Reproductive justice

The term reproductive justice combines reproductive rights and social justice. It was coined and formulated as an organizing framework by a group of Black women who came together for that purpose in 1994 and called themselves Women of African Descent for Reproductive Justice.[5] They gathered in Chicago for a conference sponsored by the Illinois Pro-Choice Alliance and the Ms. Foundation for Women with the intention of creating a statement in response the Clinton administration's proposed plan for universal healthcare. The conference was intentionally planned just before the attendees would be going to the International Conference on Population and Development in Cairo, which reached the decision that the individual right to plan one's own family must be central to global development. The women developed the term as a combination of reproductive rights and social justice, and dubbed themselves Women of African Descent for Reproductive Justice.[6] They launched the framework by publishing full-page statement titled "Black Women on Universal Health Care Reform"[7] with 800+ signatures in The Washington Post and Roll Call addressing reproductive justice in a criticism of the Clinton health care plan.[5] The women who created the reproductive justice framework were: Toni M. Bond Leonard, Reverend Alma Crawford, Evelyn S. Field, Terri James, Bisola Marignay, Cassandra McConnell, Cynthia Newbille, Ross Loretta Ross, Elizabeth Terry, ‘Able’ Mable Thomas, Winnette P. Willis, and Kim Youngblood.[6]

Loretta Ross, co-founder and National Coordinator of the SisterSong Women of Color Reproductive Justice Collective from 2005–2012, defines reproductive justice as a framework created by activist women of color to address how race, gender, class, ability, nationality, and sexuality intersect.[8] As a concept, reproductive justice was created by these activist women of color because they felt that the dominant paradigm of "pro-choice" did not meet their needs. They reported not being able to exercise reproductive choices as easily as their more privileged counterparts. For them, reproductive politics was not about choice, but about justice.[8]

Abortion discourse in the United States is often explained in terms of being "pro-choice," i.e. in favor of abortion rights, or "pro-life," i.e. favoring fetal development and protection of the life of the "unborn child" and opposing abortion. Reproductive justice challenges the pro-choice/pro-life dichotomy. RJ understands "choice" as something that divides women in policy and practice because it assumes that all women have an equal ability to make the same choices. Therefore, "choice" ignores structural factors such as economic status, race, immigration state, etc.[9] Some women's studies scholars like Greta Gaard argue that "choice" is a "scheme of omission" which means that it leaves many women out of the conversation, particular women of color, immigrant women, queer women, transgender women, etc. Structurally, these identities do not have the same degrees of choice when it comes to accessing reproductive care. Gaard argues that this further divides women according to class and race.[10] This creates a need for a new frame that is more inclusive, and reproductive justice was created to be that frame.

Reproductive justice is a critical, theoretical framework that was invented as a response to United States reproductive politics. The three core values of reproductive justice (RJ) are (1) the right to have a child, (2), the right to not have a child, and (3) the right to parent a child or children in safe and healthy environments.[11] The framework moves women's reproductive rights past a legal and political debate to incorporate the economic, social, and health factors that impact women's reproductive choices and decision-making ability.[12]

Reproductive justice is based on the theory of intersectionality, which states that people have different life experiences and opportunities based on how their identity categories, such as race, class, gender, and sexuality, interact with each other. Reproductive justice explains how people oppressed by the marginalization of their intersectional identities also experience higher levels of reproductive oppression – systemic oppression that impacts their reproductive lives. This means that it is often harder for oppressed people to access healthcare because of factors such as education, income, geographic location, immigration status, and potential language barriers, among others. Activist women of color created this framework because they felt they did not have as much choice as their privileged counterparts when it came to making decisions about their bodies, healthcare, and reproductive lives.[8]

There are three frameworks that focus on women's reproductive needs:

1. Reproductive health: Addresses inequalities in health services by advocating for the provision of services to historically underserved communities.[13]
2. Reproductive rights: Emphasizes the protection of an individual woman's legal right to reproductive health services, focusing on increasing access to contraception and keeping abortion legal.[14]
3. Reproductive justice: Encompasses reproductive health and reproductive rights, while also using an intersectional analysis to emphasize and address the social, political, and economic systemic inequalities that affect women's reproductive health and their ability to control their reproductive lives.[13]

