The field of public health has long named unintended pregnancy a problem concentrated in people of lower social class and associated with negative outcomes. A main strategy to reduce the unintended pregnancy rate is to increase women's use of specific contraceptive methods via contraceptive use metrics. However, scholars have criticized these metrics for a lack of attention to the issue of coercion. This study aimed to critically describe how policymakers constructed a contraceptive use metric targeting women with Medicaid insurance with attention to the discussion of contraceptive coercion. Using Critical Discourse Analysis and Reproductive Justice as guiding frameworks, I analyzed publicly available policy documents including meeting minutes, presentation slides, policy guidance texts, public testimonies, a stakeholder survey, and one audio recording. My analysis revealed healthcare system experts constructed the metric in alignment with mainstream public health discourse naming unintended pregnancy the cause of negative health outcomes and women’s use of specific contraceptive methods, particularly long-acting reversible contraceptives, as the solution. Policymaker discourse reinforced the assumption that women are responsible for pregnancy prevention. Policymakers minimized stakeholder concerns about incentivizing coercion by changing the topic to improving access to contraception and through silence about the issue. Finally, a fertility reduction discourse was present naming certain people as being in no position to have children and children of impoverished people as high-cost children. Study results suggest a eugenic ideology and a mother-blame narrative may underpin contraceptive use metrics. These findings point to a need to focus policy on removing healthcare system barriers to contraceptive access for fertile people of all genders rather than increasing women’s use of specific contraceptives.