Evaluation of the Safety of Modern Contraceptives in Developing Countries

Modern contraceptive methods have been tested and developed in industrialized countries and then transferred to developing countries without adaptation or prior safety testing under condition of differing local risk factors and predispositions. The obstacles to such testing are manifold; e.g. other health needs are pressing and medical and human resources for long-term safety or epidemiological studies are lacking; an absence of good medical records and consequently of data on disease incidence to be used in comparisons with contraceptive-related disorders. The importance of increased safety testing in spite of the obstacles is stressed and the need for more area-specific information emphasized. Current investigations primarily of the IUD and oral contraceptives are described (e.g. The WHO Taske Force on Oral Contraceptives and the WHO Task Force on IUDs) as well as the impediments associated with them and invetive approaches for overcoming these. A table shows allocations for safety studies in progress and estimations of cost factors and ranges are discussed. In evaluating the risk/effectiveness ratio a long-term perspective must be maintained. Multiple case-control studies sharing controls for investigations of different suspected health risks probably represent an economical approach.