“It’s our Healthcare:” Risks of a Medicine Monoculture

BY AVA SHVARTSMAN

In 2015, the United Nations pledged a responsibility for “good health and well-being” and a “partnership” through their 17 Sustainable Development Goals (SDGs), which aim to create a more equitable and sustainable world.¹ To this end, many countries are attempting to share modern technology developed in their universities and laboratories beyond their borders to drive worldwide progression of medicine alongside organizations like the WHO. However, ethical considerations arise when one examines the contingencies attached to this allocation of resources and their role in cultural ethnocentrism. Take, for instance, the distribution of Norplant by the United States (US) to regions in Sub-Saharan Africa to decrease birth rates and promote family planning.² With the US being one of the major countries sharing its technology to achieve the UN’s goal, it is important to investigate how this aid is given. When increasing contingencies are attached to basic medical care, we should reflect on how it might promote the creation of a global medicine monoculture in which long-standing cultures–but more broadly, a sense of autonomy—are placed at risk. 

According to Obianuju (Uju) Ekeocha, a biomedical scientist in Nigeria and president of the pro-life organization Culture of Life Africa, “In order to receive aid (monetary, medical, and more), an African organization must demonstrate how at least some of their aid will go toward ‘population programs.’”^3,4 These population programs would entail decreasing birth rates and increasing family planning, which are not inherently negative measures. However, when their definitions and standards are defined by other countries with vastly different cultures, then those standards often ignore the cultural practices and norms of the place. As such, with US traditions valuing a nuclear family—marriage before children and home-based stability founded on a level of education, job security, and age—the standards of when someone “should” have children have different definitions across cultures. 

For example, a study on the town of Renk in South Sudan concluded that “Childbirth is considered a return on investment” and met with celebration and relief. One participant explained that “The family who paid the dowry will be happy when the woman gets pregnant. They won’t feel like they lost money over her.”⁵ With this knowledge, it is not surprising that the birth rate in South Sudan (28.6 per 1,000 people) is over double that in the US (12.2 per 1000 people) in 2025.⁶ Similar to South Sudan, many Sub-Saharan countries hold different ideas that are impacted by political climate, surrounding violence, long-held traditions, and more. This is not to claim that any country’s standards are better than another’s or that the standards of other countries are always moral under the guise of culture. It is to say that—perhaps unknowingly—we expect others to adapt to our way of life because it is our technology, and thus we have the right to apply it as we see fit. 

How can we expect people in South Sudan to take up the US form of family planning to access contraceptives when we fail to learn what family planning might encompass for those with different values? Hence, it is not the sharing of technology that imposes Western culture upon other countries, but rather the expectation that those countries adapt to our beliefs to receive aid that poses questions about cultural imposition. To actually achieve “good health and wellbeing,” we must consider that the image of “wellbeing” is not global, but maintains shared characteristics of access to food, shelter, clean water, and healthcare. By virtue of spreading its technologies, the US’s influence and culture is spread globally, but the use of power to demand others to adapt to our standards before receiving the technology necessary for basic healthcare calls that power into a moral question. By necessitating adaptation, the US establishes American culture as the “ideal” culture and risks the loss of indigenous culture because people need healthcare sometimes more than anything else. 

Power is further implied by the messaging involved in sharing discontinued medications and technologies as aid. For example, Norplant is a form of birth control delivered via arm implantation that was withdrawn from the US market in 2002 due to issues with “insertion and removal.”⁷ Despite this product being deemed unsafe and unfit for care in the US, a 2007 Family Health International article emerged documenting Norplant and its younger versions, Jadelle and Implanon, as a promising method of family planning in sub-Saharan Africa.² While they admit “Norplant is being phased out,” its younger version, Jadelle, was its replacement, even while still having the same issues with removal and side effects as Norplant.² By giving aid that a country has withdrawn from its own population, does that country not suggest and justify a lower standard of care for those outside its population? It should be considered that resources are limited and some care is better than none, but employing this care with the knowledge of its faults alongside the lack of communication of these risks poses a lack of regard for autonomy. 

A 2022 BMJ study cites that “Women from a sub-Saharan African country described being pressured to adopt [long-acting reversible contraception],” despite them not wanting or fully understanding its purpose or risks.⁹ Due to “limited choices, biased counselling, scare tactics and misinformation from service providers,” the right to choose one’s own risks was taken away from this population.⁹ Stripping women in sub-Saharan African countries of the right to make an informed health decision works in tandem with “several women [reporting] being denied removal services” in Western Kenya, trapping women into the use of a contraceptive.⁹ Whether they wanted to become pregnant, faced intense side-effects, or just wanted the implant out, US standards of what is an appropriate time to start a family and what symptoms are “normal” means doctors and health professionals deemed their knowledge more important than the desires of the people they are “helping.” Therefore, they ignored their needs under the pretense of “family planning initiatives.” Such was the experience of a young woman from a rural area named Maddie, who, after asking to remove the implant due to severe menstrual side-effects, was told, “no, that [she] cannot change and that [she] [has] to continue with it.”⁸ Sadly, this story was shared among many others in Senderowicz and Kolenda’s study alone.⁸ Thus, a precedent has been established that aid needs to be “imposed” onto a population for its effectiveness rather than shared, excusing medical professionals who violate the rights of autonomy outside the borders of their home countries. 

