My reproductive health journey has been affected by being a woman* of color. Living in my Afro-descendant female body comes with historical and current narratives that want to dictate how I manage my health and wellness. I was introduced to contraception in my early 20s because of a supposed irregular cycle, subtly coerced into using hormones to “fix” something that I came to learn was never broken. From time to time, I have wondered if my critique and apprehension of modern reproductive health technologies is ill-formed; being so in tune with my body and spirit dismisses those thoughts because I have also learned that the way I feel is not exclusive to me. The need to find other folks that have concerns in regards to contraception is why I seek out gatherings and resources such as the webinar I tuned into yesterday.
Part of SisterSong’s Collective Voices webinar series, LARCs: Access, Coercion and Reproductive Justice brought together leaders from different organizations who are doing work to ensure the access to long-acting reversible contraceptive methods (LARCs) for women is free of coercion, particularly for young women, elderly women, women of color, LGBTQ individuals, and low-income women. The panel of speakers did an excellent job discussing the history and current ongoing reproductive coercion for women of color in this country. That resonated deeply with me as I recalled both personal and collective trauma related to reproductive health and racism. I suffered psychologically on birth control pills without getting a real understanding of what they were nor having a provider dedicated to helping me understand; I didn’t know what to ask because of my then-limited knowledge of my body. The IUD experience was terrible enough for me to never consider it again. While not every woman experiences what I have, the enthusiasm to get women on birth control can often downplay the side effects of these technologies.
I am skeptical of the promotion of LARC because of the recent push for funding to expand access. I have seen my community of low-income ethnically diverse people be targeted in ways that remind me of population control theories and eugenics. Before even getting to the issues I have with contraception, Aimee Thorne – Thomsen, Vice President for Strategic Partnerships at Advocates for Youth, said something important in the webinar that encompasses a sentiment I’ve held because of my own. “We live in a society that is set up to not support our development into sexually healthy people,” she said, speaking to the lack of comprehensive sex education throughout this country; this absence is further compounded by race and class.
I am a firm believer that people cannot make informed decisions about their bodies without having access to resources and information that is comprehensive, age-appropriate, and free of Puritan, paternalistic and patriarchal undertones. To get a better idea of the deficiency of sex education in the United States, 24 states require public schools teach sex education (21 of which mandate sex education and HIV education), 33 states and the District of Columbia require students receive instruction about HIV/AIDS; of those states, 20 states require that if provided, sex and/or HIV education must be medically, factually or technically accurate. State definitions of “medically accurate” vary, from requiring that the department of health review curriculum for accuracy, to mandating that curriculum be based on information from “published authorities upon which medical professionals rely.” Additionally, 35 states allow parents to opt-out on behalf of their children (National Conference of State Legislatures). This is wildly disturbing and makes it so that those of us who did not receive comprehensive sexual education arrive at the doctor’s office with little to no information about our own bodies, much less the contraception (and the side effects) we are being offered and often coerced into.
Reproductive coercion of women of color has a ugly history in the United States. Jamila Taylor, Senior Fellow at Center for American Progress, opened up the webinar with a concise history of the reproductive coercion of enslaved Africans and their African American descendants. She spoke of starting with the enslavement, where countless people were raped, forced to breed to produce free slave labor, and had their loved ones ripped away from them. “Women of color were experimented on and then a movement to expand options began rooted in racism and classism,” Taylor continued, highlighting the population control movement and eugenics that began in this country. La Operación, which refers to sterilizing a large percentage of Puerto Rican women from the late 1940s until the late 1960s, often comes to the forefront of my mind when I think of contemporary examples of coercion and vulnerable bodies; this same population of women were also victims of the first large-scale human trial of birth control pills in the 1950s that causes severe side effects due to the high dosage of hormones. I think about the recent documentary, No Más Bebes, and the recounting of the similar horror experienced by Puerto Rican women but instead taking place in California to Mexican and Mexican – American women at the same time. Jamila Taylor’s words made me recall the history of American gynecology, specifically Dr. J Marion Sims (whom I lovingly refer to as “that sick motherfucker”) and his multiple experimental surgeries on enslaved women for the benefit of white middle class women. The reminder that this is not a thing of the past came again from Taylor as she shared that in the 1990s, Norplant marketed specifically to low-income Black women and teenage girls, with cash rewards to entice low-income women on public assistance programs to use it.
The webinar also included the expertise of Victoria Gómez Betancourt, Communications and Development Director at Colorado Organization for Latina Opportunity & Reproductive Rights (COLOR) Anu Gomez, board member at National Women’s Health Network, and Tannia Esparza, Executive Director at Young Women United, spoke about the ways young women and teen pregnancy is targeted through expanding access to LARC. Specific topics also included how to nonconfrontationally address coercion with health professionals from Anu Gomez and supporting unintended pregnancies without shaming teens from COLOR. This further delves into solution-based responses from different organization centering the voices of people vulnerable to being coerced.
