March 28, 2014 — Summary of "Celebration Meets Caution: LARC's Boons, Potential Busts, and the Benefits of a Reproductive Justice Approach," Higgins, Contraception, Feb. 12, 2014.
Noting the "attention" and "palpable enthusiasm" devoted to long-acting reversible contraception (LARC) in the reproductive field in recent decades, Jenny Higgins of the University of Wisconsin's Department of Gender and Women's Studies highlights the "compelling advantages of LARC," its "possible drawbacks" and how a "reproductive justice approach" can be integrated into the "LARC promotion toolkit."
She notes that for the purposes of her commentary, "LARC refers to intrauterine contraception (IUC), implants and other in-development methods that prevent pregnancy for extended time periods without user action."
"The reproductive health field's excitement about LARC is certainly understandable, especially along lines of efficacy," Higgins writes, noting that IUC and implants are unparalleled in their ability to prevent pregnancy. Further, more widespread use of LARC could lower the unintended pregnancy rate and "thus reduce both the social and financial consequences of unintended pregnancies," she writes.
According to Higgins, one of the "less frequently" noted benefits is that "many LARC users enjoy not having to think about or attend to their device after insertion." LARC also "has the potential to improve some women's sexual enjoyment," including by allowing more sexual spontaneity, she adds.
"Given LARC's efficacy, acceptability, and both documented and potential benefits," it is understandable why one of the reproductive field's "primary charters is to simply increase access to LARC," she states, adding, "Increasing access to LARC is a vital aspect of a broader reproductive rights agenda in which women can avail themselves of basic preventive health care."
LARC's Potential 'Drawbacks'
There are "at least three aspects of LARC to which we should devote care and consideration," in order to "avoid repeating prior reproductive rights abuses, from eugenicist promotion of birth control in the early 20th century, to use of population 'targets' in developing country settings, to U.S. sterilization laws affecting the disabled and poor women of color," Higgins argues.
Higgins cautions against treating LARC as "a potential magic bullet, without larger consideration of the cultural and structural factors that may contribute to unintended pregnancies in the first place." Such "reasoning suggests that lack of access to effective contraceptives is the primary driver behind this health disparity -- and that unintended pregnancies are a cause rather than a consequence of social inequality," she adds.
Reproductive health advocates also should be aware of "how we consider recommending contraceptive methods to clients," Higgins continues, adding that heath care professionals should be careful about "equating pregnancy prevention with other types of health prevention such as heart disease, cancer and other illnesses." Higgins "celebrate[s]" the fact that "we do have an array of methods to recommend to women and their partners," but notes that while LARC is "a terrific option for many women ... no one method will be perfect for all couples."
Higgins continues, "A third and final consideration to keep in mind is the ways in which our socially disadvantaged clients, particularly women of color, have endured legacies of social injustice that will affect the way they experience LARC promotion." She argues, "Directly acknowledging such racist and eugenicist legacies," such as compulsory sterilization programs, does not necessarily discourage LARC use, but it could aid in addressing clients' "suspicions of reproductive injustice" and "facilitate more possible openness to long-acting contraceptive services."
Integrating a Reproductive Justice Approach
Higgins calls for "integrat[ing] a reproductive justice approach into our reproductive health toolkit." She explains, "Reproductive justice recognizes that the main reproductive challenge facing poor women of color is not unintended pregnancy by itself, but rather socioeconomic and cultural inequalities that provide some people with easier access to self-determination and bodily autonomy than others."
She stresses that the "ultimate reproductive justice endgame is to enhance the heath, social well-being and bodily integrity of all our contraceptive clients." As such, "let us continue our efforts to make LARC affordable and easy to access, but let us also respect women's decisions not to use LARC, their ability to have LARC removed when they wish and their ability to have the children they want to have," she writes.