Long-Acting Reversible Contraception

Statement of Principles

 

We believe that people can and do make good decisions about the risks and benefits of drugs and medical devices when they have good information and supportive health care. We strongly support the inclusion of long-acting reversible contraceptive methods (LARCs) as part of a well-balanced mix of options, including barrier methods, oral contraceptives, and other alternatives. We reject efforts to direct women[i] toward any particular method and caution providers and public health officials against making assumptions based on race, ethnicity, age, ability, economic status, sexual orientation, or gender identity and expression. People should be given complete information and be supported in making the best decision for their health and other unique circumstances.  

We call on the reproductive health, rights, and justice communities, including clinicians, professional associations, service providers, public health agencies, private funders and others to endorse the following principles.  

___________________________________________

We acknowledge the complex history of the provision of LARCs and seek to ensure that counseling is provided in a consistent and respectful manner that neither denies access nor coerces anyone into using a specific method.  

  • Many of the same communities now aggressively targeted by public health officials for LARCs have also been subjected to a long history of sterilization abuse, particularly people of color, low-income and uninsured women, Indigenous women, immigrant women, women with disabilities, and people whose sexual expression was not respected.

 

We commit to ensuring that people are provided comprehensive, scientifically accurate information about the full range of contraceptive options in a medically ethical and culturally competent manner in order to ensure that each person is supported in identifying the method that best meets their needs.

  • A one-size-fits-all focus on LARCs at the exclusion of a full discussion of other methods ignores the needs of each individual and the benefits that other contraceptive methods provide. A woman seeking care who is preemptively directed to a LARC may be better served by a barrier method that reduces the spread of HIV and other sexually transmitted infections (STIs); a pill, patch, or ring that allows her to control her menstrual cycle; or any method that she can choose to stop using on her own without the approval of clinician.
  • Women—particularly young women, elderly women, women of color, LGBTQ individuals, and low-income women—frequently report that clinicians talk down to them, do not take their questions seriously, and treat them as though they do not have the basic human right to determine what happens with their bodies. Only affordable coverage of all options and a comprehensive, medically accurate, and culturally competent discussion of them will ensure treatment of the whole human being and truly meet the health and life needs of every woman.

 

Advocates and the medical community must balance efforts to emphasize contraception as part of a healthy sex life beyond the fear of unintended pregnancy with appropriate counseling and support for people who seek contraception for other health reasons.

  • The current focus on straight, cisgender women limits the health information given to people whose primary need may not be for preventing pregnancy, but for treating endometriosis, ovarian cysts, heavy or painful menstrual cycles, and more. This current focus also reinforces a limited set of public health outcomes that have been historically problematic, rather than respecting the bodily autonomy and rights of all women.
  • Health care providers need good information to effectively consult with their patients.  We seek to ensure access to training and up-to-date information on the benefits and possible drawbacks or limitations of any given option so that health professionals and clinic staff are able to provide the highest quality counseling for each and every patient.  

 

The decision to obtain a LARC should be made by each person on the basis of quality counseling that helps them identify what will work best for them. No one should be pressured into using a certain method or denied access based on limitations in health insurance for the insertion or removal of LARC devices.  

  • Too often, providers receive biased promotional information from funders and pharmaceutical companies. It is critical that providers receive information that doesn’t privilege LARC over other methods.
  • Governments, foundations, and providers should reject explicit and implicit targets or goals for total numbers of LARCs inserted, which inappropriately bias the conversation between women and clinicians and can lead to coercion.
  • Governments, foundations, and providers should reject incentives that limit patient choice, such as vouchers that can only be redeemed for LARCs.

 

The decision to cease using a long-acting method should be made by each individual with support from their health professional without judgment or obstacles.  

  • A woman who wants her LARC removed should have her decision respected and her LARC promptly removed, even if her clinician believes that she might ultimately be happy with the device if she were to wait.
  • Removal of a LARC can be more demanding than insertion, but many women face significant obstacles when they want their LARC removed. Every clinic that offers a LARC should also have clinicians trained and able to remove LARCs and should offer appointments for removal at that same site. Likewise, providers should make clear that if women are not insured at the time they want their LARC removed, they may have to pay for removal out of pocket.
  • When programs are implemented to increase access to LARCs, they should clearly address issues of removal, particularly how the needs of patients will be met if and when a program ends.

