January 10, 2017
For the past few months, I’ve seen a flurry of magazine features and Facebook posts urging everyone of fertile age to sprint to their gynecologist and demand an IUD before Trump is inaugurated (e.g., "Here's Why Everyone Is Saying to Get an IUD Today"; “Get an IUD Before It’s Too Late”). I appreciate the fear that drives these posts: The flurry of headlines predicting the end of Obamacare and defunding of Planned Parenthood would make anyone with a uterus want to protect themselves in any way possible against an uncertain, terrifying future. But I can’t help wincing whenever I come across yet another person instructing everyone to consider the IUD—especially as so many of these pleas come from white folks who are likely unaware of the toxic history of forced sterilization on people of color, which casts a shadow on their well-intentioned advice.
While IUDs and other forms of long-acting reversible contraception (LARCs) are the right choice for some, their recent rise in popularity has given pause to some activists. As gynecologists and pharmaceutical companies increasingly frame LARCs as a one-size-fits-all solution to unintended pregnancy, advocate groups like SisterSong and National Women’s Health Network have urged providers to proceed with caution. In the complicated context of fertility and people that society has historically marginalized, including people of color, people with disabilities, and people on low incomes, the line between medical advice and coercion can be easily blurred. This has been true throughout the 20th century, as the U.S. government repeatedly institutionalized policies of coercively sterilizing Black, Latina, and Native American women without their informed consent. Black women in particular have been targeted by state efforts to increase the use of long-term birth control, a societal dynamic rooted in our country’s legacy of white control over black bodies that dates back to the era of chattel slavery. In an attempt to retain control over Black women’s reproduction, the government has invoked racist stereotypes (e.g., “welfare queen”) to propagate the idea that Black women are not suitable mothers to their children and to justify the state’s attempts to stop them from having children. One such attempt that gained attention in the early 1990s was a nationwide trend of state bills that financially incentivized or even required the insertion of the long-acting contraceptive Norplant for women receiving public benefits.
Unfortunately, such targeted efforts to control women’s reproduction and especially the bodies of those on the margins, is not a thing of the past. In 2013, inquiries into abusive corrections practices revealed that hundreds of tubal ligations have been performed on incarcerated people under sketchy circumstances, and recently prosecutors in multiple states have been accused of using sterilization as a condition in plea bargains. The long and egregious history of contraception weighs heavily on the current culture of LARC promotion.
Nothing speaks more clearly to this than the tragic case of Dalkon Shield, an intrauterine device that was designed and marketed in the 1960s and ’70s using the paternalistic framework of population control and the idea that underprivileged women were not responsible enough to prevent pregnancy using barrier methods or the Pill. Unfortunately, due to a design flaw, this early IUD caused miscarriages, infections, total fertility loss, and even death. The device was at the center of over 300,000 lawsuits brought by patients who suffered as a result of the faulty product. Both A.H. Robins, the pharmaceutical company behind the device, and doctors who prescribed it refused to listen to patients who came to them with complaints, instead telling them that their symptoms were caused by poor hygiene or risky sexual behavior, according to Andrea Tone’s Devices and Desires: A History of Contraceptives in America.
Loretta Ross, an activist who used the Dalkon Shield, said her doctor “kept treating me for all these bizarre venereal diseases that I’m convinced he only did because I was Black and female.” As a result, he failed to diagnose her with Pelvic Inflammatory Disease, an infection caused by the Dalkon Shield that eventually led to Ross’s emergency hysterectomy at the age of 23. Despite the mounting data outlining the device’s horrific patient outcomes, Dalkon Shields were sold by the millions for years before its parent company finally declared bankruptcy as a result of patient organizing and a class-action settlement.
This is only a glimpse of the violent history of racialized sterilization that well-meaning people unknowingly tap into when they deem IUDs a necessity in Trump’s America. Racial assumptions still affect the ways in which providers engage with patients about their fertility and advise them on which contraception method is best. A 2009 study found troubling data suggesting that Black and Hispanic women received birth-control counseling at a higher rate than white women, and that this “increased frequency of contraceptive counseling reported by minority women was likely not patient initiated.” The doctor-patient relationship, already fraught with power imbalances, becomes increasingly complex when a patient of color is advised to essentially hand over their reproductive autonomy to a device that requires a medical professional to physically insert and remove it. Of course, this is not to say that doctors should never counsel a patient of color about contraception or that every person of color who has an IUD has been manipulated by the medical establishment. Nor is it to say that the IUD hasn’t become an effective and desirable form of birth control—it has vastly improved since its early days.
But what I am saying is this: We must hold providers and one another accountable to trust ourselves to make medical decisions that are best for our needs and lived experiences. In order to protect our rights to bodily self-determination, we must work to ensure that all birth-control options are accessible and affordable for everyone, and that we all have access to comprehensive and culturally competent contraception counseling. We can’t let the fear of this new repressive administration, together with a GOP-led House and Senate determined to defund Planned Parenthood and overturn Roe v. Wade, allow a number of white feminists to unwittingly perpetuate the racist assumptions and behavior they claim to be fighting against.