Mortality associated with fertility and fertility control: 1983

Abstract

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)

PIP: New data is used to update estimates of mortality associated with fertility and fertility control published in 1979 by Christopher Tietze. Estimates and assumptions differ from Tietze's as follows: data on contraceptive effectivenss and on health risks and benefits through 1978 are used; estimates of maternal mortality are those deaths related to ectopic pregnancy and childbirth based on U.S. vital statistics from 1972 through 1978, inflated to account for well-documented underreporting; recently published and more precise age-specific estimates of 1st year failure rates experienced by women using each contraceptive method are employed; new estimates of mortality associated with oral contraceptives are used; estimates of legal abortion mortality are slightly lower; and the concept of cumulative mortality risk is used. Bases on the lowest contraceptive failure rates reported, levels of mortality associated with all major methods of fertility control are low in comparison with risk of death from childbirth and ectopic pregnancy when no method is used. Exceptions are risks associated with pill use after age 40 (or 35 for women who smoke). Except for the lowest risk methods (condom and abortion) and the highest (pill use by smokers), most strategies of fertility control result in a similar risk of mortality until the woman reaches 35 years of age, at which time risk from pill use rises more sharply than risk associated with other methods. If highest failure rates are employed, use of the pill by a nonsmoker or of IUD is safer than reliance on barrier methods or rhythm. It is noted, however, that few women make contraceptive choices solely on the basis of perceived risk of mortality.