacceptably high burden of maternal mortality and the need to improve antenatal health care. However, many of the approaches to reducing maternal mortality (e.g., increasing the number of deliveries at health facilities with skilled attendants or improving access to emergency obstetric care) are complex and will take time to implement. In the meantime, maternal mortality can be reduced relatively inexpensively by preventing unwanted pregnancy through family planning. The decision to practice family planning is personal and private, and it need not require professionals or health clinics. Although inexpensive at the program level, however, family planning may be difficult for individuals to afford. Thus, women face barriers, including cost, lack of transportation and the fear of side effects (real or rumored). In developing countries, making contraceptives available and accessible may be the most important, cost-effective and easily accomplished primary health care goal. Reducing barriers to family planning may lessen the burden of maternal death in low-resource settings.
Letter in response to the Perspective “REPRODUCING IN CITIES” by Mace published in Science February 2008 in Science
In her Perspective “Reproducing in cities” (8 February, p. 764), R. Mace assumes that differences in birth rates between rural and urban areas largely represent the wishes of parents. Human beings in all societies have sexual intercourse hundreds or even thousands of times more often than is needed to conceive the number of children they want. Once individuals have access to the means and information to separate sex from childbearing, family size often falls rapidly (1). For rural women there are an astonishing number of barriers to access to modern contraception (2), while urban women are often better placed to overcome these barriers.
We suggest that birth rates fall in cities primarily because contraception and safe abortion are easier to obtain than in the countryside. For example, in rural Ethiopia only doctors and nurses are permitted to give contraceptive injections, so this popular method is denied to rural women. The total fertility rate (TFR) in Ethiopia as a whole is 5.4, while in Addis Ababa it is now thought to be below 2.0 children. Addis is unusual among African capitals in that safe abortion was available for several years before the recent liberalization of the abortion law. Tens of thousands of operations were performed annually and linked to effective post-abortion contraceptive advice.
We posit that fertility will fall in rural Ethiopia as contraception and safe abortion become more easily available. In Bangladesh, where many women now have access to modern contraception and reasonably safe abortion, two large predominantly rural areas (Khulna and Rajhashi) now have replacement-level fertility (3).
Published in Science, May 16 2008, 874