Most Direct Public Health Indicator Effect of Contraceptive Use
The most direct public health indicator effect of contraceptive use is reduced maternal morbidity and mortality. 1, 2
Primary Mechanism: Prevention of Pregnancy-Related Deaths
The most immediate and measurable impact of contraceptive use operates through a straightforward pathway:
- Contraceptive use has reduced maternal deaths by 40% over the past 20 years in developing countries simply by reducing the number of unintended pregnancies. 1
- Over 1 million maternal deaths were averted between 1990 and 2005 because fertility rates declined due to increased contraceptive use. 2
- An additional 30% of maternal deaths could be prevented by meeting the current unmet need for contraception. 1
Dual Mechanism of Maternal Mortality Reduction
Contraception reduces maternal mortality through two distinct pathways:
Direct effect: By preventing pregnancies altogether, contraception reduces the number of times women are exposed to the inherent risks of pregnancy and childbirth. 2
Indirect effect: By specifically preventing high-risk births (particularly high-parity births and those in older women), contraception reduces the maternal mortality ratio (MMR) by an estimated 450 points during the transition from low to high contraceptive use. 2 This means contraception not only prevents deaths by preventing pregnancies, but also makes the pregnancies that do occur safer. 1
Why This is More Direct Than Other Options
Fetal abnormalities (option a): Contraception prevents pregnancy entirely but does not reduce the incidence of fetal abnormalities in pregnancies that do occur. 3
STD prevalence (option b): While barrier methods like condoms reduce STD transmission, most contraceptive methods (hormonal methods, IUDs, implants) do not protect against STDs. 3 This is an indirect and method-specific effect, not a universal public health indicator of contraceptive use.
World population growth (option c): This is a macro-level outcome that results from widespread contraceptive use but is not a direct health indicator—it's a demographic indicator. 3
Socioeconomic status (option e): This is an indirect societal outcome with multiple confounding factors, not a direct health indicator. 3
Clinical Context for This Patient
For the 40-year-old woman with hypertension and three children requesting pregnancy termination:
- Women who use any contraceptive method would have no more than 5 births during their reproductive lifetime, compared to 18 births among women who never use contraception. 4
- Use of any contraceptive method prevents more deaths from pregnancy and childbirth than are associated with the method itself. 4
- Pregnancies among women of advanced reproductive age carry higher risks for maternal complications including hemorrhage, venous thromboembolism, and death. 3
The answer is d. Reduced maternal morbidity.