The problem with Depo-Provera
I have learned of forced or coerced sterilization of women in Africa, mostly through advocacy groups who work to put pressure on governments and health care systems who sanction the practice and by raising public awareness of this practice.
Coerced sterilization is still taking place but in a more formal, legitimate fashion - through study upon study of women in Africa using Depo-Provera, a contraceptive which is injected every twelve weeks to prevent pregnancy.
The pressing question which has been asked time and again is whether women using Depo-Provera are at an increased risk of acquiring HIV. The most recent concern was the World Health Organization's reluctance to issue a warning about increases in HIV while a woman is using the Depo-Provera contraceptive.
The more pertinent question which has been a topic of discussion by many women's advocacy groups in the United States and Canada for many years is - should women be offered Depo-Provera as a contraceptive tool at all? Women in the United States and Canada, including Black women, Latina women, Mexican women, Puerto Rican women, Native American women and women with disabilities who often represent the socioeconomically disenfranchised portion of the population respond with a resounding NO. It is deemed to be a way of controlling the population, aggressively pushed on this demographic, while presenting the side effects as minimal.
Depo-Provera is hailed as a drug with lots of good benefits and minimal side effects. There are no more daily pills, the injection lasts 12 weeks, there is no Estrogen involved, no risks of strokes, reduction in endometrial cancer and endometriosis. There are fewer rates of mortality for women during childbirth, fewer children which would reduce poverty in Africa.
This video from Saskatoon promotes the use of Depo-Provera and it is no coincidence that this region has a high population of First Nations women.
The fact that Depo-Provera use is tied to race, gender, poverty and lack of education has been a contentious issue since the 1960's. Clinical trials held in the 1960s with this targeted population raised ethical questions and issues, as white middle class, educated women were not pushed to use this method and were offered other less harmful options.
The FDA was reluctant to approve Depo-Provera in the 1970s, recommending it be used only on specific populations and questioned the ethics of using a drug with side effects on these specific populations.
Over the years women’s organizations, including the Black Women’s Health Project, the Native American Women’s Health Education Resource Center, the National Latina Health Organization, and the National Women’s Health Network have opposed Depo-Provera as an appropriate form of contraception because of the way it is targeted at these communities without a fully informed explanation of the risks involved in using this form of contraception.
There were and remain few efforts to address socioeconomic factors involved in sexual and reproductive human rights, but rather a push in the direction of controlling these populations by providing a drug which would prevent further pregnancies. It was a quick fix to a complex problem that left many women with serious physical side effects.
Side effects profile
Some of the potential health hazards of Depo-Provera as described in 2011-2013 by the Committee of Women, Population and the Environment include:
- Breast Cancer: According to three separate studies, breast cancer occurs two to four times more often among young women who use Depo-Provera.
- Osteoporosis: Depo-Provera is now believed to cause loss of bone mass among women. Osteoporosis is a debilitating condition that becomes more life-threatening as women grow older.
- Cervical Cancer: Some studies indicate that Depo-Provera increases the risk of cervical cancer.
- Excessive Bleeding: Depo-Provera can cause heavy and prolonged menstrual bleeding.
- Weight Change: On average, Depo users gain 12-16 pounds over four to five years, but some women have gained up to 40 pounds.
- Difficulty Getting Pregnant: Some women who stop using Depo-Provera don’t get their period again for as long as two years, preventing pregnancy for much longer than intended.
- Other Side Effects: Severe Depression, Loss of Sex Drive, Fatigue, Dizziness, Headaches, Nervousness, Abdominal Pain, Hair Loss, Facial Hair Growth.
Pfizer has been subject to class action law suits in North America. In 2005, a $700-million class action suit was filed against Pfizer at their office in Toronto Ontario.The law suit claimed that long term users of Depo-Provera were diagnosed with bone density problems including osteoporosis, spine injuries, brittle teeth, hip injuries and fractures. The law suit alleged that Pfizer failed to forewarn both doctors and patients of the serious risks associated with long term use of the drug. In 2010 Pfizer settled several class action suits and individual claims against Pfizer are ongoing.
In spite of the concerns for this contraceptive in the 1990s and 2000s Depo-Provera shipments were heavily targeted at the African continent. The US Agency for International Development sends more shipments of Depo-Provera to Mozambique, Tanzania, and Nigeria than anywhere else in the world (Mosher, 2008).
Banning Depo-Provera would leave many women in developing countries without immediate access to alternative contraceptive options, which would likely lead to more unintended pregnancies, said lead author Lauren Ralph, an epidemiologist at the University of California, Berkeley, School of Public Health in 2015. Gregory Mirtz in 2013 discussed how shamefully, the largest distributor of ' Depo-Provera ' is the International Planned Parenthood Foundation (IPPF). IPPF refuses to acknowledge that there are side effects with using ‘Depo-Provera” and advocates against using condoms.
With 25 years of compelling scientific evidence which indicates the risk of HIV acquisition linked to Depo-Provera, the WHO is yet to state with certainty there is a risk and has chosen to take the middle ground, which in essence means they choose to say nothing to protect their own interests.
So why are we waiting on WHO to issue a statement when there has been enough concern and scientific evidence to show the risk of HIV acquisition? Pfizer's Warning and Precautions in 2015 stating "Depo-Provera should be used as indicated only if other treatments have been considered to be unsuitable or unacceptable and should be used for the shortest period of time possible. "This product does not protect against sexually transmitted infections (STIs) including HIV/AIDS. For protection against STIs it is advisable to use latex or polyurethane condoms." are enough acknowledgement requiring no further research studies.
Is it necessary at this late stage to expect the WHO to issue a clear warning about the risks of HIV while taking Depo-Provera? I think we got the message, we need to pass it on to those who need to be informed about not just the risk of HIV but all of the other serious side effects.
Waiting on WHO to announce a warning and precaution sign is a red herring to distract us from the real issue of coerced sterilization, an atrocity on disenfranchised African women who are not offered contraceptive options as is the rest of the white privileged world. It distracts from examining the real issues - socioeconomic, gender and race disparities and the lack of options given to women in Africa and men for that matter.
There are many other less harmful contraceptives on the market but women involved in coerced sterilization under the guise of research are not given options. African women are told their needs are being met in reducing unwanted pregnancies and reduced mortality risks during childbirth. Their consent is not fully informed and often it is a question of having no health care at all or signing on to a study in order to be given at least interim health care, until the research study ends.
Women in Africa with limited or no health care are not given options for birth control and this could be one of the few options they could exercise, given the opportunity with their sexual and reproductive human rights.
Depo-Provera is a diversion from addressing the underlying socioeconomic problems we created as colonizers. Resources and funding to conduct yet another research study could be used to help alleviate poverty while we engage African women's voices in meaningful investments to undo the harm we have created for centuries. If socioeconomic problems are addressed perhaps women in Africa would have more options in deciding for themselves the size of their family.
Volscho,Thomas W. 2011. Racism and Disparities in Women’s Use of the Depo-Provera Injection in the Contemporary USA. Critical Sociology September 2011.vol. 37 no. 5 673-688