The founders of the reproductive justice framework argued that it is "purposefully controversial" because it centralizes communities of color. Advocates state that centering these communities pushes back against the "dehumanizing status quo of reproductive politics."[15] By centering the needs and leadership of the most oppressed people instead of the majority, reproductive justice seeks to ensure that all people can create self-determined reproductive lives.[5] The reproductive justice lens is therefore used to address issues related abortion, contraception, immigration, welfare, HIV/AIDS, environmental justice, racism, indigenous communities, education, LGBTQ+ rights, and disability, among other issues impacting people's reproductive lives.[16] For example, unlike the pro-choice reproductive rights or reproductive health movements, reproductive justice includes community safety, violence, and the government's role in reproduction. The reproductive justice framework addresses community issues including the right to safety and to parent in safe environments, so it includes issues like police brutality and the water crisis in Flint, Michigan, whereas pro-choice typically does not. Asian Communities for Reproductive Justice, recently renamed Forward Together, defines the concept as follows:

"Reproductive Justice is the complete physical, mental, spiritual, political, economic, and social well-being of women and girls, and will be achieved when women and girls have the economic, social, and political power and resources to make healthy decisions about our bodies, sexuality, and reproduction for ourselves, our families, and our communities in all areas of our lives."[13]

The reproductive justice movement, in its efforts to illuminate these issues, challenges the right to privacy framework established by Roe v. Wade that was predicated on the notion of choice in reproductive decision-making; reproductive justice in effect turns the focus from civil rights to human rights.[12] The human rights approach of reproductive justice advocates the right of reproductive decision-making as inalienable for all women and trans people regardless of their circumstances, while the civil rights-based pro-choice framework advocates for the legal right to choose abortions without addressing how the possession of resources and privileges influences the choices one has.[17] As Rickie Solinger notes in Reproductive Politics: What Everyone Needs to Know, "the term rights often refers to the privileges or benefits a person is entitled to and can exercise without special resources,"[18] whereas the privacy framework established by Roe and interpreted by the Supreme Court in Maher v. Roe, holds that "the state is not obligated to provide the means for women to realize their constitutionally protected rights, but only to refrain from putting any 'obstacles' in their 'path'".[19][20][21] The reproductive justice movement seeks to secure women's reproductive rights by attempting to abolish the civil rights foundation created by Roe, which has not addressed issues of abortion access or reproductive oppression, and replace it with a human rights foundation that would require the state to ensure every person's access to free reproductive decision-making.[22] In 2017, Loretta Ross along with Solinger wrote Reproductive Justice: An Introduction (Reproductive Justice: A New Vision for the 21st Century) detailing the many ways Reproductive Justice and Human Rights intersect with one another.[22]

The organization Asian Communities for Reproductive Justice, one of the original groups to define and promote reproductive justice,[23] defines the challenges to reproductive health, rights, and justice as the concept of reproductive oppression. They explain,

"The control and exploitation of women and girls through our bodies, sexuality, and reproduction is a strategic pathway to regulating entire populations that is implemented by families, communities, institutions, and society. Thus, the regulation of reproduction and exploitation of women's bodies and labor is both a tool and a result of systems of oppression based on race, class, gender, sexuality, ability, age and immigration status. This is reproductive oppression as we use the term."

The definition of reproductive justice established by these groups as a counter to reproductive oppression illustrates the broadening of the reproductive rights and health frameworks, expanding focus from protecting individual rights and choices to address broader socioeconomic conditions.

Using the term reproductive justice instead of pro-choice, reproductive rights, or reproductive health, is a rhetorical choice. Robin West, professor of law and philosophy at Georgetown, explains that "pro-choice" court cases may have been lost because of how the issue was framed. For instance, she argues that "rights" rhetoric gives courts, specifically the Supreme Court, immense rhetorical power. Reproductive "health" often places power in the hands of doctors, medical professionals, and ability to access clinics. In this view, "rights" and "health" both refer to power being given to the people from a top-down perspective. As a response, the "justice" frame is meant to put power back into the hands of the people.[24]

