A 35-year-old woman, a smoker of 15 cigarettes/day, requests oral contraception. The MOST appropriate contraceptive option based on WHO Medical Eligibility Criteria (MEC) is:

• A Combined oral contraceptive pill — WHO MEC Category 2 (benefits outweigh risks)
• B Progestogen-only pill — WHO MEC Category 2 (benefits outweigh risks)
• C Emergency contraceptive pill — acceptable as regular method
• D Combined oral contraceptive pill — WHO MEC Category 4 (unacceptable health risk) ✓

Explanation

WHO MEC assigns combined hormonal contraceptives (pills, patch, ring) a Category 4 (unacceptable health risk — do not use) for women aged ≥35 who smoke ≥15 cigarettes/day because the combination dramatically increases the risk of venous thromboembolism, stroke, and myocardial infarction. Progestogen-only pills are Category 1–2 for smokers regardless of age, since they do not increase cardiovascular risk. Category 4 means the method should not be used.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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