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Contraceptives

Volume 128: debated on Wednesday 2 March 1988

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To ask the Secretary of State for Social Services (1) if he will make a statement outlining the failure rates of condoms revealed by the different world studies referred to in the October 1987 edition of the "Prescribers Journal", published by his Department;(2) what assessment he has made as to whether the background information on the failure rates of condoms used to establish a range of 2 to 15 per 100 women years in the "Prescribers Journal" of October 1987 can be used to establish an average failure rate for such contraceptive devices in the developed world;(3) whether he will list, by order of frequency of failure, the failure rates of different contraceptive techniques referred to in the "Prescribers Journal" of October 1987; and if he will make a statement.

The following table, ranking different contraceptive techniques by range of user failure rate, appeared in the "Prescriber's Journal" (Volume 27, Number 5, October 1987):

Table 1
User-failure rates for different methods of contraception/100 woman-years
Range in the world literature1
Sterilisation
Male0–0·2
Female0–0·5
Injectable (DMPA)0–1
Combined pills0–1
50 µg oestrogen0·1–1
<50 µg oestrogen0·2–1
IUD
Lippesdoop C0·3–4
Copper 70·3–4
Progestogen-only "pill"0·3–5
Diaphragm2–15
Condom2–15
Coitus interruptus8–17
Spermicides alone4–25
Natural family planning
Pre-plus post-ovulation15–30
Post-ovulation alone1–6

Range in the world literature

1

Contraceptive sponge9–25
No method, young women80–90
No method at age 4040–50
No method at age 45c10–20
No method at age 50c0–5

1 Excludes atypical studies giving particularly poor results, and all extended-use studies.

Notes:

1. Ranking of efficacy, but overlap of ranges.

2. Influence of age: better results are obtained, for any given degree of compliance, in older women.

The user failure rate for condoms quoted in the table is based on a number of studies over the years in this country and abroad. It is thought to be a reasonable estimate of the position in the United Kingdom, bearing in mind that incorrect use is a significant factor. Because of this, and other variables such as age, experience or motivation of user, it would be misleading to present figures in terms of an average failure rate.

To ask the Secretary of State for Social Services (1) whether he will review his policy on the promotion of the use of condoms as part of his safe sex campaign, in the light of the statement in The Lancet of 7 February, a copy of which has been sent to him, that in contraceptive use condoms have a failure rate of 13 to 15 per cent.;(2) whether he will commission research into the statistical relationship between the failure rate of condoms in preventing the general exchange of body fluids and their failure rate when used as a contraceptive device; and if he will make a statement.

I have no plans to commission such research. A significant cause of failure in condoms is thought to be incorrect use. This was quoted as contributing to the failure rate range mentioned in the letter published in The Lancet on 7 February 1987. While it is important to ensure that condoms are of high quality and that there are clear instructions for use, the Government have stressed in their AIDS public education campaign that condoms only reduce the risk of disease transmission; they do not remove it.