There has been increased attention and funding in recent years for long-acting reversible contraceptive methods (LARCs). While LARCs are part of a well-balanced mix of contraceptive options, there are concerning practices when it comes to who is targeted for long-acting methods and the way in which counseling is provided.
The debate around appropriate promotion of LARCs is linked to a long history of the abuse and disrespect of marginalized communities, but for women whose grandmothers or mothers were sterilized without their consent, this is not history. It is the present. It is their families and their lives. And these troubling instances are still happening. In recent months, women using public benefits have been pushed to use LARCs to receive support and women in the criminal justice system have been offered reduced sentences if they agreed to use a long-acting method.
But coercion is a complicated concept and comes in many forms. It is not always these stark examples of violence and the outright denial of bodily autonomy. It can also come in the form of programs that only offer financial support for long-acting methods or insurance coverage for the insertion of a LARC, but not the removal. We also need to think about what it means when a health professional approaches counseling in a way that pushes the efficacy of certain methods without taking into account the other criteria that women consider when deciding what is the best option for them, their health and their individual circumstances.
We need to be honest about these complexities while striving for continued availability and affordability of the full range of contraceptive methods that people need. That is why the National Women’s Health Network and SisterSong, the national women of color justice collective, released a LARC statement of principles. More than 250 advocates, public health professionals and organizations have signed on in support. This document is meant to both start a conversation and clearly lay out a set of principle values and expectations on how LARCs should be discussed, promoted and provided.
By wrestling with these important questions and developing and utilizing a strong set of principles, we can address the disparities marginalized communities seeking quality health services face and promote the appropriate provision of care. Further, we must commit to expanding access to the full range of reproductive health care services to ensure we can all manage our health and plan our families.