Incentivising contraceptive use: a helping hand or a push in the wrong direction?

Abstract

Contraception is essential to allow women control over their bodies and to fulfil their sexual and reproductive health rights. Despite this, in 2014 the World Health Organization (WHO) estimated that 222 million women and adolescent girls were living without modern contraception, mainly affecting vulnerable groups within society.1 A number of schemes have emerged to address this need for increased contraceptive access in marginalised groups of women. These include incentivising programmes, where a reward is offered in return for use of a contraceptive. Enticing people into any medical intervention invites ethical analysis as the incentive may coerce the individual into a decision that they may not otherwise have made. Coercion threatens informed consent by undermining voluntary decision-making. Thus, using the widely accepted Four Principles of biomedical ethics, beneficence, justice, non-maleficence and autonomy,2 I will assess whether two high-income-setting-based contraceptive incentivising programmes, chosen as examples, could be seen as disregarding the autonomy of the women they are supposedly trying to help. The US-based Project Prevention is a non-profit organisation that has garnered much publicity since its founding by Barbara Harris in 1997, following her adoption of four children born to a mother with crack cocaine addiction. The organisation offers a substantial cash incentive (US$300) to drug-addicted women in return for use of a long-acting reversible contraceptive (LARC) or a sterilisation procedure.3 Offering cash incentives to women fuelling a drug habit raises difficult ethical questions: some would claim that this could be looked upon as coercion and a threat to human rights. On the other side of the Atlantic lies Pause, a UK-based programme that offers support to women who have had children taken into care, and who are at risk of future custodial losses. One of the conditions of entering the programme is for women to use a LARC. In …