Physicians in Alabama are pushing intrauterine devices and arm implants for birth control on patients who are black, Latina, or low-income, TIME magazine reports.
An article published in the magazine in May focused particularly on the experiences of black Medicaid recipients in Alabama who were encouraged to use long-acting, reversible contraceptives (LARCs)—either intrauterine devices (IUDs) inserted into the uterus or implants inserted into the arm—to prevent unplanned pregnancies.
LARCs are effective at preventing pregnancies and are reversible, but doctors are not always cooperative about reversing them, the magazine story states, citing “patient testimonials, medical studies, and interviews with 19 experts in the field of reproductive justice.”
Reporters found physicians are more likely to recommend LARCs—and refuse to remove them upon request—when their patients are black, Latina, or low-income women.
LARCs require less compliance from the patient than some other forms of birth control, such as oral contraceptives and products sold over the counter.
Attributed to Dobbs Fallout
Doctors are doubling down on recommending LARCs in states with restrictive abortion laws, according to TIME.
Government funding has made this an issue, says health economist Devon Herrick
“I don’t have a problem with Alabama Medicaid offering a range of contraceptive options to poor women,” said Herrick. “More than half of babies delivered in Alabama are funded by Medicaid. Children are expensive. Child poverty is a huge problem, especially in single-parent families, and abortion bans have made the topic timely.”
Long-term contraception was being pushed well before the Supreme Court opinion in Dobbs v. Jackson Women’s Health that overturned Roe v. Wade, says Michelle Cretella, M.D., a pediatrician with expertise in adolescent sexuality and a former executive director of the American College of Pediatricians.
“My pediatric training, which included additional training in gynecology, occurred from 1990 through 1997, said Cretella. Long-term contraception was being pushed then, well before Dobbs and any state abortion bans.”
Donna Harrison, M.D., director of research for the American Association of Pro-Life Obstetricians and Gynecologists, says the practice of doctors pushing long-term contraception “predates Dobbs by several decades.”
Problems with LARCs
Long-term birth control is extremely effective and requires much less work than other forms of birth control, says Cretella.
“Even when used perfectly, condoms prevent pregnancy perhaps only 80 percent of the time,” said Cretella. “Although with perfect use natural family planning and the daily use of a birth control pill will prevent pregnancy over 95 percent of the time, both fail when pills are forgotten or if the couple’s charting is inaccurate.”
The federal government has at times discouraged less-invasive birth control methods such as natural family planning.
As of 2014, IUDs ranked below the pill, condom use, and female sterilization as the contraceptive method of choice, according to the Guttmacher Institute.
“Long-term birth control is implanted and requires the user to do nothing to effectively prevent pregnancy, and as an added bonus for the eugenicists may cause permanent sterility,” said Cretella. “There has long been a subtle (and at times, not-so-subtle) Malthusian ethos in medicine and medical education.”
IUDs Once Discouraged
Far from pushing IUDs on patients, physicians once discouraged the use of IUDs, says Cretella.
“IUDs can cause infertility and therefore were always discouraged for any woman who had never given birth and [for] young women in general,” said Cretella. “They work primarily by creating inflammation in the uterus, which prevents the implantation of a newly conceived life.”
In other words, IUDs “cause an early abortion before implantation, before a pregnancy can be diagnosed,” said Cretella.
Modern IUDs contain the same hormones found in the birth control pill, says Cretella.
“They can prevent fertilization by thickening women’s cervical mucus and preventing ovulation,” said Cretella. “The side effects remain the same: increased risk of sexually transmitted infections, perforation of uterus and sterility, plus additional risks due to the hormones, such as strokes and cancers.”
Seen As Elitism
Cretella compares the aggressive promotion of LARCs to early eugenicists targeting black Americans.
“Both then and now, black Americans make up a disproportionate percentage of those who live in our cities,” said Cretella. “This is why Planned Parenthood still has its clinics primarily in cities to this day, and it explains why blacks, who make up about 14 percent of the U.S. population, account for 38 percent of induced abortions.
“Elite eugenicists have merely traded in surgical abortion for chemical abortion but call the chemical abortion ‘long-term contraception,’” said Cretella.
Such thinking is part of an elitist desire to uplift poor people, Cretella says. Doctors go through “an atheistic system of medical education imbued with moral relativism, utilitarianism. and elitism,” Cretella said.
“Specifically, do they think poor people are having too many children and thus need the interventions of their doctors and nurses to prevent them from having more?” said Cretella.
“Although this is the end result, and some may state it this bluntly, it is most often framed as ‘This is how we best help the poor and people of color attain higher education and upward mobility,’” said Cretella.
Harry Painter (harry@harrypainter.com) writes from Oklahoma.
Internet info:
Alan Semuels, “I Don’t Have Faith in Doctors Anymore.’ Women Say They Were Pressured into Long-Term Birth Control,” Time Magazine, May 13, 2024: https://time.com/6976918/long-term-birth-control-reproductive-coercion/
“Contraceptive Use In The United States,” Guttmacher Institute, April 2020: https://www.guttmacher.org/sites/default/files/factsheet/fb_contr_use_0.pdf
M E Ortiz, et. al, “Mechanisms of Action of Intrauterine Devices,” Obstetrical & Gynecological Survey, December 1996: https://pubmed.ncbi.nlm.nih.gov/8972502/
“AAPLOG Committee Opinion: Embryocidal Potential of Modern Contraceptives,” AAPLOG, January 2020: https://aaplog.org/wp-content/uploads/2024/05/Committee-Opinion-7-updated.pdf
“What is Natural Family Planning?” United States Conference of Catholic Bishops, 2024: https://www.usccb.org/topics/natural-family-planning/what-natural-family-planning
