Bringing to Light the Hazards of Smoking When Using the Pill

In 1977, Population Council researcher Anrudh K. Jain illuminated the increased risk of death for women who smoke heavily and use oral contraceptives.

The Landscape

Before Jain’s analysis, it was thought that use of oral contraceptives greatly increased the risk of heart attack, stroke, and death among women over 40. The FDA had proposed guidance to physicians that “the use of oral contraceptives in women in this age group [40 and over] is not recommended.”

The Paradigm Shift

Contrary to current thinking, Jain’s work revealed that the Pill was safe for most women of any age—and that the factor that posed a considerable health risk was heavy smoking.

Jain reviewed several studies from Great Britain and the United States and examined annual mortality rates from heart attacks among women, both those who used and did not use the Pill, those who smoked and those who did not, and those from various age groups.

Jain found that “the annual mortality rate among women ages 40–44 who use oral contraceptives but do not smoke is 10.7 per 100,000, while the rate among pill users who smoke is about 62 per 100,000.” The rate for women in this age group who neither took the Pill nor smoked was 7.4 per 100,000. He found that for nonsmokers ages 30–44, there was no statistical difference in death rates between those who used the Pill and those who did not. His findings shifted the discussion from age as a major risk factor for women on the Pill to the risks of smoking for Pill users.

The Lasting Impact

Jain’s analysis changed the way the Pill was viewed by women, doctors, and researchers. He described the extent to which smoking raises the risks for those on the Pill, and demonstrated that the Pill is safe for most non-smoking women of any age.

As a result of Jain’s work, the FDA altered its recommendations to advise physicians about the health risks of smoking and Pill use. Today, oral contraceptives are widely recognized as safe for most women who do not smoke.


Jain, Anrudh K. 1976. “Cigarette smoking, use of oral contraceptives, and myocardial infarction,” American Journal of Obstetrics and Gynecology 126(3): 301–307.

Jain, Anrudh K. 1977. “Mortality risk associated with the use of oral contraceptives,” Studies in Family Planning 8(3): 50–54.


US National Institutes of Health