Contraception: an overview.

Abstract

In this century, paramount progress has been made in many areas of medicine, not least in the field of contraception, with landmarks such as the introduction of intrauterine contraceptive devices (IUDs), hormonal contraceptives (OCs), and laparoscopic sterilization. The general optimism of the 1960s about overcoming the problems of global overpopulation with these new tools has subsequently been replaced by growing concern about the risks of contraception in general and of OCs especially. It was not before the 1980s that the benefit-risk balance of hormonal contraception turned out to be much more favorable than was formerly suspected. The wide variation from country to country in the prevalence of contraceptive methods has economic, political, religious, sociological, educational, and legal rather than medical reasons. Former misjudgments have led to a ban on valuable tools such as the sequential regimen or the use of 17-acetoxyprogestogen analogues as components in OCs, or to a ban on the licensing of depot progestogens in some countries but not in others. The recent decision of U.S. firms to cease production and sale of IUDs for legal reasons is unique and hopefully will not be imitated elsewhere. Just after the introduction of oral contraception, tremendous inventive dynamics led to the discovery of several new contraceptive principles. Most of these have reached the stage of clinical application and are being used satisfactorily, at least in some parts of the world. Later contraceptive concepts are still in the stage of experimentation and no breakthrough appears to be directly ahead. If contraception means more than just meeting individual wants--if it is also to be an instrument for handling the increasing problems of overpopulation--then much more must be done to deepen our knowledge of reproductive physiology, to popularize efficient means of contraception, and to make them available to everyone. Otherwise, all efforts to improve health standards throughout the world according to the "WHO Global Strategy for Health for All by the Year 2000" will be in vain.