Health risks of OCs versus pregnancy

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Dr. Nelson

Both men and women strongly believe that birth control pills are at least as hazardous to a woman's health as pregnancy, according to a summary of six surveys recently published in the journal Contraception.

“In every survey and in every subgroup, including those women who were most highly educated, that answer was consistent and alarming,” said primary author Anita Nelson, MD, professor and chair of ob/gyn at Western University of Health Sciences in Pomona, California.

Earlier research from the investigators indicated that nonpregnant women were quite uninformed about the health risks of pregnancy. “But these more recent surveys verify that even pregnant women and their male partners are unable to recognize that the risks of hypertension, blood clots and diabetes increase in pregnancy,” Dr. Nelson told Contemporary OB/GYN. 

The authors were motivated to undertake the surveys for several reasons: the persistently high rate of unintended pregnancy, lack of reproductive life planning, low use of preconception care, high rate of pill discontinuation, and persistently high percentages of women who expressed fear about using the pill. 

“I have spent 30 years in research trying to develop new contraceptive methods to meet the needs of more women, but I realized that we needed to know more about women as customers of contraception,” Dr. Nelson said. “Thus we set out on a different path and started asking different groups of women–and men-in a series of surveys questions designed to learn what they knew about the need to prepare for pregnancy for healthier outcomes, as well about the effectiveness and safety of the most popular methods of birth control, the health risks of pregnancy, and if contraception was allow by their religion.”

The six surveys were conducted from 2008 to 2017 in Southern California, mostly on the campus of the Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center (LA BioMed).

In total, 93.1% of the 1,839 responders were women, and half of the female/male responders were between ages 18 and 30. In addition, 36.8% of respondents had a high school education or less, whereas 38.6% had at least a college degree. Further, 16.9% spoke only Spanish.  

Overall, only 28.4% of the combined male/female population and 29.1% of female responders alone correctly answered that the health risks posed by pregnancy were greater than for oral contraceptives (OCs).

In subgroup analyses, responders who rated OCs at least as hazardous to a woman's health as pregnancy ranged from 64.4% to 81.9%.

“This ignorance may be fueling the malpractice crisis,” Dr. Nelson said. “Everyone expects a perfect baby and an uncomplicated pregnancy. And it certainly can explain why women are not seeking opportunities for preconception care.”

The logical follow-up question then becomes how can a woman give informed consent to using any of the methods designed to reduce her risk of pregnancy without first knowing the benefits to her health from not becoming pregnant, according to Dr. Nelson.

“The ultimate responsibility to ensure that women are informed about those risks before they decide to become pregnant, and before they decide to use contraception to avoid pregnancy, clearly lies with ob/gyns and our colleagues who provide reproductive health care,” Dr. Nelson said. “What is the best way we can do that?”

Disclosures:

Dr. Nelson has received grants and/or honoraria from many companies involved in manufacturing or developing new contraceptive methods.