Distributing Condoms and Hope

The Racialized Politics of Youth Sexual Health

Chris A. Barcelos, Chris Barcelos

• Publisher: University of California Press
• Year: 2020
• ISBN:
  9780520973732
• Edition: 1
• Topic: Social Sciences
• Subtopic: Gender Studies
• Index: Social Sciences

Distributing Condoms and Hope is a feminist ethnographic account of how youth sexual health programs in the racially and economically stratified city of “Millerston” reproduce harm in the marginalized communities they are meant to serve. Chris A. Barcelos makes space for the stories of young mothers, who often recognize the narrow ways that public health professionals respond to pregnancies. Barcelos's findings show that teachers, social workers, and nurses ignore systemic issues of race, class, and gender and instead advocate for individual-level solutions such as distributing condoms and promoting "hope." Through a lens of reproductive justice, Distributing Condoms and Hope imagines a different approach to serving marginalized youth—a support system that neither uses their lives as a basis for disciplinary public policies nor romanticizes their struggles.
 

1

Race, Pregnancy, and Power in Millerston

During my research for this book, the disparate collection of youth sexual health promotion activities in Millerston coalesced into a grant-funded coalition called the Teens Count initiative. As a strategy to streamline their work, the initiative began to host “collective impact” meetings to bring together the numerous professional stakeholders in the city.¹ The email invitation to the first of these meetings addressed the invitee as a “community champion in adolescent sexual health” and asked them to participate in a high-impact collaboration to improve the sexual health of youth. It noted that community partners were already taking “bold steps to begin to develop a high impact sustainability plan to fundamentally change how our communities address the high rates of teen births and sexually transmitted infections among youth.” The invitation went on to state that this new collaboration would foster relationships among diverse sectors, including community-based organizations, human-service providers, medical clinics, youth leaders, and federal and state teen pregnancy prevention initiatives to “merge their collective strength into one highly disciplined, coordinated, collaborative group,” and concluded by proclaiming that “by addressing teen pregnancy and other adverse sexual health outcomes, we will help eliminate barriers so that youth can reach their full potential.”

As I entered the meeting space to attend the first collective impact session, a cheery staff person from the PASH Network, the host organization, greeted me and handed me a name tag that read “sexual health superhero” under my name. A major player in the area’s youth sexual health promotion work, the PASH Network (Promoting Adolescent Sexual Health), served as a visible organizing presence in the area with the goal of using “research, advocacy, and community education and collaboration to influence policy and practice in adolescent sexual health.” Jenny Díaz, a Latina obstetrician-gynecologist in her forties with a background in public health, was the founder and executive director of PASH and had sent out the meeting invitation to a large number of professional stakeholders in the area. The meeting room was set up with chairs arranged in an oval shape and side tables bearing refreshments, including cheese, crackers, fruit, coffee, and water bottles. Under each seat was a goody bag containing noisemakers, candies, and a mug with the PASH Network logo on it. The walls were covered in posters from various PASH Network events, as well as foam-core standouts presenting data on teen pregnancy and STIs in the greater Millerston area. As participants milled about, some in scrubs, some in jeans, others in suits, I could hear smooth blues music coming from the overhead speakers. I could not discern the objective of this elaborate setup. Was it an attempt to make yet another meeting at the end of a long workday more pleasant for the participants? Was it part of the cheerleading strategy Jenny often employed, a sort of reward for all the sexual health superheroes who were engaged in valiant battles against teen pregnancies and sexually transmitted infections?

As I took my seat and idly played with the items in my goody bag, I noted who was and was not in attendance. The “usual suspects” were accounted for: members of MASHPC (Millerston Adolescent Sexual Health Promotion Committee), staff from the family planning clinic Continuum Health Services, staff from the Millerston Community Health Center, and a variety of city health officials. Lourdes Colón Cruz, the educational director at the Towne House, was there, but she was one of the few service providers who worked for an organization that supported pregnant and parenting teens (as distinguished from those that focused on preventing teen pregnancy). A group of young people were in attendance, but it was not clear what their role would be. To the best of my knowledge, there were no current pregnant or parenting teens at the meeting. The Center for Reproductive Justice, a local organization that works nationally to advance the movement for reproductive freedom, did not have a presence at the meeting, even though their work certainly fell under the rubric of “sexual health superheroes.”

