First paragraph: Dundee, the city with the highest rate of drug deaths in Europe, is the first place in Scotland to deliver the Pause intervention to 20 women from some of the city’s poorest areas. The programme, which started in England, offers support to women who use drugs on the condition that they receive long-acting reversible contraception (LARC), including implants, injections and intrauterine devices – the pill is not an option. These LARCs are administered by healthcare professionals and don’t require – or allow – the woman to do anything.https://theconversation.com/why-we-need-to-ask-questions-about-the-birth-control-conditions-attached-to-treatment-for-women-who-use-drugs-13170

Fotopoulou, Maria

Parkes, Tessa

English

First paragraph: Dundee, the city with the highest rate of drug deaths in Europe, is the first place in Scotland to deliver the Pause intervention to 20 women from some of the city’s poorest areas. The programme, which started in England, offers support to women who use drugs on the condition that they receive long-acting reversible contraception (LARC), including implants, injections and intrauterine devices – the pill is not an option. These LARCs are administered by healthcare professionals and don’t require – or allow – the woman to do anything

Stirling Online Research Repository (RIOXX)

AuthorsMaria FotopoulouLecturer in Criminology, University ofStirlingTessa ParkesResearch Director, University of StirlingAcademic rigour, journalistic flairDundee, the city with the highest rate of drug deaths in Europe, is the first place inScotland to deliver the Pause intervention to 20 women from some of the city’s poorestareas. The programme, which started in England, offers support to women who use drugson the condition that they receive long-acting reversible contraception (LARC), includingimplants, injections and intrauterine devices – the pill is not an option. These LARCs areadministered by healthcare professionals and don’t require – or allow – the woman to doanything.An independent report on Pause states that: “As a condition of beginning this voluntaryprogramme women agree to use an effective form of reversible contraceptive for the 18-month duration.” The aim is to give women the chance to “pause” and take control of theirlives. In the Dundee Pause programme, LARC use is required for women to proceedbeyond the first four months of the programme.Disinformation is dangerous. Listen to experts.Get our newsletterShutterstockWhy we need to ask questions about the birth control conditionsattached to treatment for women who use drugsMarch 6, 2020 1.17pm GMTHowever, the very heart of the intervention – the condition that the woman uses a long-actingreversible contraceptive – is highly contentious. As two academics with experience in researchingwomen who use drugs and who have significant other health and social challenges, we want to raisequestions about the use of conditions when it comes to women’s reproductive rights in these kinds ofprogrammes.Incentives and conditionsUndoubtedly, LARCs have provided women with valuable new birth control options. LARCs arehighly effective compared with other methods, such as the pill, and can be seen as helping womenwho wish to prevent pregnancy but cannot shoulder the responsibility of making decisions aboutcontraceptive use. Yet, because LARCs depend on the provider, they can also be problematic sincethey effectively involve the women relinquishing any control over their fertility – some forms of LARClast up to 10 years.Critics have argued this denies women agency and renders them objects of social surveillance byproviders of sexual and reproductive healthservices. In the US, research has reported on cases wheredoctors resisted requests, or refused to remove, intrauterine devices when a woman asked for it to bedone.Questions have also been raised by academics and practitioners regarding public health campaignsthat have moved beyond ensuring access to LARCs for all women, to promoting LARCs to smallnumbers of women deemed at “high risk” of unplanned pregnancy. Research has highlighted racialand socioeconomic disparities in LARC use by demonstrating that women who are poor, less educatedor from black and minority ethnic groups were more likely to use them.Based on such findings, LARCs have been criticised as being implicated in state and medicalinterventions where racism, poverty and sexism intersect, resulting in serious violations of women’sautonomy. Reproductive health analyst Rachel Benson Gold examined US proposals to providefinancial assistance on the condition that women agree to use LARCs. And in a paper on disparities inwomen’s use of the Depo-Provera injection in the US, sociologist Thomas Volscho uses the termPause in Action“sterilisation racism” when highlighting the potential of LARCs to be used as a punitive, raciallytargeted population control measure.LARCs and women with drug problemsWomen who use drugs are commonly regarded as both “at risk” and “risky”. The media often portraywomen drug users who get pregnant as undeserving mothers. Maternal drug use is routinely associated with words such as “abuse” or “kill”, and pregnant women who use drugs are portrayed inthe media as “lethal foetal containers”, for which the American sociologist Jaber Gubrium coined “the mother-as-monster image”.Designated a risk to themselves, their children and their unborn babies,and society in general, it should come as no surprise that thereproductive capacity of women who use drugs has been at the forefrontof policy and practice concerns. In the US, women have been subjectedto criminal prosecution for using drugs during pregnancy. In Scotland, in2006, a Scottish MSP suggested “putting some form of oralcontraception in methadone” during a parliamentary debate atHolyrood.LARCs are featuring more and more in interventions involving womenwho use drugs as an effective and beneficial way to address the unmetneed for contraception, with suggestions of “nudging” them towards itsuse. But such practices have been accused of preventing women fromexercising agency. A prime example is Project Prevention in the US,which “incentivises” people who use drugs to either get long-term birthcontrol or get sterilised in exchange for money.Researchers have condemned Project Prevention, highlighting that paying women to limit or stoptheir ability to have children is coercive, infringes on their rights and freedoms, and constitutespopulation control. “Nudging” can be even more explicit: in the US, there have been suggestions of forced LARC implantation for women who show signs of substance use during pregnancy.Pause: a slippery slope?Pause in Dundee does not provide financial incentives to women drug users in exchange for agreeingto use LARCs. It does, though, attach strings to offers of support and treatment to women who haveexperienced, or who are at risk of their children being taken away. Undoubtedly, access tocontraception may help women to control their fertility and is essential to ensuring they are involvedin decisions about their own bodies.But shouldn’t treatment and support for those with drug problems be provided to all those that needthem? Is it ethical to attach conditions to providing support that public services are already expectedto deliver? And what could follow next?We should not ignore the many examples throughout history, such as the forced sterilisations of HIVpositive women throughout the world. There seems to be a fine line between “supporting” women inYoung women who use drugs often have chaotic lifestyleswhich can put them at risk of unplanned pregnancy.ShutterstockBirth control Long acting reversible contraceptive unplanned pregnancytheir reproductive decisions and forcing them to control their fertility. It could be a slippery slope tosomething far more disturbing.Before you go...Democratic norms are being stress-tested all over the world, and the past few yearshave thrown up all kinds of questions we didn't know needed clarifying – how long istoo long for a parliamentary prorogation? How far should politicians be allowed tointervene in court cases? To monitor these issues as closely as we have in the past weneed your support, so please consider donating to The Conversation.Laura HoodPolitics EditorDonate now

Why we need to ask questions about the birth control conditions attached to treatment for women who use drugs

Stirling Online Research Repository

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Why we need to ask questions about the birth control conditions attached to treatment for women who use drugs

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