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Rebecca Oas, Ph.D.

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New doctor practice in Delaware: ‘Would you like a contraceptive with that?’

Rebecca Oas, Ph.D.

February 4, 2019 (C-Fam) – If a woman visits a doctor in Delaware for a sore throat or a sprained ankle, she may be asked a surprising question: "Do you want to become pregnant in the next year?" If she says no, she could leave the clinic that same day with a long-acting contraceptive implant or intrauterine device.

Promoting contraception as a way to reduce poverty is the result of a partnership between the state of Delaware and an organization called Upstream. The approach has received national attention and is being considered for a national expansion. Although this approach may seem innovative in the United States, it looks very familiar in an international context.

For decades, women in developing countries have surveyed about whether they would like to become pregnant in the near future. Those who answer no are described as having a "demand" for family planning, even if they say they have no intention of using a method.

The global contraceptive market has become increasingly saturated, and knowledge of methods is near universal. Meanwhile, family planning organizations have redoubled their efforts to increase demand among women on the ground through mass marketing campaigns, including radio and TV dramas. To donors and governments, they offer contraceptives as a solution to poverty, conflict, and environmental degradation.

Like all marketing experts, family planning organizations have done extensive research on how to increase "sales." Recent years have seen a broad international push to integrate family planning into all areas of health care. In practice this means any woman of reproductive age may be offered contraceptives when she visits a health clinic, regardless of the reason for her visit.

As retailers know, most impulse buying occurs when people are already in stores, and may be followed by buyer's remorse. But unlike food or an item of clothing, the insertion of a long-acting reversible contraceptive (or LARC) is a major medical decision that carries risks and side effects. Researchers found that four in ten women who stopped using long-acting contraceptives did so because of health concerns. Nevertheless, Upstream focuses on promoting such contraception over other methods due to their low failure rates. A spokeswoman for the pro-abortion National Institute for Reproductive Health expressed concern to the New York Times that the Upstream approach may be "tipping the scale" in favor of these methods.

Some women currently seeking to avoid pregnancy may want to return to fertility in the near future. As Lyman Stone notes in The Federalist, women accepting long-acting contraception may not realize that the effects can last up to a year after removal.

Whether in Delaware or sub-Saharan Africa, decisions around procreation are best made within the context of the family. The campaign for same-visit delivery of long-acting contraceptives eliminates the opportunity for women to consult their partners – or parents, in the case of adolescents – before making a decision.

Delaware's former governor Jack Markell started the partnership with Upstream in 2014. He now sits on the organization's board of directors, alongside an Upstream co-founder who worked as a lobbyist for Planned Parenthood and other pro-abortion organizations.

As for the hope of reducing poverty, the data is mixed. Brookings Institution fellow Isabel Sawhill told the New York Times, "It's very expensive and very hard to reduce poverty. Reducing unplanned births is easy by comparison."

Published with permission from C-Fam.



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