February 25, 1983

Reproductive Mortality and Oral Contraceptives-Reply

Author Affiliations

Family Planning Evaluation Division Center for Health Promotion and Education Atlanta

JAMA. 1983;249(8):1003. doi:10.1001/jama.1983.03330320011007

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In Reply.—  Drs Rosenfield and Cushner make a number of useful comments that help the reader correctly interpret our analysis of reproductive mortality in the United States. They also say our article implied that the number of reproductive deaths may be reduced by half if women stop using oral contraceptives—we did not intend to imply this. As they correctly point out, a small group of oral contraceptive users, women 35 years of age and older who smoke, have a high risk of pill-related mortality and account for most deaths caused by oral contraceptives. For women in this group, the risk of oral contraceptive use appears to far outweigh the risk of pregnancyassociated mortality. If this small group stops using oral contraceptives, most of the pill-related deaths can be eliminated.Our analysis of reproductive mortality does not consider the recently identified noncontraceptive benefits of oral contraceptives. The reproductive mortality rate is