Should contraception be seen as a choice that each of us is entitled to make according to our own intimate preferences, possibly taking account of the advice of a doctor? Or should birth-control methods be dictated by policymakers as a condition of social support, on the basis of what they think is best?
It seems a crazy question to even consider in contemporary Britain. Compulsory birth control was an ignominious feature of interwar family-planning movements, which make us shuffle with embarrassment when we’re reminded of them today. And so they should. In the 1920s, birth control became associated with social policies aimed at reducing the number of unfit children born to unfit mothers. Sterilisation programmes aimed at the ill, the destitute, and those supposedly lacking the self-control to avoid adding to large families, became common in North America and Europe, including Britain. ‘Eugenics’ only became a troublesome concept within public health when it became associated with the excesses of the Nazi regime.
No one would condone the compulsory sterilisation of the poor today. But there are growing concerns that some women, those deemed unable to make good birth-control choices, are being targeted by policy interventions that take day-to-day responsibility for contraception out of their hands.
This week, the Pause programme proudly announced that it had been granted £6.8million by the government to support vulnerable women. Pause supports women who are at risk of having repeat pregnancies after having children taken into care, on the condition that they use long-acting, reversible contraception, such as the implant or IUD, over an 18-month period. The programme also helps women with housing and their educational and career aspirations. It started in Hackney, east London, in 2013, and now has centres in Doncaster, Greenwich, Hull, Islington, Newham and Southwark.
Of course, women on the programme are not being literally compelled to use IUDs, which can only be removed by medical professionals. But they are told that the benefits of the programme are only available to those who agree to use the contraceptive. If the contraceptive is removed, the woman is denied the benefits.