Excerpt from “Birth Control Isn’t Always a Choice” by Karla Sanchez
When most people think of birth control, they think of freedom—the ability to decide if or when to have children. But for many, especially in marginalized communities, birth control hasn’t always been about choice. It has often been used as a tool of control, shaped by systemic racism, eugenics, and medical coercion.
Historically, reproductive healthcare in the U.S. has been used to reinforce power imbalances. Johanna Schoen’s Choice & Coercion reveals how, in the early 20th century, public health programs promoted sterilization and contraception to poor women and women of color—not for their benefit, but because they were viewed as “unfit” to reproduce. These practices were rooted in eugenics, the belief that certain groups should be prevented from having children. Under state-sanctioned programs, Black and Indigenous women were disproportionately targeted, often under the justification of economic efficiency or public health. These acts weren’t isolated—they were part of a broader belief system that devalued the reproductive rights of anyone who didn’t fit the mold of whiteness, wealth, or able-bodiedness.
Even today, reproductive coercion continues in more subtle but no less harmful forms. Grace Howard (2017) highlights that healthcare providers sometimes pressure patients—particularly Black and Latina women—into using long-acting reversible contraceptives (LARCs) like IUDs. In some cases, providers have even received financial incentives from institutions to increase LARC placements, raising serious ethical questions about consent. These patterns suggest that the medical system still struggles to trust marginalized women to make their own reproductive decisions. Consent becomes complicated when the person being “offered” care is being subtly nudged, or even financially incentivized against.
This legacy of coercion has contributed to a deep mistrust between communities of color and the healthcare system. That mistrust is not unfounded and it stems from a long history of medical abuse, including unethical experimentation, forced sterilizations, and systemic neglect. A study by Dehlendorf et al. (2014) found that racial biases, poor access to care, and negative experiences with providers are major factors in the inconsistent use of contraception among women of color. When the system has repeatedly harmed you, it’s hard to trust it with your most intimate decisions—especially when those harms are still happening today.
These issues go beyond race. Disabled women, especially those with intellectual or developmental disabilities, often face their own set of injustices. A 2022 study in Women’s Health Issues found that many disabled women don’t get to decide whether or how they use birth control. Those decisions are made by guardians or providers, sometimes without full understanding or consent. That’s not just paternalistic; it’s a direct violation of bodily autonomy. It reinforces the dangerous idea that some people are unfit to parent and don’t deserve control over their own bodies.
The idea that birth control is a symbol of empowerment becomes complicated when we look at who gets to choose and under what conditions. True reproductive freedom isn’t just about having access to contraception. It’s about ensuring that people can make informed, voluntary decisions about their bodies—without pressure, judgment, or systemic coercion. Until that’s possible for everyone, the promise of choice remains unequal.
