Summary

In 1987, the threat of litigation led to the withdrawal of intrauterine devices (IUDs) from the American market where depot medroxyprogesterone acetate (DMPA) had already been banned. There were fears of repercussions that would have led to the limiting of contraceptive choice in Britain. HIV was also an emerging issue and a revival of interest in barrier contraception led to an emphasis on male condoms, with strengthening of manufacturing standards, promotion in the media, improved accessibility and emphasis of their value for dual protection. Twenty-five years later, links still need to be sought within reproductive health services, especially at the interface between the management of contraception and opportunities for HIV prevention.

Restricting choice

An editorial in this Journal in 19871 referred to ‘The customer comes first’ as a current political slogan and stressed the role of choice when “the commodity on offer is contraception”. It was felt that there was a threat that “freedom of choice will be whittled away”, as two government discussion documents had neglected to mention community services for family planning despite their widespread recognition as being essential for primary health care.2 Community services were perceived as providing value for money, as well as offering alternatives both to hospitals as service delivery points and to general practitioners (GPs) for service provision. It was felt that GPs tended to focus on oral contraception, to the exclusion of IUDs and barrier methods.

At that time, major challenges were being faced in the promotion of IUDs, both because of inadequate service provision and due to misconceptions regarding their indications, contraindications and effectiveness. Whereas IUD fitting by hospital gynaecologists would provide “a contraceptive service nearer to the Rolls-Royce than the rickshaw”3 for the great benefit of a few individual clients, it seemed more appropriate for service improvement to prioritise the …