Currently, there is an increase in funding and attention being given for the expansion of access to LARC. I feel that many of us who are in the reproductive justice field are concerned about who is being targeted for the use of LARC. Because of my personal experience with LARC and all the stories I have heard from women and their experiences with contraception, one of my main grievances is the lack of attention to the apprehension women have about contraception, particularly emotionally, physically and mentally. I suspect that the actual amount of women who have side effects from birth control pills and LARC is not reflected in the amount of women providers say have adverse reactions. For all the focus on having quantitative studies and the subsequent obsession with statistics, the truth is that not everyone reports their side effects. This is further compounded by the quality of healthcare that is available to low – income ethnically diverse population. The reality is that the hospitals that are in low income communities are subpar and the providers there are often not invested in their patients; many of these providers are white and/or culturally disconnected from their patients on some level. These hospitals tend to be teaching hospitals as well, with residents that are eager to practice their skills. There is an influx of people seeking the services of these institutions and an insufficient amount of staff and facility resources to handle the volume of patients. Ideally, a medical visit should give both the patient and the provider enough time to fully discuss the patient’s health concerns and questions; this is not the case. The medical staff then is faced with the tough choice between the quality of the care provided and the demands of the quantity of patients being served, which creates a profit over people model of providing services. In this profit-over-people model, the amount of time spent on thorough patient education is overshadowed by the need to treat as many patients as possible.
I want to be clear that I am not accusing public hospitals and federally qualified health centers (community based facilities that receive reimbursement from the government to serve all people regards of insurance; by default, many of the patients are low income people of color) of promoting population control tactics and coercing their patients into LARC. What I am saying is echoing the concerns of various leaders in the reproductive justice movement surrounding the unconscious (and sometimes conscious) promotion of population control by targeting and aggressively pushing birth control. The situation I explained above makes it easy to have providers who have unchallenged biases about their patients and views on birth control as well as who should be on it coerce women by aggressively promoting LARC as the best option (in their opinion), subtly persuading patients to use LARC for learning purposes, while not ensuring proper follow up with women to see how they are faring on the LARC.
I find it suspect that money is so readily available for the provision of LARC and yet, the other resources needed to fully support women and their families have bee underfunded for decades if not centuries. Even the notion that one should consider planning for their family is a slippery slope; it is often a privilege to be able to plan far in advance when folks are living paycheck to paycheck. This is not to say that it’s impossible nor it is saying that impoverished community members are incapable of planning, but being in survival mode drastically reduces a person’s ability to conceptualize the future. Caring so much about a woman’s reproductive lifespan as it relates to birth control but not the classist and racist restrictions to access is also characteristic of white feminism. White feminism has done a lot of work around reproductive rights but does not always center reproductive justice for ethnically diverse and low income women in their struggle to secure their ease of access.
To expand access to LARC particularly for young women, elderly women, women of color, LGBTQ individuals, and low-income women is not in and of itself a worthless endeavor. I feel that it is important to make sure more women can get the birth control they desire to receive. What I take issue with is directing women towards LARC based on a provider’s and public health official’s assumptions about the woman’s identities. The Long-Acting Reversible Contraception Statement of Principles put forth by SisterSong and the National Women’s Health Network is a concise document of detailed guidelines and principles to support the inclusion of LARC in the options available to women while combating questionable and coercive practices. Recommendations and statements include:
- Acknowledging the complex history of the provision of LARC.
- Consistent and respectful counseling.
- Providing patients with comprehensive, scientifically accurate information about the full range of contraceptive options.
- Avoiding the focus on LARC as a one-size-fits-all method.
- Advocates and the medical community balancing efforts to emphasize contraception as part of a healthy sex life beyond the fear of unintended pregnancy with appropriate counseling and support for people who seek contraception for other health reasons.
- The decision to obtain a LARC should be made by each person on the basis of quality counseling that helps them identify what will work best for them. No one should be pressured into using a certain method or denied access based on limitations in health insurance for the insertion or removal of LARC devices.
- The decision to cease using a long-acting method should be made by each individual with support from their health professional without judgment or obstacles.
- The current enthusiasm for LARCs should not distract from the ongoing need to support other policies and programs that address the full scope of healthy sexuality.
The Long-Acting Reversible Contraception Statement of Principles is available to read in full and to add your signature in support of it. I encourage more people become informed and sensitive to the nuanced approach that expanding access to LARC comes with. This essay is by no means conclusive nor an authoritative piece. For more information, here are some links that informed my thought process:
*I use “woman” and “women” throughout this statement and recognize that these terms do not encompass the full range of people who utilize contraception and who may be impacted by coercive practices.