 

The current enthusiasm for LARCs should not distract from the ongoing need to support other policies and programs that address the full scope of healthy sexuality.

  • Comprehensive sexuality education must be fully funded and supported.
  • LARCs are an important addition to the range of options, but they are not the only option.  The medical community must not only ensure access to and information about the full range of current methods, but also support continued research to develop new options to continue to improve quality of care and support women and families.

___________________________________________

Women should have the right and the ability to control their own fertility whether planning, preventing or terminating a pregnancy.  Marginalized communities, and particularly women of color, have experienced many forms of reproductive oppression, from forced sterilization to restrictions on abortion access to coercive limits on their ability to have children, and they continue to face high rates of maternal mortality.  

We believe articulating these principles is necessary to protect the bodily autonomy and to respect the agency, health and dignity of marginalized women so that those who have historically been oppressed or harmed feel safe when making reproductive decisions. This is a critical step forward. This is what reproductive justice looks like.

 

[i] While we use “woman” and “women” throughout this statement, we recognize that these terms do not encompass the full range of people who use contraception and who may be impacted by coercive practices. We also use the gender-inclusive “their” and “them” as singular pronouns.

 

To sign the statement, please fill out the form found HERE.

For questions, please contact Sarah Christopherson at schristopherson@nwhn.org.

The quick link for this document is: tinyurl.com/LARCprinciples.

 

This statement of principles is endorsed by the following organizations in alphabetical order:

AccessMatters

ACCESS Women’s Health Justice

Action for Boston Community Development

Advocates for Youth

AIDS Foundation of Chicago

Association of Fertility Awareness Professionals

American Civil Liberties Union

AmeriCares Free Clinic-Norwalk

Backline/All-Options

Beyond the Pill Program at UCSF Bixby Center

Black Women for Wellness

Black Women’s Health Imperative

BSSI

CAI (formerly Cicatelli Associates Inc.)

CAIR Project

California Latinas for Reproductive Justice

Cambridge Health Alliance Sexual and Reproductive Health Program

Cardea

Center for Reproductive Rights

Center on Reproductive Rights and Justice at University of California, Berkeley

Civil Liberties and Public Policy (CLPP)

Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR)

Community Healthcare Network

Conceivable Future

Desiree Alliance

Emma Goldman Clinic

Essential Access Health

EverThrive Illinois

Feminist Women’s Health Center

Forward Together

getLARC Program, Montefiore Medical Center

Harm Reduction Coalition

HealthConnect One

Healthier Futures

Healthy Philadelphia

Howard Brown Health Center

Ibis Reproductive Health

If/When/How

Illinois Caucus for Adolescent Health

In Our Own Voice: National Black Women’s Reproductive Justice Agenda

Jacobs Institute of Women’s Health

Latino Commission on AIDS

Madre Tierra Latina Women Organization

Momma’s Village-Fayetteville

Midwives for Peace & Justice

Mississippi Reproductive Freedom Fund

Mujeres Latinas en Acción

NARAL Pro-Choice America

NARAL Pro-Choice North Carolina

NARAL Pro-Choice Oregon

NARAL Pro-Choice Virginia

National Asian Pacific American Women’s Forum (NAPAWF)

National Birth Equity Collaborative

National Center for Lesbian Rights

National Council of Jewish Women

National Family Planning & Reproductive Health Association (NFPRHA)

National Female Condom Coalition

National Health Law Program

National Institute for Reproductive Health

National Latina Institute for Reproductive Health

National Network of Abortion Funds

National Organization for Women (NOW)

