Written by Chelsea Faso, M.D.

Reproductive coercion is defined as behaviors or policies that interfere with decision-making about contraception and pregnancy. In the US, clinicians have often been complicit in implementing and enforcing reproductive oppression and coercive practices, sending and reinforcing the message: certain groups of people are more fit to parent than others. This systemic oppression results in black, indigenous, and people of color, imprisoned people, those with disabilities, and especially those who are young, having few real choices about how and when to have and raise healthy families. 

For example, in the late 1960s, Mexican women in California were coerced to sign sterilization consent forms and were wrongly told the procedure could be reversed. In the 1990s, state governments offered reduced sentencing as an incentive to adopt and retain the contraceptive device Norplant. Additionally, studies have documented clinician biases encouraging long-acting reversible contraceptive (LARC) methods for low-income and patients of color, while discouraging their removal.

Some strategies to mitigate bias and reproductive coercion include:

• Train clinicians and staff on historical examples and systems that maintain reproductive oppression.
• Recognize personal biases related to contraception and parenting.
• Inform patients about the full range of contraceptive options, and ensure that decisions about contraception and pregnancy are completely voluntary.
• Invest in prioritizing a patient’s experience and preferences, rather than in a particular method, outcome, or efficacy rate. 
• Evaluate QI initiatives related to contraception, especially LARC, to ensure provision of person-centered equitable care.
• Engage patients and community advocacy groups in development of patient education materials and initiatives in order to center patients’ needs.
• Partner with Reproductive Justice (RJ) advocates to promote incorporation of RJ values into delivery of reproductive health services.
• Advocate for state-based Medicaid policies to ensure insurance coverage of all contraceptive options, including LARC removal.

Resources:

Your Birth Control Choices Fact Sheet

Your Birth Control Choices Poster

Contraceptive Pearl: Contraception During COVID-19: Non-Coercive Contraceptive Counseling

Contraceptive Pearl: Comprehensive Contraceptive Counseling

Sources:

LARC Statement Of Principles | National Women’s Health Network. April 2021. https://nwhn.org/larc-statement-of-principles/.

American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women. ACOG Committee Opinion no. 554: Reproductive and Sexual Coercion. Obstet Gynecol. 2013;121:411-415.

Amico JR, Bennett AH, Karasz A, Gold M. “She just told me to leave it”: Women’s experiences discussing early elective IUD removal. Contraception. 2016;94(4):357-361. doi:10.1016/j.contraception.2016.04.012

Moniz MH et al. Balancing enhanced contraceptive access with risk of reproductive injustice: a United States comparative case study. Contraception. April 2022. doi.org/10.1016/j.contraception.2022.04.004

Gold RB. Guarding Against Coercion While Ensuring Access: A Delicate Balance. Guttmacher Policy Review. 2014;17(3).

Stacey D, Volk R. International Patient Decision Aids Standards (IPDAS) Collaboration. Ipdas.ohri.ca. http://ipdas.ohri.ca. Published 2019. Accessed May 12, 2022.

Person-Centered Contraceptive Counseling Measure. The Person-Centered Contraceptive Counseling Measure. https://pcccmeasure.ucsf.edu/. Published 2022. Accessed May 12, 2022.

Pharma-free

The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.