Soft Sterilization: Long-Acting Reversible Contraceptives in the Carceral State

Abstract

In the United States, between 1907 and 1978, the proliferation of eugenic state practices routinely targeted institutionalized women with legalized involuntary sterilization. Sterilization laws and policies were a form of reproductive control, which predominantly impacted women from marginalized communities. After the implementation of federal regulations prohibiting involuntary sterilization practices, state agencies continued to engage in coercive sterilization under the guise of “voluntariness.” Using a reproductive justice framework, we introduce a concept of reproductive control embedded within the carceral state. Tracing historical sterilization practices and examining the use of long-acting reversible contraceptives (LARC), we argue that LARC represents a different form of involuntary sterilization. The emergence of LARC as a highly effective, nonagentive, and mediated form of contraception for vulnerable populations demands interrogation. We identify the use of LARC as soft sterilization, which is both related to and distinct from other forms of reproductive control. As such, reproductive autonomy is not possible without the destruction of the carceral state.

In May 2017, a Tennessee judge issued an official order to reduce jail sentences by 30 days for incarcerated men who volunteered to receive vasectomies or incarcerated women who volunteered to receive Nexplanon subdermal contraceptive implants. The order prohibited men under the age of 21 from receiving vasectomies; however, there was no age restriction for women receiving Nexplanon implants (Adams, 2018). The judge justified the order as necessary to “break a vicious cycle of repeat drug offenders with children” (Hawkins, 2017, para. 2). The national controversy that emerged in response to news coverage of the sentence reduction offer led the judge to rescind the order by July 2017. During 2 months the order was in effect, more than 32 women received Nexplanon and one incarcerated woman, reportedly, cut an implant from her arm using a razor blade (Davis, 2017; Hawkins, 2017). At least 70 incarcerated people—32% of the total incarcerated population of the jail—registered to be sterilized (Lussenhop, 2017). Precluding true voluntariness for people who are incarcerated, the desire for freedom, at any cost, manifests in the violence and coercion endemic to carceral systems (Roth & Ainsworth, 2015).

Although the Tennessee case was controversial, offering coercive incentives for voluntary sterilization is not a recent phenomenon. Beginning in 1997, Project Prevention, formerly known as Children Requiring a Caring Kommunity or C.R.A.C.K., developed a program to pay current and former substance using men and women US$300 to obtain a tubal ligation, vasectomy, or long-acting reversible contraceptive (LARC), which include intrauterine devices and subdermal implants (National Advocates for Pregnant Women, 2018). Project Prevention originated in California; however, the organization expanded throughout the United States, and as of 2010, into the United Kingdom. Project Prevention emerged alongside state-administered cash incentive programs for mothers receiving government assistance who obtained Norplant subdermal implants. Incentive-driven LARC programs were proposed or enacted in Arizona, Connecticut, the District of Columbia, Florida, Kansas, Louisiana, Maryland, Mississippi, South Carolina, Tennessee, and Washington (Blake, 1995).

In 2009, Colorado launched the Colorado Family Planning Initiative (CFPI), a state-administered program that provided free LARCs, tubal ligations, and vasectomies to people with low incomes (Dube, 2015). By 2015, Colorado reported a 48% decline in teen births through expanded access to and financing of LARCs (Wolk, 2015). The positive public response to the CFPI (Budner, 2018; Leins, 2019; Tarico, 2017; Turnbull, 2019) coincides with the state of Colorado reporting program outcomes, which crossed liberal and conservative political beliefs. Providing free and accessible contraceptives, improving maternal health outcomes for low-income women, and promoting public awareness of state family planning services address concerns of liberal constituents. Conservative constituents’ concerns are also addressed by reducing abortion rates and saving an estimated US$66.1–US$69.6 million in Medicaid, Temporary Assistance to Needy Families, Supplemental Nutritional Assistance Program (SNAP), and Women, Infants, and Children (Colorado Department of Public Health and Environment, 2017).

