An immunosuppressive state can result from either a primary congenital condition reflecting an abnormality of the immune system or a secondary acquired condition resulting from medical conditions – for example, HIV – associated with a depression of the immune system. It can also be the result of incidental or purposeful effects of medications. Purposeful immunosuppressive therapy is commonly used to prevent the rejection of transplanted organs and tissues, but it may also be used to treat autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus (SLE), multiple sclerosis, and inflammatory bowel disease (IBD). It may also be used in the treatment of other non-autoimmune inflammatory diseases such as bronchial asthma and ankylosing spondylitis.

The provision for access to contraceptive counselling and advice is today considered a basic human right. The 1994 United Nations International Conference on Population and Development (ICPD) held in Cairo emphasized ‘the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice’. The guarantee that all individuals, particularly women, have access to available contraceptive information that is of good quality and coercion free opens the path towards gender equality while allowing women to control their life choices and fully participate in their community. The ICPD further reaffirmed that ‘the aim of family-planning programmes must be to enable couples and individuals to decide freely and responsibly the number and spacing of their children and to have the information and means to do so and to ensure informed choices and make available a full range of safe and effective methods’ [1].

Pharmaceutical agents have become an essential tool in the medical armamentarium. Pharmaceutical companies over the past century not only have developed more consistently effective agents that are used to manage acute-onset conditions, but also have improved the quality of life of those suffering from chronic progressive disease. The use of any medication must be tempered by its potential side effects. Thus, the clinician must assess the benefit-risk ratio between therapeutic efficacy and safety risks before resorting to any therapeutic intervention in any patient. The benefit-risk assessment (BRA) is made on the weight of randomized evidence obtained from formal clinical trials and observations collected from pharmacovigilance activities after the drug is put on the market [1]. In obstetric practice, the benefit-risk ratio assessment for a pharmaceutical agent must further consider the specific benefit-risk ratio assessment relevant to the developing fetus. The fetal risk assessment presented by a particular agent may not be immediately possible since adverse effects may not be specific and easily linked to the agent, or may present themselves later on in life.