Allegations of racial bias in use of injections

Press, 8 July 1983, Page 13

Allegations of racial bias in use of injections

The use of Depo Provera among racial minorities and women in institutions is of particular concern to the opponents of the drug. Since “intelligent middle-class” women are often not getting full information about the drug from their doctors, it is unlikely that less advantaged women are given the opportunity of a fully informed choice, says Phillida Bunkie, a Women’s Studies lecturer at Victoria University and a member of Hecate, the Wellington Women’s health collective. She estimates that 100,000 New Zealand women use Depo Provera. She believes the drug accounts for 8 per cent of all the contraceptives used by women. However, she says that when the figures are broken down they show that 25 per cent of Maori women use it compared to 15 per cent of pakeha women.

Figures from other sources suggest an even bigger racial bias in the use of the drug. A survey at the Auckland Abortion clinic showed \ that 40 per cent of Maori women

were given the drug, while only 11 per cent of pakeha women were put on it. Cases which support this point of view can be found without much difficulty. A Christchurch woman, who sponsored a Vietnamese refugee family nearly two years ago, discovered that the mother and her 18-year-old niece had both been given Depo Provera at the Mangere Immigration Centre. She believes that they did not understand anything about the drug. “They still haven’t got a very good understanding of English, so at that stage their English was very limited.” What made her anxious was that the injections of Depo Provera would be continued by their Christchurch doctor, who would assume that they knew all about it since it had already been prescribed. She made sure that the women had an interpreter with them when they kept their next doctor’s appointment so that they could make an informed decision.

Claims have also been made to The Health Alternatives for Women that Depo Provera is given to nearly all women of childbearing age in institutions like Sunnyside Hospital, Templeton Hospital, and the Kingslea Girls Home. This does not appear to be borne out by the facts, although it is clear that Depo Provera is widely used. The medical superintendent at Christchurch Hospital, Dr David Andrews, has made available figures on the amount of the Pill and Depo Provera which was supplied through the North Canterbury Hospital Board in the year ended in March. Most of these contraceptives would have gone to Sunnyside or to Templeton, he says. The board bought 550 ampoules of Depo Provera, which was enough to give 130 women doses for a year, at a cost of $3OOO. It bought 809 one-month packs of the Pill, enough to supply 67 women for a year, at a cost of about $lOOO. These contraceptives were used among roughly 290 women at Sunnyside Hospital and about 240 females, including children, at Templeton Hospital. Dr Jim Begg, the medical superintendent at Sunnyside Hospital, says that no preference is given to Depo Provera over any other contraceptive. When contraceptives are given to a patient, the usual medical and clinical indications are taken into account, as well as the individual’s choice. Every effort is made to ensure that the patients understand about contraception and the problems with any form that they use.

He adds that the staff are very cautious about giving Depo Provera to adolescent girls. “We are as aware as anyone else of the hazards that have been publicised about Depo Provera over the years, and we are doing our best to wean people off Depo Provera or to give them a break by putting them on alternative methods,” he says.

The situation for staff at Templeton Hospital is a little more complex, because they try to tread the difficult line between giving patients as much freedom as possible and preventing unwanted pregnancy.

The hospital superintendent, Dr Jim Marshall, says Depo Provera is the main contraceptive used, although some use the Pill, the intra-uterine device, and some are sterilised.

“Depo Provera is the primary contraceptive we use. We have found that other forms of contraceptive are not appropriate,” he says.

Contraceptives are needed for some patients, since every effort is made to allow them as normal a life as possible. This includes mixed-living situations and allowing some patients to live in group houses in the community. He adds that the hospital does not have enough staff to make sure that patients take the Pill. If Depo Provera could not be used, there would have to be controls on the patients which would limit their freedom and restrict the quality of their lives.

He says that the advantages of Depo Provera outweigh the possible risk involved for most women patients. Dr Marshall admits that in some cases, patients would not be able to fully understand about Depo Provera. But, as with all cases where there is the risk of pregnancy, staff discuss the situation with the parents before it is prescribed. If parents object to Depo Provera, another form of contraception is offered.

The nurse at the Kingslea Girls Home, Christine Tallott, says that most girls who use contraceptives in the home are on the Pill. Very few are given Depo Provera. The principal, Michael Doolan, says his staff is required by departmental guidelines as laid down in the Contraception, Sterilisation, and Abortion Act to give “sensitive counselling” on contraception where it is known that a girl has embarked on a sexual relationship. He says that girls are referred for prescriptions to the Family Planning Association, where the usual medical considerations were taken into account.

“We would consider it quite wrong to force contraception or any type of contraceptive without their consent,” he says.