The abusive practice is more common among people from historically marginalized backgrounds, including those who struggle with mental illness or other disabilities.

By Susan Rinkunas
June 24, 2021
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Yesterday we learned that singer Britney Spears wants more children but she has an intrauterine device, or IUD, against her will under the terms of her 13-year conservatorship that allows her father legal control of her life and her finances.

As part of a statement Spears made to a Los Angeles judge asking for the conservatorship to end, CNN reports that she said, "I want to be able to get married and have a baby. I was told I can't get married. I have an IUD inside me but this so-called team won't let me go to the doctor to remove it because they don't want me to have any more children." Spears, 39, has two children with ex-husband Kevin Federline: Sean Preston Federline, 15, and Jayden James Federline, 14. She is currently dating personal trainer Sam Asghari.

Britney-Spears-IUD-GettyImages-480822024
Credit: Getty Images

While Spears revealed other disturbing details, like being forced to take lithium, the news that she isn't being allowed to get pregnant struck a nerve. She received an outpouring of support online including from those noting that Spears is a victim of reproductive coercion and that the forced IUD-and the conservatorship overall-are both issues of disability rights.

Alexis McGill Johnson, the president and CEO of Planned Parenthood Federation of America, said in a statement: "It is incredibly distressing to hear the trauma that Britney Spears has been through-including the appalling news that she has not been able to remove her own IUD. We stand in solidarity with Britney and all women who face reproductive coercion. Your reproductive health is your own-and no one should make decisions about it for you. Every person should have the ability to make their own decisions about their bodies and exercise bodily autonomy."

According to the American College of Obstetricians and Gynecologists (ACOG), reproductive coercion is broadly defined as "behavior intended to maintain power and control in a relationship related to reproductive health." It's when someone, often an intimate partner, tries to control another person's fertility against their will to either make them have children or prevent them from having children, Gabriela Aguilar, MD, MPH, a fellow with Physicians for Reproductive Health and an ob-gyn in New York, tells Health. Reproductive coercion is a violation of people's basic bodily autonomy of whether and when to have children.

Forms of reproductive coercion include tampering with birth control methods like pills and condoms, a partner not pulling out during sex as agreed upon, interfering with decisions about abortion, and pressuring someone to get a birth control device or be sterilized. Abortion waiting periods and bans, and denial of infertility benefits are also reproductive coercion, Dr. Aguilar says.

The controlling party can also be a family member, a medical provider, or more systemic actors like a judge offering reduced sentences if a defendant gets a contraceptive implant or a vasectomy (yes, men can be victims, too), or even state- and government-run institutions like hospitals, prisons, and ICE detention centers that have forcibly sterilized people. In the 1927 Supreme Court decision Buck v. Bell, the court upheld a Virginia eugenics law that permitted the sterilization of people committed to mental institutions. The ruling has never been overturned but state laws have been repealed and subsequent cases have undermined its holdings.

As many as one in four women of reproductive age say they've experienced reproductive coercion, according to a 2019 literature review published in BMJ Sexual & Reproductive Health. Dr. Aguilar says it's more common among people from historically marginalized backgrounds, like Black women, other women of color, people with low incomes, and those who struggle with mental illness or other disabilities.

Dr. Aguilar says medical providers can be coercive by recommending methods based only on effectiveness, refusing to discontinue birth control (like not removing an IUD), pressuring somebody to use contraception when they don't want to, or not respecting their wishes to get sterilized. IUDs are a great method of birth control that last for years and are highly effective, but no one should get-or be forced to keep-an IUD if that's not what they want. Research in the American Journal of Obstetrics and Gynecology suggests that providers are more likely to recommend IUDs to Black and Latina women living on low incomes than they are white women of similar socioeconomic status, with the IUD as "poverty cure" just the latest example in our country's history of limiting the reproduction of low-income women of color and others deemed unfit due to racism, classism, and ableism.

Some patients challenge providers' sense of ethics when it comes to pregnancy, but it's ultimately the patients' choice to have children. "There are patients that make us uncomfortable because we know that their medical problems are so dire that pregnancy would be a risk to their life, but ultimately, that is up to the individual whether or not they want to take that risk. It's not our decision to make for them," Dr. Aguilar says.

But these decisions are often made for people with disabilities who may have third parties controlling their care. The reason Spears isn't in control of her own medical care is due to her mental health. Her father sought and was granted a conservatorship in 2008 over concerns about her mental health and possible substance issues after two trips to the hospital for involuntary psychiatric evaluations. (Spears has continued to perform and release new music and has long argued that the conservatorship is exploitative.) Disability advocates note that the legal arrangements are supposed to be a last resort for people who cannot take care of their basic needs but are in practice all too easy for judges to grant and there are few checks on conservators' power.

Zoe Brennan-Krohn, a staff attorney with the ACLU's Disability Rights Project told The New Republic earlier this year that able-bodied adults are allowed to make harmful choices that disabled people are not. "There's this double standard where, if you're perceived as having a disability, your preferences are subsumed by what's in your, quote, best interest," she said after the release of the documentary Framing Britney Spears.

Dr. Aguilar says medical providers have to follow whatever is legally documented in a conservatorship and providers may struggle if the patients' desires differ. In Spears' case, she claims she isn't even permitted to see a doctor to remove her IUD. "If there's a concern about the conflict between the individual desires and desires of the conservator, then that needs to be addressed through the legal system."

People who are facing reproductive coercion have some options. If you don't want to get pregnant, you can opt for discreet methods of contraception like an IUD with the strings cut short, an arm implant, or the birth control injection that you get every three months, Dr. Aguilar says. If you do want children, you should find a provider who will help you reach your goals by not forcing birth control and offering support with possible relationship issues like resources to have a healthier relationship or remove yourself from an unsafe relationship.

At the end of Spears' 24-minute statement to the court, Los Angeles Superior Court Judge Brenda Penny praised her for her "courage" and assured her that the court is "sensitive" to her concerns. According to NPR, Judge Penny said that Spears will now have to file a formal petition asking to end the conservatorship before any decisions can be made.

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