Unintended pregnancy versus contraception: Reproductive risks juxtaposed

The Obama Administration's decision to require insurance coverage of the full cost of all FDA-approved contraceptives in the Affordable Care Act (ACA) has incited controversy, with some opponents arguing that contraceptive care is not a preventive health service. In this poster, we present empirical data to repudiate this claim. We reviewed the scientific literature on the health risks of both pregnancy and contraceptive use, juxtaposing the risks of each for healthy women and those with preexisting medical conditions. Results indicate that, although contraceptives are not without risks, they are far safer than pregnancy and childbirth. For instance, one of the most serious risks of hormonal contraceptives is adverse cardiovascular events/venous thromboembolism (VTE). However, while VTE risk is increased 2-3 times by oral contraceptive use, it is increased up to 29 times in pregnancy and 300-400 times in the immediate postpartum period. The risks of pregnancy are amplified for women with pre-existing conditions (e.g. cardiovascular disease, kidney disease, thyroid disease, asthma, diabetes). Including the 33% of caesarian births, almost half of deliveries involve at least one medical complication (e.g. obstetric trauma and laceration, infection, hemorrhage, eclampsia). Studies indicate that women tend to underestimate the risks of pregnancy and childbirth and overestimate those of contraceptive use. We compare the risks of the most common and serious morbidities for these two reproductive events. Results will be useful to family planning practitioners for the development of counseling protocols and to advocates supporting family planning legislation, such as contraceptive coverage in the ACA.