These cases demonstrate the pervasiveness of reproductive control in criminal justice and criminalizing social welfare systems. Extending beyond the foundation of sterilization abuses of marginalized women, this article introduces a concept through which the widespread use of LARCs within the carceral state can be characterized as soft sterilization. Building upon the literature on reproductive justice and legal, involuntary sterilization, eugenic practices are elucidated as situated at the complex intersections of privilege and oppression (Grzanka, 2019; Largent, 2007; Ross, 2017). Thus, soft sterilization emerges as a nuanced articulation of the continuation of reproductive control as the current mechanism available to maintain and reproduce white supremacy and heteropatriarchy necessary to the work of anticarceral feminism and abolitionist scholarship.

Reproductive Justice and Intersectionality

In the United States, reproductive control has been motivated by the desire to maintain the structures of white supremacy, heteropatriarchy, and capitalism (Ross & Solinger, 2017). Adding an intersectional analysis to reproductive control, reproductive justice emerged as a reconfiguration of reproductive rights and social justice. Reproductive justice is a theory, praxis, and movement created and developed by black women in 1994 as an analysis tool that builds upon the work of black feminist thought and black feminist theory to explore the racial, economic, and social inequalities that impact and shape lived experiences. Reproductive justice is “purposefully controversial in that it disrupts the dehumanizing status quo of reproductive politics” (Ross, 2017, p. 11). Foundationally, there are three human rights at the core of reproductive justice: (1) the right to have a child under the conditions of one’s choosing; (2) the right not to have a child using birth control, abortion, or abstinence; and (3) the right to parent children in a safe and healthy environment free from violence by individuals or the state (Ross, 2017). To fulfill each of these human rights for all would reflect reproductive autonomy and reproductive emancipation and, thus, represent a standard against which reproductive health care and legal rights can be compared.

Essential to the work of reproductive justice is the implementation of an intersectional framework to reproductive politics. Intersectionality—which emerged from the tradition of black feminist thought before being enshrined by Crenshaw (1989)—is a lens through which the collision and intersection of power in interlocking identities is made apparent. Collins (1990) furthered understandings of the ways in which the systems of race, gender, and class are organized and shape lived experiences through her development of the matrix of domination. An intersectional perspective is essential to understand current politics and policies of reproductive control as histories of reproductive oppression are inextricably connected to the intersecting identities.

The traditional reproductive rights movement centers the legal rights related to reproductive choice that have, historically, focused on the right not to have children through access to birth control and the right to terminate a pregnancy. Closely associated with the women’s rights movement, reproductive rights have represented the interests of the middle class and wealthy white women. Conversely, reproductive justice utilizes a human rights paradigm to integrate the legal rights of recognition and access to comprehensive reproductive health care. Centering social justice through the work of grassroots organizing and direct action targets social inequalities to generate transformation of the lived experience for the most vulnerable communities. Reproductive justice is “an amplifying organizing concept to shed light on the intersectional forms of oppression that threaten black women’s bodily integrity” (Ross, 2017, p. 291).

Legal Involuntary Sterilization in the United States

Throughout the second half of the 19th century, a movement to sterilize people who would produce undesirable children emerged. Supported by physicians, social workers, social scientists, lawyers, social reformers, women’s groups, and politicians, the eugenics movement provided the foundation for five decades of involuntary, legal sterilization in the United States (Cahn, 2007; Largent, 2007). Characterizing poverty, sexual promiscuity, substance use, criminality, mental illness, and disabilities as social and moral ills, nearly two thirds of states passed laws classifying more than 63,000 people to be involuntarily sterilized. The 1907 Indiana Eugenics Law became the first sterilization law in the United States. The timing of sterilization laws corresponded with the emergence of surgical sterilization procedures—vasectomies and tubal ligations—deemed less radical and safer than previous methods of sterilization through castration or hysterectomy (O’Hara & Sanks, 1956). However, the Indiana Eugenics Law legalized the already present practices of sterilizing people who were incarcerated (Reilly, 1991).

Over the next 4 years, more than 14 states enacted involuntary sterilization laws. The eugenic-based sterilization laws did not go unchallenged. Prior to the enactment of the 1907 Indiana law, the first pieces of sterilization legislation—an 1897 Michigan bill and a 1905 Pennsylvania bill—passed in both the state Senates and state Houses before being vetoed by the states’ respective governors. From 1912 to 1921, eight eugenic laws—including Indiana—faced constitutional challenges with seven of the eight challenges successfully overturning the enacted legislation (Reilly, 1991). Although the overturned laws were, at times, replaced by additional sterilization legislation, the subsequent laws had more constraints than previous legislation including limitations on sterilizing people who were incarcerated or prohibiting sterilization procedures as punitive measures.

