Long-acting reversible contraception: Targeting judged to be unfit for parenthood in the United States and the United Kingdom.

Abstract

There is a long history of regarding marginalised groups as unfit to parent and of eugenic policies targeting those with ‘undesirable’ bodily conditions or behaviours. This is part of a broader pattern of stratified reproduction – structural conditions that enable or discourage certain groups from reproducing – that often brings about and exacerbates injustices. This paper critically assesses the US and UK social and medical literature on applying pressure to marginalised groups, or those who have behaved ‘irresponsibly’, to use long-acting reversible contraception (LARC). Targeting young people for LARC fails to recognise that social inequality is the context for teenage pregnancy, not the result of it. Provider pressure on women of colour to use LARC is linked to institutional racism, whilst policy for those with physical and intellectual disabilities is shaped by disability discrimination. Other groups to be targeted include so-called ‘welfare mothers’, substance users, those who have had children put into care and offenders. Particularly controversial are cases in which LARC has been ordered by courts. LARC policy incorporating these kind of discriminatory practices needs to stop; future policy should focus on person-centred care that bolsters reproductive justice.