How Do Race and Gender Show Up In Youth Sexual Health Promotion?

By Chris Barcelos

Elizabeth Randolph, a white woman in her late 50s, manages a sexual and reproductive health clinic in “Millerston,” a small, former manufacturing city in the US northeast that is known for its high rates of teen pregnancy among Puerto Rican youth. “Not to sound racist at all,” she told me, “but teen pregnancy really is a Latino cultural issue. It’s just not a bad thing if a kid gets pregnant. It’s just much more socially acceptable within that community.” Although Elizabeth was clear that she didn’t want to “sound racist,” she did frame Latinx culture as a cause of Millerston’s high teen birth rates, and this no doubt informed her professional work. Like other people involved in the city’s youth sexual health promotion efforts, her understanding of the effect of culture on sexuality and health are part of what I call a “gendered racial project,” meaning the ways in which race and gender interact to create social meanings, experiences, and inequalities. In sexual health promotion, the ingrained ways in which race and gender show up are often unnoticed by the people who design policies and programs; in Millerston, these professionals are usually not members of the communities they serve. Ideas about race and gender affect the kinds of youth sexual health promotion that communities implement and can reinforce, rather than fix, gender, race, and health inequalities.

My article “Culture, Contraception, and Colorblindness: Youth Sexual Health Promotion as a Gendered Racial Project,” explores how sexual health promotion aimed at young, low-income Latinas in Millerston can be understood as a gendered racial project. I spent three years interviewing professional stakeholders like Elizabeth and participating in coalition meetings, teen pregnancy prevention events, and provider trainings. I found that youth sexual health promoters understand “Latino culture” as stable and uniform in its approach to sexuality and reproduction. They assume that Latinas are against contraception and abortion, and that Latinx families are silent about sexuality and promote teen childbearing within the family. This understanding allows health promoters to justify their efforts to regulate the sexuality and childbearing of young Latinas, including whether they should have sex, what kinds of contraception they should use, and whether they should become parents.

In places like Millerston, where there are high rates of teen pregnancy among women of color, health professionals heavily promote LARC, or long-acting reversible contraceptive (methods such as the IUD, shot, or implant), while downplaying their undesirable side effects. For example, a white social worker in her 40s shared a story about a young client who she characterized as irresponsible because she didn’t want an IUD, while minimizing the client’s real concerns: “There’s all these reasons – they don’t want something inserted into their body, they don’t want to gain weight [sarcastically], there’s all these things, but in my head those are just excuses.” It’s also important to note, as sociologist Eduardo Bonilla-Silva explains, that many Americans believe we live in a post-racial, “colorblind” society where race no longer matters. Yet, race very much still matters, and imagining that race and racism don’t affect reproductive health allows health promoters to overlook the long history of how LARC has been used to control the childbearing of women of color, disabled people, and others whose sexuality and reproduction are seen as outside the norm.

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Fortunately, there are seeds of racial and reproductive justice being planted in Millerston and in the field of sexual health promotion more generally – for example, in partnerships between reproductive justice organizations and the Black Lives Matter movement. Health promoters in Millerston and elsewhere could contribute to planting these seeds by participating in organizing efforts among white people committed to dismantling white supremacy, such as Standing Up for Racial Justice (SURJ), or  by seeking technical assistance and training from national reproductive justice organizations such as Forward Together.  Shifting youth sexual health promotion to incorporate gender, racial, and reproductive justice frameworks means moving from a focus on paternalistically trying to modify “culture” and promoting specific contraceptives, to focusing on how to dismantle racism and enable a world where people can create the kinds of families they want.

Chris Barcelos is an Assistant Professor of Gender and Women’s Studies at the University of Wisconsin-Madison. Their research uses ethnography, discourse analysis, and visual methods to interrogate how health promotion discourses both reveal and reproduce inequalities along the lines of race, class, gender, sexuality, nation, and ability.

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