As commonly defined in medical anthropology, alongside books like The Spirit Catches You and You Fall Down by Anne Fadiman, Western medicine is a culture, just like herbal medicine and spiritual medicines.¹⁰ This is often hard to conceptualize from a Western perspective because of how deeply rooted medicine is within our scientific system and how often science is attributed to descriptors like “truth.” In the grand scheme of medicine approaches around the world, the Western scientific approach is considered only one approach, and it is an approach that the US and other Western nations are beginning to share with nations around the world. When this sharing comes at the expense of culture, choice, and respect, it is no surprise that people like Maddie are not only distrustful of US technology and systems but also vow against their future use, defining our actions as counterintuitive at best. 

The root of the ways we employ this technology, deeming our professionals experts at the expense of the patients, is our belief in our Western medicine system as the “correct” system. As such, when we share technology and medicine with contingencies, such as satisfying the same cultural goal or refusing removal of medications, we risk uptaking a eugenics adjacent approach in which we are the deciders of when people should have children and when they shouldn’t. It is not up to us or anyone to decide when people like Maddie should have birth control removed, but our physicians and technological approaches ensure that we currently do have that power. Hence, we impose our medical system onto other cultures rather than share our technology by working with those countries to create shared, culturally-centered approaches. This threatens the creation of a medical monoculture because the US has the power to spread technology and its medical system will come to replace others, since countries adapt to get aid. By removing autonomy at the individual level by our method of spreading access to birth control, there is an implied loss of autonomy at the national level in which nations must uptake goals established by the US, even if those goals are at odds with cultural values. 

A major implication of this is that as Western medicine changes, our aid and how we employ it are subject to pay fluctuations. This is becoming increasingly evident with political changes in the US advocating for pro-life measures, pitting US initiatives against access to abortion care and contraceptive availability.¹¹ As such, reports like the “US incinerat[ing] $9.7m worth of contraceptives intended mostly for low-income countries in Africa” have arisen in the US as of 2025.¹² As the US is changing political priorities, our foreign aid is following suit with prior family planning initiatives, including improved access to contraceptives, being eliminated.¹³ This volatility is harmful because we expect others to adapt to our standard, yet our standards fail to remain constant. How can we pledge work toward a global well-being when our aid grants us a power that we have misused then practically abandoned? At the crux of this issue is the maintained lack of decision-making offered to the women whose care and access are now in the hands of the US, especially now that many have implanted American birth control. From implanting contraceptives, refusing to remove them, and now revoking aid, many women are left with birth control without the knowledge and expertise to remove it.  

When nations take on a “savior complex” while making care more accessible, they excuse themselves from the negative implications of their actions. More thoughtful approaches can be employed, given the means and the stakes. Current methods not only break trust between the US medical system and countries in Africa but also actively put the lives and livelihoods of women in jeopardy. By aid being given and not shared or discussed, the countries providing medical aid place themselves at a higher hierarchical position than the countries on the receiving end, changing how these countries can interact in medicine and foreign affairs, and making true collaboration in global efforts significantly harder to achieve.

——————————

References

1. Goal 3 | Department of Economic and Social Affairs. United Nations Available at: https://sdgs.un.org/goals/goal3. 
2. Wright Aradhya, K. & Family Health International. A Promising Future for Contraceptive Implants in Africa. Mera vol. iii https://www.fhi360.org/wp-content/uploads/drupal/documents/Mera,%20July%202007.pdf (2007).
3. Stark, G. E. 4 Crucial Takeaways from “Target Africa: The Harms of US-funded Contraception Campaigns” with Obianuju Ekeocha. Natural Womanhood https://naturalwomanhood.org/4-crucial-takeaways-from-target-africa-with-obianuju-uju-ekeocha/ (2024).
4. Documentary, C. for a N. P.-L. Meet Obianuju – Culture of life africa. Culture of Life Africa https://cultureoflifeafrica.com/meet-uju.html.
5. Elmusharaf, K., Byrne, E. & O’Donovan, D. Social and traditional practices and their implications for family planning: a participatory ethnographic study in Renk, South Sudan. Reproductive Health 14, 10 (2017).
6. South Sudan birth rate (1950-2025). https://www.macrotrends.net/global-metrics/countries/ssd/south-sudan/birth-rate.
7. Reproductive Health Access Project. A history: the progestin implant. Reproductive Health Access Project https://www.reproductiveaccess.org/2025/08/a-history-the-progestin-implant/ (2025).
8. Senderowicz, L. & Kolenda, A. “She told me no, that you cannot change”: Understanding provider refusal to remove contraceptive implants. SSM – Qualitative Research in Health 2, 100154 (2022).
9. Tumlinson, K. et al. Assessing trends and reasons for unsuccessful implant discontinuation in Burkina Faso and Kenya between 2016 and 2020: a cross-sectional study. BMJ Open 13, e071775 (2023).
10. Fadiman, A. The spirit catches you and you fall down. Academic Medicine 76, 621 (2001).
11. Brooks, N. et al. U.S. global health aid policy and family planning in sub-Saharan Africa. Science Advances 9, eadk2684 (2023).
12. Taylor, L. Almost $10m of “incinerated” US aid contraceptives found safe, but still at risk. BMJ 390, r1951 (2025).
13. Matiashe, F. S. End of US aid poses death threat to women and girls in Africa | Context by TRF. https://www.context.news/socioeconomic-inclusion/end-of-us-aid-poses-death-threat-to-women-and-girls-in-africa.