Margaret Sanger’s Eugenics Heyday in the Federal Government
by Susan T. Muskett
Margaret Sanger’s dream of controlling the fertility of the poor is coming to fruition, thanks to the federal government.
Margaret Sanger was the founder of Planned Parenthood and a population control activist. She advocated that the “unfit”—the poor and the disabled—should have their fertility controlled. In her view, “hap-hazard, uncontrolled parentage leads directly and inevitably to poverty, overcrowding, delinquency, defectiveness, child labor, [and] infant mortality.”
Sanger emphasized the financial burden that the marginalized classes impose on the broader society, asserting that “if they are not able to support and care for themselves, they should certainly not be allowed to bring offspring into this world for others to look after.” In other words, to wipe out poverty, society should wipe out the poor—by wiping out the ability of poor people to have children.
These same cost-saving arguments are being used by the federal government to justify targeting low-income women for contraception, especially long-acting reversible contraceptives (LARCs).
LARCs are Margaret Sanger’s dream solution. LARCs, such as IUDs and implants, have a 99 percent effectiveness rate. In effect, they chemically sterilize young women for years. For IUDs, the sterilization lasts as much as five to ten years; for implants, it’s up to three years. Unlike other contraception, which a woman can discontinue using whenever she likes, if a woman wants to stop using a LARC, she must return to a healthcare professional to have it removed.
On both the state and federal level, the provision of LARCs to low-income women and teens is increasingly being pushed as a means to reduce the birthrate of the poor. In my last Public Discourse article, “Attention, Low-Income Women of Oregon: Your Reproduction is Now the Government’s Business,” I raised the alarm about a contraceptive metric being implemented by the state of Oregon. In today’s article, I address troubling but increasingly popular efforts to enact national contraceptive standards for all Medicaid providers, Title X-funded clinics, and federally funded home visiting programs.
Medicaid “Quality” Measure on Contraception
Efforts are underway within the federal government to enact a contraception “quality” measure within Medicaid that would have a widespread impact on the fertility of America’s low-income women.
In August 2015, an advisory body to the US Department of Health and Human Services (HHS) recommended that HHS adopt a Medicaid quality measure for adults that would measure use of the “most effective” or “moderately effective” contraception by women between the ages of twenty-one and forty-four who are “at risk of unintended pregnancy.” This contraception measure was the advisory body’s top priority for inclusion in the Medicaid performance measures for adults.
Only contraception deemed “highly effective” (e.g., LARCs) or “moderately effective” (e.g., injections) would be included within the measurement. Healthcare providers with a low percentage of female patients of childbearing age using such contraception would be rated as giving lower- quality care. A similar contraception quality measure, including a separate sub-measure of the use of LARCs, was recommended for teenagers as young as fifteen.
If enacted, these standards would put heavy pressure on Medicaid providers to increase their patients’ use of “effective” contraception, especially LARCs, in order to meet quality standards.
It gets worse. The advisory body recommended that HHS adopt a Medicaid quality measure that would measure the percentage of women using “highly effective” or “moderately effective” contraception within ninety-nine days after giving birth. In its report, the advisory body mentioned approvingly that “11 states have made specific policy changes to encourage placement of long-acting reversible contraception immediately postpartum, with the potential for others to follow.”
It is not clear when HHS will act on the recommended Medicaid contraception quality measures, but the agency seems to be taking steps in that direction. In September 2015, HHS awarded grants to thirteen states and one US territory for the collection and reporting of data to the federal government on the use of effective contraception and LARCs by women on Medicaid. The government is also working with an outside entity to standardize contraception data within Electronic Health Records, which could further facilitate the collection of this data.
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On both the state and federal level, the provision of LARCs to low-income women and teens is increasingly being pushed as a means to reduce the birthrate of the poor. In my last Public Discourse article, “Attention, Low-Income Women of Oregon: Your Reproduction is Now the Government’s Business,” I raised the alarm about a contraceptive metric being implemented by the state of Oregon. In today’s article, I address troubling but increasingly popular efforts to enact national contraceptive standards for all Medicaid providers, Title X-funded clinics, and federally funded home visiting programs.
Medicaid “Quality” Measure on Contraception
Efforts are underway within the federal government to enact a contraception “quality” measure within Medicaid that would have a widespread impact on the fertility of America’s low-income women.
In August 2015, an advisory body to the US Department of Health and Human Services (HHS) recommended that HHS adopt a Medicaid quality measure for adults that would measure use of the “most effective” or “moderately effective” contraception by women between the ages of twenty-one and forty-four who are “at risk of unintended pregnancy.” This contraception measure was the advisory body’s top priority for inclusion in the Medicaid performance measures for adults.
Only contraception deemed “highly effective” (e.g., LARCs) or “moderately effective” (e.g., injections) would be included within the measurement. Healthcare providers with a low percentage of female patients of childbearing age using such contraception would be rated as giving lower- quality care. A similar contraception quality measure, including a separate sub-measure of the use of LARCs, was recommended for teenagers as young as fifteen.
If enacted, these standards would put heavy pressure on Medicaid providers to increase their patients’ use of “effective” contraception, especially LARCs, in order to meet quality standards.
It gets worse. The advisory body recommended that HHS adopt a Medicaid quality measure that would measure the percentage of women using “highly effective” or “moderately effective” contraception within ninety-nine days after giving birth. In its report, the advisory body mentioned approvingly that “11 states have made specific policy changes to encourage placement of long-acting reversible contraception immediately postpartum, with the potential for others to follow.”
It is not clear when HHS will act on the recommended Medicaid contraception quality measures, but the agency seems to be taking steps in that direction. In September 2015, HHS awarded grants to thirteen states and one US territory for the collection and reporting of data to the federal government on the use of effective contraception and LARCs by women on Medicaid. The government is also working with an outside entity to standardize contraception data within Electronic Health Records, which could further facilitate the collection of this data.
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