The age of LARC: making sexual citizens on the frontiers of technoscientific healthism

ABSTRACT

Routinely positioned as the ‘first-line option’ for contraceptive choice-making, long-acting reversible contraception (LARC) promotion efforts have come under critical scrutiny by reproductive justice advocates for the extent to which public health actors’ preference for LARC devices may override potential users’ ability to freely (not) choose to use contraception among an array of options. We identify LARC promotion discourse as constituting ‘The Age of LARC’: multifarious strategies for producing responsible sexual citizens whose health behaviours are empowered via a LARC-only approach to contraceptive use. We suggest that immediate postpartum LARC insertion policies, which have proliferated in the U.S. since 2012, exemplify the new era of LARC hegemony, in which urgency, efficiency, cost-effectiveness, and outcomes dominate both health policy and clinical practice around these contraceptive technologies. By following these efforts to facilitate access to and use of immediate postpartum LARC, we find a discourse on sexual citizenship that paradoxically constructs sexual health freedom through the use of a single class of contraceptive technologies.

KEYWORDS:

• Reproductive justice
• contraception
• sexual health
• technoscience
• discourse analysis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 We use ‘woman’ and ‘women’ throughout this paper; however, we recognize that these terms do not encompass the full range of people who use contraception and who may be impacted by particular public health initiatives.

2 A 2019 analysis in JAMA found no statistically significant change in trend in short-interval births for adults following the policy change (Steenland et al., 2019).

3 The ACOG LARC Program compiles all state Medicaid documents: https://www.acog.org/About-ACOG/ACOG-Departments/Long-Acting-Reversible-Contraception/Immediate-Postpartum-LARC-Medicaid-Reimbursement

4 The Association for State and Territorial Health Care Providers compiles the toolkits: https://www.astho.org/Programs/Maternal-and-Child-Health/Long-Acting-Reversible-Contraception-LARC/Toolkits-and-Guides/