Culture,Contraception,and Colorblindess: Youth Sexual Health Promotion as a Gendered Racial Project

Abstract

Feminist scholars have identified how race and gender discourses influence the creation and implementation of school-based sexual health education and the provision of health care, yet there are few studies that examine how race and gender work in sexual health promotion as it occurs through community-based public health efforts. Drawing on three years of ethnographic research in a low-income Puerto Rican community, this article demonstrates how a gendered racial project of essentializing Latinx culture surrounding young women’s sexuality and reproduction works to both obscure and reinforce race and racism in sexual health promotion. Professional stakeholders mobilize culture as an explanation for high birth rates among young Latinas in the city and reproduce a “Latino culture narrative” in which Latina gender and sexuality is understood as deterministic and homogenous. Simultaneously, an ideology of colorblindness enables the uncritical promotion of long-acting reversible contraception and obscures the history of reproductive oppression experienced by women of color. I consider how colorblindness and culture narratives allow stakeholders to abdicate responsibility for gendered racial inequality and conclude by advocating for the incorporation of racial and reproductive justice frameworks in sexual health promotion.

Keywords

race sexuality health education Latinas reproductive justice

Early in my fieldwork for this project, I attended a fundraising event for the Towne House, a community-based General Equivalency Diploma (GED) program for pregnant and parenting young women that primarily served low-income Latinas in a city I call “Millerston.”¹ Through my research, I found that this fundraiser clearly illustrates how gender and sexuality are implicated in racial projects, the social processes that shape everyday meanings, and experiences of race. The fundraiser took place at an elaborate banquet hall in the wealthier, whiter side of town, and the people and community that the organization served were largely absent. The exception was a few token success stories, young Latinas who had graduated from the Towne House and went on to college or careers. Attendees at the fundraiser were mostly representatives from local nonprofit organizations, faculty from nearby colleges and universities, and a few individual major donors. Artwork from Towne House students was prominently displayed as the almost entirely white audience took their seats at white-clothed tables preset with elaborately decorated, white-frosted cupcakes. Mayor Ryan Brown delivered brief, carefully crafted introductory remarks. As he often did when speaking at Towne House events, the mayor shared that he was the son of a teen mom, a revelation I never once heard him offer in prevention-focused meetings. His whiteness, like white teen pregnancy and whiteness in Millerston more generally, went unremarked. The well-known Latino author Junot Díaz was the event’s keynote speaker, and along with the three Towne House students who introduced him, he was one of the few people of color in attendance. The students nervously took turns reading their introductions off note cards; one shared that she liked how Díaz uses Spanglish in his writing, which she noted Towne House teachers did not allow. Díaz began his keynote address by saying, “Next time you should structure it so the young sisters speak more,” and he pointed out that we often center the voices of those with power rather than those most affected by the issues at hand. Of all the speakers that evening, Díaz was the only one to explicitly name race or racism. In a city where racial meaning was implicated in a host of discourses, practices, and identities, Díaz’s presence and remarks at the fundraiser were illustrative of the simultaneous ubiquity of and silence about race and racism in Millerston. Likewise, for a fundraiser for an organization that aims to improve the lives of marginalized teen mothers, the importance of gendered inequality went suspiciously unmentioned while vague talk of hope and perseverance was emphasized. Taken together, what was centered at this event (e.g., community outsiders, tokenized success stories) and what was silenced (e.g., discussion of white privilege, acknowledgement of race and gender inequalities) exemplify what I term a gendered racial project. A gendered racial project is the way in which race and gender interact to structure social meanings, experiences, and inequalities in ways that are so entrenched they often go unremarked. Analyzing discourses of youth sexuality and reproduction in community-based sexual health promotions efforts as gendered racial projects permits an examination of how race and gender formations both reveal and reproduce inequalities.

This article argues that sexual health promotion aimed at young, low-income Latinas can be understood as a gendered racial project in that it draws on and reproduces deterministic notions of sexuality and reproduction in ways that affect policy and practice. Through in-depth interviews and participant observation, I identify how the conflation of race and culture produces a story about a homogenous and deterministic “Latino culture” that essentializes Latinx² sexualities and positions young women as in need of saving by benevolent outsiders. I then analyze how the notion of a post-racial, colorblind society enables the uncritical promotion of long-acting, reversible contraceptives (LARCs) and disregards the history of reproductive oppression experienced by women of color. This obscuring is part of a larger issue of promoting individual behaviors in a way that abdicates responsibility for structural inequalities. I conclude on a more hopeful note by commenting on how the seeds of racial and reproductive justice may be planted in Millerston.

