Women’s Health: Birth Control and Armed Social Services | by Rachel Fumilayo Lawal | October 2022

Birth control exists in a variety of forms, but the history of some of these options is murky and rooted in classism, racism, and misogyny.

Graphic by the author.

Birth control has always held quite a controversial position in politics, religion and public health. Its usefulness and importance cannot be denied, although like most things it does not exist outside the realm of criticism. For many poor and colored women in the United States, birth control was a mandatory prescription, a requirement for social support.

The development of hormone-based oral contraceptives is fairly recent, with testing and clinical trials beginning in the mid-1950s. In 1960, the FDA (Food and Drug Administration) approved the first birth control pill, titled Enovid-10. Enovid was successful in using synthetic estrogen and progesterone to stop ovulation, and this method remains the backbone of most birth control methods today.

After the approval and production of Enovid, birth control advertising was taken over by companies and marketed for its number of non-contraceptive side effects such as acne reduction and menstrual delay. The pill continued to grow in popularity, and just a decade after it was developed, about 1/3 of American women were using the pill.

However, the vision of birth control as a liberating birth control option or the miracle of reduced menstrual periods became beyond the reach of many poor and women of color.

The Norplant implant was a contraceptive device made for women that was implanted in the arm and was intended to last up to five years. It is important to note that Norplant’s development was surrounded by strong considerations of population control mechanisms. In 1995, James G. Connell III wrote about international population policy, stating, “The belief that population control should be the primary purpose of family planning programs is so ingrained in culture that it profoundly shapes the culture’s worldview.” Norplant’s inclusion in the international Politics depended on its perception as a population control mechanism. It wasn’t born out of a desire to help women by giving them a choice about when to have children. Connell further emphasizes this, claiming, “This decision is instead a product of the population control strategy being adopted by pharmaceutical companies and international population planners.” The idea that Norplant is being used and developed as a means of population control becomes even more sinister as the demographics on whom it was imposed were marginalized. Poor women, women of color, and young women in inner-city schools were the predominant targets of Norplant implantation.

Norplant received FDA approval in the late 1990s, and its longevity has been denounced by politicians who saw it as an opportunity to force women to accept the implant. During this time, the United States was battling the CIA-created crack epidemic, which disproportionately hit the black community. Subsequent addictions led to an influx of children born to addicted mothers. From this, a series of laws were passed that reconstructed lines drawn around child abuse and neglect. Addicts who are pregnant at the same time face years of imprisonment for endangering children. There have even been reports of mothers being handcuffed to their hospital beds during childbirth and sent to prison after the birth.

When Norplant entered the scene, prosecutors used it as a bargaining chip. Women accused of child endangerment, neglect or abuse because of their addiction coinciding with pregnancy had their sentences commuted to penalties in exchange for receiving the implant. However, this coercion extended beyond prison terms and became the conditional basis for welfare recipients.

Women seeking government housing, food, or cash assistance also had to receive the implant. Some politicians have gone so far as to push for laws that would make Norplant compulsory for all welfare recipients, for impoverished women, and for women addicted to drugs. These pieces of legislation relied heavily on Norplant’s five-year lifespan and assumed that its use would reduce poverty rates in a short period of time. Of course, this idea was rooted in the racist and classist belief that poverty is caused by the choices of the impoverished and not by existing systems that intentionally perpetuate and synthesize the conditions for poverty. These mandates would not have addressed poverty, they would simply deprive women of their bodily autonomy and reproductive freedom. Fortunately, none of the proposals became written law.

Medicaid was subsidized to support Norplant distribution and provide access to free implantation appointments. However, Medicaid did Not Subsidizing removal appointments that varied in price based on how long Norplant was in the patient’s arm. The implant was accompanied by a variety of side effects, including heavy bleeding for prolonged periods, excessive weight gain, ovarian enlargement, depression and extreme pelvic pain. This made it quite difficult for women to continue using it, and many who received the implant for free were surprised to find that the appointment to remove it would cost as much as $500. The costs were probably recovered under the circumstances that the implant stayed in the arm for the full five years. Those who wanted to have it removed because of unwanted side effects or who wanted to get pregnant had to pay extreme fees.

The lack of government funding for Norplant removal spurred a second problem. Untrained medical personnel often slaughtered moves. The process was reportedly extremely painful, and in some cases patients required general anesthesia and multiple surgeries to remove the implant. There have been a number of class action lawsuits following a number of patient complaints and complications.

Norplant was discontinued in 2002 in response to its ill effects.

The popularity of birth control has only increased since its inception, with millions relying on the oral pill or long-acting contraceptives such as implants. It is often presented as a hormone regulation option to treat symptoms of PCOS and hormonal acne. Despite increasing public use, side effects, implantation and removal services, and accessibility are still issues many face.

Society seems to have accepted the idea that women’s well-being is secondary to contraception. This normalization of pain and discomfort is even more worrisome when you consider that many use contraceptives for their non-contraceptive effects. Many birth control pills and medications are accompanied by the same side effects as Norplant, and some even worse. There have been reports of birth control deaths, as well as serious health problems such as stroke, vision problems, heart attacks and pulmonary embolism.

It is strongly recommended that you have an understanding of personal health risks and family medical history when deciding which birth control option is best for you. As always, consult your doctor if you have any questions about this choice.

As noted in my previous article on women’s health, pain is built into gynecology. Accepting and normalizing common, widespread adverse effects is not the norm with other popular drugs and should not be the norm in birth control. Many of the problems women were forcibly exposed to with Norplant in the ’90s are reflected in the problems we see today. IUD removal procedures are expensive, and sometimes doctors suggest postponing them or not doing them at all. Long-lasting contraceptives are still touted as a cure for poverty, and the pressure to use them is greater on poorer women. Side effects associated with use are still painful and difficult, so the same side effects found in a study involving men were enough to stop the study entirely.

Gynecology moves in the modern world with outdated research, practice and equipment. When considering what factors are impeding women’s health progress, it is crucial to understand intersectionality in relation to the field and how precisely this incompetence is deployed against a variety of disparate identities. It’s high time we put our research dollars and efforts into women’s health care to protect, treat, and care for ourselves and those who come after us.

Comments are closed.