Clare Daniel. Frontiers: A Journal of Women Studies. Volume 43, Issue 1, 2022.
The first three years of the Trump Administration had dire effects on the status of reproductive rights in the United States. Within this context, reproductive rights, health, and justice advocates had to respond creatively and forcefully, sometimes utilizing tactics that involved strategic compromises to accomplish their goals. This essay examines the politics of compromise occurring within contemporary fights for equitable access to comprehensive sexual health education and contraception. Analyzing news media and public policy in relation to these advocacy efforts, this essay illustrates that arguments made for sex education in the name of preventing teen pregnancy and for long-acting, reversible contraceptives in the name of preventing abortion undermine the goal of reproductive self-determination. These arguments reinforce notions that have long plagued advocacy for sex education and birth control in the United States—that certain people are illegitimate reproducers and that specific reproductive options are intolerable. As such, these strategic compromises often support the directing of resources toward programs that constrain, rather than enable, reproductive freedom for all people.
Introduction
A December 2018 article in the online magazine Vox explains that abortion rates have decreased, and we have birth control—possibly long-acting, reversible contraception (or LARCs)—to thank for that. Noting that a reduction in abortions could be due to restrictions placed on access to the procedure, the author states that researchers, “tend to think the biggest driver of the decline is increased access to better contraception.” At the same time, she notes, “this decline in abortions is happening amid other positive trends in reproductive health” including the reduction of teen pregnancies, which also “seems to have to do” with better access to contraception. The piece makes an important point about the connections between access to reproductive health services and reproductive outcomes, but does so by casting the use of contraception, especially LARCs, as inherently positive in opposition to unplanned pregnancy, adolescent pregnancy, and abortion as unquestionably negative. This is an example of a politics of strategic negotiation that occurs regularly within contemporary debates about reproductive issues, in which one or more reproductive rights is unceremoniously surrendered in the service of another. This essay examines some of these instances as they play out in the news media and public policy to argue that such strategic sacrifices ultimately undermine the goal of enabling reproductive self-determination for all people.
I focus my analysis on the relationship between concurrent and overlapping movements within reproductive rights, health, and justice activism and advocacy. The first section of this essay looks at the fight for equitable access to comprehensive sexual health education in relation to the battle for the rights of pregnant and parenting youth. The second section examines efforts to advocate for access to contraception in relation to the struggle for abortion rights and access. The framework of reproductive justice—developed by Black women and other women of color seeking to address reproductive in-justices experienced by poor women and women of color, which have been sidestepped or even exacerbated by the mainstream, white-centric, reproductive rights movement—recognizes each of these as complementary projects within a larger movement to create conditions in which all people have the information and resources necessary to make unencumbered reproductive decisions and to raise children in safe and healthy environments. However, dominant discourses surrounding sex education, contraception, abortion, and adolescent and unplanned pregnancy produce institutional and discursive contexts that sometimes pit these efforts against each other.
Early advocacy efforts for sex education and birth control were fraught with mixed motivations, which continue to shape contemporary discourses. Historians have demonstrated, for instance, that formalized sex education in the modern Western world originated in the late 1800s as an effort to negotiate a variety of political and social anxieties about childhood, marriage, whiteness, and the economic futures of nations. Sex education has been presented and used as a tool for molding children according to normative sexual behaviors and familial structures at the same as it has been lauded as a path toward increased bodily, sexual, and reproductive autonomy for young people. Similarly, birth control advocacy of the early 1900s presented it as both a tool for curtailing the reproduction of undesirable classes, as well as greater independence for women. Sex education and birth control have been understood at various points throughout history as mechanisms for preserving white, middle-class norms and controlling the reproduction of poor people, working class people, and people of color. It is therefore unsurprising that contemporary efforts to express the need for equitable access to both—shaped and constrained by the hostility of the Trump Administration toward sexual and reproductive freedom (and the broader political context that ushered that administration into power)—sometimes undermine reproductive justice.
