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Depo advocates vs. women’s rights

Anyone who offers Depo to women should tell them about Depo’s risks. This is simply good behavior, caring about others. It also a medical ethics and human rights issue.

WHO is on the wrong side on this. In 2019, WHO recommended “women at high risk of HIV infection are eligible to use” Depo (page 6 in this link).[1] To get there, WHO rejected evidence from multiple studies that Depo increases women’s risk to get HIV by 40%-50% and, instead, relied on one trial, the ECHO (Evidence for Contraceptive Options and HIV Outcomes) trial. The ECHO trial was not only unethical but meaningless, designed in such a way that it could not show how much Depo use increased women’s HIV risk.

International organizations, health aid programs and governments have overlooked their duty to warn women about Depo. Here’s a 2018 report from South Africa[2]:

Pfizer’s Depo Medroxyprogesterone acetate, commonly known as Depo-Provera, is a contraceptive injection given every three months which was introduced in South Africa in the 1970s and largely given to black women as part of the apartheid government’s population control agenda. Multiple reports and research papers tell of how women were either forced to accept the drug or were given it without their knowledge, especially after giving birth. In democratic South Africa, there are laws requiring informed consent … aimed at protecting women’s autonomy over their own bodies. But the practice of injecting women with Depo-Provera without proper informed consent – especially those who are poor, black and using the public health sector – is still happening, especially after an abortion or birth.

“It is happening right now. Today,” said Dr Tlaleng Mofokeng, one of the country’s most vocal sexual reproductive health rights experts and activists. “Our society never cared about black women in the past and still doesn’t.”

In 2012, Paula Donovan, co-founder, AIDS-Free World challenged WHO and other family planning advocates to tell women that Depo may increase their risk to get HIV[3]:

Women’s rights to informed consent are sacrosanct… When a woman receives a hormonal contraceptive injection to protect against pregnancy for three months… [s]he must be clearly informed that unless she uses the condoms, she may be at increased risk of HIV… No global experts or family planning organizations have the right to censor the life-and-death information women need in order to weigh their own risks… Women need information: complete, uncensored, and factually correct.

Here’s what the World Medical Association says about patients’ rights[4]:

Physicians and other persons or bodies involved in the provision of health care have a joint responsibility to recognize and uphold these rights… The patient has the right to the information necessary to make his/her decisions… Every person has the right to health education that will assist him/her in making informed choices about personal health and about the available health services…

Here’s what the United Nations’ Beijing Platform for Action, says about women’s rights to information about birth control methods and risks[5]:

Reproductive health therefore implies…the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice…

In 2017, after ignoring and denying evidence for decades, WHO finally recommend warning women that Depo might increase their risk to get HIV.[6]:

There continues to be evidence of a possible increased risk of acquiring HIV among progestogen-only injectable users… Women considering progestogen-only injectables should, however, be advised about this, about the uncertainty over whether there is a causal relationship, and about how to minimize their risk of acquiring HIV.

But WHO soon backed away from this good advice. In 2019, as noted above, WHO recommended Depo for all women, including those at high risk to get HIV.

With continuing protests, one can hope women at risk will learn about risks, and will learn to discount bad advice from WHO and other irresponsible organizations. Many experts do not toe the party line. For example, Paula Donovan[7] and Edra Spevak[8] urge telling women about Depo risks and offering alternate and safer birth control interventions.

References

  1. WHO. Contraceptive eligibility for women at high risk of HIV: guidance statement: recommendations on contraceptive methods used by women at high risk of HIV. Geneva: WHO, 2019. Available at: https://www.ncbi.nlm.nih.gov/books/NBK546035/pdf/Bookshelf_NBK546035.pdf  (accessed 22 February 2021).
  2. Green A. Health-e news: contraception, HIV and control over black-women’s bodies. Daily Maverick, 12 February 2018. Available at: https://www.dailymaverick.co.za/article/2018-02-12-health-e-news-contraception-hiv-and-control-over-black-womens-bodies/#.Wo8J66iWbIU (accessed 22 February 2018).
  3. Donovan P. Planned Parenthood whitewashing life-and-death info on HIV protection. Huffington Post, 5 February 2012. Available at: https://www.huffingtonpost.co.uk/entry/planned-parenthood-aids_b_1315840.html (accessed 31 March 2018).
  4. World Medical Association. Declaration of Lisbon, 2015. Available at: https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/ (accessed 11 March 2018).
  5. Annex 2, para 94 in: Fourth World Conference on Women. Beijing Declaration and Platform for Action. United Nations, 1995. Available at: http://www.un.org/womenwatch/daw/beijing/pdf/BDPfA%20E.pdf (accessed 31 March 2018).
  6. WHO. Hormonal contraception eligibility for women at high risk of HIV. Geneva, WHO: 2017. Available at: https://www.hst.org.za/publications/NonHST%20Publications/Hormonal%20Contraceptive%20Eligability%20for%20Women%20at%20high%20risk%20of%20HIV.pdf (accessed 2 April 2018).
  7. Donovan P. The UN’s gag order on reproductive health. AIDS-Free World 13 February 2012. Available at: https://web.archive.org/web/20151023123521/http://www.aidsfreeworld.org/Our-Issues/Womens-Rights/The-UNs-Gag-Order-on-Reproductive-Health.aspx (accessed 24 May 2022)
  8. Spevack E. The long-term health implications of Depo-Provera. Integrative Medicine 2012; 12: 27-29. Available at: https://pdfs.semanticscholar.org/3fa9/48dfe365b053e02c62fe0e9599d8459a3b2e.pdf (accessed 2 April 2018).

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