Long‐acting reversible contraception: A route to reproductive justice or injustice

Abstract

This article presents information on unintended pregnancies and the ongoing efforts of policy makers to promote long‐acting reversible contraception (LARC) to reduce the numbers of such pregnancies. Also discussed is the tension between the encouragement of LARC to promote the public's interests in achieving that goal versus the need to assure that all women can decide about their bodies and reproductive needs. Our discussion includes information, primarily from the United States, on (a) risks associated with unintended pregnancies, (b) LARC devices approved in the United States (copper intrauterine devices (IUDs), hormone IUDs, and implants), (c) public and social benefits of increasing the use of LARC, (d) disadvantages and barriers to using LARC, (e) dangers of promoting LARC in unjust ways, and (f) the meaning of reproductive justice and its connection to social justice. By sharing the information with the audience of this journal, we hope that it will be integrated into clinical work and research on mental health and development. We also hope that experts in those fields will become discussants in the conversation regarding women's reproductive health and social justice that is taking place in the United States and elsewhere.

Addressing long-acting reversible contraception access, bias, and coercion: supporting adolescent and young adult reproductive autonomy

“…Over the last decade, this framework has been used to examine the ways in which LARC promotion, a strategy to curb pregnancy rates, threatens reproductive autonomy especially amongst historically oppressed populations [3,9 ▪▪ ,10,11]. AYAs are one such group who experience infringements upon their reproductive rights due to the perceived cost to society of AYA pregnancy, bias against AYA pregnancy, and the paternalistic assumption that AYAs lack the maturity to make autonomous reproductive choices.…”

“…LARC promotion, contraceptive coercion, and pregnancy disparities cannot be separated from the racist policies that have created these issues and allowed them to persist. Policy must address disparities in pregnancy rates by focusing on the systemic root causes (e.g., racism, poverty, and access to education) instead of contraceptive promotion [9 ▪▪ ]. Additionally, it is imperative that medical education and healthcare systems address health inequities and rebuild trust within communities of color through the creation of a healthcare workforce representative of the community served, inclusion of antiracism education, and collaboration with community partners [27 ▪▪ ,28 ▪ ,29 ▪▪ ].…”

Long-Acting Reversible Contraceptive Use by Rural–Urban Residence among Women in Nigeria, 2016–2018

“…This finding is explained by a study in Nigeria [ 22 ] which showed that 65% of the 558,571 LARCs provided by five selected program initiatives in Nigeria were implants. While this finding is reassuring from public health and demographic standpoints, it raises concerns about inappropriate LARC-related coercion among poor women given that fertility, contraception, and sexual intercourse are private issues to be determined by individuals [ 24 ]. In our study, we found that the odds of using LARCs were significantly higher when the final decision on the contraceptive method to use was made by the provider alone or together with the woman.…”

Impact of prenatal contraceptive counselling on immediate postpartum intrauterine device use

“…However, while this study included live deliveries of all gestational ages, waiting to counsel until the third trimester may limit counselling opportunities for patients who deliver preterm. Counselling, when offered and accepted, should be comprehensive, based on the patient's desires and preferences, and rooted in principles of reproductive justice which acknowledges historical reproductive injustices, avoids coercion, and promotes autonomy [14].…”