Although distinct from pro-choice frameworks, reproductive justice advocates typically rely on narrative as a rhetorical strategy to mobilize consensus. These narratives centralize women's stories and decision-making, similar to Tiller's "Trust Women" argument mentioned above. Narratives relying on public memory of feminist movements and link women's stories across time and space.[25] Narratives also explain why people are organizing.[26] Narratives are used because they are more personal than abstract policy decisions and put a human face on political issues.[27] While feminist narratives emphasize women's stories and experiences, reproductive justice narratives focus on the stories specifically of women of color, situating those with lived experience of each issue as the real experts on that issue.[28] For social justice issues, narratives operate on two levels: (1) individual narratives as a rights-gaining strategy and (2) narratives about social justice or activist movements.[29]

For rhetoricians, Celeste Condit's book on abortion discourse helps put pro-life and pro-choice ideologies in conversation. Her book, Decoding Abortion Rhetoric: Communicating Social Change (1990), was released before reproductive justice was created, but it is a heavily-cited starting point for understanding how rhetoric shapes abortion debates.[25] Some people believe that rhetoric is opposed to action and therefore less useful, but Condit shows how reality is made through rhetoric and how rhetoric is the key to communicating social change.[25]

Technology-based tactics used by activist groups to speak out against reproductive oppression can be linked to digital rhetoric. For example, women used social media to gather their forces in an attack against abortion bill HEA 1337 in 2016.[30] Through their planning on an online announcement portal, participants would systematically call Mike Pence's office to offer information about their periods to prove the bill's problematic requirements.[30] As a digital form of rhetoric, media can become more than just a way to exchange messages and can emerge as infrastructures in our lives.[31]

As a concept that falls under digital rhetoric, technofeminism complements the framework and goals of reproductive justice. Both technofeminism and reproductive justice are centered on intersectionality and its emphasis on recognizing the existence of multiple, unique identities. Technofeminism reinforces the presence of digital spaces as useful for feminist activism, but these spaces can also empower the wrong groups in a given situation; this can be problematic intersectionally.[32] Reproductive justice is at odds with such an issue because online spaces can empower both feminist activists and pro-life groups simultaneously, for example. Addressing the existence of power formations through notions of intersectionality will ensure that there is no indirect compliance with the behaviors these groups can exhibit.[32] In addition, recognizing the connection between identity and power allows for more attentiveness toward technofeminist changes and diversity.[32]

Early notions of women's liberation focused largely on freedom from the Victorian Era gender roles. These roles placed white women in the cult of domesticity, confining them to the expectations of motherhood and home-maker, void of any autonomy separate from their husbands or families. These feminine norms and restrictions did not apply the same exact way for Black women and other women of color. Black women were considered to be outside the cult of domesticity and many of its gender norms that were perceived by white people; as Stephanie Flores wrote in The Undergraduate Journal of the Athena Center for Leadership Studies at Barnard College, “Blacks were not perceived as feminine, but rather as less than human” but contraception was still socially unacceptable for Black women because it was their perceived duty to produce more slaves.[33]

Neither Black nor white women had been historically granted full bodily autonomy with regards to their reproductive health, but they experienced this lack of freedom differently, and thus emerged the need for a movement that was able to cater specifically to the unique experiences and challenges faced by Black women. Similarly, Latinx, Arab/Middle Eastern, Indigenous, and Asian/Pacific Islander women have all faced different gender norms based on their race/ethnicity. However, the gap in the US has always been widest between white women, who are the most privileged group, and Black women, who have been the most maligned.

Historically, at the beginning of the mainstream women's rights movements in the United States, reproductive rights were understood to be the legal rights that concerned abortion and contraceptive measures like birth control. The predominantly white early advocates and organizations fighting for reproductive rights focused almost explicitly on these goals, which resulted in the widespread, long-lasting exclusion of Black women from mainstream women's rights movements.[34]