Racializing Youth Sexuality and Reproduction

Feminist scholars across the social sciences have illustrated how youth sexuality and reproduction are racialized, that is, how racial meanings are ascribed to the bodies, identities, and practices of young people’s sexuality and reproduction (Bettie 2003; Bridges 2011; Fields 2008; García 2012; Mann 2013; Pillow 2004; Roberts 1997; Solinger 2005). The racialization of youth sexuality and reproduction through youth sexual health promotion can be thought of as part of a “racial project,” Michael Omi and Howard Winant’s (2015, 13) term to describe “efforts to shape the ways in which human identities and social structures are racially signified, and the reciprocal ways that racial meaning becomes embedded in social structure.” Racial projects link signification and structure not only to shape policy and exercise political influence but also to organize everyday understandings about race or confirm “what everyone already knows” (Omi and Winant 2015, 126). Omi and Winant argue that “racial projects connect the meaning of race in particular discursive or ideological contexts and ways that social structures and everyday experiences are racially organized based upon that meaning” (2015, 125). In other words, racial projects link the everyday experiences and meanings of race to the social and political contexts in which ideas about “race” are elaborated.

Racial projects are also gendered, that is, the formation of racial meaning in society, structure of racial inequalities, and social experiences of racialized peoples are intertwined with the signification, structural inequalities, and experiences related to gender and sexuality. For instance, the experience of being a young woman of color whose doctor insists on a long-acting, provider-controlled form of contraception is intertwined with the signification of racialized women’s fertility and the raced and gendered inequalities built into accessing reproductive health care (Mann 2013). A large and varied body of literature considers how gender is implicated in racial social formations, ranging from Korean women’s emotional and body labor in beauty service work (Kang 2010), to the disproportionate deportation of working-class Latino immigrant men (Golash-Boza and Hondagneu-Sotelo 2013), to the construction of how transgender women of color “do” gender (Vidal-Ortiz 2009). The concept of a gendered racial project links and brings into focus these disparate interactional and structural gender formations by explicitly naming and interrogating the ways in which the lived experiences of race and gender cannot be separated from the social signification of race and gender and the inequalities that hinge on that meaning. For example, gendered and raced ideas about what it means to do gender as a trans woman of color (e.g., stereotyped ideas that they are always already sex workers or not really women) are inseparable from the social exclusion and marginalization trans women of color experience (e.g., surveillance by law enforcement, rejection from women’s spaces).

Gender, Race, and Reproduction

Youth sexual health promotion in Millerston can be understood alongside other historical and contemporary gendered racial projects related to reproduction, such as the politics of teen pregnancy and motherhood, punitive social policies related to welfare reform, and the regulation of Latina sexuality and reproduction. First, “teen pregnancy” as a discursive construct and an object of social policy concern has a relatively short, although deeply racialized, history. The initial emergence of teen pregnancy as an “epidemic” in the late 1960s coincided with it being seen as something affecting “our girls,” that is, white young women (Pillow 2004). This framing supported rights-based claims to create funding and programs to help young mothers, including little-known Title IX provisions that protect the rights of pregnant and parenting teens in schools (Pillow 2004). By the mid-1990s, pregnant and parenting young women came to signify the problem of government “dependency,” with Black teen mothers in particular becoming nearly synonymous with “welfare mothers.” With its racialized rhetoric of “welfare queens,” the 1996 welfare reform law sought to limit the reproduction of poor, single women. The law included specific provisions to prevent teen childbearing (i.e., abstinence-only until marriage sex education) and regulate the lives of teen mothers (through stipulations on living situations and schooling) (Mink 1998). Racialized young mothers were and continue to be produced as social and economic burdens on the (white) taxpaying public rather than as a vulnerable group deserving of resources (Hoffman 2008).

Fears regarding the rapid growth in the Latinx population and the U.S. panic surrounding immigration are part of a gendered racial project that has helped shape current teen pregnancy prevention efforts in terms of hypersexual and hyperfertile Latinas. As anthropologist Leo Chavez (2008, 72) suggests, “Latina reproduction” as an object of discourse produces a limited range of meanings that focus on supposedly “excessive reproduction, seemingly abundant or limitless fertility, and hypersexuality, all of which are seen as ‘out of control’ in relation to the supposed social norm.” Scholars and activists have noted the intensifying focus on Latina teens in pregnancy prevention discourses: The specter of the Black “welfare queen” is being replaced by the hyperfertile, opportunistic Latina (Erdmans and Black 2015; Fuentes, Bayetti Flores, and Gonzalez-Rojas 2010; García 2012; Mann 2013). For example, in her ethnographic work with Puerto Rican and Mexican communities in Chicago, Lorena García (2009, 2012) describes how young Latinas are positioned as “bad girls,” always already pregnant or promiscuous, their bodies excessively reproductive, their families strictly bound to a static, sexually silent Latino culture. Likewise, Emily Mann (2013) demonstrates how sexual and reproductive health service providers frame young Latinas’ sexual practices as potentially dangerous and out of line with normative scripts of reproduction while they prioritize the prevention of Latina teen pregnancy to the exclusion of other sexual and reproductive health concerns.

