The contraceptive pill--still controversial.

The oral contraceptive (OC) is evaluated as a means of curbing the worlds population explosion. Attention is directed to the chemistry of the OC (estrogens and progestagens) mode of administration mode of action additional effects of the OC: metabolic changes side effects and complications (vascular thrombosis cerebrovascular accidents myocardial infarction hypertension endometrial cancer cervical carcinoma ovarian neoplasia breast tumors hepatocellular adenoma pituitary adenoma) beneficial effects risk assessment changes in behavior and mores and impact on population growth and attitudes. There is no question that among the temporary contraceptive methods the OC is the most effective easy to use and acceptable. The main action of the OC is on the hypothalamus and hypophysis blocking the release of gonadotropins and especially of the luteinizing hormone in sufficient quantities thus preventing ovulation. The side effects of OC use are numerous and their importance lies in the subjective feeling of the woman using them. Although the complications may be severe and may sometimes cause death they need to be kept in their proper perspective. This is especially the case when compared with the dangers of pregnancy and delivery in developing countries. Beneficial effects of OC use include a decreased incidence of benign and possibly malignant breast tumors and ovarian tumors. Except for certain very specific groups OC use is definitely an acceptable calculated risk. The question of whether the OC has been responsible for increased promiscuity has not yet been resolved and the problem remains controversial. It appears that for the individual couple who wants to restrict the size of their family modern contraceptive methods and particularly the OC are adequate but OCs are not the answer when it comes to large masses of population. The OC is a 1st step as current methods do not really cure the disease. It does seem that only a total change in the mores and attitudes of the establishment whether secular or religious can change the situation. The economic and other incentives practiced at this time to increase the family should be changed to incentives for the small family. Couples should be persuaded to marry late and tax benefits should be given to smaller families.