The beginning of the birth control movement in the United States alienated Black women in many ways.[34] With mostly white leadership, advocates in this movement catered mainly to the needs of white women. Additionally, in the early 20th century, white nationalists spread the concept of “race suicide,” the fear that white women using birth control would reduce the number of white babies being born, thus limiting the power and control of white people in the United States.[33] This concept has been complemented by a history of forced and coerced sterilization of women of color around the world, including in the US. The most recent cases of non-consensual sterilization in the US occurred throughout the 20th century, targeting “women living with HIV, women who are ethnic and racial minorities, women with disabilities, and poor women, among others.”[35] Often, the “consent” for sterilization was obtained from women under distressing circumstances (i.e. during childbirth) or obtained without providing all of the necessary information regarding the sterilization. Other times, a woman's consent was not given, and the procedure was done when the woman thought she was receiving only a cesarean section. These sterilizations were often publicly funded, occurring throughout many states in the US.[35] They resulted in the near-elimination of some Native American tribes.[36] “The mainstream feminist movement recognized coerced sterilization as a problem for black women, but continued to argue for easier access to sterilizations and abortions for themselves. Their demands directly and negatively impacted black women as they failed to take into account the needs of black women for protection from hospitals and government officials who would otherwise force black women to limit their reproduction.”[33] The genocidal connotations and lack of consideration for forced sterilization in the birth control movement contributed to intersectional challenges faced by women of color. They also resulted in a movement of Black people against Black women's making personal decisions about using birth control and abortion, rather than producing more Black babies to build the community. This effectively divided the Black community.[36]

Additionally, the birth control movement essentially espoused the idea that women could attain freedom and equality by receiving legal access to family planning services, which could help lift them out of poverty. While this may have been true or partially true for some white women who were free of racist or classist discrimination, Black women had many more barriers that were blocking their way to liberation, by nature of being Black in such a racially unequal society.[33]

There is also a history of coercive promotion of birth control among women of color in the United States. Before their approval by the FDA, birth control pills were tested on Puerto Rican women who were not told they were participating in a clinical trial of little-tested medication, nor were they told about side effects that were occurring among their peers in the trial. Some women were not even told that the pills were meant to prevent pregnancy, and those who were told this were told it was 100% effective. Women in the trials were given doses ten times higher than what is actually needed to prevent pregnancy. Although a few trial participants died, they were not autopsied to discover if the drug was related to their deaths.[37][38] More recently, women of color, women with low incomes, women in conflict with the law, and women who have used illicit drugs have been coerced into using long-acting reversible contraceptives (LARCs). Women have been given the choice between LARCs and jail, or have been told that they would lose their public benefits if they did not use LARCs. Medicaid has covered the implantation of LARCs, but not their removal, which has disproportionately affected women of color, who often experience poverty and rely on Medicaid. LARCS have also been disproportionately promoted to women of color. Many criticize these efforts as based in eugenics and seeking to curtail population growth among communities of color.[39]

Anti-abortion advocates have used this history of forced and coerced sterilization and birth control to claim that abortion itself represents a eugenics conspiracy. This movement cites the high abortion rates among Black women and the presence of abortion clinics in predominantly Black neighborhoods as evidence. Its methods center on erecting billboards across the country with messages like "Black children are an endangered species" and "The most dangerous place for an African American is in the womb." Reproductive justice advocates respond by showing that Black women have higher abortion rates because they have higher unplanned pregnancy rates due to factors like disparities in healthcare and sex education. The fertility rate among Black communities is the same as among white communities, showing that Black populations are not in decline. Abortion clinics are intentionally cited in low income neighborhoods to increase access, and economic disparities mean that many of these neighborhoods are predominantly Black. Dorothy Roberts, author of Killing the Black Body, says, "“Black women’s wombs are not the main enemy of black children ... Racism and sexism and poverty are the main enemy of black children. [The billboard] doesn’t highlight the issues behind why women are having so many abortions, it just blames them for doing it ... [These billboards] are essentially blaming black women for their reproductive decisions and then the solution is to restrict and regulate black women’s decisions about their bodies. Ironically, they have that in common with eugenicists.”[36]

The reproductive justice framework seeks to address these issues by emphasizing the importance of every woman's right to a self-determined reproductive life, including unbiased information about and access to all kinds of birth control.

Even when topics of racial genocide were no longer at the forefront of the birth control conversation, reproductive freedom for Black women was still not a priority of the mainstream civil rights movement in America. While reproductive politics were central to the mainstream feminist movement, they were often not addressed in ways that represented the needs of women of color as well as white women. These gaps in both the civil rights movement and the women's rights movement shed light on the need for Black women's organizations that would be separate from the existing movements focused only on racial equality without addressing women's specific needs or only on gender equality without addressing Black women's specific needs.