Despite a large body of research that considers how race and gender structure the creation and implementation of school-based sexual health education (Bay-Cheng 2003; Fields 2008; Fine and McClelland 2006; García 2009) and the provision of health care (Bridges 2011; Brubaker 2007; Mann 2013), there are few studies that examine how race works through sexual health promotion as it occurs across institutional and organizational sites. Similarly, although scholars have elucidated how the gendered racialization of sexuality and reproduction is experienced in young Latinas’ sexual subjectivities (Asencio and Battle 2010; García 2012) and reproductive experiences (Barcelos and Gubrium 2014; Mann, Cardona, and Gómez 2015), there remains a need to “turn the gaze around” to examine the politics and practices of health promotion (Green and Labonte 2007). The research described here contributes to and extends the feminist literature on racialized sexuality and reproduction and critiques of sexual health education by specifically naming youth sexual health promotion as a gendered racial project. My analysis examines the processes by which the racial signification of young Latinas’ reproduction plays out in the policies and practices of youth sexual health promotion and articulates how this gendered racial project works within a “post-racial” era to both obscure and contribute to racial inequalities.

Methods

The data in this article are drawn from a feminist ethnographic and discursive study of the politics of youth sexual health promotion. As Wanda Pillow and Cris Mayo (2007) suggest, a key aspect of a feminist ethnographic approach is looking at what is missing, what is passed over, and what is avoided. Although race and gender are central to the health disparities that motivate health promotion policies and practices, the ways in which race and gender are produced and deployed in these efforts are underexamined by public health professionals and researchers alike. To apply a gender and race analysis to the practice of youth sexual health promotion, I use Clarke’s (2005) situational analysis approach to examine how identities and subjectivities, power/knowledge, ideologies, and control are produced through discourse; in other words, I examine how what “everyone knows to be true” about race, gender, and youth sexuality is produced. In combining feminist ethnographic and discursive approaches, I emphasize how race and gender are implicated in the production of knowledge and thus affect health promotion policy and practice.

This research took place over three years across multiple fieldwork sites in Millerston, a small, deindustrialized city in the U.S. Northeast with significant racial and socioeconomic stratification. In the section of the city where the Towne House fundraiser took place, the population is 89 percent white, the median annual income is $65,000, and the teen birth rate is 34 births each year per 1,000 young women ages 15 to 19. In contrast, in the neighborhood where the Towne House is located, just over three miles away, the median annual income is $13,000, the population is 90 percent Puerto Rican, and the teen birth rate is 154 births per 1,000 young women ages 15 to 19.³ Millerston maintains a long-held reputation as a place with high levels of poverty, school dropouts, unemployment, substance abuse, violence, and numerous health disparities—outcomes that are experienced disproportionately by Puerto Ricans in the community.

I was employed by a number of community-based health organizations in Millerston over several years prior to conducting this research. As an academic, mixed white and Latinx former teen parent, I shared positions in a matrix of domination (Collins 2000) with both the professionals and young people in this study. I identified 15 key informants across the city whose work related to youth sexuality and reproduction. These professional stakeholders were recruited by e-mail and at networking events; they included medical providers, social workers, health educators, policymakers, and program administrators who worked in the public school system, city government, medical clinics, and human service organizations. I conducted semi-structured interviews focused on how they made sense of youth sexuality and reproduction in Millerston and in their work and asked for their thoughts on how to best develop programs and policies. Thirteen of the professional stakeholders were women, and two were men. Nine of the stakeholders interviewed were white, non-Latinx, and six were Latina or Latino. They ranged in age from 24 to 52. I also interviewed 26 pregnant and/or parenting young women at the Towne House; all but two were Latina. I gave all people, places, organizations, and projects pseudonyms to protect confidentiality. I conducted participant observation at the meetings of the Millerston Adolescent Sexual Health Promotion Committee (a group composed of representatives from city government, health clinics, and social service organizations with the goal of decreasing teen pregnancy and sexually transmitted infections in Millerston), meetings of the Teens Count project (a $1.1 million, multipartner teen pregnancy prevention project in the area with the specific goal of reducing the teen birth rate by 10 percent), and numerous provider trainings, policy forums, and teen pregnancy prevention rallies. I also reviewed sexual health education curricula, program documents, reports, and policy statements from all of the projects through which I conducted participant observation. This article focuses primarily on findings from professional stakeholder interviews and participant observation; findings centered on youth participants are described elsewhere (Barcelos and Gubrium 2014).

Data analysis proceeded iteratively and inductively and was guided by a constructivist grounded theory approach to coding (Charmaz 2006). I open coded all interviews and participant observation notes and compared codes against one another to identify similarities and differences while also keeping in mind the importance of what did not appear in the data—where race or gender were implicated but not named. Next, I wrote a codebook that described each code and subcode in narrative format. Once the codebook was refined, I coded interviews and fieldnote text in MAXQDA version 11. Finally, I employed situational analysis mapping exercises (Clarke 2005) as a way of moving in and around the data. Adele Clarke (2005, 30) suggests that as visual representations of data, maps “help to rupture some of our normal ways of working and allow us to see things fresh.” The resulting maps are not final analytic products but rather are used to “open up” the data. Situational mapping exercises revealed racialized gender to be a key element of the situation of inquiry, albeit one that was frequently elided by sexual health promotion professionals.

