3137. The Dangerous Rise of the IUD as Poverty Cure

By Christine Dehlendorf and Kelsey Holt, The New York Times, January 2, 2019


A nurse discussing birth control at a clinic in 1940.CreditCreditHansel Mieth/The LIFE Picture Collection, via Getty Images

Over the past decade, more and more women have begun using long-acting, reversible birth control methods like intrauterine devices and implants. These birth control methods are highly effective at preventing pregnancy but were previously not widely accessible because of high costs and lack of knowledge among health care providers. Increasing access to these methods, for women who want them, is a sign of progress.

However, many researchers, advocates and policymakers aren’t selling their rise solely as a victory for women’s health. They claim IUDs and implants may be a powerful new tool to fight poverty. This sort of language should set off alarm bells because the idea that limiting women’s reproduction can cure society’s ills has a long, shameful history in the United States.

Between 1909 and 1979, about 20,000 people were involuntarily sterilized in California — one of 33 states where compulsory sterilization in the name of eugenics and social well-being was legal in the 20th century. In the 1990s, multiple states proposed laws to incentivize or even require welfare recipients to use the new contraceptive Norplant — and while none of these became law, they helped shape public discourse. Even in recent years, some judges have offered reduced sentences to defendants who agree to be sterilized or use birth control. All of the above are instances in which the state sought to limit the reproduction of the poor, people of color and other groups, because of a belief that doing so would be for the good of society.

Today, this age-old idea that reproduction is to blame for societal problems has seen a resurgence in the current enthusiasm around long-acting, reversible contraception.

We can see echoes of this view in how some politicians argue for expanded access to birth control as a tool to address intergenerational poverty. We can see it in the priorities of philanthropic funders and in glowing media coverage about the promise of long-acting birth control that produces headlines like “Can the IUD Prevent Poverty, Save Taxpayers Billions?”

Promoting IUDs and implants is certainly less egregious than state-sponsored eugenics. But promoting them from a poverty-reduction perspective still targets the reproduction of certain women based on a problematic and simplistic understanding of the causes of societal ills. Such tactics could also, ironically, harm the quality of family-planning care for the very women they are intended to help.

Of course contraception is critical to individuals’ human right to control their reproduction and shape the course of their own lives. But there is a clear danger in suggesting that ending poverty on a societal level is as simple as inserting a device into an arm or uterus. This idea distracts from the structural factors — like the availability of social services and racial discrimination — that determine economic opportunities. Providing contraception is critical because it is a core component of women’s health care, not because of an unfounded belief that it is a silver bullet for poverty.

We also have concerns about how this emphasis on birth control as a tool of poverty reduction actually plays out in clinics. Claims about the social benefits of increasing the use of IUDs and implants can contribute to a narrative that says these methods are the best methods for everyone and that a program’s success should be judged by the numbers of IUDs and implants its providers insert. This, in turn, can contribute to providers neglecting individual women’s preferences when it comes to birth control: applying subtle pressure to use long-acting contraception, for example, or resisting requests to remove IUDs and implants.

These concerns about the quality of family-planning care are particularly salient for women of color. Research has shown that black women are more likely to feel pressured to use contraceptives. When studying counseling about IUDs specifically, we found that providers are more likely to recommend IUDs to low-income black and Latina women than low-income white women.

Given these biases, and the long history of coercion, it is no wonder that research has found that more than 40 percent of black and Latina women think the government promotes birth control to limit births among communities of color. Such beliefs should not be dismissed as conspiracy theories but recognized as understandable reactions to lived experiences. Programs to promote long-acting methods among women of color can further erode trust in family-planning services. Indeed, women of color have led efforts to raise awareness about the dangers of these programs and define principles for respectful provision of these methods.

Prioritizing women’s access to all contraceptive methods is undeniably a laudable goal. But access shouldn’t be contingent on the dangerous claim that it will address the fundamental societal problem of poverty and economic inequality. This, in fact, requires policies such as raising the minimum wage, instituting paid family and sick leave, and expanding access to social services.

Instead, policies and programs around family planning should keep their focus where it belongs: on whether women’s needs are met and their preferences for building — or not building — a family are respected. These efforts should explicitly acknowledge and respond to the continuing bias in health care and the mistrust many women feel in family-planning services. In doing so, they can begin to address the dark history of reproductive coercion and ensure all women receive the care that they deserve.

2794. How the Other Half Lives in Iran

By Shahram Khosravi, The New York Times, January 14, 2018

A Kurdish koolbar (porter) who carry goods between Kurdistan of Iran and Kurdistan of Iraq on their back.  Kurds are an oppressed nationality in both countries and have been fighting for self-determination for decades. 

The village of Zaras lies in a valley circled by the Zagros Mountains in southwestern Bakhtiari Province of Iran. An hour’s ride from Izeh, the nearest town, Zaras is home to about 60 families, who make a living from farming, pastoral nomadism and working as migrant laborers in Iranian cities.

