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  • Title: Contraceptive implants: long acting and provider dependent contraception raises concerns about freedom of choice.
    Author: Thompson MS.
    Journal: BMJ; 1996 Nov 30; 313(7069):1393-5. PubMed ID: 8956712.
    Abstract:
    David Bromham's editorial on contraceptive implants ignores the wider issues to voice concern that trial by media could limit contraceptive choice by jeopardising research into new methods. However, it is more beneficial to the public for points of conflict to be debated openly. Furthermore, the impetus for research into new contraceptive technology is driven by profit and political motives and is only marginally affected by the media. Implanted contraceptives may increase the choice of contraceptive methods, but they put control of fertility increasingly into the hands of the medical profession. Herein lies their greatest problem: their potential to increase providers' control over clients' choice. There is the danger that certain groups of women may be targeted for their use: in the United States the coercive use of Norplant for mothers receiving welfare benefit has been suggested. Long acting contraceptives are a contraceptive of choice only when they are available without pressure, as part of a wider menu; when instant removal on request is guaranteed; and when there is an open and free flow of information and opinions between users, health professionals, and special interest groups. A previously-published editorial by David Bromham about contraceptive implants argued that spurious concerns over side effects raised by the mass media were unfairly causing women to limit their choice of contraceptive method. In addition, he contended that "trial by media" discourages contraceptive use and jeopardizes research activities. These points fail to acknowledge that information is an important component of choice and that the burden of proof that a method is safe rests with those who produce the method. Debates about methods, therefore, should take place in a public forum. In addition, the impetus for the contraceptive research industry is financial, and "trail by media" has only a small impact on profit. Provider-dependent contraception (such as the Norplant implant) has the potential to increase provider control over the choice of clients. Such control is dangerous, and testing such contraceptives in populations where women are subordinate to men raises ethical questions. An additional danger exists that contraceptive implants may be targeted for use by women with social problems such as those on welfare (as has been proposed in the US). Thus, providers in Britain must not be complacent about claims that Norplant simply increases women's choice of method. More serious questions about contraceptive choice and informed consent will arise with the testing and use of the next generation of long-acting contraceptives. Biodegradable implants are of limited reversibility, and contraceptive vaccines are nonreversible during their period of efficacy. While the range of methods may increase, individual choice may be limited in favor of provider control.
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