Op-ed: Ongoing push for LARC use must address history of coercive reproductive policies

August 18, 2016 — "Since long-acting reversible contraceptives (LARCs), including intrauterine devices and hormonal contraceptive implants, are among the most effective means of pregnancy prevention, many family planning and reproductive health providers are increasingly promoting them, especially among low-income populations," Jamila Taylor, a senior fellow at the Center for American Progress, writes in a Rewire opinion piece.

However, "the promotion of LARCs must come with an acknowledgment of historical discriminatory practices and public policy related to birth control," Taylor continues. She writes, "To improve contraceptive access for low-income women and girls of color -- who bear the disproportionate effects of unplanned pregnancy -- providers and advocates must work to ensure that the reproductive autonomy of this population is respected now, precisely because it hasn't been in the past."

Taylor outlines the history of reproductive coercion against women of color, including slavery and government-funded family planning programs that encouraged the use of birth control among black women and in some cases sterilized them against their will. More recently, Taylor describes the introduction in the 1990s of Norplant, a contraceptive implant that "was marketed specifically to low-income women, especially Black adults and teenage girls." Noting that the federal government incentivized Norplant's use among low-income populations, Taylor explains that "promoting this method among low-income Black women and adolescents was problematic" because "[r]acist, classist ideology dictating that this particular population of women shouldn't have children became the basis for public policy."

According to Taylor, "Even though coercive practices in reproductive health were later condemned, these practices still went on to shape cultural norms around race and gender, as well as medical practice." She writes, "This history has made it difficult to move beyond negative perceptions, and even fear, of LARCs, health care, and the medical establishment among some women of color. And that's why it's so important to ensure informed consent when advocating for effective contraceptive methods, with choice always at the center."

To promote reproductive autonomy, Taylor continues, "providers must deal head on with the fact that many contemporary women have concerns about LARCs being recommended specifically to low-income women and women of color." For example, she suggests that family planning providers receive "cultural competency training that includes information on the history of coercive practices affecting women of color" to help providers "understand this concern for their patients."

Providers also "must address other barriers that make it difficult for women to access LARCs in particular," Taylor writes. She explains that "LARCs can be expensive in the short term," insurers do not always cover the full cost of LARCs and "complicated billing and reimbursement practices in both public and private insurance [can] confuse women and providers." She adds that in addition to removing barriers, low-income black women and teenagers "should be given information on the full array" of contraceptive options to "help them choose the method that best meets their needs, while also promoting reproductive autonomy."

Taylor writes, "Clinical guidelines for contraception must include detailed information on informed consent, and choice and reproductive autonomy should be clearly outlined when family planning providers are trained." She adds that "[i]t's crucial we implement these changes now because recent investments and advocacy are expanding access to LARCs," citing the success of a Colorado initiative that facilitates LARC access.

"Recognizing that prevention is a key component to any strategy addressing a public health concern, those strategies must be rooted in ensuring access to education and comprehensive counseling so that women and teens can make the informed choices that are best for them," Taylor writes. She concludes that while "[t]he history of coercion undermining reproductive freedom among women and girls of color in this country is an ugly one ... this certainly doesn't have to dictate how we move forward" (Taylor, Rewire, 8/15).