Dec. 2, 1999 (Atlanta) -- On the cusp of the new millennium, family planning, though not quite in its infancy, still has a lot of room for growth. But enough has been accomplished in that area during the last 100 years for the CDC to consider it one of the century's 10 greatest public health achievements, alongside control of infectious diseases and declines in deaths from heart disease and stroke.
In an article in Thursday's issue of the CDC's Morbidity and Mortality Weekly Report, the ability to achieve desired spacing between the birth of children and family size are called the "hallmarks" of family planning since 1900, and key contributors to "the better health of infants, children, and women."
But family planning does far more than help inside the home. The benefits reach outside the home, helping to improve the social and economic role of women, and health in general, according to the report. "The development of a system of reproductive health care in this country really also allows medicine to do a lot of other good things. The family planning clinics are doing cervical cancer screening, they're doing STD [sexually transmitted disease] detection and treatment, they're teaching women breast exams, and they're providing a lot of primary care of other sorts," John Santelli, MD, the lead author of the article, tells WebMD.
"I think what we've seen is the broadening of the concept of what reproductive health care is, from sort of a narrow focus on strictly controlling fertility, to a more broad understanding of what's important for women's health and women's reproductive health, that's a real success story," says Santelli, who's also an epidemiologist and assistant director of science in the division of reproductive health at the CDC.
Achieving that success was not easy, though. Family planning has been dragged, at times kicking and screaming, into the modern era. In 1900, between six and nine of every 1,000 women died while giving birth, but distributing information and counseling about contraception was illegal under many federal and state laws. Now, "the rates are one-hundredth of that, 1% of that," says Santelli. "But lots of women used to die, lots of women had medical problems."
One of the two key turning points, according to Santelli, occurred in 1916. That's when Margaret Sanger, the founder of the Planned Parenthood Federation of America, opened the first family planning clinic in New York. Police shut it down nine days later, and a court battle followed. Sanger lost that battle, but she won the war. Family planning became an issue of public debate, and legal precedent was set. By the 1920s and 1930s, condom and diaphragm use began to become popular, and "there's lot of support for [Sanger] among the medical profession," Santelli says.
That phase was more social. The second was more technological, and it began in 1960, when the FDA approved the birth control pill and the intrauterine device (IUD). "The truly modern methods, the hormonal methods and the IUD, came towards the end of the century, since 1960, and in the last 10 years there's been a proliferation of newer methods like Depo-Provera and Norplant [long-acting hormonal contraception]," Santelli tells WebMD.
Actually, family size was at its highest point this century near the end of the baby boom, in 1957. There were 3.7 children per family, comparable to the 3.5 in 1900. Rates since 1972 have leveled off to about 2 children per family. That is similar to the rate in 1933, when families averaged about 2.3 children.
Still, according to the CDC, 49% of the pregnancies in the U.S. are unintended, and 54% end in abortion. In developing parts of the world, the numbers are improving, but they are still far higher than in the U.S. and other developed nations. With 6 billion people on the planet and counting, there's plenty of challenge for the next century.
"I think there's going to be changes here and everywhere," Santelli tells WebMD. "It's hard to know where, and what new methods are going to be developed that will be highly effective, but there's clearly a lot of research going on and I think the technology's going to get better, and that's going to trigger important health and social changes in the future. I don't think the story's over yet."