The Committee to End Sterilization Abuse (CESA) was an organization formed in 1977 that was specifically dedicated to addressing the forced sterilization of Black women in the US. CESA created a “working paper” that essentially served as an open letter to mainstream feminist activists called Sterilization Abuse: A task for the Women’s Movement. This paper highlighted one of the biggest intersectional challenges Black women faced in their fight for reproductive rights. It explained how despite not being addressed in mainstream feminism's fight for reproductive freedom, forced sterilization is indeed an infringement on one's reproductive rights, and one that disproportionately affected black women over white women. Calling attention to this infringement on the reproductive freedom of Black women was an important step in leading to the expansion of reproductive politics in the US.

Many new reproductive health organizations for women of color were created in the 1980s and 1990s, including the National Black Women's Health Project, and they objected to the rhetoric employed by the mainstream reproductive rights movement to define the issue of abortion along the pro-choice and pro-life lines that figured in abortion disputes[40] since the 1973 Roe v. Wade Supreme Court decision legalizing abortion in the US.[41] These new women-of-color-led organizations felt that the term "choice" excluded minority women and "masked the ways that laws, policies and public officials punish or reward the reproductive activity of different groups of women differently."[40] Activists for the rights of women of color subsequently expanded their attentions from a focus on unfair sterilization practices and high rates of teen pregnancy among women of color to include the promotion of a more inclusive platform to advance the rights and choices of all women.

The concept of reproductive justice was first articulated in June 1994 at a national pro-choice conference by an informal Black Women's Caucus that met at the Illinois Pro-Choice Alliance in Chicago.[42] This caucus preceded the 1994 International Conference on Population and Development (ICPD) that took place two months later[43] and produced the Cairo Programme of Action, which identified reproductive health as a human right.[44] After Cairo, the Black women promoting the reproductive justice framework sought to adapt the human rights framework outlined by the ICPD to the United States' reproductive rights movement. They coined the term "reproductive justice," defining it at first as "reproductive health integrated into social justice" by using the moral, legal, and political language of human rights.[45]

In 1997, 16 organizations representing and led by Indigenous, Asian/Pacific Islander, Black, and Latinx women, including women who had been involved in the Black Women's Caucus,[46] came together to form the SisterSong Women of Color Reproductive Justice Collective[45][47] in order to create a national movement for reproductive justice. Their website states that reproductive justice is a human right, is about access (not choice), and is about more than just abortion. They argue that reproductive justice can be achieved by examining power structures and intersectionality, joining together across identities and issues, and putting the most marginalized groups at the center of advocacy.[48] SisterSong spearheaded the push for a new, comprehensive reproductive justice movement as a more inclusive alternative to the "divisive" argument for women's rights that primarily emphasized access to contraception and the right to an abortion.[49] The founders of SisterSong also felt that some of the pro-choice activists "seemed to be more interested in population restrictions than in women's empowerment".[50]

As SisterSong spread the concept of reproductive justice, the framework gradually won increasing support and prominence in the discussion of women's rights and empowerment. The 2003 SisterSong National Women of Color Reproductive Health and Sexual Rights Conference popularized the term and identified the concept as "a unifying and popular framework" among the various organizations that attended.[40] In 2004, Jael Silliman, Marlene Gerber Fried, Loretta Ross, and Elena R. Gutiérrez published the first book on reproductive justice, Undivided Rights: Women of Color Organizing for Reproductive Justice.[51] Moving forward, reproductive justice groups modeled some of their rhetoric after Dr. George Tiller, a late-term abortion provider who was assassinated in his church in Wichita, Kansas in 2009. He coined the phrase "Trust Women" which was used to promote abortion rights by arguing that women should be trusted to make their own decisions. "Trust Women" became the name of an organization and conference based on women's reproductive rights.[52] Building on his legacy and the popularity of this phrase, SisterSong and reproductive justice advocates adopted Trust Black Women[53] as an organizing slogan and the name of a national coalition of Black-women-led organizations led by SisterSong and devoted to advancing reproductive justice for the Black community (TrustBlackWomen.org).[54]