Sex Education to Prevent Young Parenthood
Throughout the first half of the twentieth century, sex education was touted as a technology for preserving the nuclear family and addressing the declining white birth rate by reducing infidelity, venereal disease, and divorce. In the wake of the sexual revolution of the 1960s and the various social transformations that followed, many supporters saw sex education as a way to manage the reality of premarital sex and its consequences. Throughout the late 1960s and early 1970s, the age of marriage rose along with the age at which adults could reach economic self-sufficiency; women were increasingly able to access birth control, abortion, and higher education; and welfare eligibility widened to include previously excluded racialized groups. All of these transformations combined with the rise of neoliberal economic and cultural logics to form the context in which politicians, pundits, and public health professionals named “teen pregnancy” as a social problem.
While attention to the issue of adolescent pregnancy helped generate support for contraceptive access among minors, the so-called “epidemic” of teen pregnancy also enabled a focus on individual behaviors, engaging preexisting concerns about childhood innocence and inadequate parenting, to provide a compelling explanation for deepening economic and social inequalities. Along with punitive welfare reform, sex education was identified as one of the key solutions to this problem. After welfare reform of 1996 and through the first decade of the 2000s, politicians and advocates across the political spectrum continued to understand teen pregnancy almost unquestionably as a social problem, while the debate about how to address it became centered on abstinence-only education versus comprehensive sex education—in other words, whether the target of prevention should be sex itself or the perceived negative consequences of sex.
The United States has never had a centralized sex education system. Rather, advocates have long struggled in a context in which there is no federal mandate and varying levels of funding for different types of education. This results in a wildly inconsistent landscape of education across the country, a situation that often reinforces preexisting inequities. Over the last few decades, the federal government has provided funding for both abstinence-only and comprehensive or “evidence-based” sex education programs in the form of competitive grants to states and nongovernmental agencies. Given the lack of substantive support for comprehensive sex education, advocates have consistently drawn on teen pregnancy prevention as the justification with the broadest appeal. They have regularly, and often primarily, invoked the US teen birth rate, one of the highest among developed nations, to justify the need.
In recent years, however, activists and scholars have increasingly critiqued the standard narratives of pathology and ruin associated with adolescent pregnancy. During the 2010s, a movement for young parents’ rights, informed by the reproductive justice framework, emerged into the public eye, stemming from a tradition of advocates, service providers, and activists validating and supporting young mothers, as well as from scholarship that dispels myths about the supposed dire consequences of teen child-bearing. For instance, the organization NoTeenShame was founded in 2013 by a group of young mothers to create a social media response to “harmful policies and stigmatizing messages” about young parents. In 2016 Bold Futures (formerly Young Women United), a New Mexico-based reproductive justice organization published a report, “Dismantling Teen Pregnancy Prevention,” that pulled together decades of research showing that the dire consequences so often attributed to young parenthood—dependence on government assistance, poor educational and economic outcomes, increased criminal activity, etc.—are unfounded and serve primarily to fuel punitive social policy. Such organizations and individuals have contributed to the rising popularity of notions that (1) becoming a parent as a teenager is a valid choice, (2) that teen parenthood does not cause poverty and other social ills, (3) and that current, widely accepted teen pregnancy prevention tactics do harm to pregnant and parenting teens and potential teen parents.
Nonetheless, the conceptualization of teen pregnancy as a problem is powerfully embedded in our institutions and discourses about youth and sexuality. Most federal funding sources available to support comprehensive sex education programs are explicitly meant to prevent teen pregnancy, as opposed to other social goods that might result from sex education, such as increased self-efficacy, healthier relationships, decreased sexual assault, or increased knowledge about sexual and reproductive health resources. In fact, the demonstrable decline in participants’ adolescent pregnancy rates often forms a primary type of evidence required to establish that an approach is “evidence-based” and therefore deserving of funding. A closer look at one of these grant programs, the Office of Adolescent Health’s Teen Pregnancy Prevention Program (TPP), illustrates that, as its name would suggest, an emphasis on pregnancy prevention and other related outcomes, such as delayed onset of sexual activity, takes precedence over the specific content of the funded curricula.
