Fully Informed Patient Choice and Consent Have to Be Central to Expanding Access to Highly Effective Contraceptive Methods

Expanding LARC Access Must Not Cross Fine Line Between Encouraging Use and Unduly Steering Method Choice

Also in this issue of Guttmacher Policy Review:

"More than a Pack of Pills: The Many Components and Health Benefits of Quality Family Planning," by Kinsey Hasstedt

" What Is Behind the Declines in Teen Pregnancy Rates?," by Heather Boonstra

" Looking Back While Moving Forward: Marking 20 Years Since the International Conference on Population and Development," Sneha Barot

As reproductive health advocates and providers work to improve access to highly effective long-acting, reversible contraceptive (LARC) methods like the IUD and hormonal implant, it is important to be vigilant that such efforts—at all times—respect women’s and couples’ ability to make childbearing decisions freely and for themselves, according to a new Guttmacher analysis. This is especially important given the historical context of coercive practices related to contraception, which most often targeted disadvantaged groups.

"Highly effective LARC methods have the potential to significantly reduce unintended pregnancy in the United States, and reproductive health providers and advocates have made tremendous efforts to make these methods available to women who want and need them," says Rachel Benson Gold, author of the new analysis. "At the same time, it’s crucial that such efforts walk the fine line between leveling the playing field for LARC methods and tilting it in a way that could be unduly directive."

Gold’s analysis traces the history of coercive practices related to contraception in the United States, especially those targeting disadvantaged groups. These practices fall along a spectrum, according to Gold, ranging from extreme, overt and intentional instances of involuntary sterilization to more subtle attempts to influence women’s contraceptive decision making by providing financial incentives. One troubling example is the experience with the contraceptive implant Norplant in the 1990s, when state legislatures attempted to make welfare payments contingent on poor women agreeing to use the method and judges made implant insertion a condition for a reduced sentence.

"Understanding and acknowledging this dark history—some of which is all too recent—is important in today’s conversations about helping women avoid unintended pregnancy by facilitating the use of LARC methods and, more broadly, in any discussions about individuals’ contraceptive options," says Gold. "Health care providers have to ensure that their patients’ choices are fully informed and completely voluntary and that they are empowered to choose freely from the range of contraceptive options, including highly effective LARC methods."

The analysis also discusses strong safeguards already in place to prevent coercion, such as those in Medicaid and the federal Title X family planning program. Although these safeguards have been instrumental in stemming the worst of the abuse, they must constantly be reexamined to ensure that they are not having the unintended effect of impeding individuals’ access to care they clearly want.

Read the full article: "Guarding Against Coercion While Ensuring Access: A Delicate Balance," by Rachel Benson Gold

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