In 1924, Carrie Buck, a then 18-year-old woman, who had recently birthed a child out of wedlock was committed to a state facility due to her alleged intellectual disability. Fearing a pattern of additional “illegitimate” births of children with intellectual disabilities, the superintendent of the state facility petitioned and received approval for Carrie’s sterilization (Largent, 2007; Solinger, 2005). R. G. Shelton—Buck’s attorney—immediately appealed the sterilization decision to the Circuit Court of Amherst County, Virginia. With the circuit court’s decision to uphold Buck’s sterilization without dissent, Shelton appealed Carrie’s case to the United States Supreme Court. Ultimately, in an 8-to-1 decision, the Supreme Court upheld the involuntary sterilization law in Virginia. Following the Supreme Court decision in Buck v. Bell, the number of states with involuntary sterilization laws increased from 17 to 30. Thus, Buck v. Bell facilitated the enactment and implementation of involuntary sterilization programs (Lombardo, 2011).

By 1932, the number of women sterilized under the involuntary sterilization policies exceeded the sterilizations of their male counterparts. Sterilizations of women in 1929—2,362 completed operations—exceeded the completed sterilizations of women in 1927 and 1928 combined. Subsequently, the number of sterilizations increased each year until the operations peaked in 1932 when 3,921 sterilization operations were completed. Reilly (1991) speculates that the economic constraints of the Depression prohibited states from building additional institutions to manage growing populations with “undesirable” traits. Southern political coalitions destroyed hospitals by denying federal funding until closure and schools by dismantling the public school systems. The lack of medical care coupled with the public disdain for government interference served as significant barriers for eugenicists in the South. Thus, by the time the South adopted “progressive” sterilization legislation in the late 1930s, the sterilization legislations were perceived to be outdated (Larson, 1991). States developed strategies to institutionalize cases deemed to be most severe while sterilizing and paroling those characterized as less severe. For the people who were institutionalized who understood the sterilization for parole exchange option, parole was a powerful incentive to consent to sterilization operations.

By 1935, physicians in the American Association for Mental Deficiency argued that “all defective women in their reproductive years should be sterilized” (Reilly, 1991, p. 93). Focused on the connection between undesirable genetic traits and a “deprived early home life” as the foundation for developmental issues in young children, eugenicists appealed to the economically constrained state budgets with “progressive” sterilization policies by calling for the involuntary sterilization of women of reproductive age with undesirable traits–especially if that woman had already been labeled a “bad mother” (Kluchin, 2009; Reilly, 1991). Thus, involuntary sterilization came to represent a mechanism of state reproductive control that limited the proliferation of less desirable traits under the guise of state fiscal responsibility.

In 1974, state sterilization programs were halted due to a hold on federal funds for involuntary sterilization pending a review by the United States Department of Health, Education, and Welfare. In spite of the moratorium of sterilization procedures without newly developed precautions to prevent deceptive or coerced sterilization, the ACLU reported rampant noncompliance with the policies designed to preserve the rights of vulnerable populations (Kruse, 2014). The noncompliance was targeted by local, grassroots anti-involuntary sterilization organizations. As a result of legislative successes, regional activist organizations were able to demand government compliance of approved voluntary sterilization procedures (Kruse, 2014).

Reproductive Control

Reproductive control is critical to the foundational colonial project in the United States. Solinger (2005) argues: “from the white settlers’ point of view, population growth among Europeans was crucial for establishing, developing, enlarging, and defending their land claims, their accumulation of wealth, and their political control of the settled territories” (p. 18). Critical to the desired U.S. expansion of colonization were the production of white citizenry, the production of labor and laborers through enslaved black women, and the destruction of indigenous communities and culture through warfare and “civilization” efforts. Free white women were not subjected to same violences of colonization and chattel slavery, reflecting the racialized and gendered oppression at the very foundation of life in the United States, which continues to structure reproductive control today.