The Gendered Racial Project of Regulating Latina Reproduction

Situational analysis identified two main aspects of a gendered racial project in Millerston’s youth sexual health promotion work: (a) conflating the socially constructed, political concept of “race” with a deterministic Latino culture surrounding gender, sexuality, and health and (b) promoting long-acting reversible contraceptives without a critical examination of their history in regulating the reproduction of racialized women. First, I describe how professional stakeholders mobilized culture as an explanation for high birth rates among young Latinas in Millerston and reproduced a “Latino culture narrative” in which Latinx culture is understood as deterministic and homogenous. Elements of the Latino culture narrative include the notions that Latinx families are silent about sexuality, are averse to contraception and abortion, and promote teen childbearing within the family. Second, I describe how an ideology of colorblindness in the so-called post-racial era (Bonilla-Silva 2014) enables the uncritical promotion of LARC as a strategy to reduce the teen pregnancy rate rather than meet the contraceptive needs of individual young women. Colorblind ideology allows LARC promotion to seem race neutral, thus obscuring the histories of forced and coerced contraception aimed at low-income, racialized young women.

The Latino Culture Narrative

Although “race” or “racism” was seldom mentioned during the course of my fieldwork, “culture” was part of a regularly invoked story told during individual interviews and committee meetings. Elizabeth Randolph, a white woman in her late 50s, manages a sexual and reproductive health clinic in Millerston. Because of her work, Elizabeth saw teen pregnancy mainly as a health problem, but she thought that there was a “cultural aspect” to it as well. “Not to sound racist at all,” she told me, “but it really is a Latino cultural issue. It’s just not a bad thing if a kid gets pregnant. It’s just much more socially acceptable within that community. Right or wrong, I don’t know.” The cultural explanation also was taken up by some Latinas. Clarisa Ortiz, a Latina in her 20s who grew up in Millerston and coordinated teen health programs at the Millerston Community Health Center, used the phrase “it’s a cultural thing” to explain the higher rates of teen pregnancy among Latinas in Millerston:

I think because [the rate] is just so high here, and then when you look at the numbers, and the highest numbers are Latino, I have no choice but to make it more of a cultural thing. And not only a traditional Latino culture, but also a Millerston culture, and when you walk around the streets of Millerston and you see that there’s plenty of people, you know, saying that they’re getting [welfare] assistance, and there are plenty of people who are kind of like, sometimes even gypping the system.

In this quote, Clarisa connects high rates of teen birth among Latinas in Millerston to culture by virtue of the fact that the rates are “so high.” In addition to a “traditional Latino culture,” she extends this correlation to a “Millerston culture” in which there is a visible culture of dependency on welfare assistance that ostensibly fuels the teen pregnancy rate.

Similarly, Hannah McNeil, a white woman in her 60s who serves as the chair of the Millerston Adolescent Sexual Health Promotion Committee (MASHPC), connected high rates of teen pregnancy in Millerston to Latino culture and emphasized the role of familial norms around early childbearing:

I think [teen pregnancy] is a cultural issue that is perpetuated, and because of the lack of education, I think that definitely has contributed to young people not having the understanding of what becoming a teen parent involves. And, unfortunately, because there is not that educational component as part of their upbringing, they tend to gravitate towards what they feel is the right thing to do. And because they have seen it, it’s intergenerational. In order to change an intergenerational pattern, you have to be aware that there’s a problem. And you have to want to change it. And I don’t think that awareness, until now, has been there. So that’s where we are helping. But without that awareness, I don’t think that it could ever change.

Here a culture of teen childbearing is identified as a deeply ingrained problem affecting generations of families (implied but not stated to mean Latina mothers and their daughters). Although some of these families did not see it as a problem, Hannah saw a role for herself and other cultural outsiders to intervene and bring awareness, or put differently, teach Latinas how to change their family structures. Hannah’s notion of “awareness” is predicated on an individual behavior change model that fails to account for the structural inequalities that affect fertility timing patterns (Geronimus 2003; López 2008).

The first element of the Latino culture narrative in Millerston is an assumed silence around sexuality and sexual health in Latinx families and communities. Clarisa Ortiz suggested, “Rarely in a Latino family will you hear them talking to their kids about, you know, how to use a condom, why they should wait. It’s more like, ‘Don’t have sex. Why? Because I said so.’” Accordingly, professional stakeholders view increasing parental communication as an important part of their work. Belief in the sexual silence of Puerto Rican families inspired MASHPC members to organize a series of “parent education” forums in the community, with the goal of encouraging Latinx parents to talk to their children about sex. These forums were sparsely attended; members attributed this to poor timing, bad weather, and parents feeling distracted by a recent shooting in the community. While all of these factors may have been at play, stakeholders failed to understand that families likely had priorities that took precedence over attending an event in which a group of community outsiders wanted to help them parent differently.

