Dr. Rageshri Dhairyawan—physician, researcher, writer and consultant in sexual health and HIV medicine working with the NHS—recently published the opinion piece “Listen to the voices of the medically silenced” in PLOS Global Public Health. A clear call to center patients and an example of her work to improve health equity, Dhairyawan writes:
“...we in health care and research need to learn to listen better and do so in ways that do not cause further harm. This includes acknowledging the inherent power imbalance between doctors and patients and more highly valuing patients’ expertise in their own bodies.”
It is a message with profound resonance for contraceptive innovators in particular. With a history of harm in its wake, impactful advocates have long been committed to holding the field of family planning accountable, helping it constantly to become more alive with real intentions to repair and to shift power to communities of the “medically silenced” and marginalized. Current and potential contraceptive clients belong to many medically silenced communities, and it’s worth observing at least a few examples of how advocates, researchers and developers are actively centering the lives and lived experiences too often overlooked across health care:
Earlier this year and after considerable user feedback, the CDC revised their guidelines to recommend patients be counseled on pain management options to address potential IUD insertion discomfort—meanwhile, Aspivix has been working to address IUD insertion pain with the development of a suction-based alternative to the tenaculum
The Reproductive Injustice Initiative and their Decolonizing Contraception project created the Clap Back on the Contraceptive Patch campaign to call for the method’s availability in an inclusive range of skin tones
The development of over-the-counter options such as Opill, approved by the FDA just last year, has the potential to expand access especially for youth and for trans and nonbinary people, for whom it may also serve as gender-affirming care—the importance of which we observe with special attention this Transgender Awareness Week
On the other end of the age spectrum, researchers and clinicians are highlighting the use of hormonal contraception to address symptoms of perimenopause
Identifying the disparities in access experienced by disabled people can create pathways to solutions, including through product innovations—such as an oral dissolvable pill for those who have trouble swallowing medication
Those with chronic pain caused by menstrual disorders and sickle cell disease might see quality of life improved with contraceptive use
The LISA trial is looking at the potential for the hormonal IUD to address iron deficiency and anemia
Earlier this year, the Society for Family Planning published a statement helping to address the need for contraceptive guidance inclusive of those with higher BMIs
We need more research to understand and meet the needs of those who are refugees, displaced, who experience housing instability and poverty, especially in cases where worsening crises such as climate shocks can impact access
Advocates and researchers are looking at the potential for contraception to support mental health and wellness, such as addressing premenstrual dysphoric disorder and ADHD
With a rights-based approach and human-centered lens, contraceptive scientists must continue to listen more intently to all current and potential users, with extra attention to those our systems continue to squelch. But funders can also listen to users and the scientists who work with them to better understand the imperative to support these opportunities for innovation, with contraceptives holding the potential to address so many and varied health needs and personal desires. Investing in the development of new methods—and new method uses—can fuel medical discoveries, improve wellbeing, increase client satisfaction, strengthen markets and nurture the R&D ecosystem.
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