‘Soft sterilization’: How doctors are coercing disadvantaged women into long-acting contraception

A recent article published by TIME exposes the continuing acts of eugenics carried out against women of color and financially disadvantaged women in America. Using coercion and repeated pressure, some doctors are participating in what one professor calls the “soft sterilization” of specific, targeted groups of women — discriminatory behavior reminiscent of the forced sterilizations that plague United States history.

Three of the women who shared their stories with TIME — Miannica Frison, LeAnn, and Crystina Hughes — spoke of being pressured into using long-acting reversible contraceptives (LARCs). Frison, a woman of color, was asked about both sterilization and a LARC immediately after giving birth to her third child. LeAnn, a white woman who accesses Medicaid for health care, was pressured into a LARC when she had her second child. For Hughes, a doula, it took seeing other women being pressured into a LARC to realize that she had been pressured into one as well.

LARCs include hormonal IUDs sold under ‘pretty’ names like Mirena, Skyla, and Kyleena, as well as the non-hormonal IUD ParaGard. There are also contraceptive implants, the contraceptive injection Depo-Provera, and contraceptive patches. All have side effects and risks. But while women of all backgrounds are often advised to consider birth control — or even permanent sterilization — after giving birth to a certain number of children, when women of color and underprivileged women refuse to use LARCs, some doctors refuse to take no for an answer.

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“The idea is that we can stop people that we don’t want to be reproducing from reproducing, but can say, ‘This is temporary because it’s removable,’” Della Winters, a professor at California State University, Stanislaus told TIME.

Winters has studied the history of LARCs and calls the rise of this ‘provider-controlled contraception’ a “soft sterilization.”

Modern cases of eugenic birth control

Doctors refused to remove her IUD, though she begged… for three years

Frison told TIME she was in the middle of labor with her son in 2020 at UAB Hospital in Birmingham, Alabama, when a nurse — who had learned this was Frison’s third child — asked her if she wanted to be sterilized immediately after giving birth. An angry Frison kicked her out of the room.

But as Frison then lay on the operating table, moments after having an emergency C-section, a doctor entered the room with a specific intent. “We can go ahead and put an IUD in right now, since you’re already open,” the doctor said.

The birth had been traumatic and Frison was “woozy,” reported TIME, and she gave the doctor permission to implant the Mirena IUD. She was told it would work for eight years — but it only took a few months before Frison asked for it to be removed.

No one granted her request.

For its part, UAB told TIME that all of its patients are counseled on contraception and options throughout their pregnancy, claiming it provides equal care to all patients.

TIME reported that doctors told Frison she had to lose weight before they would remove the IUD. Stunningly, she was also advised to keep the IUD in place and take other medications instead, to simply mask the side effects she was experiencing — throwing more drugs at her rather than honoring her request to remove the device.

It was three years before a doctor finally removed the IUD — and by that point, it had embedded into the lining of her uterus. IUD migration is a known problem that has caused horrific injuries to women. The doctor left four thumb-sized scars on Frison’s stomach in the process of attempting to locate the IUD inside her.

“I don’t have faith in doctors anymore,” said Frison. “I can’t trust any of them.”

Her doctor didn’t remove her IUD for a year… and not until she agreed to other contraception

LeAnn was a stay-at-home, 20-year-old mom using Medicaid when she welcomed her second child in 2018. Her doctor repeatedly questioned her about her plans for birth control after she gave birth — and eventually, she agreed to get the Mirena IUD.

Almost immediately, LeAnn began experiencing side effects. She would wake at night with uterine pain intense enough to warrant an emergency room visit. After three months, she asked her doctor to remove the IUD, but unbelievably, he told her he wouldn’t remove it unless she chose another type of contraception as a replacement.

“I suffered for a year,” she told TIME.

Research suggests that the women in the TIME article are not alone. Doctors are often unwilling to remove IUDs from women who already have children or are of low income. One study found that one in four women at a clinic in Bronx, New York, were refused after asking doctors to remove their IUDs.

Additional research published on PubMed included a quote from one doctor who said, “I’ll never just walk in a room, ‘Oh, we’re just taking the IUD out?’ Sometimes I’ll get them to say, ‘Let me just examine you, do some cultures, let me do an ultrasound and make sure it’s in the right position.’ And then secretly I know I’m not going to fix their bleeding, but secretly I’m hoping that they’ll just leave and not come back in … or they just can’t get back in to get it removed and things will calm down” (emphasis added).

Her doctor wouldn’t take no for an answer, so she gave in

Hughes told TIME that moments after her daughter was born in 2019, a doctor asked if she wanted an IUD since her cervix was already dilated. She refused, but after her husband left the room to check on their baby in the NICU, the doctor asked her again.

