AJPH.2016.Locating LARC within the Context of SRJ

We agree with the recent AJPH Perspectives piece by Gubrium et al. in response to Northridge and Coupey’s column on long-acting reversible contraception (LARC) and reproductive health equity. Northridge and Coupey’s recent response acknowledges that they see LARC as one component of a larger social justice agenda. However, both the initial piece and the response to Gubrium et al. fail to locate LARC within the context of sexual and reproductive justice. As Gubrium et al. discuss, the Reproductive Justice framework, created by African American women in 1994, illuminates the history of reproductive coercion experienced by women of color—not only by male partners (as highlighted by Northridge and Coupey), but also by institutions — and centers the right to bodily autonomy in sexual and reproductive health. Reflections on barriers to contraception should thus acknowledge how structural racism and poverty drive health disparities. Omitting this history, even unintentionally, contributes to the silencing of communities that have experienced sexual and reproductive oppression.

Accordingly, the New York City Department of Health and Mental Hygiene (DOHMH) has recently reexamined our own work. The catalyst came when planning a public awareness campaign, “Maybe the IUD,” intended to promote equitable access to and knowledge of LARC and other contraceptive options. As we shared our plans, colleagues in academia and the community raised concerns that the campaign could be viewed as promoting LARC as the “best” birth control option, inadvertently raising echoes of the historical use of contraception to control the fertility of women and girls of color. These dialogues expandedour awareness of the continued threats of stigma, shame, coercion, and implicit biases. In response to these concerns, the DOHMH set forth to engage a diverse array of community stakeholders and reproductive justice advocates and established a community engagement group. The community engagement group provided feedback on the campaign, and the DOHMH made changes to better align it with a Sexual and Reproductive Justice framework (we modified the term to reflect the importance of justice and bodily autonomy across the spectrum of human sexuality). We were successful in articulating this framework in the press coverage the campaign received, making thestory about the “Maybe the IUD” campaign a story about increased access to all contraceptive methods and Sexual and Reproductive Justice.

The DOHMH and community partners are now on a journey together—building trust, learning from each other, keeping open minds, and finding common ground. Thepartnership is driven by our shared commitment to promoting communities’ rights to exercise bodily autonomy and access resources needed to make informed decisions about sexual and reproductive health. We hope our work can inspire others to take a similar approach.

Deborah Kaplan, DrPH, MPH, R-PA and Lynn Roberts, PhD –  On behalf of the Sexual and Reproductive Justice Community Engagement Group and the New York City Department of Health and Mental Hygiene


The authors, listed in the acknowledgement, are from the NYC Department of Health and Mental Hygiene (DOHMH) and the Sexual and Reproductive Justice Community Engagement Group (CEG). The CEG is comprised of representatives from a diverse group of citywide and community-based agencies including the DOHMH.

Correspondence should be sent to Deborah L. Kaplan, Assistant Commissioner, Bureau of Maternal Infant and Reproductive Health, New York City Department of Health andMental Hygiene, 42-09 28th Street, CN-10, Queens, NY 11101-4132 (e-mail: dkaplan@health.nyc.gov). Reprints can be ordered at http://www.ajph.org byclicking the “Reprints” link. This letter was accepted March 19, 2016.


M.T. Bassett originally conceptualized the idea for this piece. D. L. Kaplan, L. Roberts, S. P. Roberts, and A. B. Steinberg contributed to the design and writing of the piece. A. B. Steinberg was also responsible for outreach to other contributors. F. Diaz-Tello contributed to revision of the piece. The remaining contributors, all of whom have participated in the work reflected in the piece, reviewed the piece and approved the final version.


Mary T. Bassett is with the New York City (NYC) Department of Health and Mental Hygiene (DOHMH), New York, NY. Deborah L. Kaplan, Sarah P. Roberts, Allyna B. Steinberg, Alzen Whitten and Jacqueline Quinones-Lugo are with the Bureau of Maternal, Infant, and Reproductive Health, NYC DOHMH. Lynn Roberts is with the Department of Community Health and Social Sciences, City University of New York Graduate School of Public Health and Health Policy, New York. Farah Diaz-Tello is with the National Advocates for PregnantWomen, New York. George Askew and Krystal S. Reyes are with the Division of Family and Child Health, NYC DOHMH. Aletha Maybank and Khushbu Srivastava are with the Center for Health Equity, DOHMH. Vivian Cortes is with New York City Teens Connection, NYC DOHMH. Gabriela S. Betancourt is withthe Latino Commission on AIDS, New York. Vicki Breitbart is with the Health Advocacy Program, Sarah Lawrence College, Bronxville, NY. Nicole Clark is with Nicole Clark Consulting, LLC, Brooklyn, NY. Cecilia Gaston is with the Violence Intervention Program, New York. Kayhan Irani is with Artivista/Story Lab, New York. Debra Lesane is with Caribbean Women’s Health Association, Brooklyn. Zulu Queen Benu Ma’at is with Phoenix Queens of the Nation: Wisdom Born Zulu Chapter 29, Bronx, NY. Renee McConey is with The Door—A Center of Alternatives, Inc, New York. Adrienne Mercer is with the Federation of County Networks, New York. Chanel L. Porchia-Albert is with Ancient Song Doula Services, Brooklyn. Estelle Raboni is with the Morris Heights Health Center, Bronx. Gabriela Gutierrez, Paloma Hernandez and Nicole Schuett-Lefkowitz are with Urban Health Plan, Inc., Bronx.


1. Gubrium AC, Mann ES, Borrero S, et al. Realizing reproductive health equity needs more than long-acting reversible contraception (LARC). Am J Public Health. 2016;106(1):18–19.

2. Northridge JL, Coupey SM. Realizing reproductive health equity for adolescents and young adults. Am J Public Health. 2015;105(7):1284.

3. Northridge JL, Coupey SM. Northridge and Coupey respond. Am J Public Health. 2016;106(1):19–20.

4. Song S. Women of Color Reproductive Justice Collective Website. Available at: http://sistersong.net. Accessed March 19, 2016.

5. Goldberg D. City health department takes on reproductive justice framework. Politico New York. September 30, 2015. Available at: http://www.capitalnewyork.com/article/city-hall/2015/09/8578144/city-health-department-takes-reproductive-justice-framework. Accessed March 19,2016.

6. Gan V. Why the City of New York wants to talk to you about IUDs. The Atlantic’s CityLab. October 7, 2015. Available at: http://www.citylab.com/navigator/2015/10/why-the-city-of-new-york-wants-to-talk-to-you-about-iuds/409375. Accessed March 19, 2016.