Choice! It’s a powerful concept, one that reproductive justice advocates like myself are celebrating on the 38th anniversary of Roe v. Wade. I strongly believe that people should be able to decide what works best for us in our own sexual and reproductive lives. “What” might be the gender of our sweethearts, the contraceptive we like best, or how to move forward after an unexpected pregnancy.

I put my belief in choice into practice at HIPS, the nonprofit where I work. At HIPS, our philosophy is that people whose actions are stigmatized (people trading sex for drugs/money/housing and people using injection drugs) deserve meaningful choices about their own health. We understand that condoms are not one-size-fits-all, and that someone is way more likely to wear a condom if it’s the size and shape they like! We understand that situations like domestic violence and coerced sex are not one-size-fits-all either, and that if people have options about how to respond, they will feel more empowered in their own therapeutic process.

At its heart, choice is about human dignity. As we celebrate our movement toward increasing people’s sexual and reproductive options, it is vital to remember why options are so important, and how few marginalized people have historically had in the United States.

Roe brought tremendous legal change, but its little-remembered half sister is the passage of federal guidelines against sterilization abuse on November 1, 1975. These guidelines called for mandatory waiting periods before sterilizations, explicit written statements saying that you cannot be denied welfare benefits for refusing to be sterilized, and consent forms in women’s native languages.

Just as Roe doesn’t automatically ensure abortion access, the anti-sterilization abuse guidelines didn’t automatically deter abuse. But they were a huge stride toward ending a protracted (and shocking, often ignored) history of forced sterilization in the United States. In the 20th century, over 30 U.S. states had eugenics laws that allowed for the involuntary sterilization of disabled, incarcerated, or otherwise “unfit” people (which often included single moms, women of color, moms on welfare, or young rape and incest survivors). Ad hoc eugenicist doctors, operating outside the law, sterilized their patients using shady consent practices. Doctors in an LA hospital, for example, sterilized hundreds of Spanish-speaking women in the 1970s by handing them consent forms written in English, often while they were in labor. North Carolina had a robust anti-poverty sterilization program in which welfare officers were allowed to withhold benefits if mothers did not agree to sterilization for themselves or, sometimes, their daughters. By the late 1970s, 7,600 North Carolinians were sterilized.

I had the privilege of interviewing women sterilized in North Carolina about how the experience affected them over time. Their overwhelming message: human dignity matters, and people want theirs recognized! Rickie Solinger (the inspired author of Beggars and Choosers: How the Politics of Choice Shapes Adoption, Abortion, and Welfare in the United States) warns that, if we don’t think carefully enough about what “choice” really means, then it can become just another way to deny people dignity and shore up abortion rights for people who can afford the procedure. Who can afford it? The richer and whiter and older you are, the better your ability to find money and a doctor for your abortion.

So, in celebration of Roe, I also want to throw out there that my vision of choice is not just about abortion access: it is about the right to reproduce, the right to control how and when you reproduce, and the right to end pregnancies. I want to remember the legacy of reproductive justice advocates who have fought against sterilization abuse, for comprehensive choice, and for the inclusion of issues that affect women of color and poor women.

When I celebrate choice, I want that choice to be meaningful. I don’t want it to be the sort of choice that says, sure, you can choose an abortion--if you can afford it! Or, you can choose whether or not to get sterilized--just remember, you’ll lose your welfare benefits if you say no! Or, go ahead, choose to inject heroin--but expect to get HIV, because there won’t be any new needles for you! To make a nation where people have sexual and reproductive autonomy, we need to think about who does and does not have choice, and how we can get the most choices to the most people, as much of the time as possible.