On a September afternoon in 2014, I sat by the mud wall of a hazelnut garden with Darab, a 50-year-old farmer in Zaras. Darab, a man with a charming face and rough, calloused hands, cultivated potatoes, beans and onions on a plot of land slightly larger than an acre. Yet the harvest wasn’t enough to feed his family — his wife, his six children and his elderly parents. Iran imported grains and potatoes on an enormous scale, and the prices fell each year.

Darab supplemented his meager earnings by digging wells and working for a few months at construction sites in nearby cities. He would make less than the equivalent of about 20 American dollars for 10 hours at a construction site — work that did not offer the safety net of insurance against accidents or ill health.

The village of Zaras has, like the rest of Iran, suffered from drought in the past decade. The land and the harvest have depleted. Darab spoke wistfully about a time when there was enough water for the gardens and the fields in the village. “It gets worse every year,” he said. “Nowadays they pour some water around the trees. It does not reach the roots.” Many hazelnut trees around us were already dead.

On Dec. 31, Izeh, the town near Darab’s village, witnessed one of the more violent protests triggered by economic hardships across Iran. Young men in Izeh took over the city for several hours. Several young men were killed; many were injured. They had

But the first targets of the protesters’ rage were the buildings housing the banks. The drought has forced an increasingly large number of people in the region to seek loans. Unable to pay off their loans, their debt grows, and the bank confiscates what they have left — land, a house or a tractor.

“People’s lives are worthless!” I repeatedly heard Iranians in the villages and the cities make this despairing declaration. Sociologists use the term “precarity” to describe this abandonment, these depriving people of a livable life. “The world has boycotted us,” Darab said. Before the sanctions were imposed on Iran, Darab and other workers would travel to Iran’s Persian Gulf area to work for oil and gas companies. Foreign companies moved out after the sanctions and the jobs dried up.

Almost all young men in Darab’s village moved to cities to join the growing urban precariat, who are exploited as cheap and docile workers in the informal labor market. The absence of opportunity has intensified the migration from the villages to the urban areas, which have been growing five times faster. According to the Iranian Parliament data, the number of Iranians living in slums has increased 17 times since the revolution in 1979 to almost 10 million.

Every year more Iranians are classified as poor. Official sources reported in 2015 that 40 percent of Iranians lived below the poverty line. The unemployment rate among young people — between 20 and 24 years old — rose to 30 percent in 2016. This explains why more than 90 percent of the people arrested during the recent protests were under age 25.

About 11 million Iranians, around 50 percent of the workforce, work in irregular employment, according to Iran’s Ministry of Labor and Social Affairs. Almost all young workers I met during my extended fieldwork in the past 15 years have been in irregular employment, rarely paid on time, with little protection from exploitative employers. Between 10 million and 13 million Iranians are entirely excluded from health, work or unemployment insurance.

The Iranian poor do see the vast riches of the Iranian elite. Since the early 2010s Iran has witnessed the growth of a consumerist culture and rising inequality. An increasing number of imported luxury cars have appeared on the roads; buildings whose price per square meter equals three years of a worker’s wage have come up across the cities. Ice cream covered in edible gold — worth a worker’s monthly salary — is on the menus of luxury restaurants.

After the day’s work, I would walk with workers from Darab’s village from the construction sites in wealthy neighborhoods in North Tehran to their modest rented rooms in the poorer South Tehran. As we walked past Porsches and Maseratis parked outside luxury boutiques and restaurants, they would address God satirically and say, “If these people are your creatures, what am I then?”

Alongside financial insecurity and drought, Iranians are reeling from intense pollution in the cities. A decade of sanctions has significantly increased the prices of groceries, medicines and fuel. The sanctions also excluded Iranians from the formal international banking system and forced them toward informal cash-based transactions, making them vulnerable to fraud and black market prices. The value of the Iranian toman has fallen by more than half against the dollar since 2012, which affected all other costs inside the country.

President Trump’s anti-Iranian tirades leave no hope for lifting or easing sanctions on Iran. The fear of military attack by Israel or the United States has added to the popular anxieties.

Yet hope for democracy and social justice in modern Iran has been replicated time and again through political struggles, from the constitutional revolution in 1911, the oil nationalization movement in 1950, the revolution in 1979, the green movement in 2009 and the most recent protests led by the poor.

As the images of the protests in Iran appeared on screens worldwide, I thought of my conversation with Darab in his village. We had stared at the distant mountains rising toward a clear, blue sky in silence. “See all these lands that we cannot get one single toman from. We do not have water. Write it,” he had commanded. “And write that those in Tehran have been taking all money for themselves and have forgotten that we also are people.”

Shahram Khosravi, a professor of Anthropology at Stockholm University, is the author of “Precarious Lives: Waiting and Hope in Iran” and “Young and Defiant in Tehran.”