Contraception and Reproduction Health Consequences for Women and Children in the Developing World (1989) / Chapter Skim
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4 Contraceptive Benefits and Risks
4 Contraceptive Benefits and Risks
Pages 36-52
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From page 36... ...
Information about these risks and benefits is necessary for informed decision making. Oral contraceptives, for example, not only prevent pregnancy, but they also reduce the risk of endometrial and ovarian cancer and protect against acute pelvic inflammatory disease and ectopic pregnancies.
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From page 37... ...
OCs prevent pregnancy primarily by inhibiting ovulation, although changes in the cervical mucous and endometrium may also have contraceptive effects. Failure rates associated with OC use are low—roughly 3 percent of women using OCs became pregnant in the first year of use, mainly because of improper or incomplete use (Trussell and Kost, 1987~.
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From page 38... ...
Two mechanisms may be operative: OCs may change the cervical mucous such that it prevents pathogenic organisms from ascending into the upper genital tract; or OCs reduce menstrual blood flow, thus decreasing the amount of medium available for bacterial growth (Rubin et al., 1982~. Unfortunately, most of the studies of oral contraceptives and PID have been hospital-based, so the results may not apply to women who are asymptomatic or who have PID not requiring hospitalization (Washington et al., 1985~.
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From page 39... ...
The risk of serious illness or death attributable to OC use from adverse cardiovascular effects is concentrated primarily among older women over age 30 and women who smoke cigarettes or have other cardiovascular risk factors. The excess risk of cardiovascular diseases seems to be directly related to both the estrogen and progestin content of the pill.
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From page 40... ...
Neoplasac Diseases Me forms of neoplasia that are of greatest concern with the potential effects of OC use are breast cancer, cervical cancer, endometrial cancer, and ovarian cancer. There are two main reasons for the concem.
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From page 42... ...
While OCs probably do not dramatically increase the overall risk of cervical dysplasia or cancer, long-term OC use or use by specific subgroups of women may increase the risk. Two large British cohort studies have shown a higher incidence of cervical neoplasia among oral contraceptive users (Vessey et al., 1983; Beral et al., 1988~.
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From page 43... ...
Early studies (Boston Collaborative Drug Surveillance Program, 1974; Royal College of General Practitioners, 1982) suggested that the risk of gall bladder disease might be increased in OC users.
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From page 44... ...
No other noncontraceptive health benefits to IUD use have been identified. ~~ Major health risks that have been associated with IUD use include pelvic inflammatory disease, tubal infertility, septic abortion, spontaneous abortion, and uterine perforation.
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From page 45... ...
Failure rates are estimated to be as high as 12 percent per year in practice (Trussell and Kost, 1987~. A number of in vitro studies have demonstrated that latex condoms are effective barriers to herpes simplex virus type 2, chlamydia trachomatis, cytomegalovirus, and HIV.
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From page 46... ...
and Noristerat DEW, have been approved in over 90 countries worldwide.2 Estimated failure rates in the fist year of use are between 0.3 and 0.4 percent, depending on the kind of progestin 2 Neither DMPA nor NET has been approved for use in the United States. See Richard and Lasagna (1987)
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From page 47... ...
Unlike OCs, injectables appear to have little effect on the coagulation and fibrinolytic systems that affect blood clotting. Amenorrhea or irregular, unpredictable bleeding episodes are the most commonly reported problems with injectables and the primary reason for terminating use (World Health Organization, 1978; Swenson et al., 1980; World Health Organization, 1987b)
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From page 48... ...
Failure rates, which vary by method of tubal occlusion, surgical expertise, and patient characteristics, are overall estimated to be between 2 and 4 per 1,000 in the first year of use (Trussell and Kost, 1987~. When female sterilization failure occurs, ectopic gestation is more likely than intrauterine gestation, but the absolute likelihood of ectopic pregnancy is actually lower than that associated with use of no method or even IUDs.
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From page 49... ...
In contrast to animal findings, at least six epidemiologic studies in humans, including a large study in China, have indicated that the risk of myocardial infarction is not increased in the 10 years following vasectomy (Goldacre et al., 1978, 1979; Walker et al., 1981; Petitti et al., 1982; Massey et al., 1984; Perrin et al., 1984~. Possible relationships between vasectomy and prostatic disease have been examined (Sidney, 1987; Ross et al., 1985~.
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From page 50... ...
The United Nations reports that over 77 million women rely on one of these methods United Nations, 1989~. Periodic abstinence and withdrawal are much less effective than most of the modem methods already discussed, with failure rates around 15-20 percent in the first year of use (Trussell and Kost, 1987~.
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From page 51... ...
DIMENSIONS OF NEW RESEARCH Clearly, no modern method of contraception is completely free of health consequences, whether adverse or beneficial or both. Oral contraceptives, which increase the risk of a variety of cardiovascular problems, also protect against PID, ectopic pregnancy, and two cancers of the reproductive system.
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From page 52... ...
Finally, the life consequences of childbearing for the mother and child must also be considered. We now turn to the health consequences of controlled fertility for children, again with special consideration of high-risk categories.
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