To assess beliefs about the safety of oral contraceptives compared to pregnancy to determine if men and women possess accurate information to make informed choices. In each of six surveys conducted in Southern California from 2008 to 2017, participants were asked "Which do you think is more hazardous to a woman's health - birth control pills or pregnancy?" A total of 28.4% of all 1839 male and female respondents and 29.1% of the 1712 female respondents answered correctly that the health risks posed by pregnancy were greater. In subgroup analyses, 64.4%-81.9% rated oral contraceptives at least as hazardous to a woman's health as pregnancy. The vast majority of respondents incorrectly believed that oral contraceptives are more hazardous than pregnancy. Health decision making relies upon patients' understanding of the relative risks and benefits of each available option. Most sexually active women do not understand that there is no contraceptive method current guidelines would offer them that is as hazardous to their health as pregnancy. Such misconceptions can lead to risky decisions. Clinicians need to explicitly provide their sexually active patients more accurate and balanced information, putting contraception in the context of its probable alternative - pregnancy.