A 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.
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.