better even than the numbers we’ve used here, and by some way the most effective form of contraception, according to the NICE data. Note that this doesn’t address possible side-effects.
One way to make these comparisons is to imagine a woman considering various contraceptives. Assume an infinite sex life. How long before she typically becomes pregnant? In the case of female sterilisation, about 200 years. The failure rate is one pregnancy for every 200 woman-years. So if 200 women took it for one year, one would be expected to become pregnant. For contraceptive implants the failure rate is so low that an accurate figure is hard to calculate. By one estimate, it is about one pregnancy every 2,000 woman-years.
If they don’t have access to contraception, then women can end up having a lot of children. The French data showed that women in the 1700s who married between 20 and 24 had on average 7 children each, as women still do in Niger and Uganda. Total Fertility Rate is the average number of children expected per woman if current fertility carried on through her life. It took the UK more than 200 years to reduce thenumber of births per woman from 5.4 in 1790 to 1.9 in 2010, while other countries have shown a similar decline in just a generation: Bangladesh took only 30 years to go from 6.4 in 1980 to 2.2 in 2010. * Some countries have a remarkably low fertility rate, particularly prosperous countries in South-East Asia (Singapore’s is only 1.1) and countries in Eastern Europe – the Czech Republic’s is 1.5, well below what is necessary to replace the population.
Pregnancy is not generally considered a great idea for young girls. In 1998 in England 41,000 girls aged between 15 and 17 conceived – that’s 47 in every 1,000, or 1 in every 21. Imagine that at school. The UK government set a target to halve this rate by 2010, and by 2009 the headline figure had dropped to 38 per 1,000 girls, which is an important fall but a fraction of the target. There is wide variation in these rates around the country – from 15 per 1,000 in Windsor and Maidenhead to 69 in Manchester: that’s 1 in every 15 girls aged between 15 and 17, pregnant every year. There is a strong correlation with low educational attainment, and deprived seaside towns traditionally have high rates, with 1 in every 17 pregnant in Great Yarmouth each year, and 1 in every 16 in Blackpool 7 .
Nearly half of these teenage pregnancies end in abortions, but there are still many births. A 2001 report 8 put the UK highest in Europe, with 30 births per 1,000 women aged 15 to 19, with only the USA exceeding it among high-income OECD countries, at 52 births per 1,000. This is in staggering contrast to countries such as South Korea, Japan, Switzerland, the Netherlands and Sweden, which all have birth rates of fewer than 7 per 1,000 teenagers.
Of course, we could turn these dangerous odds around and make them the measure of hope for those who want to have a baby. Pregnancy isn’t always well described as a risk – it can obviously also be a blessing.
Which you can’t really say about disease and infection. HIV, syphilis, gonorrhoea, chlamydia, hepatitis and numerous other STIs – some potentially fatal, some unpleasant – are a danger of unprotected sex of various kinds, and some even with protection, whenever there is a chance your partner is infected.
Figure 12: Historical number of diagnoses of syphilis in England and Wales (left-hand axis) and Scotland (right-hand axis) for men and women, GUM clinics
Risks are higher for young adults, men who have sex with men, and people who inject drugs, and black African and black Caribbean men and women continue to be disproportionately infected. The peak risk in women tends to be among those aged 19 or 20, and in men a few years later.
There has been an increase in the number of diagnoses for many STIs in the past ten years, partly because people’s behaviour has changed, mostly because we are simply testing a lot
One way to make these comparisons is to imagine a woman considering various contraceptives. Assume an infinite sex life. How long before she typically becomes pregnant? In the case of female sterilisation, about 200 years. The failure rate is one pregnancy for every 200 woman-years. So if 200 women took it for one year, one would be expected to become pregnant. For contraceptive implants the failure rate is so low that an accurate figure is hard to calculate. By one estimate, it is about one pregnancy every 2,000 woman-years.
If they don’t have access to contraception, then women can end up having a lot of children. The French data showed that women in the 1700s who married between 20 and 24 had on average 7 children each, as women still do in Niger and Uganda. Total Fertility Rate is the average number of children expected per woman if current fertility carried on through her life. It took the UK more than 200 years to reduce thenumber of births per woman from 5.4 in 1790 to 1.9 in 2010, while other countries have shown a similar decline in just a generation: Bangladesh took only 30 years to go from 6.4 in 1980 to 2.2 in 2010. * Some countries have a remarkably low fertility rate, particularly prosperous countries in South-East Asia (Singapore’s is only 1.1) and countries in Eastern Europe – the Czech Republic’s is 1.5, well below what is necessary to replace the population.
Pregnancy is not generally considered a great idea for young girls. In 1998 in England 41,000 girls aged between 15 and 17 conceived – that’s 47 in every 1,000, or 1 in every 21. Imagine that at school. The UK government set a target to halve this rate by 2010, and by 2009 the headline figure had dropped to 38 per 1,000 girls, which is an important fall but a fraction of the target. There is wide variation in these rates around the country – from 15 per 1,000 in Windsor and Maidenhead to 69 in Manchester: that’s 1 in every 15 girls aged between 15 and 17, pregnant every year. There is a strong correlation with low educational attainment, and deprived seaside towns traditionally have high rates, with 1 in every 17 pregnant in Great Yarmouth each year, and 1 in every 16 in Blackpool 7 .
Nearly half of these teenage pregnancies end in abortions, but there are still many births. A 2001 report 8 put the UK highest in Europe, with 30 births per 1,000 women aged 15 to 19, with only the USA exceeding it among high-income OECD countries, at 52 births per 1,000. This is in staggering contrast to countries such as South Korea, Japan, Switzerland, the Netherlands and Sweden, which all have birth rates of fewer than 7 per 1,000 teenagers.
Of course, we could turn these dangerous odds around and make them the measure of hope for those who want to have a baby. Pregnancy isn’t always well described as a risk – it can obviously also be a blessing.
Which you can’t really say about disease and infection. HIV, syphilis, gonorrhoea, chlamydia, hepatitis and numerous other STIs – some potentially fatal, some unpleasant – are a danger of unprotected sex of various kinds, and some even with protection, whenever there is a chance your partner is infected.
Figure 12: Historical number of diagnoses of syphilis in England and Wales (left-hand axis) and Scotland (right-hand axis) for men and women, GUM clinics
Risks are higher for young adults, men who have sex with men, and people who inject drugs, and black African and black Caribbean men and women continue to be disproportionately infected. The peak risk in women tends to be among those aged 19 or 20, and in men a few years later.
There has been an increase in the number of diagnoses for many STIs in the past ten years, partly because people’s behaviour has changed, mostly because we are simply testing a lot
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