Women or LARC First? Reproductive Autonomy And the Promotion of Long‐Acting Reversible Contraceptive Methods

Abstract

In recent years, enthusiasm about long-acting reversible contraceptive (LARC) methods has skyrocketed among U.S. reproductive health care providers because of these methods’ potential to budge the rate of unintended pregnancy, which “stubbornly” persists at the same level despite efforts over many years to reduce it.1 For too long, LARC methods—IUDs and implants—have not been an option that women could easily choose, because of a range of barriers: lack of knowledge,2 providers’ low familiarity and lack of training,3–5 cost6,7 and unavailability in clinics.8 While we strongly believe that these barriers should be reduced so that LARC methods are an integral part of a comprehensive method mix, we also are concerned that unchecked enthusiasm for them can lead to the adoption of programs that, paradoxically, undermine women’s reproductive autonomy. Our concern is that when efforts move beyond ensuring access for all women to promoting use among “high-risk” populations through programs and contraceptive counseling aimed at increasing uptake of LARC methods, the effect is that the most vulnerable women may have their options restricted. To avoid this pitfall, it is vital that programs designed to promote LARC methods put the priorities, needs and preferences of individual women—not the promotion of specific technologies—first. While the possibility that LARC promotion efforts can undermine reproductive autonomy may seem remote in the face of the myriad barriers women face in using these methods, we believe that now is a pivotal time to engage in a critical discussion of this topic, given that use of LARC methods is on the rise,9 new clinical models are showing success in reducing and eliminating barriers to using them10,11 and many women have newfound access to contraceptives thanks to provisions of the Affordable Care Act.12 Such a discussion may illuminate the ways in which narrowing the scope of possibilities for family planning program innovation to promoting a particular class of technologies allows the widespread social inequalities that underlie unintended pregnancy to become invisible. It also may show how prioritizing method effectiveness above other contraceptive features may deny some women reproductive control.