{"id":2136,"date":"2018-09-20T09:13:21","date_gmt":"2018-09-20T09:13:21","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjsrh\/?p=2136"},"modified":"2018-09-20T09:16:21","modified_gmt":"2018-09-20T09:16:21","slug":"decolonisingcontraception-the-importance-of-preventing-unethical-practice-in-srh-and-learning-from-history","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjsrh\/2018\/09\/20\/decolonisingcontraception-the-importance-of-preventing-unethical-practice-in-srh-and-learning-from-history\/","title":{"rendered":"#DecolonisingContraception \u2013 The Importance of Preventing Unethical Practice in SRH and Learning from History"},"content":{"rendered":"

By Annabel Sowemimo\u00a0<\/strong><\/p>\n

Many times a week when I grab hold of a \u2018Sims\u2019 speculum (used in gynecology theatres across the world) I feel a shudder as I think of the legacy of J.Marion Sims<\/a>, often nicknamed \u201cthe father of Gynaecology\u201d. We can thank the many nameless Black American and poor women that Sims operated on, often without anesthesia, for many gynecological advancements.<\/p>\n

\"\"<\/a><\/p>\n

Sexual and Reproductive Health (SRH) is colonised. The belief that medical developments in SRH are in part due to experimentation on colonised or previously enslaved populations has been discussed by many academics<\/a>, and has inspired a generation of activists<\/a>. Despite this, many health professionals working in the Sexual and Reproductive Health sector are unaware of the oppressive history of many of the contraceptive devices and techniques we employ, and how this relates to modern-day practices.<\/p>\n

As the UK population becomes more diverse<\/a>, and we strive to engage more communities in the optimisation of their reproductive health, it is vital that we acknowledge how colonial history has come to shape the services we deliver, and how it may still be restricting our practice.<\/p>\n

Take for example the combined contraceptive pill, which is often seen as one of the most liberating inventions amongst white Western women. However, for the Puerto Rican women who were experimented on during clinical trials, the pill has a more complicated history. As we extend our use of long acting contraceptive (LARC) devices it is vital that we acknowledge reproductive rights and ensure that women of colour, disabled women, incarcerated women, and impoverished women who have an extensive history of oppression of their reproductive freedoms are incorporated into conversations on modern contraceptive methods.<\/p>\n

What is #Decolonising Contraception?<\/strong><\/p>\n

#DecolonisingContraception\u00a0is a movement that aims to promote discussion related to the ways in which some SRH practices have developed from unethical medical research, often on previously colonised populations. This movement intends to provide spaces to discuss how these issues still affect our practice today.\u00a0#DecolonisingContraception aims to understand the colonial history of contraception, discuss modern contraceptive methods, and start new conversations about reproductive justice.\u00a0This movement is about\u00a0helping those accessing contraception and other sexual health services to feel empowered to make informed choices and strive for reproductive justice, even if that means having difficult and awkward conversations.<\/p>\n

In 1994, the definition of \u2018reproductive health\u2019 was coined in Cairo at the International Conference on Population and Development<\/a>, with a focus on ensuring the reproductive rights of both men and women. It was recognised that people deserved to have equal access to reproductive services and matters relating to their sexuality without fear of discrimination, retribution, or coercion. This was a pivotal moment given that SRH had historically been used against marginalised groups, with many benefitting from unethical experimentation on these populations. For example, the Tuskagee Syphilis Experiment<\/a> carried out between 1932 to 1972 where hundreds of Black American men were allowed to suffer and some die so that scientists could study the progression of the disease. This was despite investigators knowing that there was a known cure for their condition in the form of a simple penicillin injection. Harriet Washington in her book \u2018Medical Apartheid\u2019 outlines how unethical medical experimentation on Black Americans has led to much scientific scepticism amongst this community and perhaps, an aversion to part take in medical research: \u2018To gain trust, we must first acknowledge the flagrant abuses of the past and the subtler ones of the present\u2026\u2019<\/p>\n

#DecolonisingContraception\u00a0explores SRH history and encourages those working within the field to reflect on previous poor practice. Increasingly the specialty takes a more global stance on SRH issues and it is vital that alongside this we acknowledge past practice to better understand socio-cultural dynamics within the field.<\/p>\n

