Benefit and harm
University of Leeds, Leeds, UK
On 25 May 1965 in London, Professor Sir Dugald Baird of Aberdeen delivered a
lecture entitled The Fifth Freedom. Published in the BMJ, it became a classic.
To Roosevelt’s four freedoms – freedom of speech and worship and freedom
from want and fear – Baird added a fifth: ‘‘freedom from the tyranny of
excessive fertility’’. Like the other four, this freedom is still denied to
many people today.
Baird divided the benefits of contraception into those affecting populations
and those affecting individuals. Population growth no longer hits the headlines
but perhaps it should. Too many nations still rely on disease, war and famine to
control their population. Contraception is a more beneficial option.
Specific methods of contraception have specific benefits. The combined oral
contraceptive prevents ovarian and endometrial cancer. Long-acting progestogens
prevent menstrual disorders, which cause not only inconvenience but also major
ill-health. Condoms prevent the transmission of HIV.
And yet contraception is still regarded as harmful by some. Male-dominated
institutions may see little benefit in liberating women from their traditional
role. In some countries, reducing the demand for therapeutic abortion is
financially harmful to gynaecologists. We should understand views with which we
do not sympathise.
By breaking the link between coitus and pregnancy, contraception has altered
people’s attitudes to sex. The change is not entirely beneficial. Today in the
UK, over 25% of girls have had intercourse by the age of 16. In 1965 the BMJ
predicted that ‘‘the use of the ‘pill’ must lead to a considerable
spread of venereal disease.’’ Nearly forty years on in Britain, there is
indeed an epidemic of chlamydia.
The pill causes venous thromboembolism and the IUCD is associated with pelvic
infection. These risks are low but they have received major publicity in the
media, perhaps because people feel that a price must be paid for sexual freedom.
The risks of contraception must be set against the risks of conception, which
vary from country to country. Worldwide, pregnancy causes one maternal death
every mnute, mainly in developing countries, where pregnancy is seen as less
harmful than the pill. This misperception is one reason why many women are still
denied access to contraception, which otherwise could save thousands of lives