Throughout Reconstruction and Jim Crow, when black reproduction no longer served as a capitalistic investment of chattel slavery, black fertility was no longer beneficial to the colonial project. Black sexuality, reproduction, and motherhood were characterized as transgressive and, often, the byproduct of poor choices. The emergence of social work and social welfare programs—exemplified by Jane Addams and Edith and Grace Abbott—was designed to address the needs of poor white women. White mothers who represented hegemonic racial, cultural, and moral ideals of the “cult of true womanhood” (Giddings, 1996, p. 47) had access to aid and assistance, which further entrenched racialized ideologies of care (Abramovitz, 2006; Solinger, 2010). Black women, through the racialized ideologies of white supremacy, were excluded from narratives and benefits of virtuous womanhood signifying the pervasive and accepted institutionalized white violence (Ocen, 2013; Ross & Solinger, 2017).

The emergence of programs like Aid to Dependent Children claimed to support women in need of financial assistance, while in reality, providing women minimal financial support with no additional resources—such as childcare. With the social “concern” of population growth concentrated on black women, immigrant women, and poor women, the surveillance required by receiving government assistance allowed the policing of women’s sexual and reproductive behaviors, often criminalizing women who became pregnant while receiving assistance (Abramovitz, 2006; Ross & Solinger, 2017; Solinger, 2010). Punitive actions against mothers on assistance reflected racialized ideologies.

Compelling black women and women of color to consent to sterilization in exchange for social services—day-care assistance, housing assistance, SNAP, and Medicaid—contributed to their higher rates of sterilization. From the 1970s onward, sterilization was the fastest growing method of birth control with most sterilizations performed on women of color (Roberts, 1997). White women, by comparison, faced access barriers to tubal ligations and were often required to receive clearance from two physicians and a psychiatrist, in addition to meeting the desired formula (Age × Number of Children > 120; Solinger, 2005).

The political fixation on reproductive choice—typically referring to contraceptive and abortion access—exemplifies the nonexistent reproductive choices that have always existed for black women, indigenous women, and women of color. Reproductive history in the United States is a history of reproductive injustices. The lived experiences of women are constrained through race, class, sexuality, and ability in ways that vary with one’s positionality. LARCs epitomize this nuance. For privileged white women with access to health insurance and reproductive health care, LARCs are highly effective contraceptive devices that require no additional action on the part of the user after insertion. The extremely low risk of unintended pregnancy with LARCs can be emancipatory for privileged women who are able to have the device removed if that is what they choose to do. For black women and women of color, who are disproportionately poor and criminalized, LARCs do not represent the same experiences of emancipation. Lack of access to comprehensive sex education, regular reproductive health-care providers, transportation, and language translators influence the ways in which black women and women of color navigate their reproductive health.

Organizations, such as A Step Ahead, a Tennessee-based nonprofit, which provides free LARC and transportation to and from the medical appointment to any woman who resides in an area where A Step Ahead operates, and the CFPI, an exemplar state-administered LARC program, focus on populations who are most in need of reproductive health-care assistance. These seemingly progressive organizations tout LARC as the solution to the social ills of poverty and low educational attainment by reducing unintended pregnancies. However, it is the positionality of those in need—being poor, undocumented, black, or disabled—which reproduces rhetorics and patterns of eugenic sterilization. By focusing on the removable nature of the device, nonprofit and state-sponsored organizations avoid the stigma of previous involuntary sterilization programs, thereby allowing for the strategic reduction of pregnancies among black women, indigenous women, women of color, and poor women through the targeted provisions of LARC.

LARCs

The crux of soft sterilization is the highly effective contraceptive technologies, which prevent a user from pregnancy for 3–10 years, depending on the device. National health organizations, such as the American College of Obstetrics and Gynecology and the American Academy of Pediatrics, recommend LARCs as the preferred contraceptive to prevent unintended pregnancies (Grzanka & Frantell, 2017; Gubrium et al., 2016). LARCs require a medical professional to insert and remove the device for the user, and furthermore, LARC devices eliminate human error in contraceptive use as no additional action is required by the user after insertion. With failure rates at less than 1%, LARCs are comparable to tubal ligations and are the single most effective reversible contraception (Russo, Miller, & Gold, 2013; Stoddard, McNicholas, & Peipert, 2011).

