A risk-benefit analysis of five alternative approaches to fertility control among US women over the age of 30 was performed: tubal ligation, vasectomy, intrauterine device, barrier method (condom), and combined oral contraceptives. Taken into account were age-specific probabilities of contraceptive failure, fecundability, spontaneous abortion, reproductive mortality (ectopic pregnancy, delivery, or induced abortion), life table mortality, and mortality from specific cancer sites (ovarian, endometrial, breast, and prostate) and cardiovascular disease. Relative to women using no contraceptive precautions, the use of any method of contraception between the ages of 30 and 50 was associated with net benefit in terms of averted deaths. However, when duration of observation was extended up to age 80, we predicted an excess of about 880 deaths from prostate cancer per 100,000 users of vasectomy. Other methods continued to be associated with net benefit, ranging from 130 to 360 deaths averted per 100,000 users. It was concluded that the non-reproductive risks and benefits of contraceptive methods continue to be relevant long after the reproductive years. The balance of risks and benefits may differ in other countries with different cause-specific and life table mortality rates.
PIP: Considering age-specific probabilities of contraceptive failure, fecundability, spontaneous abortion, cardiovascular disease reproductive mortality, life table mortality, and mortality from specific cancer sites, a risk-benefit analysis was performed on tubal ligation, vasectomy, IUD, condom, and combined oral contraceptives as alternative approaches to fertility control among US women over the age of 30. The model assumes that 30 year old women have completed their families and wish to avoid further pregnancies at any time. They therefore begin to use their chosen method of family size limitation at that age. The cumulative mortality of each cohort was calculated until they reached age 50, when women were assumed to reach 100% sterility. Follow-up was then extended until age 80 to allow for the long-term risks and benefits of using each method. Several survey and vital statistics data sources were used. Compared to women using no contraception, analysis found the use of any method of contraception among 30-50 year olds to be associated with net benefit in terms of averted deaths. Extending the duration of observation up to age 80, however, the authors predicted an excess of approximately 880 deaths from prostate cancer per 100,000 users of vasectomy. Other methods continued to be associated with net benefit, ranging from 130-360 deaths averted per 100,000 users. It is concluded that the nonreproductive risks and benefits of using contraceptive methods continue to be relevant long after the reproductive years, and that reliability should not be the sole criterion for choosing a method of fertility control among women who have completed their families. It is also noted that the balance of risks and benefits may differ in other countries with different cause-specific and life table mortality rates.