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  • Title: Comparing the health risks and benefits of contraceptive choices.
    Author: Kost K, Forrest JD, Harlap S.
    Journal: Fam Plann Perspect; 1991; 23(2):54-61. PubMed ID: 2060612.
    Abstract:
    Simulation models were used to compare the health consequences of birth control methods currently relied on by American women with those of using no method. The incidence of morbidity and mortality related to unintended pregnancies, live births, abortions, upper genital tract infections, tubal infertility, cardiovascular disease and reproductive cancers were estimated for hypothetical cohorts of 100,000 women aged 15-44. Women who never use any method and who never have an abortion would have an average of 18 births during their reproductive lifetime, compared with no more than five among women using any of the available birth control methods. Consequently, use of any method prevents more deaths from pregnancy and childbirth than are associated with method use. The proportion of women who would become infertile--estimated by taking into account the likelihood of developing upper genital tract infections and the probability that any pregnancies that occurred would be ectopic--is reduced substantially if women at low risk of sexually transmitted diseases use any method and if women at high risk use oral contraceptives or barrier and spermicide methods. Oral contraceptive use has a relatively small, independent effect on the risk of cardiovascular diseases, but it greatly augments that risk in combination with smoking and increased age. When ovarian, endometrial and breast cancers are considered together, there will be approximately 110 fewer diagnoses of these three cancers per 100,000 ever-users of the pill aged 15-54 than among 100,000 never-users; furthermore, prior to age 45, 100,000 ever-users will experience 10 fewer deaths from ovarian or endometrial cancers than never-users of the pill.(ABSTRACT TRUNCATED AT 250 WORDS) This study compares the risks of pregnancy, infertility, heart disease, cancer, and death associated with various contraceptive methods with the risks faced by women using no method. Estimated risks are derived from a decision-tree analysis program for a hypothetical cohort of 100,000 women. Method-specific estimates of the probability of various outcomes were obtained from published reports. Low estimates of typical use, first-year failure rates were used in the models. Tabulated data reveal that women who use no contraceptive method throughout their reproductive life (aged 15-44) and never have an abortion would have 18 births as compared to no more than five for women who use any contraceptive method. Data were also tabulated for the method-specific risks of developing upper genital tract infections, ectopic pregnancies, and tubal infertility (caused by the acquisition of a sexually transmitted disease [STD]) were calculated with method differences modeled for women at high and at low risk of acquiring a STD. The third table shows the estimated annual number of deaths per 100,000 ectopic pregnancies, live births, and induced abortions by five-year age groups. The annual pregnancy-related and method-related mortality rates per 100,000 women at risk of unintended pregnancy and at low risk of STDs was also calculated by contraceptive method. The fifth table illustrates the estimated annual incidence of and number of deaths from cardiovascular diseases per 100,000 women by smoking status, age group, and use of nonuse of oral contraceptives. OC use is also compared in a determination of the estimated annual number of ovarian, endometrial, and breast cancers diagnosed per 100,000 women by age at diagnosis. Finally, estimated deaths averted by each age group annually per 100,000 were calculated for current users of barrier and spermicide methods and of OCs and for ever-users before age 45. The conclusions drawn from these comparisons are that each contraceptive method presents different combinations of risks and benefits to women at different stages of their lives. Engaging in multiple sexual relationships, smoking, and irregular or incorrect method use are the three factors which most compromise a woman's ability to reach her reproductive and health goals.
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