Almost half of women using long-acting reversible contraception (LARC) felt pressured to accept this method

Dr Mark Limmer and Dr Rachael Eastham
Dr Mark Limmer and Dr Rachael Eastham

Almost half of users of long-acting reversible contraceptives felt under pressure from health professionals to accept these highly effective methods of contraception say researchers.

The report is by the charity BPAS, Shine ALOUD UK, Decolonising Contraception and Lancaster University into the provision of Long-Acting Reversible Contraception (LARC) in the UK.

Researchers found that nearly half (43.8%) answered definitively ‘yes’ that they had felt pressure to use LARC.

The qualitative study looked in particular at the experiences of those from marginalised groups who may be disproportionately targeted for LARC uptake based on assumptions about their ability to avoid unplanned pregnancy or concerns about their suitability for pregnancy and parenthood, due to their physical or mental health, and who may feel under pressure to accept this method in exchange for access to services and support.

Dr Rachael Eastham, Senior Research Associate at Lancaster University said: “The experiences included offer an important reminder of the ways that these pressures, for example, to save money or focus on specific ‘vulnerable’ populations can impact users‘ rights and contribute to widening inequalities, however unintentionally.”

Dr Mark Limmer, Senior Lecturer at Lancaster University said: “The experiences of the users who contributed to this report highlight the continuing social inequalities in the promotion and provision of LARC in the UK and point the way clearly to the need to embed such provision in a commitment to upholding the rights of users to accessible and non-discriminatory sexual and reproductive health services.”

The report evaluated these experiences against the World Health Organisation’s (WHO) standards for human rights in contraception services, focusing on accessibility, informed decision-making, and non-discrimination, conclude that the sector requires some improvement to deliver person and rights centred LARC services.

Clare Murphy, Chief Executive of BPAS, said: “LARC can be a brilliant method that gives women the most effective protection against unwanted pregnancy. But like all technologies, it can be used to control as well as liberate. No woman should feel pressured into accepting LARC based on judgments about her sexuality or suitability for pregnancy and parenthood, and the experiences uncovered in this research give us real cause for concern.”

Preliminary recommendations include ensuring LARC provision centres the following:

· Legitimacy – working to ensure modes of LARC provision always have a ‘legitimate’ (non-discriminatory) aim and outcome.

· Accessibility– equitable access including for removal of LARC methods

· Resources - to support fully informed consent.

· Challenge – a recognition that there is no universal ‘one size fits all’ in relation to LARC and wider SRH services

Dr Jane Dickson, Vice President of the Faculty of Sexual and Reproductive Healthcare, (FSRH), said: “We are not surprised that this new report corroborates the findings of the APPG SRH’s Parliamentary Inquiry into access to contraception in England. For years now, our members have been reporting that the system is failing to equip providers with the resources necessary to provide an accessible, comprehensive contraceptive service inclusive of LARC.”

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