Examples of Colonised Contraception <\/strong><\/p>\n

The most commonly cited example of colonised contraception is the forced sterilisation of men and women. It is difficult to estimate how many women and men have been subjected to forced sterlisation, but the practice has been extensively used as a means of population control including in Nazi Germany<\/a> and targeting Aboriginal women in Canada<\/a>. It is often directed at the poorest, most vulnerable members of society, and driven by eugenic<\/a> theories. There are many accounts of non-consensual sterilisation of African American women, including the case of the Relf sisters<\/a> sterilised at aged 12 and 14 years. Civil rights leader Fannie Lou Harmer often referred to her own forced sterilisation at the age of 14 as her \u2018Mississippi Appendectomy\u2019<\/a>, and spoke about the importance of preventing the infliction of such procedures on other young women. In 1974, the Southern Poverty Law filed a lawsuit demonstrating that between 100,000 to 150,000 poor people were being sterilized every year using federal funding.<\/p>\n

In the 1990s American women (a disproportionate number of whom were of a Latina or African American descent) were forced to accept implant insertions<\/a> as a requirement of reduced judicial sentencingIn the case of Darlene Johnson, convicted of child abuse in 1991, a judge ordered that she have a Norplant device inserted as part of her sentencing. There are also examples of men being forced to accept contraception as part of sentencing, including the case of a man in Virginia<\/a> in 2014, who was ordered to have a vasectomy as part of his plea bargain.<\/p>\n

More recently, in the early 2000s reports arose stating Israel had given the contraceptive injection to migrating Ethopian-Jewish women without informed consent. Although, disputed by the Israeli government the report by leading Women\u2019s NGO Hedva Eyal states \u2018it was a method for reducing the number of births in a community that is mostly black and poor\u2019.<\/p>\n

Acknowledging how SRH has been colonised also means continuing to recognise how important historical figures may have been unethical in their practice or guided by extreme ideologies. For example, starting to discuss the legacy of J.Marion Sims whom I previously mentioned operated on enslaved Black Americans without anesthetic and recently had his statue removed from Central Park<\/a>. Whilst Planned Parenthood is one of the leading non-governmental organisations providing Sexual and Reproductive Health services globally, it is only recently that people have shed light on its founder Margaret Sanger, and her engagement with eugenic theory<\/a>. In a\u00a0famous speech<\/a>\u00a0from 1921, she proclaimed that procreation by \u201cirresponsible and reckless people\u201d needed to be stopped.<\/p>\n

The legacy of colonisation is ever-present within SRH, and we must begin to contemplate what this means for those working within the profession and those accessing our services, however uncomfortable we find this legacy.<\/p>\n

Practical ways we can start #DecolonisingContraception<\/strong>\u00a0<\/strong><\/p>\n

Given the previous history of ethical malpractice within SRH, it is vital that we foster an environment that incentivises providers to offer women and men the best contraceptive options, free from coercion, and with full consent.<\/p>\n

Understandably, many health providers face time constraints during the course of a contraceptive consultation, but we need to understand that those accessing sexual and Reproductive health services present from an array of cultural backgrounds, and that they may require more time (irrespective of any language barriers) in order to develop a full understanding of contraception and other SRH issues. This may be because they hold a different belief system surrounding a particular contraceptive method, or that certain methods need to be demystified.<\/p>\n

If your practice or clinic treats more women of a specific cultural background it may be worth exploring any common ideas or belief systems they hold in relation to contraception. While certain concerns – for example that contraception can cause infertility – may seem ridiculous to you, they may have a historical basis.<\/p>\n

Stay informed and read about some of the issues brought up in this article. Many of these events occurred because doctors thought that they were acting in the best interest of society, rather than for a particular patient. To prevent history repeating itself and make progress we need to acknowledge previous ethical misdemeanours and continue to interrogate our own clinical practice.<\/p>\n

\"\"<\/a><\/p>\n

#DecolonisingContraception will be hosting a panel discussion + Q&A at SOAS on 23rd<\/sup> October as part of Black History Month <\/em><\/p>\n

\u00a0<\/em><\/p>\n

\u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

By Annabel Sowemimo\u00a0 Many times a week when I grab hold of a \u2018Sims\u2019 speculum (used in gynecology theatres across the world) I feel a shudder as I think of the legacy of J.Marion Sims, often nicknamed \u201cthe father of Gynaecology\u201d. We can thank the many nameless Black American and poor women that Sims operated […]<\/p>\n

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