In recent years, there has been a surge in the education and promotion of long-acting reversible contraceptives (LARCs).
We are encouraged by the tremendous progress made in the last 40 years in LARC design, safety, and efficacy. We strongly support the development of, and access to, the full range of safe and effective contraceptive options. And, we advocate for the elimination of financial, regulatory, and social barriers that prevent women from getting LARCs.
Yet, the NWHN is deeply concerned that enthusiasm for LARCs threatens individuals' ability to decide which methods are best for their unique circumstances. Aggressive promotion of LARCs—or of any method—infringes on reproductive autonomy, and can't be separated from the broader context of reproductive coercion.
The NWHN is particularly troubled by reports—confirmed in a number of qualitative studies—that providers and public health officials are promoting the use of LARCs regardless of a person’s independent sexual and reproductive health needs, desires, or family planning priorities.
While we continue to fight rampant, on-going attacks on access to contraception and abortion care, we must also protect and defend reproductive autonomy from coercive programmatic and provider practices. Every person must have complete information about all of their contraceptive options and be able to choose the method that is right for them without any cost or access barriers.
Get Help to Make Good LARC Policy
In partnership with the National Institute for Reproductive Health (NIRH), we developed a toolkit to help activists evaluate and shape LARC policymaking at the state level.
LARC Coercion History & Toolkit Webinar
Watch our May 2019 webinar on the history of LARC coercion and how activists can use the toolkit to effect change in their states.
Statement of Principles
These examples and more are why the NWHN joined with our allies at SisterSong to craft a statement of principles to guide the non-coercive provision of LARCs:
“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 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."
“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.”
The statement has been endorsed by hundreds of national, state, and local organizations and individuals. This is a living document shared by Sister Song and the National Women's Health Network.
Human sexuality, and even pregnancy intention, can be complicated, and while a method's effectiveness is important, it doesn't capture the full scope of trade-offs that people make in choosing the contraceptive option that's best for them. When women are given the chance to make non-directive, fully informed decisions for themselves, they are much more likely to be satisfied. In contrast, studies have found that when providers impose their views, some patients simply "accept their providers' contraceptive suggestions as a way to end counseling encounters — methods they rapidly discontinued." And what's more, "experiences of implicit pressure were longitudinally impactful, with some participants curtailing future healthcare access and contraceptive use because of negative clinical encounters."
Coercion, subtle or explicit, is always ultimately counterproductive to the long-term goal of improving public health, and reinforces a deep distrust of the health care system and medical community that will long outlast the method or the encounter. That's why instead of a LARC-first discussion, we emphasize a patient-centered discussion of needs and preferences.
Building on our statement of principles and in partnership with SisterSong, we offer trainings to clinicians, administrators, counselors, activists, and funders about best practices when providing contraceptive services and information. Instead of assuming that effectiveness is the most important factor, for example, we encourage providers to ask questions like:
- What matters most to you in a contraceptive method?
- Is it most important to you to have a method that almost never fails?
- Is it important to be able to ‘set it and forget it’ or to be able to start and stop on your own?
- Is it important to have a monthly cycle?
- Do you need a method that can be kept private from a partner or parent?
- Are you at risk of losing health insurance in the next year?