Abstract

PIP: The mortality risk of voluntary surgical contraception (VSC) is compared to the mortality risk of other methods of fertility control, pregnancy and delivery, and selected nonreproductive-related events. After 1 year the rates per 100,000 are .1 for vasectomies, .3 for IUD use, 2.2 for legal abortion, 4.0 for female VSC in developed countries, and 18.7 for pregnancy and delivery. Rates for female VSC, pregnancy and delivery, and legal induced abortion were expressed as deaths per 100,000 procedures or live births and mortality risks for IUD use were presented as deaths per 100,000 women per year, per 5 years, and 10 years. After 10 years the mortality risks remain constant for single-exposure events but increase to 3.0/100,000 for IUD use, to 12/100,000 for the lowest risk category of OC users, and to much higher cumulative totals for higher risk pill users. Risks at 5 and 10 years after abortion and other pregnancy outcomes depend on the reproductive alternatives chosen; risks of barrier methods appear related to unintended pregnancy during use. In developed countries the mortality risks of smoking, driving, power boating, and drinking are higher than those for female VSC and vasectomy at 1 year. Mortality rates for all reproductive strategies in developing countries are estimated to be higher: the rate for female VSC in Bangladesh was recently estimated at 16.2/100,000 and of vasectomy at 19.0/100,000, although vasectomy death rate estimates as low as .1/100,000 have also been made for some developing countries. The risks of VSC in developing countries are considerably lower than those of a single pregnancy or delivery. The risk of VSC is concentrated in the 1st 6 weeks after the procedure and thereafter is related to pregnancy resulting from method failure.