Letters

Contraceptive effectiveness may be being sacrificed for safety

Recently, the Marie Stopes Centre in Leeds reported a rise in the use of condoms by women seeking abortion after the safe sex campaign of the early 1990s³; one possible interpretation of this trend was that women had been influenced in their choice of contraceptive by the huge publicity attendant on that campaign. The use and methods of contraception of women seeking abortion at the centre were surveyed over five years. The percentage of women not using contraception fell over time in direct relation to the rise in the use of condoms.

Figure 1 shows the change in the use of contraceptives by women seeking abortion from January to June for three consecutive years, 1994-6. These findings from the Leeds centre are part of a nationwide study being undertaken by Marie Stopes International. The proportion of women reporting that they used condoms for contraception at the time of unintended or unwanted pregnancy has increased, while the proportion not using contraception has fallen. A similar pattern was found in our previous study.³ Also, the proportion of women choosing to use condoms as their primary method of contraception after abortion has doubled.

View larger version (34K): [in this window] [in a new window]   Fig 1--Change in use of contraceptives by women seeking abortion at one centre during January to June, 1994-6

No society can attain a situation in which abortion is not required, but the numbers of requests for abortion can be reduced with good provision of contraceptives.⁴ Bromham has highlighted the possibility that misleading information may prevent uptake of new methods of contraception,⁵ but are women also experiencing a reduction in choice in real terms and moving away from more effective methods that are already available to those methods with fewer perceived side effects but less contraceptive efficacy?

Medical officer Centre manager Marie Stopes Centre, Leeds LS2 8AJ

Judy Murty, Sue Firth 

1. Committee on Safety of Medicines. Oral contraceptives and breast cancer. London: CSM, 1996.
2. Walsh J, Lythgoe H, Peckham S. Contraceptive choices: supporting effective use of methods. London: Family Planning Association, 1996.
3. Murty J, Firth S. Use of contraception by women asking for termination of pregnancy. British Journal of Family Planning 1996;22:6-8.
4. Kulczycki A, Potts M, Rosenfield A. Abortion and fertility regulation. Lancet 1996;347:1663-8. [Medline]
5. Bromham DR. Contraceptive implants. BMJ 1996;312:1555-6. (22 June.) [Free Full Text]