The development of contraceptive technologies: a feminist critique.

Women's health advocates have criticized the choice of contraceptives available for not meeting reproductive needs and for controlling women's fertility at the expense of women's health. There is a call for technology that is appropriate, safe, and under the user's control. Concern about contraceptive testing does not mean that all contraceptive methods should be criticized. Development and evaluation of contraceptive technologies involves conformity with drug regulatory and licensing groups. Scientific trials are used to evaluate a drug's performance, but a shortcoming of the method is the exclusion of vulnerable populations such as adolescent, anemic, pregnant or breast-feeding women. The assumptions for distribution after approval are healthy, well-informed clients, in clean, well-equipped settings, with adequate follow-up. However, the realities may be quite different. Providers may be poorly trained to serve users who are in poor health and/or illiterate, and who will be likely not to return for follow-up. Clinical trials are limited also by the time frame, which is usually five years and not long enough to ascertain long-term effects for cancer, for instance. Sample sizes may be too small to detect serious side effects. Acceptability trials also have limitations. Acceptability is defined by researchers and is sometimes not made explicit. The generally agreed upon criteria is the continued use of the method by the women in the trial, who do not represent the entire population of potential users of the method. Goals of users and researchers may be different. Prevention of pregnancy is the goal of researchers, while women may be selectively concerned with safety and acceptability. Researchers make value judgments about what is and what is not important to women. Menstrual disturbance is one measure that is frequently cited as more important to women than researchers, or for which cultural practices may be violated. Population growth limitation can be used as the entire justification for research; researchers do not report that women themselves desire longer acting contraceptive alternatives. Consideration is not given to client-provider relations, or to deficiencies in health infrastructure affecting provision. The potential for abuse or coercion is ignored by researchers.