Taking Liberties with Women: Abortion, Sterilization, and Contraception

Abstract

This paper analyzes four areas in which reproductive freedom is being denied to women. The first area involves the use of sterilization without adequate counseling as to the risk of reversibility of the method or when it is made a precondition for performing an abortion. The second concerns the sterilization technique chosen, especially in developing countries, and the failure of international population agencies to note the higher complication rates of certain procedures. The third involves the inadequate information provided to women about the side-effects of the controversial injectable contraceptive, Depo-Provera. The fourth area concerns the unethical marketing of the Dalkon Shield device. It is concluded that physicians have a responsibility to avoid allowing authoritarian attitudes or racial, class, or sex prejudices to influence their treatment of women.

Incidence of hysterectomy and tubal ligation in public hospitals in South Australia, 1980–82

“…Although tubal ligation is a less hazardous procedure than hysterectomy, it has been criticized for the possible consequent complications which in many cases lead to subsequent hysterectomy (Savage, 1982;Shapiro, Fisher & Diana, 1983).…”

“…Serious reservations have been expressed with regard to elective hysterectomy performed solely for contraceptive purposes on asymptomatic women, in view of the mortality associated with the operation and the risk of further morbidity (Laros & Work, 1975;Amirikia & Evans, 1979;Haynes & Martin, 1979;Easterday et ai, 1983). Although tubal ligation is a less hazardous procedure than hysterectomy, it has been criticized for the possible consequent complications which in many cases lead to subsequent hysterectomy (Savage, 1982;Shapiro, Fisher & Diana, 1983).…”

Hidden in plain sight: A systematic review of coercion and Long-Acting Reversible Contraceptive methods (LARC)

“…Across the three metanarratives, there is one clear conclusion: all instances of coercive practices in LARC programs target marginalized, disadvantaged and excluded population(s). Regardless of the metanarrative, coercive practices are always related to a specific population of women: indigenous Adivasi and Dalit women [41][42][43], African American and First Nation women [33,43,44], low-income women [45,46], young people [47,48], substance users [49][50][51][52], marginalized women in the global south [40,[53][54][55][56][57][58], women in the carceral system [32,46,[59][60][61], women receiving welfare [34], women with psychiatric conditions and intellectual disabilities [62], and women in refugee settings [62]. This clear association of LARCs with the coercion of certain groups of people demands our attention.…”

Depo-Provera--ethical issues in its testing and distribution.

“…The individual is the most important focus of any discussion on drug use and distribution and, in the case of Depo-Provera, those problems that have arisen during distribution have sometimes been as much a failure to inform the potential user and respect her choice, as they have been due to side-effects ofthe drug (25).…”

“…Conversely, the long-acting drug could be attractive to a government or institutional health worker attempting to subvert the woman's own decision-making about fertility. These opposite points of view have been well expressed by Christopher (24) and Savage (25). DISTRIBUTION The hazard of a contraceptive (or any other drug) is a matter of probability in which every individual user may have an exceedingly small hypothetical risk of death, but that risk is immediately translated into 100 per cent certainty for the one who dies.…”