These “evidence-based” programs are defined by TPP as “those proven to reduce teen pregnancy, behavioral risk factors underlying teen pregnancy, or other associated risk behaviors.” According to Power to Decide (formerly the National Campaign to Prevent Teen and Unplanned Pregnancy), TPP “is focused on evidence and results” rather than content and therefore supports approaches that teach about abstinence, among other things. For instance, the health intervention curriculum Promoting Health Among Teens—Abstinence Only (PHAT-AO) has been funded by TPP in multiple locations throughout the nation. Billed as an approach for settings in which a more comprehensive curriculum is “not permissible,” PHAT-AO does not include instruction on condom use or contraception, but instead focuses on instructing students about the “faulty reasoning and decision making that can lead to HIV, other STIs, and pregnancy.” Designed to teach students that they can easily abstain from sex and convince their partner to cooperate, they learn about the “many positive benefits, both psychological and physical, of practicing abstinence.”
Given the emphasis on a particular type of evidence related ultimately to the curbing of teen sexual activity and pregnancy, TPP is far from an ideal mechanism for the advancement of comprehensive sex education and reproductive self-determination. In fact, not all of the CDC’s nineteen comprehensive sex education topics are themselves conducive to reproductive self-determination, a reality that hearkens back to the conflicting motivations that spurred sex education efforts historically and that continue to inform its definition and implementation today. Despite TPP’s shortcomings, the landscape of funding for adolescent sexual health interventions is such that comprehensive sex education advocates have found TPP to be one of their most treasured resources. This is best illustrated by the Trump Administration’s attacks on the program.
In July of 2017 the Trump Administration cut funding for all eighty-four grantees in the 2015-2019 TPP funding cycle. Citing the “very weak evidence” of the program’s effectiveness, the Department of Health and Human Services claimed that TPP had not delivered on its promises and needed to be reevaluated. In response, advocates argued that the program’s results were actually very impressive from a scientific perspective and that stopping the program in the middle of the cycle defeats its self-correcting and ever-improving design. Moreover, state health officials argued, the cessation of these programs leaves young people who have benefitted from them in the lurch. Leana Wen, then Baltimore’s health commissioner (later, briefly president of Planned Parent-hood Federation of America), noted that TPP funding allowed for “comprehensive reproductive health education in middle schools and high schools across the city.” Politicians rallied to seek clarification as to why the Office of Adolescent Health unilaterally eliminated funding that had been appropriated by Congress. Given the massive upset these cuts caused in terms of sexual health education—research and evaluations that were already underway but would not be brought to completion, and nonprofit organizations that would be forced to downsize or disband—it is not surprising that there was substantial outcry. As multiple organizations sued the Trump Administration to have the funding reinstated and prevailed, commentators made appeals to comprehensive sex education in the name of teen pregnancy prevention and all of adolescent reproduction’s purported negative consequences.
Despite evidence that national players in sex education advocacy had received the messages sent to them by young parents’ rights advocates throughout the 2010s and shifted their approach, local parties on all sides of the debate about TPP publicly agreed that teen pregnancy should be prevented. The Department of Health and Human Services claimed that TPP is no longer necessary, because “teen birth rates have been declining since 1992 and less than one percent of the teen population is served by [TPP].” Meanwhile, supporters of the program argued that teen pregnancy and birth rates are still unreasonably high, that the consequences of teen parenthood are dire, and that TPP funding is likely partly responsible for the decline in rates in recent years. Authors of an opinion piece in the Washington Post, citing increased health risks for mothers and babies; higher rates of high school dropout, poverty, and unemployment; and skyrocketing taxpayer costs, state that “despite the decline, teen pregnancy and childbearing remain a public health priority.” Sidestepping studies that show adverse health, education, and economic outcomes to be correlated, rather than caused by a mother’s age at the time of birth, as well as critiques of the calculus used to determine the purported costs of teen childbearing to taxpayers, these authors perpetuate a number of damaging myths about pregnant and parenting young people in the name of bringing sexual health education to low-income communities of color.