National Organization for Women of New Jersey

National Organization for Women Northern New Jersey Chapter

National Partnership for Women & Families

National Women’s Health Network

National Women’s Law Center

NEWCAP, Inc

New Mexico Perinatal Collaborative

New Voices for Reproductive Justice

New York City Department of Health and Mental Hygiene

New York City LARC Access Task Force

New York Latina Advocacy Network

Nursing Students for Sexual & Reproductive Health

Oregon Inter-Tribal Breastfeeding Coalition

Our Bodies Ourselves

Pandora’s Box Productions

Physicians for Reproductive Health

Planned Parenthood Federation of America

Mt. Baker Planned Parenthood

Planned Parenthood Great Plains

Planned Parenthood Hudson Peconic

Planned Parenthood Minnesota, North Dakota, South Dakota

Planned Parenthood Mohawk Hudson

Planned Parenthood Northern California

Planned Parenthood of Greater Ohio

Planned Parenthood of Greater Texas

Planned Parenthood of Illinois

Planned Parenthood of Middle and East Tennessee

Planned Parenthood of Nassau County

Planned Parenthood of New York City

Planned Parenthood of Northern New England

Planned Parenthood of South West and Central Florida

Planned Parenthood of Southern New England

Planned Parenthood of the Great Northwest and the Hawaiian Islands

Planned Parenthood South Atlantic

Planned Parenthood Southeast

Planned Parenthood Southeastern Pennsylvania

Planned Parenthood South Texas

Planned Parenthood Votes Northwest and Hawaii

Population & Development Program at Hampshire College

Positive Women’s Network

Power to Decide

Prison Birth Project

Pro-Choice Alliance for Responsible Research

Program in Woman-Centered Contraception at University of California, San Francisco

Provide Inc.

Rainier Valley Community Clinic

Religious Coalition for Reproductive Choice

Religious Institute

Reproaction

Reproductive Health Access Project

Reproductive Health Technologies Project (RHTP)

Sacramento Sister Circle

Seattle Medical and Wellness Clinic

Sexual Health and Reproductive Equity Program, University of California, Berkeley

Sexuality Information and Education Council of the United States (SIECUS)

SisterLove

SisterReach

SisterSong: National Women of Color Reproductive Justice Collective

Society for Adolescent Health and Medicine (SAHM)

Southern Birth Justice Network

Southwest Women’s Law Center

SPARK Reproductive Justice NOW!

St. John’s Well Child and Family Center

Surge Reproductive Justice

Tapestry Health

THE ALLIANCE: State Advocates for Women’s Rights & Gender Equality: California Women’s

Law Center • Gender Justice • Legal Voice • Southwest Women’s Law Center • Women’s Law Project

Training in Early Abortion for Comprehensive Healthcare (TEACH)

Unitarian Universalist Association

Unitarian Universalist Legislative Ministry of New Jersey

Unitarian Universalist Pennsylvania Legislative Advocacy Network

Upstream USA

URGE: Unite for Reproductive & Gender Equity

Women and Teens Healthcare, Inc

Women Engaged

Women with a Vision

Women’s Centers

Women’s Health Specialists, Feminist Women’s Health Centers

Woodhull Freedom Foundation

WV Free

Young Women United

YWCA of Greater Charleston

 

The American College of Obstetricians and Gynecologists supports the value of this document as an educational tool, January 2017.

 

This statement of principles is endorsed by the following individuals in order of date signed:

Samara Azam-Yu, M.B.A.

Executive Director, ACCESS Women’s Health Justice

 

Dr. Carrie N. Baker

Associate Professor, Program for the Study of Women and Gender

Smith College

 

Dr. Rajani Bhatia

Assistant Professor, Women’s, Gender & Sexuality Studies

University at Albany

 

Dr. Laura Briggs

Chair and Professor, Women, Gender, Sexuality Studies

University of Massachusetts Amherst

 

Ynanna Djehuty, Founder

These Waters Run Deep

 

Suzan Goodman MD MPH

Fellowship and Curriculum Director of the TEACH Program

Training Director for Beyond the Pill, University of California, San Francisco

 

Dr. Aline Gubrium

Associate Professor, Health Promotion and Policy

University of Massachusetts Amherst

 

Dr. Betsy Hartmann

Professor Emerita, Development Studies

Senior Policy Analyst, Population and Development Program

Hampshire College

 

Judy Norsigian

Co-founder and former Executive Director, Our Bodies Ourselves

 

John Peller, President & CEO

AIDS Foundation of Chicago

 

Dr. Krystal Redman

Executive Director, SPARK Reproductive Justice NOW!