Trusting the doctor, Hughes decided that if he was going to ask twice, it must be important, so she agreed.

Within a year, the IUD had to be removed due to a prolapsed uterus.

After Hughes became a doula, she began noticing that other women were pressured into getting LARCs, too. “It really took me becoming a doula to realize that I was coerced into getting the IUD,” she said.

ACOG claims “cost-benefit” to immediate IUD placement after childbirth

TIME notes some seemingly valid reasons for doctors to suggest an IUD during labor. The woman may already be on pain medication, she is already there at the hospital, and women on Medicaid may sometimes only be able to access the health benefits through the postpartum period.

Another reason, however, is concern that if she doesn’t get a LARC immediately, she may return pregnant at her next visit.

The pro-abortion, pro-population control American College of Obstetricians and Gynecologists (ACOG) argued that based on “cost-benefit analysis data,” placing an IUD immediately after birth is best “especially for women at greatest risk of not attending the postpartum follow-up visit.” But this doesn’t explain why doctors are not discussing this subject with patients during routine pregnancy appointments instead of waiting until patients are in active labor or are in vulnerable physical and mental states immediately after birth. And as TIME pointed out, it also leaves the door open for doctors to fall back on their own preconceptions about women to essentially presume who will or won’t show up for a postpartum checkup.

In addition, Medicaid often covers postpartum IUD placement while private insurances may not — and TIME reported a disturbing trend. Since 2012, 43 states have changed their Medicaid policies to allow hospitals to receive additional financial compensation when doctors place an IUD or implant immediately after birth. So these states not only pay for the IUD — they also give the hospitals a bonus for the “soft sterilization” of women on Medicaid.

A history of sterilization

In the United States during the 1960s and 1970s, disadvantaged women and women of color were pressured — and forced — into sterilization. As Live Action News previously reported, Elena Orozco was surrounded by doctors telling her that she should have her tubes tied. Out of fear, she signed a consent form, but it wasn’t for the procedure that she actually received.

“What I was signing,” she said, “I understood it to tie my tubes, not to sterilize. If they would have put the word ‘sterilization’ there, I would not have signed the papers.” Instead of tying women’s tubes, doctors actually cut her fallopian tubes and cauterized them — an irreversible procedure.

Consuelo Hermosillo delivered three children by C-section, and when she became pregnant for a fourth time, doctors lied to her, saying it was illegal for a woman to have more than three C-sections unless she agreed to be sterilized. Trusting her doctors and fearing that she and her baby would die, Hermosillo “consented” to sterilization at age 24.

The State of North Carolina has made headlines for its eugenic history, including a sterilization program in Charlotte that targeted the Black community. The program focused on “the poor and destitute, with a particular focus on black Americans.”

Wallace Kuralt, the man behind the program, believed it would save tax dollars by reducing poverty among the “low mentality-low income families, which tend to produce the largest number of children.”

Other women have shared stories of consenting to being sterilized while they were still under the influence of the drugs doctors gave them during the deliveries of their babies. Some were even told they couldn’t have pain medication during labor unless they agreed to be permanently sterilized. One witness, Dr. Karen Benker, said:

On an almost daily basis, the doctor would hold a syringe in front of the mother who was in labor pain and ask her if she wanted a painkiller; while the woman was in the throes of a contraction the doctor would say, “Do you want a painkiller? Then sign the papers. You want the pain to stop? Do you want to have to go through this again? Sign the papers.”

When the feminist group, the Advisory Committee on Sterilization, was formed in 1975, it sought to end such discriminatory population control tactics and proposed safeguards like waiting periods before sterilization. However, according to author Rebecca M. Kluchin, “Advisory Committee members confronted fierce resistance from physicians [and] family planners like Planned Parenthood… Perhaps the most surprising opposition came from white liberal feminist organizations like the National Organization for Women (NOW) and the National Abortion Rights Action League (NARAL)” (emphases added).

These groups feared that regulating family planning in any way would lead to restrictions on abortion, and ultimately voted against the reproductive “choice” and “bodily autonomy” they claim to care so much about.

Mieke Eeckhaut, a sociologist at the University of Delaware, explained to TIME that women of color, as well as women who are young, economically disadvantaged, and unmarried are today disproportionately being coerced to use LARCs with similar tactics used by pro-sterilization doctors of the mid-century.

“These ideas of who should and shouldn’t have children are still very much influencing our policies and practices,” he explained, “even if it’s more subtle than in the past.”

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