The cancelling of TPP grants was an abrupt move to redirect resources away from evidence-based programs and toward abstinence-only approaches, as the call for funding proposals issued in the wake of the grant cancellation makes clear. In fact, the 2018 Trump Administration proposed budget allocated $277 million in new funding for “sexual risk avoidance” education, which is widely regarded by advocates and public health researchers as a rebranding of abstinence-only education. It follows, then, that the response from the reproductive rights and public health communities was great. Some advocates for the continuation of TPP cited racial and socioeconomic disparities in birth rates and pointed to data showing that rates are highest in places that mandate abstinence-only programs. Despite this attentiveness to social inequality and shifts away from the teen pregnancy prevention framework in response to young parents’ rights advocacy, supporters of TPP did not publicly engage with the question of whether or not teen pregnancy prevention is the proper goal of sex education or the appropriate metric by which it should be evaluated. Instead, their efforts focused on reinstating one of their most valuable resources in a hostile political climate. Advocates of comprehensive sex education likely assumed that they could not afford to voice this burgeoning reproductive justice-informed approach to young pregnancy and parent-hood within the TPP debate.
Nonetheless, advocating for comprehensive sex education in the name of preventing teen pregnancy has a variety of effects that run counter to the tenets of reproductive justice and arguably even to the goal of providing comprehensive sex education. It undermines the movement for young parents’ rights by perpetuating the notion that adolescents make bad parents, that parenting ruins their lives, and that pregnant and parenting young people put a strain on, rather than contribute to, the greater good. Underlying this is the assumption that adolescents should not be trusted to navigate their own sexual and reproductive lives.
Moreover, this laser focus on preventing teen sex and pregnancy not only sets the conditions for debate about the merits of comprehensive sex education, but also enables federal funding of abstinence-only programs like PHAT-AO, and shapes what data is collected and what scholarly research is done to determine the value of comprehensive sex education. The vast majority of data collection efforts and studies done on the effectiveness of sex education programs in the US use sexual activity, unintended pregnancy (the definition and measurement of which is contested), and STI transmission as their primary evaluation metrics. Much less attention has been paid, for instance, to the role of comprehensive sex education in potentially increasing knowledge about consent; reducing sexual assault; improving self-efficacy or body image; deepening students’ understanding of sexual and reproductive anatomy and health; orienting students to sexual and reproductive health resources in their communities; developing communication, negotiation, and relationship skills; navigating media-based sexual content (including pornography, sexting, and online dating); or increasing students’ understanding of sexual pleasure.
Given the current lack of consistent support for comprehensive sex education, advocates must strategically focus on the instrumentalization of sex education—its ability to produce desired outcomes (as opposed to its intrinsic value as a curriculum akin to other required subjects taught in middle and high school, which students have a right to access). Despite the movement for young parents’ rights and corresponding recent changes within organizations historically working on teen pregnancy prevention and sex education advocacy, the current landscape of social conservatism represented and fomented by the Trump Administration presents teen pregnancy prevention as the most salient argument for comprehensive sex education. This is partly the result of the ongoing institutionalization of teen pregnancy as a perceived social problem, but it is also the effect of a capitulation on the part of advocates who seem to have decided not to publicly voice the recent revelation that the goal of preventing young pregnancy and parenthood is not in line with a social justice mission and instead have conceded the notion that there are certain situations in which a person should not be allowed to decide if, when, how, and under what circumstances to become a parent.
