Impact of the October 1995 pill scare in Grampian

Abstract

Over two years have elapsed since the Department of Health issued a press release concerning the safety of some third generation contraceptive pills. Warnings about increased abortion rates followed and recently published national figures for England and Wales have confirmed this. In Grampian we have assessed the impact of the pill scare at a subnational level, which has received much less consideration. Grampian has a stable population with an estimated 116,500 women in the reproductive years. The six month period from November 1995 until April 1996 was chosen to monitor the immediate aftermath of the pill scare. Aberdeen Royal Infirmary provides a regional, dedicated abortion service and has maintained a service specific database since 1994. This is an ideal situation to monitor trends in abortion rates in a specific population. Women attending for abortion counselling were asked to complete a questionnaire regarding their recall of media publicity. Live-births at Aberdeen Maternity Hospital from June to November 1996 were also recorded, reflecting conceptions in the study period. Prescribing patterns for combined pills and emergency contraception for Grampian general practitioners and Grampian Healthcare family planning service were also analysed. There was no increase in the abortion rate in the study period when compared with the same period in the preceding year - a total of 728 women underwent an abortion. Forty six women were identified within the 728 as having conceived as a direct consequence of the scare, but their characteristics were not dissimilar to the other women on the database. Live-birth rates were also stable. Emergency contraception prescribing was slightly increased for the family planning service but not in general practice. Both general practice and the family planning service showed an immediate and sharp fall in prescribing of third generation pills mirrored by an increase in second generation pill prescribing. For family planning particularly, prescriptions for third generation pills have shown an increase again from early 1996, although remaining below original levels. Fifty five per cent of the women who were given the questionnaire about media publicity responded. Seventy nine per cent recalled some publicity, but 17 per cent of these women could not remember any specific details. Unlike national reporting, our figures do not substantiate any increase in abortions or deliveries in the aftermath of the pill scare. The slight increase in emergency contraception prescribing by the family planning service more probably reflects local awareness campaigns rather than any appreciable switch away from regular pill use. On a population level, the scare did not have the predicted negative impact on pill users in Grampian and it would have been incorrect for us to extrapolate from national data in this instance. Failure to demonstrate numerical impact for the population does not deny the devastating effect of a termination for an individual woman. The emotional impact of the scare on women, while more difficult to measure, should not be underestimated. The influence on the next generation of women with regard to their contraceptive choice remains to be seen.

PIP: The effect of the October 1995 "pill scare" on induced abortion rates has been investigated for England and Wales, but little consideration has been given to the impact at the subnational level. The present study used data from Aberdeen (Scotland) Royal Infirmary from November 1995 to April 1996 to monitor abortion rate trends in the immediate aftermath of negative publicity about the pill's side effects among the estimated 116,500 Grampian women of reproductive age. There were 728 pregnancy terminations in the study period compared with 723 in the same months in the preceding year. 46 of the 728 women who aborted claimed they conceived as a result of media publicity about the pill's side effects (e.g., discontinued all contraceptive use or switched to condoms or a lower-dose pill); they did not differ significantly from the other women undergoing abortion in terms of age, parity, or number of previous terminations. Moreover, the proportion of induced abortions resulting from failure to use effective, reliable contraception remained constant at 80% both before and after the pill scare. A separate analysis of prescribing patterns of Grampian general practitioners and family planning services revealed an immediate, sharp fall in prescribing of third-generation pills and concomitant increases in second-generation pill prescribing. The number of third-generation pills prescribed began to rise again in early 1996, without reaching previous levels. Finally, of the 403 abortion patients who responded to a postal questionnaire, 319 (79%) recalled some publicity about the pill, but 17% could not remember any of the details. Although these findings fail to substantiate an increase in abortions after the October 1996 publicity, the emotional impact of the scare on individual women and its influence on the contraceptive choices of the next generation should not be dismissed.