Published online by Cambridge University Press: 27 September 2011
There are many factors which affect the choice of contraceptive practice in middle age. Co-existing disease is only one and in some ways is the least important. Childbirth itself poses a considerable risk to the health of the mother in as much as maternal mortality rises steeply with age especially after 45 years (Fig. 1); similarly perinatal mortality increases with age (Fig. 2). Together these two factors make the need for careful contraception all the more important. Fertility is reduced with age and this unfortunately lulls some couples into a false sense of security and they may take unnecessary risks.