Mortality associated with fertility and fertility control: 1983

This analysis demonstrates that levels of mortality associated with all major methods of fertility control (tubal sterilization, the pill, IUD, condom, diaphragm, spermicides, rhythm and abortion) are low in comparison with the risk of death associated with childbirth and ectopic pregnancy when no fertility control method is used. The exceptions are the risks associated with pill use after the age of 40 for women who do not smoke, and with pill use after the age of 35 for smokers. The safest approach to fertility control is to use the condom and to back it up by abortion in case of method failure. Except for the lowest-risk method of fertility control (condom and abortion) and the highest (pill use by a smoker), most strategies of fertility control result in a similar risk of mortality until the woman reaches 35 years of age. At that point, risk from pill use rises more sharply than risk associated with other methods. The above conclusions are based on the lowest contraceptive failure rates reported by Schirm and his colleagues for married American women. If, instead, the highest failure rates are employed, use of the pill by a nonsmoker or the IUD clearly is safer than reliance on barrier methods or rhythm. As noted earlier, there are few women who make their contraceptive choices solely on the basis of perceived risk of mortality. Very few, for example, would consider abortion as a primary method of birth control; and for many, abortion would not be acceptable even as a backup for failed contraception. Although the risk of mortality resulting from use of the IUD is low, many women who have not yet had children might not want to face the increased risk of infertility problems from pelvic inflammatory disease that have been associated with use of this method.(ABSTRACT TRUNCATED AT 250 WORDS)