Last November, Colorado voters rejected a constitutional amendment that would have defined personhood as inclusive of fetuses. This victory for reproductive rights, however, was won amid a slew of attacks on Coloradans’ reproductive freedom. Now, many of Colorado’s Republican lawmakers, armed with shoddy science, are pushing an agenda that prioritizes not only the not-yet-born, but the not-yet-conceived.
These lawmakers are working to ensure the demise of the Colorado Family Planning Initiative, a program focused on reducing rates of unintended pregnancy, particularly among teens and younger adults. The program makes long-acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs), available at low or no cost to Colorado residents otherwise unable to afford such methods. IUDs and implants are highly effective, and because they last several years, they can be more practical for people unable to easily access a clinic to obtain short-term contraceptives such as birth control pills. However, the upfront cost of an IUD—ranging from $500 to well over $1000—is often prohibitive, and many on the Right want to keep it that way.
With help from the Susan Thompson Buffett Foundation, which furnished the state with a grant to the tune of approximately $25 million, Colorado has been able to defray the costs of more than 30,000 LARCs for low-income, uninsured, and underinsured people who can become pregnant. But the pilot period funded by the grant is coming to a close, and the grant is not being renewed, leaving the program’s fate uncertain. State Representative K.C. Becker (D-Boulder) has introduced a bill that would provide $5 million in state funding for the program, but the legislation—which enjoys Republican co-sponsorship—faces strong opposition from certain Republican lawmakers. Senator Kevin Lundberg (R-Berthoud), for instance, erroneously claims that IUDs are abortifacients, which, under current state laws, would make them ineligible for state funding except in cases involving life endangerment, rape, or incest.
Lundberg and his allies are propelled by post-Hobby Lobby v. Burwell momentum. In January, Hobby Lobby served as precedent for a federal judge to approve requests from three Colorado companies wanting to circumvent the Affordable Care Act by offering employee health plans without coverage for sterilization or contraceptives. They also have substantial backing from right-wing organizations, including Focus on the Family (headquartered in Colorado Springs), Colorado Right to Life, and Personhood USA.
Given that the termination of this program would most affect the reproductive autonomy of low-income women, many of whom are of color, this is certainly a Reproductive Justice issue.
Crucially, when applied to the conflict in Colorado, this framework does not allow for easy demarcation between right and wrong. While access to LARCs is a critical component of full bodily autonomy for people who can become pregnant, it certainly does not guarantee bodily autonomy—indeed, programs meant to enhance access can further endanger bodily autonomy, especially for women of color. I wrote extensively about how programs which on the surface seem to be providing greater choice to women, often turn out to be little more than right-wing initiatives pushing a eugenics agenda among women of color.
Reproductive Justice advocate and activist Natasha Vianna challenges directed attempts at lowering teen pregnancy rates, writing, “Across the country, young girls of color are often being coerced and forced onto long-acting contraception like the IUD. This is not teen pregnancy prevention, this is abuse.” As Vianna aptly underscores, to treat teen pregnancy as inherently negative or harmful to young people who become pregnant is far more damaging than teen pregnancy itself is. Indeed, teen pregnancy need not be damaging at all, and resources spent “ending” it would be better devoted to ensuring that young parents have the resources and support necessary to parent without making sacrifices in other areas of their life.
Similarly, in “Women or LARC First? Reproductive Autonomy and the Promotion of Long-Acting Reversible Contraceptive Methods,” Anu Manchikanti Gomez, Liza Fuentes, and Amy Allina identify the relationship between reproductive oppression, particularly racism in family planning settings, and insufficiently careful promotion of LARCs. The authors cite studies, history, and current events to substantiate the claim that care providers respond differently to patients who are profiled as members of “high risk populations,” often directing these patients toward particular contraceptive methods. The report adeptly situates this phenomenon in “the long-standing devaluation of the fertility and childbearing of young women, low-income women and women of color in the United States, and the perception that these women have too many children.”
A study undertaken by Philliber Research Associates shows that in Colorado in 2008 (just prior to the onset of the initiative), unintended pregnancies occurred at disproportionately high rates among Latina women, African American women, and other women of color: groups whose reproduction is consistently demonized and pathologized. Consequently, unintended pregnancy can be used as a coded way to discuss population control among communities of color. The connections the authors draw between LARCs and coercive sterilization of populations of color must not be overlooked: while LARCs are, of course, reversible, they are costly to remove, and whether the initiative funds their removal—or whether their removal would be affordable after the program’s termination—is not clear.
Furthermore, a key aspect of the argument presented in “Women or LARC First?” is that LARCs ought not to be presented to patients as the ideal contraceptive, yet this is exactly the approach taken by Greta Klinger, the family planning supervisor for Colorado’s Department of Public Health and Environment. Klinger told the Washington Post, “If you have a drug that is 20 times more effective than other drugs, you will always start with that as your first option…What we did (in the Colorado Family Planning Initiative) is kind of flip the mindset, so rather than introducing all contraception as being on the same playing field, we said, ‘Let’s start with what is most effective.’”
Given that the appropriateness of LARCs must be evaluated on a patient-by-patient basis, it would seem that Klinger is most concerned with cost-effectiveness. It is telling that coverage of Colorado’s initiative tends to highlight both Colorado’s steep decline in teen pregnancy rates and the estimated amount of public funds saved in accordance with this decline. Mother Jones reports a state estimate of between $49 million and $111 million saved by Medicaid based on the number of births prevented. Moreover, a report issued by the Guttmacher Institute and co-authored by Klinger herself uses as a metric of success the numbers of infants receiving services through the Special Supplemental Nutrition Program for Women, Infants and Children. Cost-benefit analyses such as this, when applied to reproduction, have eugenic implications.
Without question, there is value in programs that make contraceptive methods accessible and affordable to anyone who wishes to use them; these initiatives are no less than necessary. However, their conception and implementation must be careful, critical, and fully contextualized in the United States’ eugenic past and present. The impetus for such programs cannot be eliminating Medicaid costs or controlling populations (however coded the articulation of the latter goal may be). On the contrary, these projects must be impelled by the liberatory vision that SisterSong’s framework maps for us: a vision that strains against reproductive oppression and strives for a world in which all people have full control over their reproductive lives.