MORAL AND POLICY ISSUES IN LONG-ACTING CONTRACEPTION

The advent of reversible long-acting contraceptives-IUDs, injectables and implants-has provided women throughout the world with valuable new fertility regulation options. These highly effective methods, togethe r with male and female sterilization, have proven to be enormously pop ular and are now used by the majority of women and men who are current ly contracepting worldwide. Despite their remarkable popularity, long- acting contraceptives have engendered considerable controversy. Politi cal, ethical, and safety questions have emerged, stemming from the way s in which these contraceptives have been developed and used over the course of this century. At the heart of the concern is the issue of re productive rights and freedom. This paper reviews the history of the d evelopment of long-acting contraceptives, including the prospect of ne w methods that will likely emerge from ongoing research and developmen t. It also examines the history, in the United States and in developin g countries, of the use and abuse of long-acting methods, including st erilization, in the context of eugenics and population control policie s. It then describes a new paradigm of reproductive health and rights that has emerged from the International Conference on Population Devel opment in Cairo, and which offers an enlightened approach to future po licies and programs. In light of the wide variety of ways in which lon g-acting contraceptives have been provided, the paper examines the rig hts and responsibilities of governments, family planning providers, an d individuals. An ethical framework for the use of long-acting methods is discussed, and public policies for the future are proposed.