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CONTRACEPTION

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 other pharmaceutical.[166] Even IUDs, which pose substantially greater risks than oral contraceptives, pose very low absolute risks.[167]

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 physician 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 physician should explain the risks carefully and encourage the patient to stop smoking as an alternative method of reducing the risks.

[166]ACOG: Technical Bulletin 106, Oral Contraception. (July 1987).

[167]ACOG: Technical Bulletin 104, The IUD. (May 1987).

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