WHO Still Pushing Dangerous Contraceptive on African Women at Risk

By | April 13, 2017

WASHINGTON, April 14 (C-Fam) The World Health Organization is urging women to use a contraceptive known to increase the risk of HIV.

The WHO’s long-awaited guidance for use of Depo Provera admits what growing evidence has supported: a link between increased HIV risk and use of the injectable contraceptive. Yet the agency asserts that Depo remains a viable option for “women at high risk of acquiring HIV” because “the advantages of these methods generally outweigh the possible increased risk of HIV acquisition.”

According to WHO, the advantage is the avoidance of pregnancy, citing both unintended pregnancy and complications of pregnancy and birth as “significant threat(s) to the lives and well-being of women and their families.”

WHO withdrew its previous guidance on Depo, which brushed aside the HIV link, amid an outcry from HIV/AIDS and women’s health advocates.  Following a lengthy period of consultation, the reissued guidance treats the potential link more seriously, raising questions among family planning groups on how to proceed.  Some family planning providers expressed concern over how to counsel women, fearing that this news could discourage them from using family planning at all.

This view is not unfounded – among women described as having an “unmet need” for family planning, concern about side effects is a major reason for non-use.

The new WHO guidance notes that injectable contraceptives are among the few methods available “in many areas where the risks of HIV and mortality are the highest.”  The extreme popularity of Depo in these high-risk areas is no coincidence. The Gates Foundation strongly backed injectable contraceptives as part of its FP2020 campaign.  Gates partnered with the pharmaceutical company Pfizer to scale up distribution of Depo in a self-injectable form called Sayana Press, doubling its production and negotiating a special low price per dose.

For several years, human rights lawyer Kwame Fosu has been sounding the alarm on the problems with Depo, accusing the Gates Foundation of deliberately attempting to conceal the evidence linking it to increased HIV risk.  At a WHO event in New York last week, Fosu pointed out that women in European countries, who have a wide range of family planning options, rarely use Depo, yet it is being pushed on African women without adequate counseling about its potential harms.

High prevalence of HIV and high maternal mortality, which in turn can be exacerbated by HIV, remain severe problems in many sub-Saharan African countries, and cannot be solved by hormonal contraceptives alone.  Nevertheless, poor maternal health and the threat of dying in childbirth remains a central justification for pushing Depo on the part of the Gates Foundation and its partners. For WHO it is a justification to continue encouraging its use among high-risk women.

Critics of WHO’s new stance argue that the problem of maternal deaths requires a comprehensive solution regardless of the intendedness of pregnancy, which, although sometimes risky, should not be treated as a disease.

A randomized clinical trial is underway to better understand the potential risk of HIV among Depo users.  Its funders include the Gates Foundation and the governments of the U.S., Sweden, and South Africa.  Results are anticipated in 2018.