 

Malika Redmond, MA

Founding Director, Women Engaged

 

Dorothy E. Roberts, J.D.

George A. Weiss University Professor of Law and Sociology

Raymond Pace & Sadie Tanner Mossell Alexander Professor of Civil Rights

Professor of Africana Studies

Founding Director, Program on Race, Science, and Society

University of Pennsylvania

 

Lynn Roberts, PhD, Assistant Professor

Community Health & Social Sciences Program

CUNY Graduate School of Public Health & Health Policy

 

Dominika Seidman, MD

University of California San Francisco

 

Jessica Terlikowski, Director

Prevention Technology Education, AIDS Foundation of Chicago

 

Joan Whitaker, Director

Action for Boston Community Development Family Planning Partnership

 

Alyssa N. Zucker, Ph.D.

Vada A. Yeomans Chair of Women’s Studies

University of Florida

 

Mrs. Barbara Moore

Bethlehem, PA

 

Christopherson Vichiola

Danbury, CT

 

Dennis Ruffer

Santa Clara, CA

 

Michelle Mosher

Denton, TX

 

Lisa Hughes

Galveston, TX

 

Mary V. Lisbon

Miami, FL

 

Leta A Dally

Chicago, IL

 

Mark Goldfield

Brooklyn, NY

 

Bonnie Richardson

Illinois

 

Marcia Bailey

Florida

 

Anna Forbes, MSS

Independent consultant

Kensington, MD

 

Julie Callahan

Brooklyn, NY

 

Gayla S. Keesee

Augusta, GA

 

Joan Smith

San Francisco, CA

 

Melissa Saunders

Lawrenceville

 

Rev. Jes Morgan

Pensacola Florida

 

Sarah Stewart

 

Dorothy Hasler

Sterling Heights, MI

 

Sophie Tramel

Fairfield, CA

 

Nicole Clark, LMSW

Nicole Clark Consulting

Brooklyn, NY 11202

 

Dea Smith

Loveland, CO

 

Alfredo Roldan-Flores

Newton, MA

 

Russ Ziegler

Chicago, IL

 

Marian F Iris Moore CNM

Sebastopol, CA

 

Ed Parks

Lawton, OK

 

Emelyn Erickson

Homeless Prenatal Program

San Francisco, CA

 

James A Clark Jr

Colorado

 

Amy Levi

RhN – Reproductive Health in Nursing

Albuquerque, NM

 

Julie Slater-Giglioli

West Hollywood, CA

 

Mrs. Elke Hoppenbrouwers

East Haven

 

Owen Gustafson

Minnesota

 

Alison R. Park

New York, NY

 

Sally Gwin-Satterlee

Felton, CA

 

Alexa Lesperance, Medical Student

Northern Ontario School of Medicine

 

Susan Spivack

Cobleskill, NY

 

Robert B. Kaplan

Port Angeles, WA

 

Ronald R Hammersley

Palm Bay, FL

 

John and Martha Stoltenberg

Elkhart Lake, WI

 

Sandra Mager

Rye, NY 10580

 

Suzanne Buckley, Reproductive Rights Advocate

Durham, NC

 

Wanda Ballentine

St. Paul, MN

 

Patricia Flynn-Williams

Midland, TX

 

Diana Wilkinson, RDH

Flagstaff, AZ

 

Delaine Powerful

Baltimore, MD /New York, NY

 

Maureen

Portland

 

Caitlin Williams

Durham, NC

 

Sara Birnel Henderon

New York, NY

 

Susan Margot Ecker

Malden MA

 

Leslie Cassidy

New York, NY

 

Debra Stulberg, MD

Chicago, IL

 

Fatima Cortez Todd

Los Angeles, CA

 

Freda Ballas

Oak Lawn

 

Tonya Katcher, MD

Washington, DC

 

Danit Brahver, MD

Cambridge Health Alliance

 

Whitney Wilson, MPH

San Francisco, CA

 

Aiden Harrington APN, CNM

Howard Brown Health

Chicago, IL

 

Sarah McNeil MD

Martinez, CA

 

Biftu Mengesha MD

University of California San Francisco

San Francisco, CA

 

Linda Hardy

Matawan, NJ

 

Bennett Lareau-Meredith NP

Director of Women’s Health

South End Community Health Center

Boston, MA

 

Susan J. Waldman

Randolph, NJ

 

Natasha Vianna

Co-founder of #NoTeenShame

California

Cari Benbasset-Miller, MD

Boston, MA

 

Makeda Kamara CNM, MPH, APRN

St Croix, Virgin Islands

 

Silvia Beltran

Brooklyn, NY

 

Melissa Smith, M.D.

