Pervasive Coercion

The problem with birth control as a cure for poverty

A few years ago, when I was still at The Atlantic and writing about inequality, I asked an academic who I respected about what he thought was the best way to end poverty. “LARCs,” he said, using the acronym for long-acting reversible contraceptives like IUDs and implants. He pointed to Colorado, which had started to provide free access to LARCs, and had seen its teen birth rates and abortion rates drop as a result. Still, his response stuck with me because it seemed a little icky. The best way to fight poverty is to stop people from having children? I’ve been thinking about this a lot since then, and today published an investigation into places where this idea has taken hold in unfortunate ways.

‘I Don’t Have Faith in Doctors Anymore.’ Women Say They Were Pressured Into Long-Term Birth Control

The story is set in Alabama, but what these women experienced happens everywhere. One woman, Miannica Frison, had an IUD inserted after a traumatic birth despite not really wanting it at the time. When she asked her doctor to take it out because she didn’t like the side effects, she was rebuffed over and over again; her doctor told her to lose weight first and that she needed to make sure she wasn’t going to have a fourth child. This happened to many women I talked to, and many of them happened to be low-income and Black.

Of course, there’s nothing wrong with IUDs and implants, and they’re an extremely effective way to prevent unplanned pregnancy. But these methods are also provider-controlled, meaning a woman can’t just decide to stop taking a pill, she has to go to her doctor to remove the contraceptive. And sometimes the doctor, thinking he has the woman’s best interest in mind, won’t. When women don’t have agency to make their own choices about birth control, we have a problem, as the fight over abortion rights demonstrates.

As I detail in the story … actually, maybe it got cut for space … the whole idea that unplanned pregnancy causes poverty arose out of a pronatalist eugenics mindset. In the 1940s, researchers puzzled about relatively low birth rates set out to study white, married, Protestant families in Indiana to find out why they weren’t conceiving more, and whether their pregnancies were planned and unplanned. Though the study was looking for what could get this narrow subset of people to conceive more, the federal government then took up some of its methods, tracking unintended pregnancies. This is a good academic article about this, if you can’t access it and want to read it, email me and I’ll send you a pdf! But basically, there are problems characterizing unplanned pregnancy as a social ill, especially since the pregnancy might actually be desired, if unplanned. And saying poor people should wait to give birth until their finances improve is another way of saying maybe poor people shouldn’t procreate.

Anyway, this obsession with reducing unplanned pregnancy made philanthropists, led by the Susan Thompson Buffett Foundation, to give many millions of dollars to researchers providing women access to LARCs. But they went a step beyond providing access to IUDs and implants, doctors started to counsel women that LARCs were the most effective birth control, and started really pushing them on people. Policies sprung up so that, in some cases, if a woman wants birth control, she has to get a provider-controlled method like an IUD or implant. Today, there’s a particularly persistent policy in which doctors try to get women on Medicaid to get an IUD immediately after they give birth, even though the risks of expulsion are high. They do this because they think women on Medicaid won’t come back for a follow-up appointment and are likely to have another pregnancy soon.

This story was difficult to report because I talked to a lot of researchers and reproductive justice advocates who said that this type of coercion was happening, but they couldn’t point me to any one woman who would talk about it. I kept looking and looking and getting nowhere, until I found a Facebook post by Miannica Frison, who talked about the difficulties her IUD caused her. I reached out to her and she was generous enough to share her story and put me in touch with her doula, who had seen the type of coercion she experienced multiple times. With Birmingham appearing to be the place I could center my story, I took a trip down there, meeting with many women and doulas and also reporting the maternity care story I published last week, Why Health Care for Mothers is Underpaid. I was very glad I was able to meet the women in person, because when UAB and others pushed back against my story, even calling the editor of TIME to protest before it ran, I was extremely confident in the women’s stories. Believe women, I kept telling myself, and we did.

Both of these stories were only possible to do because I got a generous fellowship from USC’s Center for Health Journalism that allowed me to travel and for us to hire a great photographer. I’d highly encourage other journalists to apply if you’re interested in getting funding to write about health and equity. Check out their various programs and fellowships here.

And again, here’s the story, there’s much more in it than I put here: ‘I Don’t Have Faith in Doctors Anymore.’ Women Say They Were Pressured Into Long-Term Birth Control

Books to Fall Asleep To BFAT

I don’t think I’ve ever shared the GOAT of all BFATs, the book that got me into BFATs. It is The Great Bridge by David McCullough, and it is about the design and construction of the Brooklyn Bridge in the 19th century. It is both fascinating and extremely detailed, and some of those details, like the depth and length of the caissons that held up the bridge, are very soothing for some reason. Listen while you drift off to sleep and learn about just how crappy much of life was in the 19th century, and how they built an awesome bridge nevertheless.