Contraception to Prevent Abortion
The history of birth control advocacy, similar to that of sex education, is fraught with conflicting motivations. During the early twentieth century proponents of contraception often held it up as a eugenic strategy for promoting the health and fitness of the national body and curtailing the reproduction of groups perceived as inferior or undesirable. Eugenic concerns spanned both sides of the debate about the social and moral worth of birth control, as opposition to birth control during this period included alarm about “race suicide” associated with the declining white birth rate. In response, many advocates promoted contraception as a means to develop healthier and more successful (if fewer) children. Others perceived it as a path toward autonomy for women and it was treated as such by many women across class and race. Amid on-going evidence that certain family planning efforts were indeed aimed at curtailing the reproduction of poor women and women of color, in the 1960s and 1970s Black feminists resisted claims that the reproductive rights movement was genocidal, citing their right to reproductive self-determination afforded by contraception, abortion, welfare provision, and an opposition to sterilization abuse. Over the course of the mid-twentieth century public support for birth control increased and a series of court decisions gradually legalized it, culminating in the 1972 Baird v. Eisenstadt Supreme Court decision that confirmed the legality of providing contraceptives to unmarried couples.
In the late twentieth and early twenty-first century contraception has not been a controversial issue. Rather, the vast majority of adult Americans think contraceptive use is morally acceptable. This support of contraception in American life, much like the widespread understanding of teen pregnancy as a social problem, stems partly from its perceived relationship to other social issues, including unintended pregnancy, poverty, and abortion. Despite the legal right to and widespread public acceptance of contraception, actual access to the array of available birth control methods remains contested and uneven. As contemporary advocates promote access to contraception—particularly in the wake of President Donald Trump appointing Neil Gorsuch and Brett Kavanaugh to the Supreme Court and the emboldened antiabortion movement that has resulted—their appeals register some of the conflicted discourses of the past, often displaying a confused tangle of sentiments related to women’s liberation, eugenics, and social conservatism. This is best illustrated by discussions of long-acting, reversible contraceptives (LARCs)-intrauterine devices (IUDs), subdermal implants, and injections—which are lauded for their high rate of effectiveness and the low level of effort required to maintain proper use.
Since their invention LARCs have been presented as a solution to a variety of perceived social problems, including unintended pregnancy, teen pregnancy, public expenditure on welfare programs, poverty, child abuse, and abortion. In a Trump-era example, the 2018 New York Times article “Set it and Forget it: How Better Contraception Could be a Key to Reducing Poverty,” author Margot Sanger-Katz discusses the potential of LARCs to reduce unintended pregnancy, abortion, Medicaid costs, and poverty. She outlines a program in Delaware that aims to make LARCs more accessible and affordable. Despite citing a number of studies that show unintended pregnancy to be a symptom, rather than a cause of poverty, she draws on the work of Brookings Institution Senior Fellow Isabel Sawhill—a longtime advocate of social policy that removes material supports from communities of poverty and instead emphasizes marriage promotion and (effectively low-wage, flexible) employment—to support the widely challenged claim that outcomes for “young women with unintended children” differ greatly from those “with planned children later on.” She writes, “Children whose births are unplanned are likelier to have health complications, to be born into poverty, to stop their education sooner and to earn less. Mothers of unplanned children tend to give birth when they are younger, leave school earlier and earn less when older.” Although later in the article she quotes an expert who refutes the implied causality in this statement, the overarching message of the article is that LARCs likely present a cost-effective approach to solving multiple social problems at once—poverty, teen and unplanned pregnancy, abortion—with broad appeal across the political spectrum.
In response to such arguments, critics and reproductive justice advocates point to research refuting the idea that LARCs reduce poverty and state that this suggestion draws attention and resources away from addressing the structural forces that cause poverty. They also refer to the US’s long history of reproductive coercion against poor women and women of color and argue that programs like Delaware’s are an extension of this history. Some re-searchers ask what difference it would make whether LARCs could reduce poverty when, either way, fertile people should have uncoerced, equal access to all contraceptive methods and the ability to choose what is right for them. As this important work helps to popularize reproductive justice goals, less consideration has been paid to the arguably more palatable argument that has gained ground in the period of crisis brought on by the Trump presidency’s stance toward reproductive rights—that LARCs reduce abortion.
