REPRODUCTIVE HEALTH THROUGH A JUSTICE LENS

In the current political environment, we aim to center the experiences of people who are—and have been—most impacted by systemic inequities and injustices. There is a long history of coercive reproductive practices globally and in the U.S. Many gynecological techniques were developed using enslaved and immigrant people without proper consent or anesthesia. Abuses continue today, including forced sterilization by a governmental agency exposed as recently as 2020 (ProjectSouth 2020), incentivized use of long-acting reversible contraceptives and resistance to removing them, and threats to parenthood (including discriminatory referrals to governmental agencies such as child protective services). These abuses have been disproportionately imposed upon people with low-incomes, people with disabilities, Black, Indigenous, and People of Color (BIPOC), immigrants, LGBTQIA+ people, people who use drugs, and incarcerated people (Briggs 2021, NPWF 2020, Owens 2017). This history continues to shape the perception of family planning services by marginalized individuals and communities (Thorburn 2005, Prather 2018).

In response to this history, communities organized and developed frameworks to fight for their reproductive autonomy (Ross 2017). The Reproductive Justice (RJ) framework was conceptualized by 12 Black women in 1994 using a human rights framework to center voices on the margins, especially those of Black women (Leonard 2017). RJ is defined by SisterSong Women of Color Reproductive Justice Collective as the:

• Right to maintain personal bodily autonomy
• Right to have children
• Right to not have children
• Right to parent the children we have in safe and sustainable communities

RJ is one of three distinct frameworks that together provide a complementary solution to address reproductive oppression and center reproductive freedom: [1] Reproductive Health (RH), [2] Reproductive Rights (RR), and [3] Reproductive Justice. An RH framework emphasizes access to necessary reproductive health services. An RR framework is based on universal legal protections, and sees these protections as rights. An RJ framework is inherently connected to the struggle for human rights within layered systems of oppression.

RJ recognizes that reproductive decisions are shaped by multiple intersecting factors, including race, gender, class, sexual orientation, age, and geographic location. These experiences are further impacted by systemic inequities—such as limited access to insurance, employment, food, clean water and air, accessible transportation, and quality education. Ensuring bodily autonomy requires acknowledging and addressing structural factors that shape reproductive health and parenting experiences (Ross 2017, Chrisler 2012, ACRJ 2005).

While the RR movement historically centered cisgender, white, nondisabled, heterosexual women in legal advocacy for abortion access (Nichols 2020), the RJ movement focuses on systemic change to improve the reproductive lives of marginalized communities (NBWRJ 2025, BMMA 2021). Given the historical devaluation of childbearing among marginalized populations (Brandi 2018, Brown 2014), known as stratified reproduction, it is essential that we provide care that respects each person’s values and preferences (Gomez 2014, Swan 2024). Our curriculum is grounded in this history and the commitment to person-centered care.

Practice brings Transformation

The TEACH Curriculum, abortion care, and the RJ framework have the power to transform not just the lives of our patients but also our own experiences as providers. This work challenges us to reflect on why and how we can stay grounded in our purpose, even in times of uncertainty.

Health care providers today are navigating complex legal and ethical challenges that are deeply frustrating. Restrictions on care and ever-changing policies make it harder for people to access essential services and also profoundly affect us as clinicians. RJ reminds us that abortion access is critical—it is about autonomy, dignity, and ensuring that people can make decisions about their own bodies and futures. Engaging in this work is an opportunity to realign with our values, reclaim our sense of purpose, and contribute to a movement prioritizing person-centered care. These challenging times also offer additional opportunities to learn from others, including those long-navigating legal challenges to abortion and those who are deeply rooted in communities impacted by these policies.

Providers also serve as educators and mentors. Sharing knowledge breaks down barriers and fosters an environment of learning and growth. This process is not just about supporting patients—but also about sustaining ourselves. It allows us to do something meaningful with our knowledge, our hands, and our hearts, especially in a time when so much is being taken away.

This work is demanding, and we cannot do it alone. Building community is not just about professional support—it’s a necessary act of care for ourselves and one another. Chapter 1 lays the foundation for this perspective, framing the curriculum as a tool for skill-building and empowerment. By grounding this work in RJ principles, we can move beyond feeling disempowered and instead recognize the role we play in shaping the future of abortion care—one rooted in resilience, connection, and unwavering commitment to those we serve.

Defining Pregnancy Desires And Outcome Indicators

Abortion care and unintended pregnancy are often linked by researchers and policy makers. The concept of pregnancy intention is complex and frequently more meaningful to researchers than people experiencing pregnancy. A conventional approach of categorizing pregnancy desires misses the complexities of people’s desires, their experiences prior to pregnancy, or the context in which a pregnancy occurs (Gomez 2019, Borrero 2015). Ambivalence, partner influence, structural factors, and cultural perspectives all inform feelings about a pregnancy (Aiken 2016). Categorizing pregnancies in a dichotomous way (desired vs. undesired) can be stigmatizing, and highlights individual behavior when, in fact, systems and structures limiting contraceptive access and sustainable parenting environments play a larger role in one’s ability to achieve or avoid pregnancy (Auerbach 2023).

Recent person-centered approaches to identify contraceptive service-needs, rather than pregnancy intention, are supported by evidence for how people want to be asked about their reproductive needs (Manze 2020, Samari 2020). In initiating sexual and reproductive conversations, ask for consent and honor a patient’s answer. New person-centered quality metrics also help us to stay focused on a person’s needs (Jones 2023).

Professional Ethics In Reproductive Health

A comprehensive approach addressing pregnancy preferences is an essential component of preventive care within a public health framework (Samari 2020, Taylor 2011). Primary care clinicians are uniquely positioned and have ethical responsibilities to provide reproductive health screening, pregnancy options counseling, contraceptive services, miscarriage management, and appropriate referral to or provision of abortion services. Clinicians in restrictive settings likely face greater ethical challenges. Health care institutions and training programs should be transparent to communities and trainees about the religious affiliations affecting health services at their institutions. People with reproductive potential want information about a hospital’s religious restrictions on care when deciding where to go for reproductive care, when a choice of provider even exists (Freedman 2018). Trainees and students deserve the same information when deciding where to go for training. Growth in the religious health care sector demands an increasing need for transparency so that people seeking healthcare and trainees can make informed decisions.

Birth Justice and Birth Equity Post-Dobbs

As individuals are increasingly forced into carrying pregnancies to term, it is important to center birth justice and equity. Birth justice and equity seeks to ensure optimal birth conditions, addressing inequities in a sustainable manner (Crear-Perry 2021). Abortion restrictions are associated with an increased risk of pregnancy complications, maternal morbidity and mortality, and increased rates of preterm births (Vilda 2021). Researchers have estimated a 21% increase in overall maternal mortality with a potential national abortion ban, increasing to 33% for Black people in particular (Stevenson 2021). These statistics are increasingly familiar to Black birthing people, with almost 40% of Black women reporting fear of death during pregnancy (PerryUndum 2022). Increased infant mortality was documented in Texas with the 6 week abortion ban (Gemmill 2024), and nation-wide after the Dobbs decision (Singh 2024). Birth justice and equity encourage us to work toward healthy and safe pregnancies and births for all communities, especially in areas where bodily autonomy is already limited by the law.