The contraceptive options for women in the United States have been
unnecessarily limited by inappropriate litigation and pseudoscientific fear
mongering by groups that believe contraception should be risk free. The
benefit- to-risk ratio for oral contraceptives is among the highest for any
pharmaceutical. [ACOG Technical Bulletin 106.
Oral Contraception. July 1987.]
Even intrauterine devices (IUDs), which pose substantially greater risks than
oral contraceptives, pose very low absolute risks. [ACOG Technical Bulletin
104. The IUD. May 1987.]
Contraception is medical therapy that is usually prescribed for healthy persons.
As with childhood immunizations, the general populace have forgotten the
risks of the alternative—be it unwanted pregnancy or pertussis. The very
success of the drugs has contributed to the expectation that they should be
risk free—not merely extremely safe.
The choice of a contraceptive is determined by physiological, behavioral, and
psychological factors. Given that most women are physiologically able to
tolerate oral contraceptives, IUDs, and barrier forms of contraception,
behavioral and psychological factors have been most important. Until recently,
these tended toward oral contraceptives. Women outside long-term
relationships usually preferred the privacy and flexibility of IUDs or oral
contraceptives. Because of the real and perceived risks of IUDs, the majority of
these women choose oral contraceptives.
The standard of care for informed consent for oral contraceptives is set by
contraceptive manufacturers, public health officials, and federal and state law.
The standard for informed consent for IUDs is set by standard consent forms
supplied by the IUD manufacturers.
The medical care practitioner should inform a patient of risks and alternatives
whether the contraceptives being used are prescription, over-the- counter, or
so- called natural methods. It is important to consider the patient’s life style
and health behavior in tailoring informed consent to the patient. A patient who
smokes is a poor candidate for birth control pills. However, if the patient has
religious objections to abortion and intrauterine devices because she believes
they are abortive, then pills may be the only acceptable alternative. The health
care practitioner should explain the risks carefully and encourage the patient to
stop smoking as an alternative method of reducing the risks.