Like the Vox article cited in the opening of this essay and Sanger-Katz’s piece, recent advocacy for contraceptive access appeals to its ability to reduce abortion rates, an argument that, while it has a longer history, responds directly to mounting antiabortion activity in state legislatures across the United States during 2010s, activity which has only increased since Trump took office. A 2017 HuffPost piece, for instance, cites LARCs as one of the most effective ways to reduce abortion. “Short of sterilization—which is permanent—the use of long-acting reversible contraception (known as LARCs) is the most effective way to prevent pregnancy.” Ignoring the reality that vasectomies are reversible and thus a nonpermanent form of sterilization, this argument hinges on the assumption that women and people with uteruses are the rightful target of pregnancy prevention efforts. The author, Anna Almendrala, also points to sex education as an important method of reducing abortion and argues that access to both LARCs and comprehensive sex education are ways of increasing reproductive autonomy rather than diminishing it in the way that laws restricting abortion do. Framed specifically as an answer to the “rash of recent statewide antiabortion laws” in the era of Trump, Almendrala states that a “large minority” of teen pregnancies end in abortion and LARCs are “the most effective way to prevent teen pregnancy.” Thus, teen pregnancy is presented as the root cause of the apparent problem of abortion and (in keeping with sources analyzed in the above section) sex education along with LARCs are presented as the best solutions.
While there is evidence to suggest that increased use of contraceptives reduces unintended pregnancy and therefore abortion, there is also reason to be skeptical of this linear story. In his 2019 study of the relationship between contraception and abortion on a global scale, medical demographer John Cleland points to a variety of factors that mediate this relationship, including cultural norms around “the length of sexually active reproductive life; the number of desired children and thus the number of years that comprise welcome pregnancies, including time to conceive, gestation and lactational protection; and the propensity to terminate unwelcome pregnancies.” He notes that in the United States, increased contraceptive use was initially accompanied in the 1980s with increased rates of abortion, which has been attributed to changes in fertility expectations and increased willingness to terminate a pregnancy. Since then, abortion rates have gone down in accordance with increased contraceptive use, but it is difficult to determine how restrictions on access to abortion have factored into this story and how future shifts in norms around family and reproduction might play a role.
Drawing on data from the Guttmacher Institute, Cleland suggests that no amount of contraceptive use will eliminate unintended pregnancies and abortion altogether. Moreover, some portion of abortions performed in the United States are terminations of intended pregnancies (estimated at around five percent) and researchers’ attempts to measure the “intendedness” of a pregnancy are themselves quite fraught. In fact, a series of articles in 2018 and 2019 in the journal Contraception debate the usefulness of this category and its relevance to a measurement of reproductive autonomy. Dehlendorf et al. for example, note that “research investigating women’s own views on pregnancy indicates that concepts of ‘intention’ and ‘planning’ do not fully capture the reality of pregnancy in women’s lives. Rather, intention may be better understood as a spectrum.” They go on to suggest that, “implicit in the use of unintended pregnancy as the preferred outcome is the assessment that abortion is a negative outcome. This assumption neglects the range of women’s feelings about abortion as a potential part of their reproductive life course.” From a “patient-centered” perspective, LARCs, other contraceptive methods, and abortion should all be viewed as equally legitimate reproductive health services. As reproductive justice advocates state, LARCs should be treated as “an important addition to a range of options,” but not the only option nor necessarily the preferable one.
