We can’t resist regressive policies with coercive practices
I’ve spent a lot of time recently thinking and talking about what happens next. The relentless corrosion of abortion rights over the past decades got the legal equivalent of a triple shot espresso with the Dobbs V. Jackson Women’s Health Organization decision. While I live and work in California, I frequently engage with folks across the country who share with me the on-the-ground realities in the most restrictive states like Missouri, Texas, and Oklahoma. There is so much being written right now about this. There are so many thoughtful, passionate, brilliant minds sharing their thoughts, feelings and action items in this post-Roe landscape. It is critical to remember that Black women, trans and enby individuals and other marginalized groups have been engaged and leading the fight for reproductive justice for many decades and have deep knowledge and lived experiences that must guide our path forward. This is my perspective from a small corner of the broader reproductive health and justice space.
My colleague, Patty, and I are Family Nurse practitioners and trainers and advocates for the PATH Framework, a person-centered care approach to conversations around reproductive desires. Shortly after the Dobbs V. Jackson Women’s Health organization draft decision was leaked in May 2020, we overheard a conversation between two health care providers at a conference. One provider said to the other “Well, with the likely overturn of Roe, now we really need to get these women on highly effective birth control…” To some, this statement might be taken as a well-intentioned provider expressing a desire to help individuals avoid an “unplanned” pregnancy if abortion is not accessible to them. Patty and I, however, heard the echoes of our field’s past and current failings, the deep-rooted legacy of racism and paternalistic and coercive practices regarding contraceptive decision making in the sexual and reproductive health world. While we grapple with and mobilize in the post-Roe landscape, one thing must be clear—our response to this stripping of human rights and assault on bodily autonomy cannot be a further stripping of people’s sovereignty over their sexual and reproductive health decisions. We must reinforce our commitment to inclusive, non-judgmental care and respectful conversations around reproductive desires and related topics.
The response to limited abortion access cannot be to assume that all people capable of getting pregnant, but not currently wanting to be parents, will now prioritize initiating highly effective contraceptive methods. Contraceptive decision making is complex. This is not to say that some people won’t come to the decision to use a highly effective method like an implant or IUD. Many patients are already identifying effectiveness as a particularly important characteristic of contraception post-Roe. Further, health care providers can pro-actively inquire about the importance of effectiveness to ensure clients have all the information they need to make informed decisions. That is very different, however, than a health care professional prioritizing their belief that people “should” use highly effective methods over an individual’s preferences about contraceptive methods.
Whether and how someone choses to prevent pregnancy is deeply personal. The availability of abortion services may or may not impact how someone feels about a potential pregnancy. In the PATH Framework, we suggest the language “How important is it to you to prevent pregnancy?” (assuming the client has indicated they do not want children or more children anytime soon) as a way to gather more information about the acceptability of a potential pregnancy. Such a question allows for the nuance inherent in these conversations. When queried about reproductive desires, it is not uncommon for someone to state they do not want (more) children at this time but would be accepting or even happy if a pregnancy were to occur.
The Dobbs decision has already had devastating impacts on so many. As health care professionals, we must see this as a moment for our own self-reflection. Do our practices align with our ideals? How are we ensuring power firmly remains with the clients we serve? While as a movement we wage legal and legislative battles to restore rights, what more can we do in our daily clinical work to actively resist this assault on reproductive rights? And how do we resist these attacks without relying on coercive practices and policies? Take some time to think about your answers to these questions. It is essential work in these traumatizing times.