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Spotlight on Hope: Reproductive Health and Justice

Many people in the United States were shocked when the Supreme Court’s long-standing precedent upholding abortion rights, Roe v. Wade was recently overturned. Reproductive rights and justice are critical issues for youth and families, and human sexuality is a core content area for Family Life Education professionals. Decisions around childbearing are complex, and shaped by a variety of factors, including: social and cultural contexts, life cycle experiences, social and emotional relationships, structural inequalities, and even experiences of violence, trauma, and abuse. As authors of a recent review article in the Journal of Marriage and Family note, “the families in which children are raised have important implications for the well-being of individuals, children, and families. Moreover, although being a parent can be a source of identity and meaning, it also demands substantial time, money, and emotional investment.” 

As we in the United States continue to hold important conversations about upholding reproductive rights, and which policies best support pregnant people, it is critical to examine the terrain in which these decisions about reproductive health are made. First, limiting access to reproductive decision-making, including access to abortion and contraception, disproportionatly affects women of color. Women of color, indigenous women, and trans people are less likely to have access to comprehensive reproductive health care, they often live in areas with less access to contraceptive care, and have historically experienced racism and/or discrimination when trying to access care, which means they are less likely to seek out care because of feelings of distrust

Second, although many conversations about reproductive rights have often been focused on the issue of abortion and choice, this type of limited view of reproductive health does not appreciate the wider structural and contextual issues that shape people’s decisions about their reproductive health and their access to comprehensive care and services. For example, as part of a broader project on reproductive health and religion, I was part of a team that conducted ethnographic research at a homeless shelter for two years. In the course of many interviews and conversations with women about their reproductive health histories, we found that women made decisions about their reproductive health – and whether or not to become a parent – in a nuanced and contextual way, thinking broadly about the impacts of parenting on their future, and recognizing that in many cases they had been limited in their choices by circumstances outside of their control. For example, some talked about how their partners coerced them into sexual encounters without a condom, others were convinced by doctors to try long acting contraceptive methods that were painful and had harsh side effects, or several women became pregnant while using birth control. 

Decisions about reproductive health are complex and cannot be limited to abortion alone. This is not to say that abortion access isn’t critical – as the American College of Obstetrics and Gynecology has stated clearly, “abortion is an essential component of comprehensive, evidence-based health care.” However, abortion is only one part of a broader reproductive justice movement that centers and uplifts the experiences and leadership of women of color and indigenous women. As SisterSong movement organizers have defined it, reproductive justice (RJ) is:

  • A human right. RJ is based on the United Nations’ internationally-accepted Universal Declaration of Human Rights, a comprehensive body of law that details the rights of individuals and the responsibilities of the government to protect those rights.
  • About access, not choice. Mainstream movements have focused on keeping abortion legal as an individual choice. That is necessary, but not enough. Even when abortion is legal, many women of color cannot afford it, or cannot travel hundreds of miles to the nearest clinic. There is no choice where there is no access.
  • Not just about abortion. Abortion access is critical, and women of color and other marginalized women also often have difficulty accessing: contraception, comprehensive sex education, STI prevention and care, alternative birth options, adequate prenatal and pregnancy care, domestic violence assistance, adequate wages to support our families, safe homes, and so much more.

Students in our Agricultural and Human Sciences (AHS) program are conducting research and doing advocacy work related to reproductive health and justice. This month, we are highlighting the work of recent AHS graduate Stacie Durocher, who spent her AEHS 510 internship course learning from and with Dr. Helyne Frederick, a CFLE and Program Director for Human Development and Family Studies at UNC Chapel Hill.

Tell us a little bit about the work that you are doing or have done related to this topic.