But a growing concern with increasing the uptake of LARCs is prevalent in public discourse due their status as the “most effective” and therefore preferred form of birth control. In the HuffPost piece, Almendrala attributes the success of LARCs to the fact that they “don’t require the woman to remember to take a daily pill, slap on a monthly patch or use condoms.” While many researchers agree that LARCs are more effective due to their lack of user-related errors, here again Almendrala ignores some important realities, including that LARCs require a somewhat invasive placing procedure that must be done by a clinician, which itself is a barrier that may outweigh some of these other benefits for contraceptive users. LARCs do not protect against HIV and STIs and are, as her statement might suggest, associated with lower rates of condom use than oral contraceptives, which arguably renders them an undesirable option in certain contexts. LARCs also require an appointment with a clinician for removal, which is perceived as a barrier to autonomy by some users. Not only are there mixed perceptions among users about the level of autonomy afforded by LARCS, but there is also evidence to suggest that physicians may sometimes resist removing them.64 In keeping with the histories of racism and eugenics in the United States, studies show that a patient’s race and class may have an effect on whether a provider recommends LARCs and how much pressure a patient feels to follow that recommendation. Almendrala’s claim that LARCs are a way of increasing reproductive autonomy while decreasing abortion rates requires reevaluation in light of these realities.
A program in Colorado, similar to Delaware’s, has also gained attention in this debate. Discussing the successes of this program in reducing unintended pregnancy and abortion, physician Patricia Salber frames LARCs as a possible “much-needed middle ground in the abortion debate.” She writes, “It prevents unwanted pregnancies and abortion. A win-win, unless, of course, punishing women with unwanted pregnancies is your thing.” Arguing, like Almendrala, that LARCs are a better approach than laws restricting access to abortion, Salber takes as a starting point the idea that abortion is bad, that it is a problem that needs to be solved, and that there are two equally rational and valid sides of the abortion debate between which a compromise can and should be reached. Implicit in this framework is the idea, refuted by many reproductive rights advocates, historians, and health professionals, that abortion can be eliminated. While her argument takes for granted that unintended pregnancies are the rightful targets of abortion, she seems to suggest not only that unintendedness can be clearly defined, but also that if eradicated, abortion would be rendered obsolete. Ending with her “bottom line,” that “LARCs should be offered free or at very low costs to all women who want them,” she confirms the primacy of this particular form of reproductive health service over all others, ceding the stigmatization of abortion, and naturalizing the otherwise deeply unequal access to reproductive healthcare in this nation.
Those who advocate against laws restricting abortion access by promoting LARCs as a path toward fewer abortions attempt to appeal to a broader swath of the political spectrum than reproductive rights advocates typically attract. They also rightfully draw connections between issues that are often decontextualized and discussed in isolation from the other structural factors that condition them. The public needs to understand the relationship between people’s access to contraception and their need for abortion. However, these writers oversimplify this relationship and ultimately uphold the notion that abortion is an illegitimate or immoral option. At the very least, they do nothing to dismantle this sentiment, which guides the very state-level abortion bans against which they claim to be arguing, such as those passed in Louisiana, Georgia, Kentucky, Alabama, Ohio, Mississippi, and Missouri in 2019. As Guttmacher researchers, Kathryn Kost and Mia Zolna, acknowledge, “When a goal of reducing unintended pregnancy is expressed as beneficial in order to reduce the incidence of abortions—and when abortions themselves are characterized as negative events—then stigmatizing narratives around abortion are perpetuated.”
This is by no means the first time that abortion has been sacrificed in the name of support for reproductive health and autonomy. As Manon Parry explains in her study of the history of birth control and mass media, advocates in the early twentieth century regularly promoted birth control while denouncing abortion. More recently, the Reducing the Need for Abortion and Supporting Parents Act, a bill introduced to Congress initially in 2006, was an attempt to find “common ground” in the abortion debate by implementing pregnancy prevention programs and providing support to people who carry their pregnancies to term. Part of a collaboration between prolife and prochoice Democrats, versions of this bill died in committee twice. This strategy appeared to be ineffective at actually creating common ground due to a lack of support on the Right for provision of reproductive health services, contraception, and public assistance (part of the larger neoliberal convergence of conservative values with the politics of privatization). Given this failure, as well as the likelihood that those who promoted the 2019 abortion bans would not support universal access to LARCs (which some believe cause abortions), and the reasons we have to doubt the status of LARCs as a panacea for reproductive self-determination, advocates must ask whether upholding the stigmatization of abortion is a reasonable price to pay. Moreover, although most states that have passed these bans would not support LARC programs such as the ones in Delaware and Colorado, we must also ask how the increasingly restrictive abortion policy landscape of the current moment might create a situation in which people feel coerced into choosing to use LARCs when they otherwise would not. Indeed, there is evidence to suggest that concerns over the election of Donald Trump and the possibility that the Affordable Care Act would be repealed may have led to an increase in women choosing to use LARCs.
