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CALLING THE SHOTS? The International Politics of Depo-Provera Phillida BunkIe Depo-Provera, the three-monthly contraceptive injection, is a case study in the dilemmas posed to women by the development of the new reproductive technology . On the one hand Depo's easy administration and contraceptive efficacy makes contraception potentially convenient for millions of underprivileged women; on the other hand these very features make it a powerful tool for the control of women. Depo is exclusively manufactured by the multinational Upjohn Corporation. Upjohn not only manufactures the drug-it also manufactures most of the information about it. Responding "rationally" to the economic system, naturally they promote knowledge favourable to their product. Depo, or medroxyprogesterone acetate, is a progestogen, that is, an artificially created drug which has some properties similar to naturally occurring sex hormones called progesterones. Upjohn started testing Depo as a contraceptive in the early 1960s. In 1967 Upjohn applied to the United States Food and Drug Administration (FDA) for a licence to sell Depo as a contraceptive (The Depo-Provera Debate, 1978). In the following year Upjohn began the seven-year dog and ten-year monkey studies required by FDA. The dog trials showed dose-related increases in both benign breast nodules and breast cancer. As a result of initial findings in dogs, the oral form of the drug, called Provest, and four other progestogen contraceptive preparations were withdrawn in 1970. Controversy has surrounded the use of the injectable long-acting Depo form ever since. In 1974 FDA responded to the licensing application by allowing marketing with very stringent restrictions (ibid.: 223-27). Even with these conditions final permission was stayed on request from a congressional committee. The debate continued with a series of Congressional Hearings. In 1978 FDA finally rejected the application to market Depo as a contraceptive in the United States. In an extraordinary move Upjohn appealed against the decision. A Public Board of Enquiry heard this appeal in early 1983 (Science, 1982; Time, 1983). As of Sep- 288 / Science's Technologies and Applications tember 1983 the results of this and a similar appeal in the United Kingdom are not known. The FDA ban meant effectively that Depo could not be manufactured in the USA. New Zealand, which had approved it for use in 1968, imports its supplies from an Upjohn subsidiary in Belgium. Not only was the company denied the lucrative U.S. market, but, more importantly, because State Department policy prevented USAID (the main channel for American overseas aid) from supplying drugs banned in the United States, Upjohn could not manufacture there for the huge Third World market (Export of Hazardous Products, 1980; Shaikh and Reich, 1981). Until President Reagan changed this policy in 1981 this was the primary cause of the company's concern. The ban not only inhibited willingness to buy by making the product look suspect, it cut off the large market that AID funds would make available. Various population agencies were led, by their perception of the overriding need to make contraception available to all women, to evade this restriction (Ehrenreich, Dowie, and Minkin, 1979; Sarra, 1982). It is alleged, for instance, that AID funds passed to International Planned Parenthood Federation (IPPF), whose headquarters are in London. IPPF purchased Depo for worldwide supply to national family planning associations. In this way family planning associations (FPA) became major sources of Depo, although many of their well-intentioned medical workers are not aware of this background. When the propriety of laundering funds was questioned, IPPF defended their actions by convening an international committee of medical experts especially to consider Depo. Some committee members had worked with FPA supplying Depo in their various countries . Their report was highly reassuring, as were the expert evaluations provided by other interested parties, the World Health Organization and AID (Bulletin of the World Health Organization, 1982; IPPF Medical Bulletin, 1980, 1982; AID, Report to USAID of the Ad Hoc Consultative Panel, 1978). Sometimes FPA doctors who prescribe Depo in New Zealand appear to have only information from these reports and package inserts supplied by the company. Who Uses Depo-Provera? The market potential of Depo was enormous. With half the world's population as potential users and manufacturing costs low, the market for contraceptive drugs is particularly large and profitable. In the West market saturation for contraceptive pharmaceuticals was reached with the pill by the late 1960s. Thereafter development of new products slowed. Market expansion depended on developing methods of administering contraceptives that would reach new populations...

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