As an OB/GYN doctor and contraceptive specialist, I care about access to birth control because I know how crucial it is to self-determination. There are few things in my personal and professional life that I love more than birth control, which helps me and hundreds of patients that I’ve sat with achieve our goals in life.
An unplanned pregnancy would have been a huge challenge for me while I was pursuing my dream of becoming a doctor. Now, I feel a sense of pride empowering my patients through access to all forms of birth control to suit their needs, whether it is a 16-year-old using a birth control implant to meet their goals of going to college without a pregnancy, or a mother of three that is satisfied with the family she has and wants to go back on her birth control pills.
Being able to control your fertility helps control your destiny. I am privileged to help my patients plan their pregnancies and their lives to whatever they can dream up.
But in this process, I have found that simply promoting contraception does not address the complex role it has in our lives, and unfortunately that can be coercive.
Contraceptive coercion is the idea of using contraception as a means of reproductive manipulation. We see it at play in couples facing intimate partner violence, where one partner either promotes or sabotages the use of contraception for their own gains—as well as in the less talked about, and perhaps more pervasive, way in which health care providers themselves may generate coercive practices around contraception, often with the intent of decreasing unintended pregnancy and promoting the most effective forms of contraception, like IUDs.
Right now, we know that half of pregnancies in the United States are unplanned—but this does not mean they are all unwelcome. Pregnancy being prevented and calculated is not the reality, nor the desire, for many people, and some people do not see the idea of pregnancy prevention as something that is aligned with their life goals. Promoting birth control indiscriminately can thusly contradict the goals that many people have for their fertility.
We should always let patients guide conversations about the right contraceptive method for them based on their values and life goals after informing them in an unbiased way of all of the available options. And we must trust and fulfill their wishes once decided. Unfortunately, in an effort to improve the types of contraception available or increase access to contraception, health care providers and researchers have historically not followed this advice, and their discussions with patients have instead been steeped with contraceptive coercion often based on racist and classist ideas.
Just looking at the two places I call home, Puerto Rico and the mainland U.S., provides critical insight into the damage that occurs when this communication breaks down.
The development of the original birth control pill relied heavily on testing the pill on Puerto Rican women prior to using it in the mainland U.S.—done because researchers thought Puerto Rican women would be a good model for uneducated women to use the pill. As if this wasn’t racist and problematic enough, the trials were done without informing the women about the experimental nature. Several women died as a result.
Stories of the implications of this tragedy still ripple through my family and our friends. So does the history of forced sterilization in many black, brown and Native communities and among people with disabilities and the incarcerated.
This is not exclusive to the U.S. Several countries still have rules about how many children families can have, forcing use of birth control despite desires of that particular family. This also creates large disparities between male and female births, and perpetuates sexism and violence against women when women make up a smaller percentage of the population. These programs use contraception as a weapon against women and families—but contraception should be a tool for the benefit of people worldwide.
We can better conceptualize the goals of contraception through the reproductive justice framework, created by women of color to express their own needs not found in traditional reproductive health and rights frameworks. RJ positions reproduction within people’s complex lives, and its authors declared that a social justice approach was needed to help people address the realities of reproduction.
The tenets of RJ suggest that it is a human right for people to choose whether or not to become pregnant, and to parent in safe and supportive environments. Access to birth control in this framework is important, but it is not the be all / end all of the conversation around reproductive rights. Instead, it is positioned as a tool—something that helps people become pregnant when they want, and avoid pregnancy if they want.
There is so much work to be done to help people parent wanted pregnancies in safe communities free of racism, sexism and classism—while also decreasing abortion stigma to allow people to choose their destinies if contraception fails. Contraception is great, but it can fail, have side effects and prevent people from pregnancy or parenting in the way they want. Those facts should all be part of our conversations around access.
I’m excited to say #ThxBirthControl today. But when I do, I honor all of the communities who have been both positively and negatively impacted by its development and promotion.
May the future of birth control be more just—and guided by those who are actually using it.
