Jeremy Laurance: Should you advise your daughter to take the Pill?

Medical Life

What advice should a mother give her daughter about contraception? "I will always be grateful to my mum for putting me on the Pill when I was 14." That was Tracey Emin's tribute for Mother's Day in
The Independent last week.

Tracey's mother met her father and became pregnant by him while he was married to another woman and the family was later plunged into poverty when Tracey and her twin brother were aged seven. Her mother, who had wanted to be a dancer until motherhood ended her ambitions, later told her: "Any woman who said giving birth didn't hurt is lying. And then when she says 'but when I saw the baby's face it made it all worthwhile' – she's also lying. Whatever you do. Don't have a baby. It will destroy your life."

Stern stuff. But whatever your viewpoint, every mother of daughters sooner or later faces the same question. Should she recommend the contraceptive pill? Many people dislike the idea of swallowing drugs, especially on a long-term basis. On the other hand the perils of pregnancy, as graphically spelt out by Tracey's mum, are well known. Even on a purely medical level, pregnancy and birth carry risks that outweigh those of all forms of contraception. So is the answer clear?

For decades, a question mark has lingered over the safety of the contraceptive pill. In the Seventies and Eighties, concern focused on the risk of thrombosis (blood clots) and stroke and the occasional sudden and shocking death was reported of a woman in her twenties.

The Pill was modified to reduce this risk but in the 1990s scares about breast and cervical cancer emerged, though these later appeared to be outweighed by reductions in other cancers of the ovary, womb and bowel.

Last week came the latest results from one of the longest studies of the contraceptive pill in the world, conducted by the Royal College of General Practitioners research unit. The study was launched in 1968 and includes 46,000 women.

The best news was for today's mothers of teenage daughters – older women, coming to the end of their reproductive lives, who are wondering what penalty they may pay for years, or in some cases decades, of carefree sex on the Pill.

The answer is, unexpectedly, that they may live longer than their more cautious sisters – overall there were fewer deaths from all causes combined among those who had ever used the contraceptive pill than among those who had never used it.

What about their daughters? Here it gets a little more complicated, because the risks to younger women are fractionally increased. The increase is more than outweighed by the decrease in risk among older women and it disappears anyway within ten years of coming off the Pill. Modern versions of the Pill are slightly different – though it would be remarkable if they carried higher risks than the older versions. So assuming you survive to the menopause, you should live longer on the Pill.

This, as doctors have said, is good news for all women – and especially for today's mothers.

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