As the preferred contraceptive devices for national health organizations, LARCs are centered on public policies designed to limit pregnancies through LARC-only promotion to women using Medicaid assistance (Mann & Grzanka, 2018) or partnerships between state health agencies and prisons/jails (Scott, 2017). Within this public health framework, the disproportionately high rates of unintended pregnancies in the United States among young, black, Latina, and poor women are used to justify the systematic targeting of marginalized women by health-care providers. For patients assumed to be “high risk” for unintended pregnancy, best practices encourage providers use a “tiered” method of contraceptive counseling where the effectiveness and ease of use of LARCs are highlighted over the preferences and lifestyles of the user (Gomez, Fuentes, & Allina, 2014; Hillard, 2013; Ott & Sucato, 2014).

LARC-first recommendations to curb unintended pregnancies inaccurately identifies unintended pregnancy as the cause, rather than a consequence, of social inequality (Higgins, 2014; Higgins, Kramer, & Ryder, 2016). The practice of LARC deployment as a cure for social and moral ills follows the historical patterns of population control where black women, indigenous women, women of color, women with disabilities, and women on state or federal assistance have been disproportionately targeted (Abramovitz, 2006; INCITE!, 2013; Solinger, 2010). The use of contraceptive mechanisms to limit pregnancy among groups of women whose childbearing is perceived negatively (Malat, 2000) is juxtaposed against the promotion of pregnancy among white, middle class, and wealthy, able-bodied women. The unique properties of LARC—being highly effective, nonagentive, and provider-controlled—combined with systematic, coercive practices designed to limit contraceptive choice are critical to the foundation of soft sterilization.

The Carceral State and Anticarceral Feminism

The expansion of the carceral state reified the convergence of systems of care and systems of punishment. The positioning of the criminal justice system—police, courts, corrections, probation—as the site of safety and justice for all women ignores the ways in which race, class, gender, and sexuality shape experiences in and with the carceral system. The emergence of carceral feminism maintains hegemonic norms through centering moralistic ideals of heteronormative families and crime control models (Bernstein, 2010; Hannah-Moffat, 1999), whereby “the further a woman’s sexuality, age, class, criminal background, and race are from hegemonic norms, the more likely it is they will be harmed” (Richie, 2012, p. 15). The more precarious a woman’s positionality, the more likely her victimization will not be recognized as legitimate. Carceral feminism, then, reproduces the patterns of white feminists who center their own experiences as universal experiences of womanhood—or the “cult of true womanhood” (Giddings, 1996, p. 47)—without acknowledging the differential experiences of economically disadvantaged and racialized women (Ocen, 2013).

To counter the oppressive project of carceral feminism, women of color and white activists developed anticarceral feminism to center the interconnectedness of gendered violence and racialized criminalization in demands for models of justice outside of the criminal justice system (Bernstein, 2010; Nelson, 2003; Ocen, 2012, 2013, 2017; Silliman, Fried, Ross, & Gutiérrez, 2004). In direct opposition to carceral feminism, anticarceral feminism moves against carceral responses to gendered violence. The antiviolence project of anticarceral feminism seeks to shift resources from policing and corrections into community-directed harm reduction, including access to sexual and reproductive health care that is inclusive, accessible, comprehensive, and free or low cost. As a “hyperregulatory” actor, the state only deploys “assistance” through mechanisms of punitive social control over marginalized people and their communities (Bach, 2014; Willison & O’Brien, 2017). Cognizant of the dangers of nonstrategic reform, anticarceral activists and scholars strategized the concurrent work moving against and within the system to obtain liberation from the carceral mechanisms of oppression (Beckett, 2018; Carlton, 2018; Thuma, 2014, 2015).

The expansion of the carceral state necessitates the criminalization of vulnerable populations—the poor (Bach, 2014; Sufrin, 2017); substance users (Maher, 1990); the unhoused (Beckett & Herbert, 2009); women (Lunde, 2013; Richie, 2012); black, indigenous, and people of color (Alexander, 2012; Ocen, 2013, 2017; Palacios, 2016; Solinger, 2005); migrants (Nayak, 2015); and the disabled (Wu et al., 2017; Zampas & Lamačková, 2011). The origins of policing and corrections as projects to maintain white supremacy render criminal justice reform not only insufficient for transformative change but often a source of carceral proliferation (Brown & Schept, 2017; Murakawa, 2014). Necessary for the creation of liberation and autonomy, there must be a meaningful decarceration process and abolition of the carceral state (Rentschler, 2017). This new abolitionist project creates a disruption, challenging the pervasiveness of the carceral state in the most intimate aspects of our lives by requiring new understandings and vocabularies of “crime, law, punishment, safety and accountability, and justice” (Brown & Schept, 2017, p. 444).

