The needs of women versus the interests of family planning personnel, policy-makers and researchers: Conflicting views on safety and acceptability of contraceptives

After having contributed significantly to women's liberation in the sixties, contraceptives [1] increasingly became subject to criticisms in the seventies and eighties. Feminist health groups point at their health risks, and advocate barrier methods, that do not interfere with complex body functions. The safety issues that are raised are related both to the working mechanism of the new technologies, and to the manner in which the technologies are used in family planning programmes. Against this background the author argues that much of the criticisms of women's health advocates concerning the safety and acceptability of new contraceptive technologies, has to do with the process of development and evaluation of contraceptive technologies that is standard medical practice. This process is not sufficiently oriented towards women's reproductive needs, their experiences in using the methods, and the health care infrastructure in which the methods are to be provided. This is illustrated with case material on Depo Provera (a hormonal injection), Norplant (a hormonal implant), the abortion pill and the contraceptive vaccine, and with a review of acceptability trials of one of these technologies, Norplant. The author argues that women's perspectives and needs should be taken into consideration in the design and interpretation of the controlled clinical--and acceptability trials. Each potential new contraceptive technology should be subjected to a 'Technology Assessment'. In such an assessment short-and long-term social consequences of the application of the technology are studied. While used extensively to study new medical technologies, technology assessment does not seem to have been used systematically to assess the appropriateness of new contraceptive technologies. The author ends her paper by pointing out that methodologies for the incorporation of women's perspectives into the contraceptive development and technology assessment process still need to be developed. Such methodologies should acknowledge the differences in perpective and needs of women in different societal and cultural settings.