Education And Debate

Contraceptive implants: long acting and provider dependent contraception raises concerns about freedom of choice

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7069.1393 (Published 30 November 1996) Cite this as: BMJ 1996;313:1393
  1. M S Thompson, anthropology research student, Durham Universitya
  1. a Apartado Postal 38, 29200 San Cristobal de las Casas, Chiapas, Mexico
  • Accepted 13 November 1996

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.

On 22 June the BMJ published an editorial by David Bromham about contraceptive implants.1 While the article seems non-controversial, by dealing purely with the biomedical aspects of these contraceptives, David Bromham ignores the complex debate over contraceptive implants and long acting systemic contraceptives in general. The main point of his article is that women should not have their choice of different contraceptive methods limited by spurious concerns over biologically implausible, newly discovered side effects—and he accused the television programme Horizon of raising such concerns. His secondary concern is that trial by media discourages contraceptive use and jeopardises continuing research into new methods of contraception, thereby precluding additions to the contraceptive menu and limiting expansion …

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