Texas

 

Abigail Reese, CNM

Albuquerque, NM

 

Alissa Perrucci, PhD, MPH

University of California San Francisco

San Francisco, CA

 

Carrie Pierce, MD

Klamath Falls, OR

 

Eshita Sharmin

Dallas, TX

 

Richard Johnson

Eugene, OR

 

Lawrence Crowley

Louisville, CO

 

Angela Oliver

Washington, DC

 

Rose  Harris

Salt Lake City, UT

 

Diana L. Siegal

Topeka, KS

 

Nina Aronoff

Boston, MA

 

Renee Potik, NP

Fresno, CA

 

Jim Dailey

 

Peter Childs

California

 

Lynn Schneider

Naples, FL

 

Dave Frank

Des Moines, IA

 

Claire Carren

Colorado

 

Sandra Mager

Rye, NY

 

Helen Hays

Oregon City, OR

 

Bruce Hlodnicki, MD

Indianapolis, IN

 

Barbara Garcia

El Portal, CA  

 

Susan Stiritz, PhD, MSW

St. Louis, MO

 

John Comella

Philadelphia, PA

 

Laura Bernstein

Hartsdale

 

Lisa Levenstein, Associate Professor of History

University of North Carolina at Greensboro

Chapel Hill, NC

 

Judith King, MD

Chicago, IL

 

Charlotte Pirch

California

 

Virginia F. Sendor, M.S.

Stamford, CT

 

Cathy Foxhoven

Bay Area

 

Suzanne Blancaflor

Windham, CT

 

Helena Likaj

New Orleans,LA

 

Karen Stamm

New York City

 

Laura Helfman

Coalmont

 

Adriane Fugh-Berman MD

Washington DC

 

Kathleen Gaffney MD MPH

New York

 

Dr. Flojaune Griffin Cofer

Reproductive Health Epidemiologist

Sacramento, CA

 

Priscilla Fairbank

Averill Park, NY

 

Freda Ballas

Dallas, TX

 

Ronald R Hammersley

Palm Bay, FL

 

Susan Margot Ecker

Malden, MA

 

Sally Barrett-Page

Boulder, CO

 

Ms. Alice B. Rasher

Mt. Kisco, NY

 

Thomas Tizard

Hawaii

 

Deborah St Julien WHNP, FNP

San Jose, CA

 

Carol Rogers, Director

Healthy Philadelplhia

Philadelphia, PA

 

Steven Kostis

New York, NY

 

Susan Elizabeth Davis

New York, NY

 

Gary Hull

Riverdale, UT

 

Juanita Hull

Riverdale, UT

 

Sally Gwin-Satterlee

Felton, CA

 

Debbie Rouse

Illinois

 

Christina Cherel, MPH

Washington, DC

 

Deborah Dill

ABCD Family Planning

Boston, MA

 

Sara Culver

New Haven, CT

 

Lauren Coy, MPH

San Francisco, CA

 

Jessica Coleman

Massachusetts General Hospital

Boston, MA

 

Peter F Davis

Greenfield, MA

 

Whitney Gray

Upper Marlboro, MD

 

Gulielma Leonard Fager

Baltimore, MD

 

M Healey

Boston, MA

 

Cori Blum, MD

Chicago, Illinois

 

Elizabeth A. Kissling, Ph.D.

