I probably do about 10-15 birth control visits a day, depending on my schedule. They are our bread and butter, and 99% of women who have sex with men will use a birth control method at some point in their lives. Most of these women choose to use that birth control method of their own free will. And because I see hundreds of patients a month, I see something that very few providers see, or know how to look for: signs of contraceptive coercion.
I have had a few cases in the past few weeks that has me thinking hard about the legacy of forced sterilization in this country (for an amazing primer, see Killing the Black Body by Dorothy Roberts).
I wrote a while ago about reproductive coercion, but hadn’t seen much of it since leaving one specific clinic site.
Then, it smacked me in the face. A 13 year old sitting in my office, with orders from her mother to start the depo shot. This young woman was not sexually active, nor did she plan to be anytime soon. I like to talk to each of my patients alone before letting a support person back with them, and man was I glad that I do that on that particular day.
Barely out of childhood, this young woman stared at her shoes, and said she needed to start the depo shot.
“Are you planning any sexual activity?” I asked
“No, but my sister got pregnant last year and my mom wants me to be on the shot.” she sheepishly replied.
“Do you want to be on the shot?”
“No, not really.” She was still staring at her shoes. I told her I was not going to make her do anything she didn’t want to do, that it was her choice, and it really didn’t make sense for her to be on the depo. We talked about all the other birth control methods out there, she took some information, and I gave her the promise that we’ll always be there if she is thinking about having sex and needs a birth control method. She thanked me and left.
The the storm hit. Mom was not happy when her daughter emerged from the exam room without the depo. She argued with the front desk staff. The daughter then said that she did want the shot.
What was I to do?
I stood my ground. I didn’t feel comfortable giving the shot. She had told me, alone, that she didn’t want it. Her mother said she understood and left. But I know that this woman will find another provider, another clinic that doesn’t screen so well, that doesn’t ask so many questions, that doesn’t speak to their patients alone, and her daughter will be forced onto a method she neither wants nor needs.
Recently I had another encounter which left me feeling even more squeamish. A young woman with a developmental disability and her mother and caregiver came in because her pediatrician refused to give her the depo shot anymore. She had been on it for two years, and the girl’s doctor was worried about bone density. (There isn’t too much good evidence to support this practice, but many providers have women cycle off the depo every few years). The mother wanted her daughter to be put on the Nexplanon, a long acting method. I immediately felt my stomach turn. Can this young woman consent to a long-acting birth control method? Can the mother consent for her and I have no choice? How much does this young woman understand? Can she truly give informed consent?
Dorothy Roberts’ book, although it focuses on the forced sterilization of black and brown women, also discusses the long history of forced sterilization of developmentally delayed and disabled individuals. It felt like a page from her book, a page from the past was hitting me square in the face.
These two cases are an ever-present reminder that even though forced sterilization is no longer codified in law, it still takes place, we, as providers, just have to know how to look for it.