Abstract

PIP: In 1977 the published results of 2 major studies indicated that the use of oral contraceptives (OC)s increased the risk of death from cardiovascular disease. The studies were the Royal College of General Practitioner's (RCGP) Oral Contraception Study, and the other was the University of Oxford/FPA contraceptive study. Manufacturers' sales of OCs fell from their 1976 peak in 1977, and in 1978 fertility began to rise once more and continued to do so until 1980, when the increase evidently began to run out of steam. It is argued that the way people responded to the adverse findings about OCs may well have played a part in the recent rise in fertility. It is acknowledged, however, that in this complex field other factors will be involved and what is important is the extent to which each contributed to the rise. Between 1964 and 1977 the number of births/1000 women of childbearing age declined from 93.0 to 58.7 in England and Wales. OCs were introduced in 1961 and use grew steadily until at least 1975. A survey conducted in 1975 shows that OCs were easily the most popular method during the mid-1970s. The whole of the reduction in the rates at which pregnancies of higher orders occurred over the period seems to have been in unplanned pregnancies. It is worth noting that the decline could have been realized without modern contraception. The low general fertility rate of 1977 of 58.7 was only slightly lower than that for 1939 (61.3). It may be possible that whenever any commonly used effective method of birth control ceases to be available for some reason, the period of adjustment to other methods is accompanied by a temporary rise in fertility. The sequence of events of adverse publicity, i.e., decline in OC use and rise in fertility in England and Wales after 1976, could be an example of mere coincidence. 2 earlier sequences of the same kind suggest that it has not. There were earlier "Pill scares," all of which possibly the most important was that of 1969. Preliminary warnings of the findings of the Committee on the Safety of Drugs in 1969 was succeeded by a flattening of the upward curve in sales of OCs between 1969 and 1970 and a disruption in the downward movement of fertility followed in 1970-1971. Also, in the U.S., where OCs were the subject of Senate hearings, there was a small but perceptible decline in use accompanied by a small but perceptible rise in fertility. Other possible explanations are reviewed.