Access Denied: The Startling Struggle for Birth Control Access in Black, Brown, and Low-Income Communities

Image of birth control methods (pill, implant, ring) rubber stamped in red ink the word "Denied"

Contraception is fundamental health care and a core part of life for those that can become pregnant. But barriers to birth control result in a stark denial of individuals’ preferred contraceptive methods. More than nineteen million women of reproductive age in the US live in contraceptive deserts— counties that lack reasonable access to a health center that offers the full range of contraceptive methods. In Illinois there are 780,370 women of reproductive age that reside in these contraceptive deserts. On top of this access barrier, individuals also face systemic obstacles to receiving care, such as racial and ethnic biases. By removing barriers to contraceptives and addressing each one with appropriate resources, we can safeguard an individual’s choice of becoming pregnant or not while expanding access to birth control in a more equitable manner.

Over the course of the last few years, long-acting reversible contraceptives (LARCs), such asimplants and IUDS, have become more popular due to their safe and highly effective characteristics. However, even with this increased traction of usage, research reveals a disparity—Black and Latina women are less likely to use these birth control methods in comparison to their white counterparts. Diving into the historical context is the key to not only emphasize this blatant inequality head on but also helps us understand why it is still an issue after all these years as we unravel the deep-rooted past of reproductive injustices in the United States, particularly against Black and brown women. The women in these communities have been subjected to various forms of mistreatment, including forced sterilization, coerced use of birth control, and eugenics among other atrocities. The backstory of birth control is crucial for a collective perspective on the challenges faced by these communities in the realm of reproductive justice and healthcare.

The origins of the gaps we see in LARC usage today go as far as forced sterilization of Black and brown women in the early 1900s that extend into the 2000s. By 1935, eugenics held a strong influence across the United States as thirty-two states maintained federally funded eugenic boards that endorsed sterilization of those that were labeled undesirable and dangerous. Women faced forced sterilization on grounds of excuses that categorized them to be “feeble-minded,” promiscuous, insane, criminal, disabled, and facing poverty. Imagine the outrage at how many women became victims of these labels that robbed them of their reproductive rights! Of course Black and brown women were amongst those that were particularly targeted under these laws.

Despite the common belief that forced sterilization is a thing of the past, it is crucial to recognize that some of the laws permitting these heinous actions are surprisingly recent:currently 17 states allow the permanent, surgical sterilization of children with disabilities and the majority of people in the United States that are impacted by forced sterilization are under conservatorship. For example, in the Summer of 2021 Britney Spears, an affluent and white American pop icon, testified that she was forced to use birth control by her father while under a conservatorship, and although she was not subject to surgical sterilization, she was not immune to the grim reality of forced sterilization. Spears’ story serves as a great example of the widespread issue of forced sterilization and while acknowledging her privileged status, it is crucial to remember that Black and brown women remain the most targeted victims of reproductive injustices.

Contraceptive coercion has played its own role in these disparities as early advocates for contraceptives, including Margaret Sanger, the founder of Planned Parenthood, adopted a racist and eugenicist argument to increase the use of birth control. Sanger championed contraceptives by suggesting that increased access to contraceptives can control growing immigrant and “poor” populations. Even the creation of the first oral contraception pill—initially celebrated as a tool for the empowerment of middle-class white women—had its origins of testing in Puerto Rico on women often without their consent or knowledge.

In the 1990s, subtler efforts of racial discrimination emerged as Norplant, a hormonal implant, was predominately marketed to Black and brown women. There were swift efforts by judges and legislators to enforce the use of Norplant among Black and brown women due its automatic functionality, easy monitoring, and requirement of medical assistance for removal. Now try and wrap your head around this one: judges in several states even went as far as to present women convicted of child abuse or drug use during pregnancy with a “choice” between utilizing Norplant or facing incarceration. It was not just a legal choice but rather a violation of personal autonomy.

Throughout the early 1990s, lawmakers in over a dozen states proposed measures that, if approved, would have compelled women to use Norplant by including financial incentives for women on welfare and making Norplant usage a requirement for continued use of their benefits or they would be at risk of losing them. Although Norplant’s distribution in the United States was discontinued in 2005, there is still reasonable mistrust against contraceptives within Black and brown communities, fostering a perception of targeted recommendation, specifically when birth control methods, such as LARCs, are suggested to them.

Here at ICAN! we understand this justifiable suspicion and have created a Know Your Rights guide that supports patients throughout their journey to seek birth control. We have also created a Birth Control Quiz and Birth Control Options page to allow health care seekers to decide for themselves which method makes the most sense based on their personal preferences and goals.

Recent evidence has revealed that clinicians disproportionately recommend LARCs to Black, brown, and low-income women as opposed to their white counterparts. Effectively addressing racial bias is imperative whether you are a provider, a policymaker, an advocate for birth control access, or an ally! You can help regain the trust of those that have been victims of reproductive injustices and contribute to dismantling a systemic barrier. ICAN! trains providers in person-centered contraceptive counseling using a TRUER care approach, i.e. Trauma-informed, Respectful, Unconscious bias aware, Evidence-based, and Reproductive well-being centered. This training improves providers’ ability to understand patients’ specific life circumstances and support them in selecting the best birth control method based on their unique needs and desires.

ICAN! also ensures that patients’ contraceptive care experiences are taken into account when measuring care quality. Our Patient Experience Survey asks if you were respected as a patient, if you were able to address what mattered to you about your birth control method, if your preference about birth control was taken seriously, and if you were given enough information to make the best decision about the birth control method of your choice. Finally, we center lived experiences of Black and brown folks through engaging our diverse Community Advisory Board to inform and receive feedback on our patient engagement work and materials. We know that we cannot change the past, but we can recognize the damage it has done and work together to create a future for birth control seekers that is safe and equitable.

By Deepali Gill, ICAN!’s If/When/ How Fellow