Beral V
Br Med J. 1979 Sep 15;2(6191):632-4. doi: 10.1136/bmj.2.6191.632.
The transfer from traditional to modern methods of contraception in recent decades has been accompanied by a transfer of deaths from complications of pregnancy to deaths from complications of the modern contraceptive methods. In 1975, for example, it is estimated that there were more deaths at ages 25-44 years in England and Wales from adverse effects of oral contraceptive use than from all complications of pregnancy, delivery, and the puerperium combined. Thus maternal mortality is no longer an adequate indicator of the deaths associated with reproduction in the community. An alternative measure, the reproductive mortality rate should be used, which includes deaths from complications of contraceptive use as well as those from complications of pregnancy or abortion. The reproductive mortality rate in England and Wales seems to have declined continuously since 1950 for women aged 25-34. But after 1960 it increased for women aged 35-44, because of the higher mortality associated with oral contraceptive use in this age group.
近几十年来，从传统避孕方法向现代避孕方法的转变，伴随着死亡原因从妊娠并发症向现代避孕方法并发症的转移。例如，据估计，1975年在英格兰和威尔士，25至44岁年龄段因使用口服避孕药产生的不良反应导致的死亡人数，超过了因妊娠、分娩和产褥期所有并发症导致的死亡人数总和。因此，孕产妇死亡率已不再是衡量社区中与生殖相关死亡情况的充分指标。应采用另一种衡量指标，即生殖死亡率，它包括因使用避孕方法产生的并发症导致的死亡以及因妊娠或流产并发症导致的死亡。自1950年以来，英格兰和威尔士25至34岁女性的生殖死亡率似乎一直在持续下降。但在1960年之后，35至44岁女性的生殖死亡率上升了，原因是该年龄组中与使用口服避孕药相关的死亡率较高。
