Gavin Barney, LSRJ Summer Intern (’16, University of California, Berkeley School of Law)
According to a recent commentary in the Association of Reproductive Health Professionals (ARHP) peer reviewed journal, Contraception, reproductive health care clinics are currently witnessing a notable upswing in the number of patients requesting the removal of their Mirena IUDs. Mirena is a hormonal intrauterine system that prevents pregnancy for around five years through the release of levonorgestrel. And like other types of IUDs and long-term birth control, Mirena is very popular among the public health community: the ARHP refers to the device as safe and effective a number of times throughout the commentary. However, many women are choosing to have their IUDs removed and report being frightened by prevalent online and television publicity of common and devastating side-effects, including migration, perforation, and infertility. The problem, explains ARHP, is that these side-effect are not common, and some of them are actually fake – or “medically implausible” as the article puts it.
The supposed dangers of the Mirena device have made their way into the public consciousness as the result of solicitations for plaintiffs in mass litigation against the device’s manufacturer Bayer. This all initially passed me by, but after researching for this blog post I can report back that there is a lot of if-you-or-a-loved-one-has-been… out there. Mirena, like any other form of birth control, has potential risks, but as a result of media and advertising coverage these risks appear hugely magnified. ARHP contends that this hurts women in two ways: 1) by decreasing the number of women using long lasting birth control, and 2) by deterring contraceptive development by threatening that future technology will be met with similar litigation – note that from the 1970s to the 1980s, the number of companies pursuing contraceptive research fell from 13 to 1.*
For me, the most significant impact that misinformation around the Mirena device causes is not a reduction in the overall number of women using long term contraception. Rather, I am most concerned that opportunistic Mirena litigation and junk science could dissuade women from pursuing or keeping a birth control method that they would otherwise have chosen. IUDs do have some common side-effects – especially immediately following insertion – that can range from unpleasant to awful, so there are entirely legitimate reasons to remove the device early. But for those who actually do want to use and keep an IUD, misinformation can be tantamount to manipulation. Therefore, the central question the ARHP article raises is: what does informed and dignified decision making actually look like when we are so often bombarded with misinformation?
A quick search of the word “Mirena” shows just how murky the waters are when it comes to information on this IUD. Case in point: the first search result on Google, after Mirena’s official website, is DrugWatch.com, which describes a terrifying and “frequently encountered complication,” called “migration,” in which the IUD perforates the uterus and enters the body cavity, causing pain, infection, and damage to nearby organs. The ARHP article, on the other hand, scathingly refers to this problem as “fictitious.” Another site, in its review of the truth behind Mirena lawsuit ads, refers to migration as “so rare that even with tens of millions of women using IUDs worldwide, we can’t estimate how often it happens.”
I can easily envision a situation where a woman may encounter that first explanation of migration and immediately visit her doctor to have her IUD removed. Should the doctor simply dismiss her concerns out of hand because she knows that they are unfounded? Or should the doctor obey her patient’s wishes with the knowledge that she may have been manipulated into removing a device she actually wanted? The answer, as answers so often do, falls somewhere in the middle. LSRJ’s definition of reproductive justice holds that people must be able to “exercise the rights and access the resources they need to thrive and to decide whether, when, and how to have and parent children with dignity…” Here, my hypothetical patient has the right to access the resources she actually wants and needs, so it is her doctor’s responsibility to explain the true nature of the risks and dispel the misinformation. Then, should the patient still decide that the risk is too great, that choice should be met with the same degree of respect. Of course this all relies on the doctors themselves being entirely up on the most recent data about the device they are inserting/ removing and that they themselves are not intent on spreading misinformation. So… fingers crossed on that one.
*From the ARHP article, this appears to have resulted from the litigation concerning the Dalkon shield. I do not think the writer intended to suggest that that was a case of junk science or junk law. I certainly don’t suggest that.