Analyzing The Language of Choice & Control

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"Are you on the pill?" seems to dominate the modern American question of contraception. It's assumed that "the pill" is synonymous with birth control and reflective of a woman's full autonomous choice. This language of the pill is symbolic of control, the practice of consciously ingesting a pill every day physically gives women control over their bodies. But is that sense of control misleading? How much control do women have over the forms of birth control they take? And how much control do drug and insurance companies have? Are women always given the choice of lesser used methods of birth control? What about specific brands of the pill and the drug companies that manufacture it? What about accessibility of the pill? The language of "the pill" feeds into the false belief that women have sufficient control over their birth control options, especially in regards to women in underprivileged circumstances.

Among other marginalized identities, Native women's experiences get erased in the conversation about contraception in America, a dialogue that largely centers around a false dichotomy of choice. Supporters of widespread contraceptive methods and legal abortion access are "pro-choice," a term that widely assumes an equal ground for all women to choose. In reality, this language overshadows the gaps in individual autonomy. Certain social identities are better positioned to exercise choice; other identities are not as privileged to access or information. 



I want to step back from the assumed autonomy that tags along the conversation of contraception. Choice is not so self-determined; women are given strategic, meditated, limited options for birth control influenced by consumer culture and drug companies. And not every woman is given the same choice to make. Falsely labeling this market as a place for women having autonomous "choice" over their bodies disregards the structures that place female bodies as helpless consumers first.

Through the Indian Health Service (IHS), Native women living on reservation land are not given the same options, and therefore do not have the same choice to make. In "Better Dead Than Pregnant," Andrea Smith discusses the narrow birth control options for Native women on reservations using data pulled from the 1980s and 90s, which was typically a choice of either Norplant or Depo-Provera. These options were not the safest for Native women, with the most severe potential side effects ranging from cancer to depression. I am having trouble finding updated statistics on IHS and birth control, but furthermore, I would be dubious to trust any findings. I cannot find anything specifically about birth control on the IHS website. I did find a 2013 petition demanding that Native women gain access to emergency contraceptives like Plan B. Narratives from these women share that reservations did not even stock emergency contraceptive pills or required a prescription from a doctor. Optimistically, the petition reports a successful outcome in changing policy to require all Indian Health Service facilities to carry emergency contraception without requiring prescription

Still, statistics on birth control usage reflect the cultural assumption of birth control equality for all women. All of the following statistics come compiled from from the Guttmacher Institute circa 2010. Here are some of my initial responses based on compiled research on birth control usage in America.

1. Four of every five sexually experienced women have used the pill.
   
   Firstly, I wonder if the surveyed population include Native women on reservations, and my instinct is to assume not. Presenting these statistics in such a way works to erase and obscure the experiences that Native women have. If Native Women still do not have access to the same birth control options, than these statistics work to erase that inequality.
   Secondly, I wonder if these four out of five women were given options, and how much their "choice" to take their specific birth control was influenced by drug companies, as well as what their specific insurances cover. All of these factors work to doubt the real nature of the choice women have.
   
2. The pill is the method most widely used by white women, women in their teens and 20s, never-married and cohabiting women, childless women and college graduates.
   
   After reading Andrea Smith, I wonder if certain social identities like white women more frequently use the pill because they are privileged with easier access to the pill through social structures. I am pondering the history of involuntary sterilization in women of color and how that contributes to these statistics.
   
3. Reliance on female sterilization varies among population subgroups. It is most common among blacks and Hispanics, women aged 35 or older, ever-married women, women with two or more children, women living below 150% of the federal poverty level, women with less than a college education, women living outside of metropolitan areas and women that are publicly insured or are uninsured
   
   Andrea Smith discussed involuntary sterilization of Native women as a common practice on reservations. I wonder if these statistics of sterilization among different groups of women reflect wholly voluntary and informed decisions, or population control strategies.
   
   In all of this, I think it's important to stay informed about the history of birth control and how certain social groups are underprivileged. It is important to think critically about statistics and the way information is presented, and recognize underprivileged identities and narratives such as those of Native women that may be frequently overshadowed. These are all ways in which education can help women have more control.