The Birth Control Movement:  The Part Played by Eugenics and Racism

by Natasha Furtado Dalomba, MD (’24) 

For many, “birth control” or contraception is a path to achieving their goals for their bodies and their lives. As a pediatrician, I often frame contraception in this way for my patients. They can have better/fewer/less painful periods, or perhaps improve their acne or mood, and of course prevent pregnancy. However, to appreciate the liberation that contraception can provide, one must also recognize and reckon with the oppression and trauma in its history.  

In 2021, Planned Parenthood took the step of denouncing Margaret Sanger’s belief in eugenics while recognizing that her work as their founder helped move reproductive rights forward. This forward movement in reproductive rights started with the exploitation of marginalized communities and removal of reproductive freedom for Black people, Indigenous people, Latino people, people with disabilities, and many other communities.

The first large scale human trials for the birth control pill were set in Puerto Rico in 1955. At  the time it was one of the most densely populated areas in the world and struggling with wide-spread poverty, so the inventors of the birth control pill thought it would be the perfect setting for their large clinical trials. Puerto Rican women were told that the birth control pill would prevent pregnancy, but they did not know that it was a clinical trial that could have dangerous side effects. The doses used in this trial were much larger than the doses in pills on the market now, leading to side effects that were deemed unacceptable by Puerto Rican health care professionals. However, the concerns were dismissed and many of the side effects were thought to be “psychosomatic” by those running the study. Three women died while participating in the trial and their deaths were never investigated.

Birth control as a method to reduce rates of poverty by preventing rising birth rates in underserved communities has a dark and brutal history. In 1927, the U.S. Supreme Court upheld the state’s right to forcibly sterilize a person considered unfit to procreate leading to the forcible sterilization of 70,000 Americans. Hysterectomies in the South were given the name “Mississippi Appendectomies” as some women as young as 12 were told that they were getting their appendix removed only to find out years later that it was in fact their uterus. This disproportionately impacted Black communities. This history is more recent than many people realize. In 1973, two young African American girls were sterilized in Montgomery, Alabama after their mother, who could not read, placed an “X” on a form thinking she was consenting to contraception injections but instead this led to both girls being sterilized. Additionally, Indigenous women in the United states were forcibly sterilized up until 1976, with an estimated 25% of Indigenous women of child bearing age being sterilized from 1955-1976.

Many of our patients have experienced generational or personal trauma at the hand of the medical system, and we cannot have a trauma-informed approach to contraception counseling without knowing the history of medicine and its impacts. The history in this post is just a portion of the story and does not touch upon the sterilization of other communities, including immigrant women and people with disabilities. Contraception is about choice and so many people from marginalized communities have had that taken away from them. As a pediatrician, my job is to provide information and education to help guide patients towards well-being with their health goals in mind. They ultimately decide what is right for their bodies. We often forget to ask our teens about their thoughts and goals around pregnancy and we don’t ask permission to discuss sensitive topics regarding their bodies.  I encourage pediatricians to think more carefully about how we discuss contraception with our patients, to recognize medical trauma, and to keep patient goals and autonomy at the center of the conversation.

 

REFERENCES

  1.        “Opposition Claims about Margaret Sanger.” Planned Parenthood, Planned Parenthood, Apr. 2021, www.plannedparenthood.org/uploads/filer_public/cc/2e/cc2e84f2-126f-41a5-a24b-43e093c47b2c/210414-sanger-opposition-claims-p01.pdf.
  2.       . Gold RB. “Guarding Against Coercion While Ensuring Access: A Delicate Balance.” Guttmacher Institute, 2014, 17(3),  www.guttmacher.org/sites/default/files/article_files/gpr170308.pdf, Accessed 13 July 2023.

  3.      Gomez AM, Fuentes L, Allina A. “Women or LARC first? Reproductive autonomy and the promotion of long-acting reversible contraceptive methods.” Perspect Sex Reprod Health. 2014 Sep;46(3):171-5. doi: 10.1363/46e1614. Epub 2014 May 23. PMID: 24861029; PMCID: PMC4167937.

  4.          “The Puerto Rico Pill Trials.” PBS, Public Broadcasting Service, www.pbs.org/wgbh/americanexperience/features/pill-puerto-rico-pill-trials/. Accessed 13 July 2023.

  5.         “Sterilizing the Sick, Poor to Cut Welfare Costs: North Carolina’s History of Eugenics.” ABC News, ABC News Network, 7 July 2011, abcnews.go.com/Health/WomensHealth/sterilizing-sick-poor-cut-welfare-costs-north-carolinas/story?id=14093458.

  6.           Gladstone, Mariah. “Decades after Forced Sterilization, Native American Women in the US Still Face Rejection and Retraumatization in Healthcare.” Lady Science, Lady Science, 11 Sept. 2019, www.ladyscience.com/features/forced-sterilization-native-american-women-face-rejection-retraumatization-in-healthcare?rq=Mariah. 

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