Jenny Díaz cofacilitated the meeting with Gerald, a staff member from a capacity-building consulting firm that was advising the Teens Count initiative. The two began with a speech reviewing the recent history of teen pregnancy prevention work in Millerston that used a progress narrative to bring us to the current moment, when the hard work was beginning to pay off and we would engage in the collective impact process to protect our investment. Every time someone mentioned declining rates of teen pregnancy in the community, the facilitators encouraged us to cheer and wave the noisemakers from our goody bags. The facilitators then invited preselected members of the audience to stand and share their history of involvement with youth sexual health promotion in the area. These speakers emphasized the important win of implementing comprehensive sex education in the public schools, the promotion of long-acting reversible contraception use among adolescents, and the relationship between high teen pregnancy rates and high school dropout.² These stakeholders lauded the importance of recognizing the structural factors—poverty in particular—that contributed to problems in the community, but discussed only individual-level solutions, such as sex education and contraceptive promotion. They shared numerous data points without context or elaboration of their significance, statistical or otherwise. The youth did not speak until the end of the meeting, when one of them thanked the adults for inviting them. To wrap up the meeting, Gerald asked the audience to stand and dance to the Teddy Pendergrass song “Wake Up Everybody” while he shouted, “Say hello to the new collective impact team!”

How did we get here? How did it come to pass that health professionals viewed preventing teen pregnancy through a large and complex set of relationships between national, state, and local players—in a community with a rapidly declining teen pregnancy rate—as the solution to an urgent social problem? What factors contributed to the practices and technologies they employed to reduce this rate? Data and evidence figured heavily in the meeting, as did talk of the structural factors that contributed to high teen birthrates, yet the proposed solutions were all individual-level modifications of young, racially and economically marginalized people’s sexual and reproductive behavior. Youth were invited into the room, but did not speak until spoken to. A local reproductive justice organization was not present.

This meeting helps to illustrate the teen pregnancy prevention industrial complex (TPPIC) in Millerston, the term I introduce in this chapter to describe the set of relationships, practices, and technologies that constrain the liberatory potential of youth sexual health promotion and serve the interests of those in power. This chapter interrogates the relationship between race, pregnancy, and power in Millerston in order to frame the chapters that follow. First, I provide a historical sketch that traces mid-twentieth-century discourses of reproduction in Puerto Rico to present-day understandings of teen pregnancy in Millerston. Next, I describe how infant mortality prevention work in Millerston in the 1980s transitioned into a focus on preventing teen pregnancy. Lastly, I introduce the teen pregnancy prevention industrial complex in Millerston and detail its relations and effects in connection with other forms of the nonprofit industrial complex.

HISTORICAL CONTEXTS OF RACE, PREGNANCY, AND POWER IN MILLERSTON

Millerston has long been a city of migrants and immigrants.³ In the eighteenth century, a group of venture capitalists selected the city for a planned industrial community because Millerston’s geography was ideal for building a canal system and harnessing the power of the Algonquin River.⁴ The first workers hired to dig the canal system arrived from Ireland seeking relief from the religious oppression and economic exploitation of British rule and its resulting potato famine. Later, French Canadians and Europeans seeking factory work found their way to Millerston. Soon thereafter, the canals begot multiple cotton mills, a machine shop, and several textile and paper factories. The factories, and by extension the city’s residential patterns, were ethnically segregated, with textile mill workers largely French Canadian and paper mill workers Irish. Millerston’s most recent wave of newcomers began arriving in the late 1950s when Puerto Ricans began to constitute an increasing percentage of Millerston’s population. By 1980, 13% of the city’s population was born in Puerto Rico. By 1990, that figure had risen to 31%, and by 2000 it had climbed to 41%. Today about half the city claims Puerto Rican descent. Like their predecessors, Puerto Ricans initially came to Millerston seeking employment and housing. What sets Puerto Ricans apart from other racially or ethnically marked groups in Millerston’s history, however, relates to a complex web of US imperialism, racialization, economic exploitation, geographical displacement, and gendered ideologies. Teasing out these complexities allows us to more clearly understand how sexuality and reproduction, and in particular teen pregnancy, become emblematic of this racialized, deindustrialized city.

A series of legislative maneuvers in the late nineteenth and early twentieth centuries, notably the Chinese Exclusion Act of 1882 and the Quota Act of 1921, slowed immigrant flows to the United States. Both acts were based on a xenophobic reaction to the perceived threat posed by outsiders, a reaction that continues to structure immigration responses today. These restrictions decreased the availability of immigrant labor, creating a demand that Puerto Rican migrants eventually filled. A convergence of economic and political factors (described in depth below) prompted several waves of Puerto Rican migration from the island to New York and other parts of the Northeast. Puerto Rican migrants to Millerston arrived, and continue to arrive, directly from the island but also by way of New York City and other major US cities in the Northeast.⁵ Migration to the Algonquin River Valley area also intensified between 1948 and 1982 as increasing numbers of farmworkers sought work in the tobacco fields. During this time the Puerto Rican Department of Labor and Human Resources helped arrange contracts for more than 400,000 seasonal workers in the region. Simultaneously, in the late 1950s, demolition of housing in the nearby city of Carlsborough, part of urban renewal programs promoted by the Lyndon Johnson administration, prompted massive relocation to Millerston. These displaced residents settled into the former tenement row houses built at the height of Millerston’s industrial economy.

