Autonomy Over One's Own Body
What Ivy and Mary Ella learn about life, is both painful and confusing. They are taught as children that they are responsible for themselves. Their bodies belong to themselves. Tragically for Mary Ella, this idea is forcibly obliterated at the hospital after her son's delivery when they sterilize her without consent. Before that, there are rumors that perhaps she was raped, her son being the result of the incident. Either way, Mary Ella's autonomy over her own body is lost. Watching this, Ivy learns the same message and becomes fearful. She hopes that she can resist and maintain control over herself, but she understands that a successful resistance against the government and her society would be a striking anomaly. Women like Jane are "supposed" to make her decisions for her.
Class Prejudice
This novel is largely purposed to outline the atrocity of North Carolina's sterilization program in the twentieth century. As Chamberlain traces through Ivy and Jane's story, these policies existed as a result of class prejudice. The laws which governed the lower class were written by the ignorant and largely removed lawmakers at the capitol. They didn't have a daily contact with people like the Harts, so they couldn't possibly have understand the individual needs of these people. Additionally, as Ivy herself points out, the government agencies seem to promote their own agenda, against the needs of the people. They didn't like people who were less educated, less wealthy, and less progressive than themselves, so they sought to forcibly wipe out the lower class through sterilization.
Functional Deception
As the book's title implies, there is a great deal of deception happening in the narrative. The community in Raleigh exists in a sort of gray area where they rely upon the government's aid but cannot afford much transparency with that same government. For example, Gardiner pays the Harts' rent because of their father's death under his employment. He doesn't say as much, but the implications are clear. He's covering up his own negligence and paying for the women's silence. Similarly, Ivy and Mary Ella know not to reveal too much personal information to Jane. They are wary and cagey around her, often lying to keep their private affairs a secret -- like Ivy's pregnancy. And they have good reason to do so, given how the government has treated them in the past, namely Mary Ella's forced sterilization. As the story progresses, even Jane learns that sometimes the most ethical path is to deceive her employers in order to actually help people like Ivy.