My internship was working for Dr. Helyne Frederick from UNC Chapel Hill and focused on the sexual health of Black women and the relationship they hold with their medical practitioner/provider. I researched the history of Black women’s sexual health within the United States and how these experiences shape their health at present. Black women have been stereotyped as hypersexual; misled and coerced into medical experiments (medical students would practice cesarean sections without the use of anesthesia); sterilized without understanding its permanent effects due to eugenics programs to control the Black population; today have an HIV infection rate that is twenty times higher than White women; and the list goes on. Because of these widespread and systemic injustices, there is a lack of trust that exists with the medical system and with White practitioners/providers. Reproductive issues affect all women and people who can become pregnant, but if Black women are less likely to have the funds or the desire to visit a doctor out of fear or lack of trust, sexual health issues will not be discussed, health literacy understanding will continue to be low, and women will not get the care they need in order to make informed and safe decisions regarding their bodies. The goal of my internship was to create content that could be shared with practitioners and providers in order to better help them understand their patients while using family life education concepts I learned as a Masters student in the AHS department.   

What resources do you recommend for people who want to learn more about this topic and how they can get involved?

The goal of the internship was to create educational material to share with medical practitioners/providers in order to encourage more conversations and better communication with their patients. If medical staff understand why they are not perceived as trustworthy then the hope is that they can work to build better relationships, have more patience with their patients, and convey medical knowledge more effectively in order to provide better care for the women they are seeing.

Learning more about the challenges Black women face starts with simple Google clicks. Additionally, public libraries have sections dedicated to autobiographies and Black feminist memoirs. Researching slavery and the history of Black women’s sexual health is a good start, but having actual conversations with Black women about their feelings or medical racism they have experienced helps the majority poplation learn more about Black women’s struggles from people that experienced it first hand instead of out of a book. Asking practitioners/providers their thoughts on patient care and how they treat people or struggles they have faced when providing care provides an opportunity to open up dialogue about the subject. 

Here are some ideas to get you started:

How do you suggest people get involved in this work around this topic?

Given the need for conversations about reproductive health and healthcare right now, I encourage people to read more about the issues women of color are facing, and support organizations that are led by women of color and indigenous women. 

Dr. Frederick’s ultimate goal is to create a documentary-type video for practitioners to watch so that they understand why Black women feel distrust and are unsatisfied with their healthcare visits. If they can watch a simple movie where Black women are interviewed and are expressing how they feel after being mistreated at office visits, the hope is that the practitioners/providers will keep that in the back of their minds and change their behavior to lead more compassionate and caring practices.  

What challenges have you faced in doing this work?

I am an educated White woman who has health insurance and access to a vehicle to get me to appointments. I had three healthy pregnancies and entered each understanding how my body works and the birthing process while having access to resources I needed to keep both myself and my children healthy during pregnancy and postpartum. The most difficult part of this internship experience was not being able to really relate and connect with the data and stories that I encountered. I have never felt racial discrimination, I have never been viewed as “young, dumb, and pregnant” as some women reported in the studies I encountered while researching, and I have a support system that many women do not have in order to create a healthy life, both mentally and physically, for myself. Fully understanding something you have not lived through is not possible; but my eyes were opened to struggles I never knew existed, I recognize biases I held, and I now feel more compassionate and sympathetic towards struggles Black women experience. Simply knowing these struggles exist has changed me and makes me want to stand beside these women who experience discrimination because of their skin color.

A common issue practitioners seem to face is that they feel as if there is not enough time available to spend on each patient because their schedules are crammed with patients all day. A 15 minute appointment is not enough time to connect and listen to fears plus medical questions and examine the patient. Practitioners/providers feel overwhelmed and go into autopilot mode to survive the day, so it will be a challenge to help them reevaluate their patient interactions as many feel they are already doing their best to give all they have daily.  The interaction with the patient is crucial to establishing trust, reducing medical racism, and providing Black women with better care. The support of practitioners/providers in committing to have better interactions with patients would make a difference, but it’s a challenge when there is practitioner burnout.       

When you think about this topic and the work you do, what gives you hope?

I have hope that most medical practitioners/providers came to this profession because they want to be helpers, that they genuinely want to do good work in the world. These people are intelligent and go through many years of rigorous schooling in order to become experts in their fields, but they are still humans, and humans are flawed. We all come with our own personal beliefs, cultures, religions, etc. due to our upbringings and these shape our worldview. When we start listening more to the person beside us, understanding their stories, and approaching them with kindness, that is when changes can be made. I hope more honest and raw conversations can be had so that we can all learn from each other. Learning can change the medical field with one patient at a time, and Black women’s sexual health, along with all women’s sexual health needs can improve.