Over the decades since SisterSong's birth, the group has inspired and mentored the creation of dozens of women-of-color-led reproductive justice organizations across the country. Groups that promote women's rights such as the National Organization for Women[55] and Planned Parenthood[56] have increasingly adopted the language of reproductive justice in their advocacy work. The movement has increasingly entered mainstream spaces, as organizations such as Law Students for Reproductive Justice have arisen to promote women's human rights using the reproductive justice framework.[57] In 2016, Hillary Clinton used the term reproductive justice during her campaign for the presidency.[58]

Reproductive rights have also been redefined digitally. Moving beyond contradictions about women and technology and exploring the ways these contradictions can be challenged allows for better opportunities to take action.[59]

On March 28, 2016, "Periods for Pence" pages were created on Facebook and Twitter to combat HEA 1337.[30] Organizers like Laura Shanley rallied women online to contact Pence's office and provide information on their reproductive health.[30] Women were ultimately using digital means to represent their bodies and band together as a team of multiple identities with unique, individual experiences.[30]

Sites like the National Abortion and Reproductive Rights Action League help to engage women with political activism. For example, some sites share petitions and links for voting/contacting political leaders so women can get involved despite their busy lives.[60]

According to The Pro-Choice Public Education Project, the US provides more funding towards abstinence-only sex education programs rather than comprehensive sex education programs. From 1996 through 2007, the US Congress committed over $1.5 billion to abstinence-only programs. When funding is not provided towards comprehensive sex education, students are not taught about how to prevent pregnancy and sexually transmitted diseases from occurring.[61] Advocates for Youth discusses how abstinence-only education programs are not effective at delaying the initiation of sexual activity or reducing teen pregnancy. Instead, graduates of abstinence-only programs are more prone to engage sexual activities without know how to prevent pregnancy and disease transmission.[62] Reproductive justice advocates call for comprehensive sex education to be available to all young people.

Reproductive justice advocates promote every individual's right to be informed about all birth control options and to have access to choosing whether to use birth control and what method to use. This includes advocacy against programs that push women of color, women on welfare, and women involved with the justice system to use LARCs (see section above on forced and coerced sterilization and birth control). By providing women and trans people with knowledge about and access to contraception, the reproductive justice movement hopes to lower unwanted pregnancies and help people take control over their bodies.

Federal programs supported by reproductive justice activists date back to the Title X Family Planning program, which was enacted in the 1970s to provide low income individuals with reproductive health services. Title X gives funding for clinics to provide health services such as breast and pelvic examinations, STD and cancer testing, and HIV counseling and education. These clinics are vital to low-income and uninsured individuals. Advocates for reproductive justice also aim to increase funding for these programs and increase the number of services that are funded."Title X Family Planning Program". United States Department of Health and Human Services. Washington, D.C.: U.S. Government. 2016-07-27. Retrieved August 9, 2016.

Advocates for reproductive justice such as SisterSong and Planned Parenthood believe that all women should be able to obtain a safe and affordable abortion if they desire one. Having safe, local, and affordable access to abortion services is a crucial part of ensuring high quality healthcare for women (and for trans and gender non-conforming people who can get pregnant). Access to abortion services without restrictive barriers is believed to be a vital part of healthcare because "…induced abortion is among the most common medical procedures in the US…Nearly half of American women will have one or more in their lifetimes."[63] Furthermore, these organizations point to studies that show that when access to abortion is prohibitive or difficult, abortions will inevitably be delayed, and performing an abortion 12 weeks or longer into the pregnancy increases the risks to women's health and raises the cost of procedures.[64][65][66][67][68] The American Medical Association echoes the importance of removing barriers to obtaining an early abortion, concluding that these barriers increase the gestational age at which the induced pregnancy termination occurs, thereby also increasing the risk associated with the procedure.[69]

