Coerced and Targeted use of Long-Acting Reversible Contraceptives (LARC)

Throughout a good chunk of the 20th century, forced sterilization, largely of women of color, proceed unchecked. This was due to a ruling which permitted forced sterilization in cases where such procedure would permit the individual it was performed on to be released from a state institution. Following this ruling thousands of people were sterilized due to their status as “mentally feeble”, often code for promiscuous or other socially undesirable qualities. While the boards overseeing many of these procedures were eventually dissolved and more covert tactics of coerced rather than forced sterilization came more prevalent, the legal ruling which permitted such practices was never overturned. (5) This ruling continues to allow for practices such as the castration of sex offenders or rulings conditioning parole of certain on them being surgically implanted with a long-acting reversible contraceptive (LARC) (4). Conditioning legal rewards are one of many strategies used to coerce and encourage folks, specifically the poor, disabled, and people of color, to get LARC.

After Norplant, a hormonal LARC implanted in the arm, was approved by the FDA in 1990, many law makers were quick to propose hinging eligibility for welfare benefits on use of Norplant (4). While none of these proposals made it to legislation, birth control clinics continued to target communities of color and Norplant was often promoted via monetary incentives and reduced prison sentences (1). Researchers Winters and McLaughlin (6) describe Norplant and other LARCs as forms of ‘soft sterilization’ because while the devices are technically reversible, they are often implanted by programs in instances when the individual is incarcerated or dependent on welfare for healthcare. Its implant and removal are therefore dependent on those in power and broader systems willingness to perform the operations and allow the individual to receive them, not the individual’s desires.

Additionally, doctors exhibit many biases in who they recommend birth control to, especially LARCs. Providers are more likely to recommend intrauterine contraception to Latina and Black women of low socioeconomic status than they are to white women of low socioeconomic status (2). And many providers believe their biases are rooted in research! It takes little research on providing access to contraceptives to find work that echo’s this sentiment: “efforts to help women and couples plan their pregnancies, such as increasing access to effective contraceptives, should focus on groups at greatest risk for unintended pregnancy, particularly poor and cohabiting women” (3).

The tendency to steer or coerce marginalized people, including poor women, women of color, women of low socioeconomic status, and incarcerated women, towards a contraceptive method which gives them minimal control over its removal is not random; it falls within a larger culture which aims to strip marginalized women, specifically women of color and Black women, of their reproductive autonomy. It depends on the logic that the disparities Black people, and marginalized people more broadly, face is not a result of systemic barriers perpetuating inequality, but rather that Black women’s reproduction is the source of poverty and other inequalities. Devaluing Black reproduction and therefore Black bodies through the targeted and coerced use of LARC contributes to a white supremacist culture while failing to address the root of issues like poverty which it claims to address.

References

[1] Bryson, A., Koyama, A., & Hassan, A. (2021). Addressing long-acting reversible contraception access, bias, and coercion. Current Opinion in Pediatrics, Publish Ahead of Print. https://doi.org/10.1097/mop.0000000000001008

[2] Dehlendorf, C., Ruskin, R., Grumbach, K., Vittinghoff, E., Bibbins-Domingo, K., Schillinger, D., & Steinauer, J. (2010). Recommendations for intrauterine contraception: A randomized trial of the effects of patients’ race/ethnicity and socioeconomic status. American Journal of Obstetrics and Gynecology, 203(4), 319.e1–319.e8. https://doi.org/10.1016/j.ajog.2010.05.009

[3] Finer, L. B., & Zolna, M. R. (2011). Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception, 84(5), 478–485.

[4] Lombardo, P. A. (2011). A century of eugenics in America: From the Indiana Experiment to the Human Genome Era. Indiana University Press.

[5] Vedantam, S. (Host). (2018, April 23). Emma, Carrie, Vivian: How A Family Became A Test Case For Forced Sterilizations [Audio podcast episode]. In Hidden Brain. npr. https://www.npr.org/transcripts/604926914

[6] Winters, D. J., & McLaughlin, A. R. (2019). Soft sterilization: Long-acting reversible contraceptives in the carceral state. Affilia, 35(2), 218–230. https://doi.org/10.1177/0886109919882320