Decades after receiving regular injections of the hormonal contraceptive Depo-Provera, an estimated 1,300 women are now suing manufacturer Pfizer, alleging the company failed to adequately warn users of potential links to meningiomas—tumors, usually non-cancerous, that form in the brain and spinal cord lining.
The mounting multidistrict litigation (MDL) in Florida and federal court follows recent studies suggesting a heightened risk, even as medical groups caution that the overall odds of developing the tumors remain small.
The controversy is particularly important to Black women, who use the injectable contraceptive at nearly double the national rate, according to the Centers for Disease Control and Prevention.
At the center of the legal challenge is the synthetic hormone in Depo-Provera, medroxyprogesterone acetate (MPA). Recent observational research has raised red flags regarding its long-term use:
- Brain Tumors (Meningioma): A study published last month in JAMA Neurology linked MPA with a twofold increased risk of meningioma. This echoed a 2024 analysis in The BMJ, based on French data, which found a fivefold increase in risk for women who used the contraceptive for more than four years. Dr. David Raleigh, a brain tumor specialist at the University of California, San Francisco, noted that progesterone (which progestin in Depo-Provera mimics) acts as “fuel on the fire” for these tumors, which are already more common in women than men.
- Lead Exposure: A 2020 study by Michigan State University, which examined African American women, found that current Depo-Provera users had, on average, 18% higher levels of lead in their blood. Researchers hypothesize that this is due to the drug’s known side effect of bone mineral density loss, which releases lead that is stored in the bone. The study’s lead author, Kristen Upson, stated, “the widespread scientific consensus is that there is no safe blood lead level.”
Despite these findings, physicians underscore that the total risk of developing meningioma remains statistically low—about 39,000 cases are diagnosed annually in the U.S. Dr. Colleen Denny of NYU Langone Health pointed out to NBC News that Depo-Provera reduces the risk of uterine cancer, a more common threat.
The American College of Obstetricians and Gynecologists (ACOG) urged caution, calculating that the risk of meningioma increases from one in 10,000 women to five in 10,000 women using the drug.
Pfizer, which manufactures the drug, denies liability and has moved to dismiss the MDL. The company maintains that it stands behind the safety and efficacy of the drug.
Facing over 1,300 plaintiffs, Pfizer’s core legal strategy hinges on federal preemption. The company contends it attempted to update the Depo-Provera label with a tumor warning following late 2023 epidemiological studies, but the Food and Drug Administration (FDA) rejected the proposal.
Pfizer argues that failure-to-warn claims are preempted when the FDA denies a labeling change, placing the ultimate authority on the federal agency. The litigation held a key federal preemption hearing on Sept. 29 in Pensacola, Florida.
The ongoing lawsuits and the disproportionate use among Black women have resurfaced decades-long critiques of Depo-Provera, connecting the current litigation to a history of reproductive oppression. Depo-Provera was denied FDA approval three times between 1967 and 1983 due to links to cancer in lab animals.
During this period, the drug was used without informed consent on thousands of women at clinics like the Grady Clinic in Atlanta, where 50% of subjects were low-income Black women.
Its eventual FDA approval in 1992 occurred despite the opposition of prominent health organizations representing women of color, including the National Black Women’s Health Project, which cited both safety concerns and coercion.
This history resonates internationally:
South Africa: During apartheid, the government intensified advertising campaigns in urban areas, targeting Black and mixed-race women with Depo-Provera, often making its use compulsory after childbirth or a condition for factory employment. Critics framed this as an implicit goal of population control rather than family planning.
Zimbabwe: In 1981, the Minister of Health banned Depo-Provera, alleging it was a racist political tool used by the former Rhodesian Front to control the majority Black population. Reports surfaced of women being coerced into accepting injections under threat of losing employment or denying their children medical treatment.
In the United States, this practice mirrors the eugenics movement of the early 20th century, which disproportionately targeted poor Black women for forced sterilizations—so common in the South they were known as the “Mississippi appendectomy.”
When Depo-Provera became available, many young Black women reported being pressured by medical providers to use it immediately following vulnerable moments like childbirth or abortion.
Critics argue that today’s disparity in Depo-Provera use—where 33% of users are under 19 and a high percentage are low-income Black women—reflects the continued legacy of reproductive oppression, where a wider range of contraceptive options and fully informed consent are often lacking.
The current legal battle is not only a medical failure-to-warn case, but a confrontation with the drug’s complicated history in communities of color.
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