Stakeholders also failed to problematize the notion that there is something particular to Latinx families that prevents them from having productive conversations about sexuality with their children. Lourdes Navarro, a Latina in her 50s who served as the educational director at the Towne House and had had her children in her late teens, called attention to this contradiction: “As a Latino person, the subliminal message that I’ve gotten from the dominant culture is, the reason why you’re in this predicament [having a pregnant child] is because you don’t talk about sexuality with your kids. And so, the innuendo there is that the dominant culture does.” Here Lourdes calls attention to an implicit assumption about the narrative’s element of cultural silence: If Latinxs have difficulty talking about sexuality (theirs or their children’s), non-Latinx people and non-Latinx families do not. As Gloria González-López and Salvador Vidal-Ortiz (2008, 313) argue, in addition to reinscribing an essential Latinx sexual culture and an absence of sexual silence among non-Latinxs, “sexual silence is not absolute but highly selective and that selectivity is not shaped by a so-called ‘Latino culture’ but by multiple forms of social inequality affecting other cultural groups as well.” In other words, sexual silence is about power and inequality rather than “culture.”

A second element of the Latino cultural narrative involves the belief that Latina women are averse to using contraception and do not terminate pregnancies. Although she saw “the tide starting to turn in the population,” Elizabeth Randolph believed that in general, Latina women didn’t “contracept because that was like a sin, because you know, you’re Catholic.” Similarly, Clarisa Ortiz recounted, “It’s a cultural thing. . . . For me growing up, it was like, only white mothers will get their child put on a birth control. We won’t do that. But we’re okay with them having kids at an early age.” Likewise, Mayor Brown wondered if the higher rates of teen birth among Latinas in Millerston were related to poverty or “religious values within a certain community.” “Anecdotally,” he told me, “talking with families who are religious, obviously they don’t believe in abortion. Many of the families I speak to, when a young woman gets pregnant, that’s not a choice.” Beth Emmerson, a white nurse in her 60s and a regular MASHPC member, stated it plainly: “In Millerston if you’re Latina and you get pregnant, you are not going to have an abortion.”

The third element of the Latino culture narrative in Millerston posits that Latinas are more likely to be teen parents because Latinx families, in particular female relatives, promote teen pregnancy by failing to stigmatize early childbearing and supporting their pregnant daughters. This element of the Latino culture narrative derives from the Latinx cultural value of familismo, or the strong identification with, respect for, and loyalty to the nuclear and extended family. Hannah McNeil saw family as playing a role in the high number of teen births in Millerston. She attributed it not to Puerto Rican culture per se but rather to a Millerston Latino culture that she was knowledgeable about through her focus group research:

It’s not, say, because you’re Hispanic. Because there [in Puerto Rico] it’s totally different—they don’t have the problems that we have, as far as teen pregnancy. . . . In this particular Hispanic culture [in Millerston], it’s not rewarded, but it’s condoned. I don’t think I’m generalizing, because I’ve had enough focus groups. I’ve worked with kids that have said their mothers had them at 15 . . . [the baby] becomes part of the family, and they give it support. And it’s not like, you know, it’s not looked upon in any way that it’s going to prevent them from having goals.

In Hannah’s understanding, the support that mothers in Millerston give their pregnant daughters serves to “condone” teen pregnancy. Beth Emmerson contradicted herself by invoking the cultural value of Latino family as a casual factor in high birth rates among young Latinas after declaring that the cultural explanation was “hogwash”:

I even brought this up at the meeting this week at the Millerston Technical High School when the nurse there said, like, “Well, it’s their culture. It’s their culture to have babies.” Come on. Whose culture is it to have babies? It’s not their culture to have babies. It just is an easy way to put it. It’s their culture not to have an abortion. It’s their culture for them to value family. When you talk about a Puerto Rican family, it’s not the little nuclear family, it’s blood relatives and it’s also emotional relatives. So family, familia, is so much different to a Puerto Rican than to white people. It’s their culture—they’re not going to put up their babies for adoption. If they can’t take care of their baby, they’re going to give it to an aunt.

Although she discounted the validity of culture as a causal factor in teen pregnancy, Beth nonetheless saw culture and the presence of an extended family of women as an explanation for why Latinas don’t have abortions or place their children for adoption.

