Oral Contraceptives in the 1980s

 As of 1980-81 over 50 million women around the world use oral contraceptives (OCs).  In developing countries users increased from 14 million in 1977 to 18 million in 1980.  Sales in developed countries fell from a peak of 287 million cycles in 1975 to 253 million in 1979 and have remained stable.  Sales in Latin American countries increased by 50% since 1975.  Between 1976-80 the number of new acceptors provided with OCs through government programs increased in several Asian countries.  Highest use based on sales is Australia, Austria, Belgium, France, West Germany, the Netherlands, and New Zealand with over 20% of all women of reproductive age using OCs.  Main government suppliers are the U.S. Agency for International Development (100 million cycles annually), the Pathfinder Fund, the International Planned Parenthood Federation, and the UN.  Knowledge of beneficial effects of OCs has recently grown.  They include protection against:  1) pelvic inflammatory disease, 2) ectopic pregnancy, 3) endometrial cancer, 4) benign breast diseases, and 5) menstrual disorders.  In February 1982 the U.S. Food and Drug Administration recommended that instructions on each pill package list OC benefits.  The greatest risk associated with the pill is circulatory system disease among women over 35 who smoke.  OC use has been found to increase the risk of venous thromboembolism, ischemic heart disease, cerebrovascular disease, and hypertension.  No increase in breast cancer has been demonstrated nor has greater incidence of cervical cancer, melanoma, or pituitary tumors.  Return of fecundability is delayed after discontinuation.  Doubts about the applicability of OC test results to all women exist, especially regarding developing countries.  OCs may reduce the volume of milk in breastfeeding mothers but use of OCs with 50 mcg or less of estrogen has not been shown to effect infant growth.  Findings conflict about effects of OCs on urinary tract infections, gallbladder disease, nutrition, acne, and some endemic diseases.  OCs have been found to protect against rheumatoid arthritis.  New OCs being researched are:  1) low-dose OCs, 2) biphasic and triphasic pills, 3) morning after pills, 4) natural vs. synthetic estrogens, 5) new progestins, 6) paper pills, 7) once a week pills, and 8) slow release pills.  For most women in developing countries using OCs for a year is less dangerous than using no contraception and risking pregnancy, even if they are over 35 and smoke.  Family planning programs must encourage older women who smoke, however, to use alternate methods.  Greater effort is needed to make OCs more widely available and to be sure they are used correctly.

Johns Hopkins Bloomberg School of Public Health,Center for Communication Programs,Population Information Program