Women of all incomes and backgrounds deserve autonomy, respect and quality care from providers when they bring new life into this world.

Unfortunately, this isn’t the experience for many black women, who are three times more likely to die after giving birth than are white women. Structural racism and bias in our medical institutions loom large for brown and black women who do not feel heard or respected.

These stories stick with you, which is why when I read “Physician lambastes Medicaid decisions” (July 29), I was confused why the former medical director of the Medicaid program in Minnesota, Jeff Schiff, was so strongly criticizing the state Department of Human Services for not implementing an extra payment to implant long-acting birth control, or intrauterine devices (IUDs), immediately after women on Medicaid give birth.

Why would a doctor want to make more money for hospitals by suggesting that women with low income get an IUD hours after giving birth?

Hospitals providing care to women on Medicaid already get paid if a woman gets an IUD after birth, and are paid for IUDs if a woman decides to get one weeks or months after. In fact, getting an IUD is better for the health and well-being of the mom at her follow-up appointment, after she’s had time to recover from childbirth. Even an IUD manufacturer’s instructions state: “Do not insert Mirena until a minimum of 6 weeks after delivery.”

Policy designed to financially incentivize IUDs for women on Medicaid immediately or within hours of giving birth shouldn’t be considered in a vacuum, and certainly not without centering the perspectives of the women themselves.

We cannot cloak the discriminatory practices and policies that have reduced and controlled the reproductive freedom of black women over the past century as “cost-effective” or as long-term budget tools for the state. The history includes government efforts around family planning targeting black women, including forced and coerced sterilization.

During the 1990s, there was also a policy push targeting low-income and women of color to use Norplant, a contraceptive implant the American Civil Liberties Union described at the time as “a vehicle for infringing on the reproductive autonomy of women.” This is why consent, conversation and support throughout pregnancy, birth and in the weeks and months after birth matter. What’s most important is to make sure women and their choices are centered in these conversations.

IUDs can be great tools for family planning. Women deserve comprehensive family planning counseling with detailed information that empowers, honors and supports them to make choices that meet their individual needs and is not based on a woman’s income or insurance coverage.

History shows us that access does not equal equity, and that people of color and their voices are left out of these discussions. As the ranking member of the Minnesota Senate’s Health and Human Service Committee, I invite Dr. Schiff and others to have this policy conversation with me. It will allow us the opportunity to center and listen to the women these policies are intended to impact, and ensure that we do not ignore the historical, racial and institutional context around reproductive freedom and justice for low-income women.


Jeff Hayden, DFL-Minneapolis, is assistant minority leader in the Minnesota Senate.