Stratified reproduction, family planning care and the double edge of history.
OBJECTIVE
There is a growing clinical consensus that Medicaid sterilization consent protections should be revisited because they impede desired care for many women. Here, we consider the broad social and ideological contexts for past sterilization abuses, beyond informed consent.


RESULTS
Throughout the US history, the fertility and childbearing of poor women and women of color were not valued equally to those of affluent white women. This is evident in a range of practices and policies, including black women's treatment during slavery, removal of Native children to off-reservation boarding schools and coercive sterilizations of poor white women and women of color. Thus, reproductive experiences throughout the US history were stratified. This ideology of stratified reproduction persists today in social welfare programs, drug policy and programs promoting long-acting reversible contraception.


CONCLUSIONS
At their core, sterilization abuses reflected an ideology of stratified reproduction, in which some women's fertility was devalued compared to other women's fertility. Revisiting Medicaid sterilization regulations must therefore put issues of race, ethnicity, class, power and resources - not just informed consent - at the center of analyses.
aDepartment of Obstetrics and Gynecology bDepartment of Women's Studies cProgram in Sexual Rights and Reproductive Justice, University of Michigan, Ann Arbor, Michigan dDepartment of Women's and Gender Studies, Rutgers University, New Brunswick, New Jersey, USA.
Lisa H
LH
Harris
Taida
T
Wolfe
D016656:Family Planning Policy / Q000266:history*; D005193:Family Planning Services / Q000941:ethics* / Q000331:legislation & jurisprudence; D005260:Female; D054625:Healthcare Disparities / Q000941:ethics / Q000266:history*; D049673:History, 20th Century; D049674:History, 21st Century; D045809:Human Rights Abuses / Q000266:history* / Q000331:legislation & jurisprudence / Q000517:prevention & control; D006801:Humans; D007258:Informed Consent / Q000941:ethics / Q000523:psychology; D008484:Medicaid / Q000941:ethics; D011287:Prejudice / Q000517:prevention & control*; D046269:Reproductive Rights / Q000266:history* / Q000331:legislation & jurisprudence; D012935:Social Justice; D013244:Sterilization, Involuntary / Q000941:ethics / Q000266:history* / Q000331:legislation & jurisprudence; D013246:Sterilization, Tubal / Q000941:ethics / Q000523:psychology; D014481:United States; D014933:Women's Rights