Minority groups experience poverty and high rates of pregnancy due to lack of available sex education and contraception. In addition, women from low income households are more likely to turn to unsafe abortion providers, and as a result, they are more likely to be hospitalized for complications related to the procedure than higher-income women are.[17][70][66][67] Although abortions were made legal in the Roe v.s. Wade Supreme Court decision of 1973, many obstacles to women's access remain. Young, low-income, LGBTQ, rural, and non-white women experience the greatest hurdles in their efforts to obtain an abortion in many parts of the U.S.[71] Obstacles to obtaining an abortion in the US include a lack of Medicaid coverage for abortions (except in the case of certain circumstances, such as life endangerment), restrictive state laws (such as those requiring parental consent for a minor seeking an abortion), and conscience clauses allowing medical professionals to refuse to provide women with abortions, related information, or proper referrals.[71] Additional obstacles to access include a lack of safety for providers and patients at abortion facilities, the conservative, anti-choice political legislators and the citizens that support them, and a lack of qualified abortion providers, especially in rural states.[63] Abortion access is especially challenging for women in prisons, jails, and immigrant detention centers. Proponents of reproductive justice argue that withholding access to abortion in these facilities can be seen as a violation of the 8th Amendment preventing cruel and unusual punishments.[72] A survey presented in Contraception found a correlation between Republican-dominated state legislatures and severely restricted coverage for abortion. Many anti-abortion groups are actively working to chip away at abortion by enacting restrictions that prevent more and women from obtaining the procedure. The research concludes that full access isn't available in all settings, and correctional settings should increase the accessibility of services for women.[73]

Organizations that promote reproductive justice such as NOW and Planned Parenthood aim to provide increased access to safe abortions at a low cost and without external pressure. They advocate increasing insurance coverage for abortions, decreasing the stigma and danger attached to receiving an abortion, eliminating parental notification for teens, training more physicians and clinics to provide safe abortions, and creating awareness about abortion.[74][75]

Researchers have found that women of color face substantial racial disparities in birth outcomes. This is worst for black women. For example, black women are 3-4 times more likely to die from pregnancy related causes than white women.[76] While part of the issue is the prevalence of poverty and lack of healthcare access among women of color, researchers have found disparities across all economic classes. A black woman with an advanced degree is more likely to lose her baby than a white woman with less than a high school education.[77] This is partially due to racial bias in the healthcare system; studies have found medical personnel less likely to believe black people's perceptions about their own pain, and many stories have surfaced of black women experiencing medical neglect within hospitals and dying from pregnancy complications that could have been treated.[77] Researchers have also found that the stress of living as a person of color in a racist society takes a toll on physical health, a phenomenon that has been coined weathering. The extra stresses of pregnancy and labor on a weathered body can have fatal consequences.[77]

Reproductive justice advocates assert the need to correct racial disparities in maternal health through systemic change within health care systems, and they also particularly advocate for access to midwifery model care. Midwifery care has strong roots in the ancient traditions of communities of color and is usually administered by fellow women, rather than doctors.[78] Midwifery practitioners treat the individual as a whole person rather than an objectified body.[79] Midwifery care involves trained professionals including midwives (who are medically trained to monitor and safeguard maternal, fetal, and infant health and deliver babies[80]), doulas (who provide emotional and practical support and advocacy to mothers during pregnancy, labor, and postpartum, but do not have any medical training[81]), and lactation consultants (who train and support mothers with lactation[82]). Midwifery model care has been shown to improve birth outcomes,[79] but is often not covered by health insurance and therefore only accessible to wealthier people. Reproductive justice groups advocate for access to midwifery model care not only to correct racial disparities in birth outcomes, but because they believe that every woman has the human right to give birth in any way she wishes, including a home birth or a midwifery model birth at a birthing center or hospital.[83]

Women of color are disproportionately targeted by the criminal justice and immigrant detention systems, particularly women with low incomes or from other sectors of society with limited access to healthcare. A Rhode Island report showed that 84% of women in prison had been sexually active within 3 months of their arrest, but only 28% had used contraception. Newly incarcerated women are therefore at a higher risk of unintended pregnancy.[84] Many of these pregnancies also become high risk due to substance use before incarceration and lack of prenatal care services both before and during incarceration, leading to preterm deliveries, spontaneous abortions, low-birthweight infants, preeclampsia, or fetal alcohol syndrome.[85] During incarceration, many women report challenges in accessing appropriate prenatal, birthing, and postpartum care, sometimes with disastrous and even life-threatening results. Women have been denied medical attention when in labor, shackled during labor even against the requests of medical professionals, and refused postpartum doctors' visits after high-risk births. Shackling in five-point restraints (both wrists, both ankles, and across the belly) during pregnancy and postpartum has been known to cause issues like miscarriage (if a woman trips and cannot break her fall with her hands) and reopen stitches from a cesarean. Women have been automatically confined to isolation after birthing and separation from newborns, which increases the risk of postpartum depression. Breastfeeding and pumping milk have also been prohibited, which is detrimental to maternal and infant health and to mother-baby bonding. Advocates in several states have been fighting these policies, often using a reproductive justice framework, and several have won policy changes. Doula groups have also formed to provide care to incarcerated and detained women, often using a reproductive justice framework.[86][87][88][89]