The Latino culture narrative at work in Millerston makes invisible the racialization of Latina sexuality and reproduction while producing Latinx culture as essential, homogenous, and deterministic. “Latinos” are normalized as a singular population rather than a large and heterogeneous group of people with disparate histories of (de)colonization and a range of geographic, linguistic, demographic, and cultural origins, not to mention sexual and reproductive practices. The narrative is not entirely uncontested—some professional stakeholders did call into question the correlation between culture and teen birth rates—but its ubiquity and embeddedness is notable. I do not mean to imply that culture has no bearing on fertility practices or health behaviors; rather, I aim to call attention to the problems inherent to producing culture in an essentialized way that enables intervention into young women’s reproductive lives. Even if there were a unitary Latino culture in Millerston that rigidly dictated sexuality and reproduction, it would not justify essentializing this culture or seeking to change it as a means to an end of lowering teen birth rates. Reifying Latino culture as the cause of teen pregnancy distracts from the raced and gendered structural inequalities that are predictors of poor health and poverty.

Colorblind Ideology: What’s Not to LARC?

At the same time that the Latino culture narrative in Millerston naturalizes race and obscures gendered inequalities, an ideology of colorblindness enables the uncritical and ubiquitous promotion of long-acting reversible contraception, or LARC. LARC includes methods such as Depo Provera (“the shot”), intrauterine devices (IUDs), and subdermal contraceptive implants (Implanon/Nexplanon). These methods are extremely effective in preventing pregnancies, with efficacy rates comparable to surgical sterilization. Significantly, these are provider-controlled methods that cannot easily be stopped by the user as one could do with a contraceptive pill, meaning that discontinuation is more difficult in the case of undesirable side effects, health complications, and the desire to switch methods or become pregnant. LARCs are implicated in histories of coerced and forced fertility control aimed at marginalized women, ranging from legislative actions that predicate receipt of public assistance on accepting LARC to judicial actions that require LARC as a condition of a reduced prison sentence (McClain 2015; Roberts 1997; Schoen 2005; Solinger 2005). Presently, scholarly and news media accounts of the promise of LARC emphasize its potential to reduce teen births and thus public assistance expenditures (Secura et al. 2014; Trussell et al. 2013).

Enthusiasm for LARC promotion in Millerston mirrors trends nationally: Increasing the number of teens using LARC methods was an objective of the multisite Teens Count project that coordinated much of the community-based youth sexual health promotion in the city during the time of my fieldwork. This project included implementing the Centers for Disease Control and Prevention’s (CDC) best practices for “Contraceptive and Reproductive Health Services for Teens,” such as promoting LARC at every visit to a clinic (regardless of the reason for the visit), providing “quick start” or immediate insertion of the method, and training clinical providers on IUD and Implanon/Nexplanon insertion. Although some professional stakeholders expressed caution at the uncritical and widespread promotion of LARC toward young people in Millerston, their concerns were overshadowed by the recommendations of funding agencies and the objectives of health promotion projects such as the Teens Count initiative in which they participated.

Clarisa Ortiz explained the purpose of LARC promotion initiatives: “I guess there were these conversations happening amongst the bigwigs, that you know, if clinics were able to have more LARC available, there would be a higher rate of less pregnancies amongst adolescents, amongst young adults.” As with other Millerston clinics that participated in the Teens Count project, Clarisa’s clinic sought to train more providers on LARC insertion, promote its use to patients, and increase the number of teens using the methods. Data from the Teens Count project indicate that from 2010 to 2012, the percentage of women ages 12 to 19 who visited a clinic in the greater Millerston area and used a LARC method increased 250 percent. When this finding was announced during a presentation at a coalition meeting, attendees from health and human service organizations across Millerston applauded the news using the provided noisemakers and kazoos. Put another way, a group of majority white, middle-aged, and class-privileged service providers from outside the community literally cheered at a practice that has historically been used to limit the childbearing of marginalized women based on their perceived lack of fitness as reproducers (Gómez, Fuentes, and Allina 2014).

In line with existing research (Gómez, Mann, and Torres 2017), professionals in Millerston often failed to understand the myriad reasons why young women would not desire a long-acting contraceptive method. Emily Lambert, a white social worker in her 40s who coordinates primary and secondary teen pregnancy prevention programs through a large health and human services provider, shared a story about a woman in one of her organization’s teen parent support programs who she characterized as lacking a sense of self-responsibility:

She has three kids, she’s 24, she’s pregnant with her fourth and talking to her about birth control, [she says she] doesn’t need it [and] doesn’t want it, but she doesn’t want any more kids, because her hands are full, and she doesn’t have a job. Sooooo work with me here because I’m thinking if you use birth control then you wouldn’t have that other child that you’re saying you don’t want, but you don’t want to use birth control . . . so this whole how do I understand that kind of thought process and get through to you is very frustrating. . . . There’s all these reasons they don’t want something inserted into their body they don’t want to gain weight [sarcastically], there’s all these things, but in my head those are just excuses, right, I mean you’re going to gain weight if you get pregnant so what’s an extra ten pounds if you gain weight this way? It’s not like you’re an exercise freak anyway, you know, it’s just I think they’re just excuses.

