Benefit and harm

Benefit and harm

J. Drife

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

every year.

Scroll to Top