Reproductive Justice Concerns Surround Long-Acting Contraception Methods

ParaGard IUD
ParaGard IUD / Photo: Misti K (cc)
By Rachel Walden |

commentary published in the April issue of the journal Contraception considers the benefits and drawbacks of long-acting reversible contraception (LARC) while also encouraging adoption of a reproductive justice approach in their promotion.

Jenny A. Higgins, an assistant professor in the Department of Gender and Women’s Studies at the University of Wisconsin-Madison, writes that many public health proponents support the use of LARCs (such as the IUD and contraceptive rod implants), citing their effectiveness in preventing unwanted pregnancy. Users do not need to worry about affording a monthly prescription or missing a dose, such as with the birth control pill. Although methods such as the IUD may have a higher initial cost than other daily methods, they may be the most cost-effective in the long run, as they prevent pregnancy for longer periods of time.

The reproductive health field’s excitement about LARC is certainly understandable, especially along lines of efficacy. No reversible method of contraception is better at preventing pregnancy than IUC and implants. Increased use of LARC could significantly reduce the rate of unintended pregnancy at the population level and, particularly if LARC use were to increase among young women, who experience the lion’s share of this health disparity. LARC could thus reduce both the social and financial consequences of unintended pregnancies.

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However, healthcare providers need to consider concerns about coercion and how LARCs have been promoted to certain demographics. Higgins urges providers to “keep in mind is the ways in which our socially disadvantaged clients, particularly women of color, have endured legacies of social injustice that will affect the way they experience LARC promotion.”

As Higgins also points out, these concerns are not new. Twenty years ago, significant concerns were raised about coercive use of the Norplant contraceptive implant to control the reproduction of low-income women of color. This 1994 ACLU piece outlines some of the issues:

In several states, judges have given women convicted of child abuse or drug use during pregnancy a “choice” between using Norplant or serving time in jail. In 1991, 1992, and 1993, legislators in more than a dozen states introduced measures that, had they passed, would have coerced women to use Norplant. Some of these bills would have offered financial incentives to women on welfare to induce them to use Norplant. Other legislation would have required women receiving public assistance either to use Norplant or lose their benefits. Some bills would have forced women convicted of child abuse or drug use during pregnancy to have Norplant implanted.

Many women may also remember that after Norplant’s initial popularity, troubles arose when women attempted to have the implants removed. For instance, state Medicaid policies funded implantation but not the costly removal, disproportionately affecting poor women and women of color.

In addition to these concerns, notes Higgins, Norplant “was aggressively marketed to poor women and women of color, especially to young, urban, African American and Latina girls.” (Read more at INCITE!, which notes that methods such as Norplant have a history of being “disproportionately promoted to women of color, indigenous women, women with disabilities, and women on federal assistance.”)

Higgins argues that providers need to explicitly acknowledge this legacy and take seriously the different experiences that may inform patients’ thoughts and choices about contraception:

Due to her social privilege, a white, middle class, fully insured, married woman will not have to wonder if her physician recommends LARC because of her race, her social class and/or the provider’s concern about her potentially out-of-control fertility. In contrast, a poor woman of color may well feel sociodemographically targeted when a provider recommends LARC, especially given prior abuses such as coerced sterilizations, financial incentives for long-acting contraceptive use and other human rights abuses. Directly acknowledging such racist and eugenicist legacies need not necessarily discourage LARC use, but it could help address suspicions of reproductive injustice among clients — and facilitate more possible openness to long-acting contraceptive services.

The bottom line for healthcare providers as they try to help women make birth control choices: “Let us remember that women themselves know better than funders or practitioners do about where contraception fits into their lives, relationships and long-term goals at any particular moment.”

Plus: Writing at the Ms. blog, Nicole Guidotti-Hernández offers a historical — and personal — perspective on the “fine line between reproductive social justice and technologies being used to control our bodies.”

Learn more about birth control in OBOS’s health information section.

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  1. Law says:

    Hi there just wanted to give you a quick heads up and let you know a few of the images aren’t loading correctly.
    I’m not sure why but I think its a linking issue.
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    the same results.

  2. Ashley says:

    Hello, I started depo provera shots April 2014 and got one more shot sometime July 2014 and was supposed to get another in October 2014 but decided I wanted to stop because it felt like I gained weight. Also my body acne was worse than ever. Basically I could pick out a list of side effects that was told to me before I began this birth control. Not sure if its my age or the fac t that I worked at Dunkin Donuts (ate donuts), but I have to lose weight or I will get diabetes

  3. Ashley says:

    ….sorry pressed post, but, I stopped getting period I think a mnth after I started in April, and I stopped October, and got my period march 2015, but I do have nausea. Could this be a side affect? Or pregnancy because I have been active after my 5 day period that began march 6th

  4. Patrick Asibor says:

    Hi, my wife had taken another (2-phase) injection for the family planning.
    The question is, can we have sex a a day or two after the injection unlike the seven-to – fourteen days break?

    • jackie says:

      Ashley: Not getting your period is a completely normal side effect. It has to do with the fact that Depo is a progesterone-only medication. You will not have regular periods again until you stop depo completely. There is no medical harm in this, however some women feel uncomfortable with the fact that they don’t have the monthly reminder that they aren’t pregnant.

      Patrick – you have to use a back-up method (like condoms) 7 days after the initial injection but as long as your wife is on time for all of her shots after the first one, you don’t need to wait to have sex.

      My credentials: I work at a family planning center, our main work is in reproductive health care, sti testing and birth control methods.

      • Dana M. Ward says:

        Jackie, I find that hard to believe about the Depo shots, I took them for two years hoping that I wouldn’t bleed so much. That was what I was told. However I bled so heavy on my Depo shot and became pregnant on my depo shot that my uterus fell through my cervix nearly a year after my last pregnancy. I was barely 23 and my obgyn requested that I have a partial hysterectomy to stop all of the bleeding and removed my uterus. The doctor, Richard Chamberlain in Winchester Kentucky, explained that if I didn’t receive the hysterectomy I could eventually die from blood loss and as well that there was no way to put my uterus back through my cervix as it was a moist organ and cancer and other illnesses would develop if my uterus wasn’t removed. I still have my ovaries, but no cervix and no uterus. I haven’t had a period since I was 23. I would never tell someone that the Depo shot stops their period when in fact it does not. And causes so many more complications with a woman’s organs.