Emily’s minimization of the side effects of contraception is interesting given evidence that side effects have considerable social weight and meaning to women and are often a key reason for discontinuance (Littlejohn 2013). Clarisa Ortiz shared a similar story that she described more than once as “crazy”:

We had an adolescent who got the [IUD] inserted, didn’t like it, went to the emergency department [at] the hospital, told the people, “Take it out!” Instead of them conferring with her PCP [primary care provider], or telling her to go back to the PCP to have that done, because we did the procedure, they took it out. And then, the patient came back, and she was like, “I want it back. ’Cause, you know, I don’t want to get pregnant.”

Clarisa’s remarks illustrate the inability to view contraception as a negotiated, embodied practice situated in a social context, including interpersonal relationships with sexual partners and health care providers. Both Emily and Clarisa’s comments speak to the almost obligatory nature of LARC in service providers’ treatment of marginalized young women of color, in which the professional stakeholders’ desire to reduce the teen birth rate takes precedence over the needs of the contraceptive users themselves (Higgins 2014).

Some stakeholders, including Latinas and non-Latinas, did struggle with the tension between freedom and control inherent in LARC methods, although their voices were often lost in the pro-LARC applause. Kristina Myers, a white nurse in her 50s serving as a nurse practitioner at Millerston High’s teen clinic, explained, “I’m not saying that if a girl came into my office and I could put in, you know, a long-acting reversible method of contraception that would give her three years of not having a baby, that that’s how you solve teen pregnancy.” Kristina was clear that although she saw contraceptive access as an important part of women’s reproductive autonomy, she did not see LARC as a magic bullet to solving teen pregnancy. Amy Lexington, a white grant writer and project manager in her 30s, dealt closely with funding agencies and acknowledged that the “power structure in Puerto Rico, you know, colluding with the U.S. government to sterilize women” had an effect on health promotion work that had not been adequately dealt with. As she stated, “The CDC is very much promoting IUDs and the contraceptive implants . . . there’s a real push to get more IUDs and implants in young women and it can be really sticky.” Thus, in Amy’s estimation, the “stickiness” of LARC promotion rested in the tensions begot by the legacies of the U.S. mainland’s regulation of Puerto Rican women’s reproduction both on and off the island. However, Kristina and Amy’s analyses were not among the majority in Millerston, and by the completion of my fieldwork, Kristina and Amy had both transitioned away from youth sexual health promotion work.

As Amy’s comments indicate, one of the ways that colorblindness enables the uncritical promotion of LARC in Millerston is through its obscuring of the history of LARC in coercive practices directed at women of color and the use of Puerto Rico as a site to develop modern contraceptive technologies (Briggs 2002; López 2008). Ana Gutierrez, a Latina sexual health educator in her 20s who grew up in Millerston, called attention to the contemporary manifestations of these legacies. She became interested in the issue while being raised by her grandmother, who never talked to her about sex and contraception. “For a long time,” Ana told me, “I thought it was maybe because my mom had me at such a young age, and she was afraid if she talked to me about sex I would end up pregnant.” Yet, as Ana grew older, she realized her grandmother’s “sexual silence” was due to her experience of coercive contraception:

My aunt actually explained that my grandmother had an IUD put in around the time that birth controls were being tested in Puerto Rico. And she didn’t really understand. She did want to have some form of birth control, but she didn’t understand how long the IUD was going to work, and how it actually worked. So, after that I became really interested in the testing—the birth control testing in Puerto Rico—and then I thought, I never asked her, like maybe it has to do something with that, that’s why she doesn’t talk about sex and birth control.

Ana’s family’s experience points to an important implication of how Puerto Rican women in Millerston negotiate the legacy of coercive contraceptive practices. Her aunt, who had her first child at 17 while still living on the island, was later pressed into having a tubal ligation and eventually a hysterectomy. Ana told me: “[My aunt] explained that having her kids at an early age was a blessing, in her eyes, because if she would have waited, till like a 30, 35-year-old age, she wouldn’t have been able to have kids, because by 30 she already had a hysterectomy.”

Ana’s family history complicates elements of the Latino culture narrative that sees Latinas’ reluctance to use contraception or have abortions as the result of religious or cultural values and reveals how early childbearing can be a strategy to navigate the possibility of future reproductive control. Similarly, it illustrates how not “seeing race” also means not seeing the ways in which race and gender intersect to exacerbate inequalities. Promoting LARC as a first-line contraceptive choice (ahead of user-controlled, more easily discontinued methods) illuminates how a gendered racial project of regulating young Latinas’ reproduction puts the desire to reduce the teen birth rate ahead of the fertility timing desires of the individual, minimizes the experience of side effects, and fails to account for the social embeddedness of contraceptive decision making. In a “post-racial” society, since race doesn’t “matter” any more, health promoters can disregard LARC’s long history as a tool to regulate the reproduction of low-income, racialized, young, and/or disabled women (Roberts 1997; Schoen 2005; Solinger 2005) and uncritically promote its widespread use while downplaying the reasons young women may be resistant to it.