The particular historical moment when Puerto Ricans arrived in Millerston helped shape a trajectory of racialization that informs the discursive context of youth sexuality and reproduction today. Although the Irish were once a racialized ethnic other, they arrived at a time of economic growth and prosperity. In particular, as fair-skinned, Anglophone Europeans, the Irish were able to access whiteness in ways that Puerto Ricans, as Spanish-speaking, diasporic Caribbeans, did not.⁶ Moreover, although the Irish came to Millerston as a racialized class of workers, factory owners valued their labor for the construction of the canal system. In contrast, despite the pull of seasonal migrant farmworker jobs in the region, Puerto Ricans arrived at a time when the city’s overall economy was declining. Unlike earlier groups, Puerto Ricans came to Millerston at a time of significantly changed economic structures and declining population in the city. Millerston’s paper and textile industries had decayed throughout the twentieth century as technological advancements introduced new techniques for producing paper and fabric and companies began outsourcing labor overseas. Millerston didn’t need Puerto Rican workers in the way they had needed the Irish, but other places needed to “get rid of” Puerto Ricans.

Reproduction and Modernity Converge in Millerston

The convergence of US colonialist development policy and eugenic ideology helped push migration from the island to the mainland, and lack of economic opportunities and affordable housing eventually brought Puerto Ricans to Millerston. The persistent colonial status of Puerto Rico has structured the economic and political events that prompted mass migration to the mainland.⁷ Sexuality and reproduction are key to understanding these processes.⁸ Indeed, Puerto Rico has long served as a literal and metaphorical “test tube” for the United States in producing knowledge about women’s lives and bodies.⁹ Examining these histories enables us to more fully understand how youth sexual health promotion constructs teen pregnancy in Millerston specifically as a Puerto Rican problem. It also makes visible how that construction elides histories of racism, economic exploitation, and the production of Latina sexual deviance. This history provides an important backdrop for the emergence of the teen pregnancy prevention industrial complex.¹⁰

Beginning with the 1898 occupation of the island, mainland US interests prompted the implementation of sweeping economic policy changes.¹¹ At that time, the island’s agricultural economy was balanced among coffee, tobacco, and sugar production, but by the 1930s sugar production grew by more than 250%, and mainland corporations controlled two-thirds of the sugar industry. Becoming a monocrop economy had significant effects on unemployment and poverty in Puerto Rico, which transmogrified into concerns about “overpopulation” on the island. Initially this concern referred to the idea that the working class was reproducing “too much,” and later became a way for mainland health officials to describe the condition of Puerto Rico as a whole.¹² In their view, excessive sexuality and fertility were to blame for poverty on the island, which almost perfectly parallels understandings of teen pregnancy in Millerston today. Then as now, hyperbolic panic about excess brown and Black babies were discursive productions rather than statistical facts. As historian Laura Briggs points out, although population increased on the island during the 1940s and ’50s, so did per capita income. Population growth was not a sufficient explanation for island poverty, yet the “argument that uncontrolled Puerto Rican sexuality and reproduction were dangerous had sufficient force that it persisted even in the face of evidence that flatly contradicted it.”¹³ Similarly, in Millerston in the 1990s, 2000s, and 2010s, the teen birthrate rapidly declined in a state with one of the nation’s lowest rates, yet policy makers, health care providers, and the media considered it a significant social, health, and economic issue with grave consequences for the city’s well-being.

By the mid-twentieth century, mainland government officials viewed migration and contraception as solutions for island poverty and overpopulation. Addressing the perceived problems of overpopulation on the island through reforming Pue...

Table of contents

• Title
• Copyright
• Dedication
• Contents
• List of Illustrations
• Acknowledgments
• Introduction: This Is What Happens When You Get Pregnant as a Teenager
• 1.   Race, Pregnancy, and Power in Millerston
• 2.   The Messy Narratives of Disidentifying with Teen Motherhood
• 3.   “It’s their culture”: Youth Sexual Health Promotion as a Gendered Racial Project
• 4.   Sex, Science, and What Teens Do When It’s Dark Outside
• 5.   Educated Hope: Imagining Reproductive Justice in Millerston
• Appendix A. Organizations and Projects in Millerston
• Appendix B. Methodological Notes
• Notes
• References
• Index