Specifically, reproductive control in the carceral state is a project that claims to provide assistance or freedom to marginalized women while ignoring the coercive systems within which this assistance occurs (Beckett & Murakawa, 2012; Gottschalk, 2014). The welfare state and the carceral state are inherently coercive spaces (Harris, 2011; Ocen, 2012, 2017). With LARC, this coercion is obfuscated under the guise of “voluntariness” (Roth & Ainsworth, 2015). That is, women have volunteered to receive a LARC in exchange for reduced jail time, to have Medicaid covered contraception, or because it was the only form of contraception provided in jails. The framing of LARCs as voluntary enables the state to avoid scrutiny of policies and programs engaging in reproductive control.

Prisons routinized mechanisms for reproductive control by perfecting coercive sterilization programs (Hannah-Moffat, 2005; Hannah-Moffat, Maurutto, & Turnbull, 2010; Kim, 2018; Sufrin, Oxnard, Goldenson, Simonson, & Jackson, 2015). With black women three times as likely as white women to be incarcerated, the raced and gendered structures of carceral systems disproportionately target black women for reproductive control (Ocen, 2013). The intrusion of the state in the regulation of women’s bodies, reproductive decisions, and parenting reflects reproductive injustice. Meaningful decarceration, the abolition of prisons, and the redirection of resources previously used to maintain the carceral systems into communities would fundamentally change the lived experiences of women to reflect the reproductive autonomy developed by reproductive justice organizers (Paugh, 2017; SisterSong, 2016). Redirecting resources back into the community would provide support for the needs of the community—housing, food, quality education, access to activities and the arts—and would allow communities to move beyond that which is needed to survive into that which allows communities to thrive.

Discussion and Conclusion

The development of soft sterilization situates LARCs—contraceptive devices that are emancipatory for women with social privilege and, potentially, oppressive for marginalized women—within the larger frameworks of reproductive control and reproductive autonomy. This is not to restrict access to LARCs. On the contrary, all people should have universal access for free comprehensive contraceptive options enabling people to make decisions about their bodies without external interference. Centering black, indigenous, and women of color is essential to the project of reproductive autonomy and abolition as the histories of reproductive control (Ross & Solinger, 2017) and policing and incarceration (Alexander, 2012) originate in, and are perpetuated by, white supremacist ideologies.

Each of the concepts outlined—reproductive justice, involuntary sterilization, and LARCs—is critical to soft sterilization. Involuntary sterilization has been used as a mechanism to limit the reproduction of “undesirable” groups—namely those who differ from the hegemonic norms of race, sexuality, age, class, and criminal background. The unique properties of LARC—being highly effective, nonagentive, and provider controlled—create an opportunity for nonprofits and state agencies to achieve the same outcome of previous sterilization programs—reproductive control of marginalized people—without the stigma of sterilization. The technology of LARCs allows for the state to obfuscate the process of reproductive control through the focus on the reversibility of the device. Although LARCs are reversible, thus reinstating the LARC user’s fertility upon removal, the power and ability to remove the device belong to the medical provider. With LARC programs operating through jails, child and family welfare, health-care providers, and nonprofit organizations, the convergence of systems of care and systems of punishment inextricably connect reproductive control with the carceral state. Therefore, to achieve reproductive liberation and autonomy, the carceral state must be abolished.

The enshrinement of LARCs as the primary mechanism for reproductive health and social policy have shifted the mechanisms of reproductive control. By situating the emergence of LARCs within the historical narrative of eugenic sterilization and using theoretical paradigms of intersectionality, soft sterilization is a concept that elucidates the obfuscated reproductive control of LARCs. The introduction of soft sterilization is not to negate the existing theories of sterilization, but rather, to build upon the foundational work on sterilization to amplify the experiences of marginalized groups targeted for reproductive control through LARCs.