The Implications of Millerston’s Gendered Racial Project

The gendered racial project of youth sexual health promotion in Millerston organizes everyday understandings of race in the city, understood as an essentialized and deterministic “Latino culture,” and structures health promotion efforts according to a racialized understanding of young women’s sexuality and reproduction. Combined with a post-racial colorblind ideology that obscures histories of reproductive oppression, the culture narrative both produces and constrains the sexual subjectivity of young Latinas in Millerston and facilitates the uncritical promotion of LARC methods. An important contribution of this research is to demonstrate how the gendered racial project of youth sexual health promotion enables outsider intervention into the sexual and reproductive lives of racialized young women in the form of promoting individual behavior change. These findings also suggest that an effect of youth sexual health promotion as a gendered racial project is the ways in which it allows professional stakeholders to escape responsibility for attending to systemic and systematic forms of racial oppression. Put another way, what the Latino culture narrative and the ideology of colorblindness do is allow professional stakeholders to abdicate responsibility for their collusion in maintaining racism and sexism. Focusing on individual health promotion strategies, such as acceptance of long-acting provider-controlled contraception, cannot possibly account for the racial and economic inequalities that contribute to high rates of unintended pregnancies among low-income women of color. What is more, the notion that modifying “Latino culture” and promoting LARC can mitigate the effects of a race-, class-, and gender-stratified society means that there is always a role for benevolent outsiders. Youth sexual health promotion, as it is currently constituted in Millerston and elsewhere, cannot eliminate the effects of colonialism and reproductive oppression or provide adequate education and employment opportunities for people in a racist society under late capitalism, but it can provide lessons on how Latinas can talk to their daughters about sex and encourage young women to elect birth control methods that cannot be easily stopped without a health care provider.

These findings document how gendered racial projects in contemporary U.S. society play out in the conceptualization and delivery of health promotion aimed at regulating sexuality and reproduction. Although not intended to be generalized to other communities, populations, or health issues, these findings are transferrable in the sense that they illuminate how the racialization of young Latinas reifies social inequalities. As such, they contribute to our understanding how gendered racial projects reveal and reinforce inequalities through sites including education (Gómez, Villaseñor, et al. 2014) and health care (Bridges 2011). Likewise, the concept of a gendered racial project can be used to highlight how race and gender discourses play out in policy and practice, that is, gendered racial formations guide the very policies that are intended to ameliorate inequalities caused by racial and gender domination. Future research can extend these findings by using ethnographic and discursive methods to elucidate gendered racial projects related to other issues affecting young Latinas, for example, high school retention and college matriculation or health concerns unrelated to sexuality and reproduction, such as cardiovascular disease and diabetes.

To conclude on a hopeful note, I end by offering that there are seeds of racial and reproductive justice being planted in Millerston and youth sexual health promotion more generally. This sort of work is already happening at both local and national levels, including the recently announced partnership between reproductive justice organizations and the Black Lives Matter movement (Rankin 2016). Though disparate and nascent, there are voices calling for a shift toward racial and reproductive justice in Millerston. Lourdes Navarro stated it well when she told me, “I think that racism is a powerful tool against poor and marginalized people—the seeds of racism have been planted so, so well that it’s been internalized in poor communities and we have begun to believe that the stereotypical comments, views, and attitudes are real.” Concrete strategies that youth-serving organizations and coalitions in Millerston and elsewhere might employ include promoting authentic and sustainable youth leadership, responding to the priorities of the community even when they do not match those of funding agencies, training staff and community members in principles of racial justice organizing, and committing to a strategic vision of reproductive justice. For instance, the members of MASHPC might participate in organizing efforts among white people committed to dismantling white supremacy, such as Standing Up for Racial Justice (SURJ), and policymakers might collaborate or receive technical assistance training from national reproductive justice organizations such as Forward Together.⁴ Shifting youth sexual health promotion to incorporate gender, racial, and reproductive justice frameworks means moving from a focus on modifying “culture” and promoting specific contraceptives to a broader analysis of gendered, racial, economic, political, and structural constraints on power.

Footnotes

Author’s note:

My sincere gratitude goes out to the individuals interviewed for this project, who face numerous constraints in their efforts to serve marginalized young people. Thanks as well to Davey Shlasko and Rachel Briggs at Second Look Editors and the anonymous reviewers at Gender & Society for making this a stronger manuscript.

Notes

Chris Barcelos is an assistant professor of gender and women’s studies at the University of Wisconsin-Madison. Their research uses ethnography, discourse analysis, and visual methods to interrogate how health promotion discourses both reveal and reproduce inequalities along the lines of race, class, gender, sexuality, nation, and ability.

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