Reproductive Justice is the Best Approach to Reproductive Health
I recently read the article, “What My First Pregnancy Taught Me about Birth Justice” on Rewire, which made me reflect on my choice to adopt a reproductive justice framework a few years ago while working on my doctoral research on racial inequities in maternal and child health.
The author, a Black woman, shares her refreshing story on her birth experience (refreshing because so rarely are the voices of Black birth stories shared in mass media). Specifically, she writes about how she felt disempowered during her first birth, in which medical personnel ordered a cesarean delivery without her input: “[E]verything happened so fast and it seemed as if all of the decisions were made for me.” Although she and her baby were safe, she was unprepared to deal with the stigma of having had a cesarean .
This experience led her to learn more about reproductive justice, defined by SisterSong: as “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” She argues for the medical community to do more to support women of color, in particular Black women, in having full control of their birth process through appropriate knowledge, education, resources, and access.
According to 2014 data from the Centers for Disease Control and Prevention (CDC), the cesarean delivery rate ‘declined for non-Hispanic white women for the fifth consecutive year, down 2% from 32.0% in 2013 to 31.4% in 2014 and 4% from the 2009 peak. Rates declined 1% for both non-Hispanic black (from 35.8% to 35.6%) and Hispanic women (32.3% to 31.9%). For the second year in a row, non-Hispanic white women had the lowest cesarean delivery rate; non-Hispanic black women continued to have the highest rate.’
So while cesarean deliveries are on the decline in the United States, Black women continue to have the highest rates.
Caesarean is major surgery that poses more risks and complications than vaginal birth, including infection, hemorrhage or increased blood loss, injury to organs, and adhesions (scar tissue inside pelvic region causing blockage or pain). It is alarming that Black women have more of these high-risk procedures, despite decreases in other populations. More alarming? As a population, Black women consistently have poorer reproductive health outcomes compared to other racial/ethnic groups of women in the United States, which reflects a broad lack of reproductive justice in the United States.
According to CDC data, in 2007, the infant mortality rate for non-Hispanic Black women was 2.4 times the rate for non-Hispanic white women. The same data shows that nearly one in five infants born to non-Hispanic Black women (18.3%) were born pre-term. For non-Hispanic Black women, the percentage of very preterm births (less than 32 weeks gestation) was 4.1%, more than twice the percentage for non-Hispanic white women. Since very preterm infants have the highest infant mortality risk, differences in very preterm births have substantial effects on the overall infant mortality prevalence.
Things are not better when we look at other maternal and reproductive health-related outcomes, like maternal mortality, which is a small problem in most develop countries, except for the United States. In the U.S., maternal mortality (includes deaths due to causes related to or aggravated by pregnancy or pregnancy management) increased by half since 1990 to 21 per 100,000 live births in 2010. To give you some perspective, other developed countries, like Japan and Sweden, and even developing countries, like Qatar and Czechia, have maternal mortality rates well below 10 per 100,000 births. Even more, recent data show that racial and ethnic disparities persist. The maternal mortality rate among non-Hispanic Black women was approximately 2.7 times that of non-Hispanic white women (28.4 versus 10.5 per 100,000).
Maternal deaths are largely preventable; however, researchers have a hard time pinpointing exactly why rates have grown in the United States, the wealthiest country in the world. Many attribute it the increased chronic health conditions like diabetes and hypertension, which are often linked to pregnancy-related complications like hemorrhage and preeclampsia. In fact, one study found that cardiovascular disease was linked to 25 percent of maternal deaths. While many health researchers are puzzled, a reproductive justice perspective suggests that maternal mortality and adverse birth outcomes are largely linked to the health of Black women at large, which is linked to their environmental, social, economic, and political well-being.
The term “reproductive justice” was coined by African American women after the International Conference on Population and Development in Cairo, Egypt in 1993; it provides “a political home for a set of ideas, aspirations and visions in language that encompasses all the social justice and human rights issues.” The term moves beyond the narrow focus on abortion rights or gender equality and understands that woman’s ability to determine her reproductive destiny is directly linked to her social, economic, and political power and autonomy.
I have learned a great deal about reproductive justice from my work on reproductive health, mainly the degree to which a woman has reproductive wellness is directly related to whether she is in a safe, supportive, and healthy environment.
Early in my career I studied disparities in the prevalence of low birth weight and preterm births among Black women, and how these disparities are linked to social, environmental, and political structures. Later, I critically examined the validity of unintended pregnancy, a concept that researchers, practitioners, and policymakers use to gauge reproductive health and need among women. Although many use the concept of unintended pregnancy to recommend policy and programs, for the most part we still do not know how and why women come to consider their pregnancies “mistimed” or “unwanted.”
My work has shown that pregnancy intention to be largely a function of greater macro-level factors, like educational access, opportunity, partnership dynamics, and even local labor markets. Efforts to decrease unintended pregnancy by increasing use of contraception is ineffectual without understanding how women relate to pregnancy, motherhood, their bodies, reproductive agency, and communities.
In this nation, we have very deep inequities that stem from decades of structural violence, resulting in health disparities that we grapple with today. Without acknowledging this fundamental relationship within the realm of reproductive health and maternal and child health, efforts to reduce disparities will likely to non-effective. What I am trying to do is bring this dialogue to the greater public so we can work en masse to change the way we talk about health and well-being. Please join me in the dialogue.