Female contraception: changing priorities.

Abstract

Late marriage, withdrawal, and induced abortion were the methods that achieved the demographic transition from high to low birth and death rates in Europe and North America. The demographic transition in France was early and significant, possibly because it was the most populous country in Europe. Induced abortion caused high morbidity and mortality, especially among working-class women. In countries where abortions are still illegal, women die, mainly due to bleeding and infections. Women who survive often suffer infertility. Modern surgical techniques and the availability of hormonal interruption of early pregnancy make abortions safe. Today, Europe has very low fertility. In Europe, Ireland has the highest total fertility rate (TFR) (2.1) followed by Sweden (2). All the other European countries have TFRs much less than 2 (1.3-1.8). The populations of these countries will decline if massive immigration does not occur. Very effective contraceptives have contributed to this low fertility. Women in Europe use contraceptives during most of their reproductive years. Thus, contraceptive safety and efficacy are extremely important. Another important consideration is the effect of contraceptives on sexually transmitted diseases. A very rapid fall in death rates has occurred in developing countries without a concomitant fall in birth rates, resulting in very high population growth. Safe and effective contraceptive methods and the revolution in information technology exist today but did not when Europe and North America went through their demographic transition. These 2 conditions may help speed up the demographic transition in developing countries. Many developing countries must reevaluate their priorities to achieve safe motherhood and a subsequent reduction in fertility. Many African governments spend more money on the safety of their Heads of State than on maternal health. Improvements in contraceptive counseling, distribution, and promotion are needed to bring about fertility reduction in developing countries.