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The ethics of state-sponsored and clinical promotion of long-acting reversible contraception
  1. Jeffrey Wale1,
  2. Sam Rowlands2
  1. 1Department of Humanities and Law, Bournemouth University, Poole, UK
  2. 2Department of Medical Sciences and Public Health, Bournemouth University, Bournemouth, UK
  1. Correspondence to Dr Jeffrey Wale, Department of Humanities and Law, Bournemouth University, Poole BH12 5BB, UK; jwale{at}bournemouth.ac.uk

Abstract

Objectives To review ethical aspects of the promotion and provision of long-acting reversible contraception (LARC). Specifically, to examine (1) the tension between informational exchange and the active promotion of LARC methods to new and existing contraceptive users by healthcare professionals; and (2) the distinct ethical issues arising from the promotion of LARC methods by state-sponsored actors and healthcare professionals.

Methods Narrative review and ethical analysis.

Findings There is an ethical difference between raising awareness/informational provision and actively promoting or prioritising specific contraceptive methods. It matters whether the policy choice is made, or the promotional activity about contraception is undertaken, by individual healthcare professionals at a local level or by more remote state-sponsored actors, because the relationship between the promoter and the (potential) contraceptive user is of a different kind. Imposing a dual responsibility upon healthcare professionals for raising awareness/informational exchange and the active promotion of LARC creates an unnecessary tension and barrier for the delivery of patient-centred care.

Conclusions This review highlights the need for ethical reflection on the central role of the promoting agent and the distinction between facilitating informational awareness and active promotion of LARC. LARC methods should not be prioritised in isolation and without regard to the wider implications of public promotion. A balanced narrative and information-sharing programme that respects the individual interests of each contraceptive user is called for, especially in direct professional/service user relationships. No assumption should be made that user decision-making will necessarily be determined and influenced solely by the relative effectiveness of the contraceptive method.

  • long-acting reversible contraception
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Footnotes

  • Twitter @rowlands999

  • Contributors SR conceived the idea for the paper. SR did an initial literature search; JW checked and added to this. Both authors were equally involved in the analysis. SR produced an outline written concept and JW produced the first full draft. Both authors reviewed/edited subsequent drafts and approved the final manuscript.

  • Funding JW received internal funding from Bournemouth University for his related research on fertility control. This research did not otherwise receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

  • Competing interests SR has received fees for acting as a trainer and for giving lectures on behalf of companies that market long-acting reversible contraception (LARC) products.

  • Patient and public involvement Members of the public participated in a conference at Bournemouth University on 13 November 2019. Feedback from participants has been considered and addressed in the authors' findings where appropriate.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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