The history of reproductive control has largely centered on permanent, involuntary sterilization. The egregiousness of forcible and permanent sterilization is discussed as though these practices are forgone (Largent, 2007; Larson, 1991). However, this perspective ignores the underlying eugenics-based ideologies responsible for the continued implementation of reproductive control through LARCs. The unique properties of LARCs when combined with systematic, coercive practices designed to limit reproduction and contraceptive choice among “undesirable populations”—poor, black, indigenous, migrant, substance using, criminalized, and disabled women—replicates the trajectory of involuntary sterilization through salpingectomies or tubal ligations of earlier sterilization laws. The argument is that “suppressing fertility, temporarily or permanently, would diminish poverty” while protecting “the interests of the industrialists and other members of the ruling elite” (Ross & Solinger, 2017, p. 32). Thus, to preserve white supremacist ideals (Cooper Owens, 2017), coercively administered LARCs serve as the current mechanism available to maintain and reproduce white supremacy and heteropatriarchy.

The similar constructions of involuntary sterilization and coercive LARC deployment have a critical point of divergence: LARCs are technically reversible. Soft sterilization does not imply that LARCs cannot be removed. Instead, because LARCs require a health-care professional for safe removal, LARC users are dependent upon the provider to reinstate fertility. Women who are unable to access medical care or obtain consent to remove the device from a health-care provider may be forced to keep their LARC after the device removal date or after they decide to become pregnant. Therefore, LARCs have the capability of producing the same reproductive control outcome—prevention of pregnancy without the consent of the user—as involuntary sterilization. The ability to remove a LARC is dependent upon the social privilege of the user. Therefore, LARC-induced infertility is conceptualized as soft sterilization.

Involuntary and soft sterilization abuses impact women of color differently than white women. To highlight the nuance of the ways women of color experience involuntary and soft sterilization practices provides insight into the ways the state apparatus functions. Legal and legitimized forms of discriminatory practices allowed sterilization abuses to flourish without social outrage. The historical patterns of reproductive control centered on permanent, involuntary sterilization are critical to tracing the rhetorics of reproductive control through new forms of soft sterilization.

Implications for Social Work Practice

Despite not being frequently deployed as a theoretical framework within the social work scholarship (Liddell, 2019), reproductive justice is accordant with the mission of the social work profession. Tasked to work “with and on behalf of clients…to end discrimination, oppression, poverty, and other forms of social injustice” (National Association of Social Workers [NASW], 1996, para. 2), the integration of the goals of reproductive justice into the praxis of social work would center and support the reproductive autonomy of the most vulnerable clients. Across the United States, laws regulating reproductive health care and reproductive rights vary from state to state and are, at present, in flux. As of June 2019, nine states have passed new abortion regulations, many of which are being currently litigated. It is critical, then, to provide social work students and practicing social workers with policy and legislative expertise to support clients when navigating the increasingly overlapping realms of the legal system and the health-care system by utilizing professional organizations, such as the NASW and the Council on Social Work Education to facilitate strategies supporting client reproductive autonomy.

In locations with resistance to the goals of the reproductive justice framework, social workers occupy a critical role (Alzate, 2009). Social workers can educate and lobby community organizations and community leaders about soft sterilization and reproductive autonomy. In the current reproductive health climate, advocating for the reproductive autonomy of clients is necessary to ensure that clients have access to the services needed to make informed, noncoercive reproductive choices. Partnering with community organizations, which utilize a reproductive justice framework, would not only provide social workers with community allies but would also provide safe locations for clients to receive reproductive health information and reproductive health services. Finally, by integrating reproductive justice into degree programs, educational training, and internships, the goals of client reproductive autonomy would become entrenched in the social work profession.

The proximity social workers have to racialized and marginalized bodies in spaces of surveillance, criminalization, and incarceration demands a reframing of social work praxis to center theories and practices of emancipation and autonomy. Integrating soft sterilization into the framework of the social work profession elucidates the obfuscated mechanisms of reproductive control through the strategic deployment of LARCs to render marginalized populations infertile, even if only temporarily, justified through white supremacist ideologies. Although the history of the United States is a history of reproductive injustices, the future has yet to be determined. The refusal to disrupt the “progressive” agenda of soft sterilization is to remain complicit in continued reproductive control of marginalized groups and to prohibit the reproductive autonomy for all.