Conclusion
The logic that sex education and LARCs should be implemented because they prevent unintended and teen pregnancies, abortion, and poverty rests partly on notion of the “success sequence,” a concept developed by social scientists who study poverty and its relationship to what is termed “family disintegration.” The “success sequence” posits that the pathway to the American Dream is for young people to first finish high school, (maybe go to college,) find a job, then marry, and only then have children. It has been embraced in one form or another across the political mainstream and it obscures the structural realities that limit some people’s access to normative forms of “success.” While the term itself seems to date back only to the early 2000s, the basic prescription it describes undergirded punitive welfare reform legislation of 1996, which, in addition to removing material supports from impoverished families, also resulted, through its emphasis on marriage promotion, in the public funding of crisis pregnancy centers that teach abstinence-only education and aim to discourage people from having abortions. Between 1996 and 2006, that policy also incorporated monetary incentives for states to reduce out-of-wedlock births without increasing the rate of abortion—an apt illustration of how abortion and unwed parenthood have rivaled each other in the economy of state-run reproductive discipline. Ultimately, current attempts to find “common ground” or appeal to “common sense” draw upon this same logic—that girls and young women must be taught to avoid the wholly negative consequences of poorly timed pregnancy. Upholding the notion that certain reproductive behaviors are at best undesirable and at worst pathological and damaging, these tactics tacitly also allow resources to be directed away from comprehensive sexual and reproductive health services and toward judgmental and factually inaccurate programs.
Indeed, with Trump’s enactment of the domestic gag rule in 2019, which removed Title X family planning funds from any facility that provides or refers for abortion services, Title X funds were newly available for antiabortion health clinics and crisis pregnancy centers that ostensibly agreed to provide contraceptive services. Obria, a California-based group of such clinics acquired $1.7 million dollars in Title X funds by agreeing to offer a “‘broad range’ of contraceptive services,” despite having told its base of supporters that it would “never provide hormonal contraception.” This means that institutions designed to dissuade people from getting the abortions they seek, many of which have long benefitted from various other types of public funding, could receive federal money specifically meant for family planning and reproductive healthcare. While this development cannot be laid at the feet of advocates who argue for contraception as a way to reduce abortion, promoting contraception as a solution to abortion sets the stage for broader public acceptance of a purported “middle ground” in which public funding for contraception is predicated on the categorical exclusion of abortion from reproductive healthcare.
Both of the cases discussed here—the use of teen pregnancy prevention to justify comprehensive sex education and the promotion of LARCs through appeals to reducing abortion—reveal the limited conditions of possibility for public discussion of reproductive self-determination in this moment of ever-increasing restrictions on access to reproductive healthcare in the era of Trump. At the same time, these conditions have been partly determined by the conflicted histories of sex education and birth control advocacy that have framed them both as a means toward optimizing the national populace according to white, middle class, heteronormative standards, and as a path toward increased bodily, sexual, and reproductive autonomy. Strategic negotiations similar to those analyzed here have been taking place for over a century—Margaret Sanger and other birth control advocates allying themselves with eugenicists to garner support for birth control clinics is a prime example. While these compromises may not always be viewed as such by those making them, and may sometimes be politically expedient, they often come at the cost of reproductive self-determination for those who are most vulnerable to coercion, discrimination, and punitive public policies.