Professor, Women’s & Gender Studies

Eastern Washington University

 

Parker Dockray, MSW

Oakland, CA

 

Marcy Darnovsky

Center for Genetics and Society

Berkeley, CA

 

Emma Pliskin

New York City, NY

 

Grace Uomoto, RN BSN

Founder of Fearless Fertility, LLC

Seattle, WA

 

Mira Weil

Massachusetts

 

Martha Boisseau

Georgia

 

Ruth Romo, FNP

 

Susan Spivack

Cobleskill, NY

 

Miranda Dettmann, MPH

New York, NY

 

Alexander Michael Brammer

Kansas City

 

Mia Kim Sullivan

Amherst, MA

 

Rae Johnson-Bundy CD(DONA)

Lancaster PA

 

Ilene Richman, LMSW, FAE

New York

 

Karen Stamm

New York City, NY

 

Jenna Weintraub

Rochester, NY

 

Lauren Abramowitz, FNP-BC

New York, NY

 

Annie Hoopes, MD, MPH

Denver, CO

 

Jade F. Hillery, MPH

Washington DC

 

Angeline Ti, MD MPH, UCSF

San Francisco, CA

 

Jaime Palmer

Klamath Falls, OR

 

Noah Davis

New York

 

Anna Churchill

Belmont, MA

 

Lucie Steinberg

New York, NY

 

Connie Folse, MPH

Austin, Texas

 

Adjoa Sankofia Tetteh

New York, NY

 

Abigail Love MD MPH

Cambridge, MA

 

Rory Woodard

Brooklyn, NY

 

Corey Westover, MPH,CLC

Brooklyn, NY

 

Rena Tucker

Brooklyn, NY

 

Meredith Manze

New York, NY

 

Susan Spivack

Cobleskill, NY

 

Ginnah Howard

Gilbertsville, NY

 

Lauren Guy, IBCLC, RLC

Greensboro, NC

 

Alison Stuebe, MD, FACOG

University of North Carolina School of Medicine

Chapel Hill, North Carolina

 

Kristen Kiely WHNP-BC

Boston, MA

 

Megan L. Kavanaugh, DrPH

New York, NY

 

Jenny LY Sheehan

JLYS Consulting, LLC

Falmouth, MA

 

Lola Akintobi

Boston, MA

 

Rebecca Duncan, BSN, RN

Public Health Home Visiting Nurse, Doula

Philadelphia, PA

 

Amie Newman

Amie Newman Consulting

Seattle, WA

 

Joann Casado

New York

 

Laurie Mootz

Cottage Grove Oregon

 

Joan Gray

Eugene, OR

 

Jack Gray

Noti, OR

 

Shannon E. O’Malley, MS

Dorchester, MA

 

Maichelly Baez

Boston, MA

 

Brenda Reyes

Chicago, IL

 

Trina Stout

Portland, OR

 

Colin McCluney, MD

Columbus, OH

 

Melissa Natavio MD MPH

University of Southern California

Los Angeles, CA

 

Kayla Bert

New York

 

Jordan Hastie, UCSF MS4

Oakland, CA

 

Grace Mueller, Medical Student

Medford, MA

 

Nicole Veilleux, RN, CNM student

New Hampshire

 

Katie Mathisen

Madison, WI

 

Jodi Lynn Fennell

The Black Virgin LLC

Las Vegas, NV

 

Meghan Eagen-Torkko, PhD, CNM, ARNP

Seattle, WA

 

Susan Hope Dundas, PA-C

Lansing, MI

 

Katherine Parker Bryden, CNM

Waterloo, Iowa

 

Amanda Heffernan

El Rio Birth & Women’s Health Center

Tucson, AZ

 

Michelle Farber, CNM ARNP

Seattle, WA

 

Rob Reed, CNM, ARNP, IBCLC

Seattle, WA

 

Heather Thompson, PhD

Deputy Director, Elephant Circle

Denver, CO

 

Bree Ferrin, RN, FNP

Brooklyn, NY

 

Erica Gollub, DrPH MPH

Associate Professor, Health Science Program, Pace University

Pleasantville, NY

 

Vivian Peters, author

OOPS! Tales From A Sexpert

Cooperstown, NY

 

Noelle Miller

Planned Parenthood of the Rocky Mountains

Denver, CO

 

Rebecca Raj

Chicago, IL