Present low-dose estrogen–progestin combinations do not increase the risk of heart attack among nonsmokers younger than age 35 years who have no other risks for vascular disease.
Oral contraceptives do not increase the risk of breast cancer.
Use of progestin-only injectable and implant hormonal contraceptives results in very low pregnancy rates without the estrogen-associated risk of thrombosis.
Hormonal contraceptives provide extensive contraceptive and noncontraceptive health benefits, including reduced risk for endometrial and ovarian cancer.
Levonorgestrel 1.5 mg (Plan B) and ulipristal acetate are the most effective hormonal means of emergency contraception. Efficacy is greatest within 24 hours of intercourse but remains high at 5 days. The copper T380A IUD inserted 5 days after intercourse is even more effective than hormonal methods.
Long-acting reversible contraceptive (LARC) methods include injectable progestins, subdermal progestin implants, and copper-or levonorgestrel-releasing intrauterine devices. These offer pregnancy rates comparable to sterilization and are among the safest methods.
Safe, long-term contraception is provided with laparoscopy and bipolar electrocautery application to three adjacent sites on each tube, the Silastic band, or the
Filshie clip.
Hysteroscopic sterilization techniques provide highly effective permanent contraception for women without the use of general anesthesia or abdominal incision.
Vasectomy provides highly effective, low-cost sterilization for men and is associated with neither heart disease nor prostate cancer.
Abortion mortality rates fell rapidly with legalization; currently, the overall mortality risk is less than 1 per 100,000, well below the maternal mortality rate of 12.7 per 100,000 live births.
The risk of abortion mortality increases with gestational age, from 0.1 per 100,000 at 8 weeks or less. Even at 16 to 20 weeks abortion is safer than continuing pregnancy.
The history of contraception is a long one, dating to ancient times. The voluntary control of fertility is especially important in modern society (1). A woman who expects to have no more than one or two children spends most of her reproductive years trying to avoid pregnancy. Effective control of reproduction is essential to a woman’s ability to accomplish her individual goals. From a larger perspective, the rapid growth of the human population in this century threatens the survival of all. At present rates, the population of the world will double in 66 years, and that of the United States will double in 75 years (2). For the individual and for the planet, reproductive health requires careful use of effective means to prevent both pregnancy and sexually transmitted disease (STD) (3).
Table 10.1 Number of Women Aged 15–44 Years, and Percentage Currently Using
Contraception Methods According to Age at Interview, United States 2006–2008a aWomen could list up to four current methods. The method shown above was the most effective method used. bIncludes diaphragm (with or without jelly or cream), emergency contraception, female condom, foam, cervical cap, Today™ sponge, suppository or insert, jelly or cream (without diaphragm), and other methods. From Vital and Health Statistics. Use of contraception in the United States 1982–2008. National Survey of Family Growth. Series 23. Number 29. May 2010, Tables 6 and 14.