Margot Sanger-Katz’s recent NYT article, “Set It and Forget It: How Better Contraception Could Be a Key to Ending Poverty,” presents a biased assessment of Delaware’s adoption of Upstream’s program to promote LARC (long-acting reversible contraceptives such as IUDs and implants) as a panacea for poverty. 

The Black Mamas Matter Alliance (BMMA) is a Black women-led cross-sectoral alliance that centers Black mamas to advocate, drive research, build power, and shift culture for Black maternal health, rights, and justice. We are grounded and guided by Reproductive Justice principles – the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities. We envision a world where Black mamas have the rights, respect, and resources to thrive before, during, and after pregnancy. This vision creates a world where our bodily autonomy is not stripped away by the systems that are meant to protect us and our families. 

We are collectively challenging programs like Upstream that fund clinical interventions, influence policy, and conduct research on Black Mamas to hold structural systems and social policies accountable for poverty, instead of developing and advancing mechanisms for controlling and limiting pregnancy and childbirth for low-income people. Programs like Upstream spend millions of dollars, per state, to teach health systems and providers how to most effectively get low income women to use LARCs. Upstream’s methodology fails to address the fundamental root causes of social inequities (e.g. racial and gender oppression) contributing to reproductive health disparities, and the long trajectory of reproductive coercion and violence experienced by women of color. Reducing barriers to contraception without investments in justice is nearsighted and should not be heralded as a possible “key to ending poverty” without supporting evidence. 

Sanger-Katz’s article could use a more nuanced debate challenging the pregnancy-poverty link, beyond differentiating between women based on their health history and desires, to clarify Delaware’s high unplanned pregnancy rate. An analysis of the social determinants, an explanation for why LARCs are favored as a one-size-fits-all solution, past failures and successes, are in question. This is an opportunity to share the perspective of reproductive health, rights and justice scholars and activists who have rejected this type of population control program for decades. Additionally, evoking the ease of “Set it and Forget It” is hardly true of our bodies. Side effects to LARCs can include irregular bleeding and inflammation, for months.

We relentlessly move forward towards reproductive justice and in opposition to programs like Upstream and their growing impact on reproductive health care systems. Our position is being echoed throughout the reproductive health, rights and justice movements. Please refer to the growing list of supporters who have signed onto this letter, below. We ask for a reply from Upstream on how this issue will be addressed. We request time with the New York Times author Margot Sanger-Katz and leadership to advance from praising problematic interventions based on population control arguments and political desires to curtail Medicaid spending.


Black Mamas Matter Alliance, Collaborators and Kindred Partner Members


Kindred Partners

Restoring Our Own Through Transformation (ROOTT), Columbus, Ohio

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Nzuri Malkia Birth Collective & Wellness Center, Baltimore, MD  

Black Women Birthing Justice Collective, Los Angeles, CA
The Afiya Center, Dallas, TX
MommyUP, Baltimore, MD
Shafia Monroe Consulting, Portland, OR
Center for Black Women’s Wellness, Atlanta, GA

Dem Black Mamas Podcast 
Black Women for Wellness, Los Angeles, CA

Ancient Song Doula Services, New York, NY 

Village Birth International, Syracuse, NY

Jessica Roach, CD, PN, MPH  
Marsha Jones  
Monica McLemore, PhD, MPH, RN  
Tanay Harris 
Shafia Monroe, DEM, CDT, MPH  
Lynn Roberts, PhD, Reproductive Justice Scholar Activist
Karen Scott, MD, FACOG, CEFM  
Avery Deroisers, MPH 
Courtney Drayton, MPH
Philicia Castillo, MPH
Jill Denson, MSW
Andrea Williams- Muhammad, CBD, CPD, CBE

Sayida Peprah, PsyD


Authored by Black Mamas Matter Alliance members Dr. Lynn Roberts, reproductive justice scholar activist in New York, New York; and Carmen Green, MPH, birth equity advocate in New Orleans, Louisiana.