Since 1980, the number of women in prison has tripled, leading to a high incidence of serious health concerns, including HIV, Hepatitis C, and reproductive diseases. The rate of HIV is higher among incarcerated women than among incarcerated men, and it can be as much as one hundred times higher among incarcerated people than in the general population. The trend towards longer and heavier sentences has also led to greater health concerns, as many prisons, jails, and detention centers offer little accessibility to adequate medical care. Due to stigma, when incarcerated and detained people are given healthcare, it is often lower quality. Additionally, prisons and detention centers are increasingly being built on rural land, isolated from major resources for medical care.[90] Two major areas of concern for reproductive justice in prisons are medical neglect and non-consensual prison intervention on a woman's right to reproduce.[91]

Prisons have demonstrated high incidents of human rights violations. These include cases of medical neglect and forced sterilization. Often, acts of forced sterilizations have been justified as punishments for imprisoned women. These violations continue to occur due to limited public attention towards cases of prisoner dehumanization and injustice. This leads to greater helplessness as imprisoned women lose say in the treatment of their bodies. For example, prisons often perform forced hysterectomies on imprisoned women. Article 7 of the International Covenant on Civil and Political Rights established by the United Nations prohibits cruel, degrading, inhumane torture. The lifelong effects of forced sterilization as well as the unnecessary suffering due to untreated disease violates these treaties.[92][93]

The criminal justice, child welfare, and immigrant detention systems frequently target and separate families with marginalized identities, which advocates say is a reproductive justice issue. The cash bail system incarcerates only people who have low incomes and cannot afford bail, which often means people of color. Due to the Adoption and Safe Families Act, parents can then lose all legal rights to their children if they have been incarcerated for 15 of the last 22 months, even if they are still awaiting trial. Both incarceration and immigrant detention separate children from competent parents who want them, which is often deeply traumatic[94] and can result in children being placed in the foster care system, where the likelihood of poor healthcare and educational outcomes increases, as does the likelihood of future criminal justice involvement, and these outcomes are worst for children of color.[95]

Access to reproductive health services is more limited among the LGBTQ community than among heterosexuals. This is evident from the lower number of training hours that students going into the medical field receive on health problems faced by LGBTQ persons.[96] Evidence also shows that once students complete training and become healthcare providers, they often adopt heteronormative attitudes towards their patients.[97] In addition to lower educational standards and evident clinical prejudice against LGBTQ patients, there is also limited health research that is specifically applicable to LGBTQ community.[98]

Like cisgender heterosexual people, LGBTQ people still need access sex education, sexual and reproductive healthcare such as testing and treatment for sexually transmitted diseases, birth control, and abortion. Despite myths to the contrary, LGBTQ people can still face unintended pregnancies. Many face increased risk for certain sexually transmitted diseases, such as HIV. Access to fertility treatment and adoption is also a reproductive justice issue for many LGBTQ people who want to raise children. Likewise, prejudice against LGBTQ people is a reproductive justice issue impacting their personal bodily autonomy, safety, and ability to create and support healthy families. Self-determined family creation is a human right for all people, according to reproductive justice. Trans people share all of these reproductive justice issues; in addition, access to gender-affirming hormones is considered a reproductive issue necessary to their personal bodily autonomy.[99] Trans people in the US, especially trans people of color, face the most severe prejudice and violence directed toward the LGBTQ community. Black trans women in particular are being murdered at alarming rates.[100]

Due to systemic racism, women of color in the US earn considerably less than white men and also substantially less than white women or men of color. This impacts their ability to afford birth control, reproductive healthcare, and abortion, as well as their ability to have as many children as they want and raise their families with adequate resources. Due to economic constraints, women of color are more likely than other women to feel they need to abort pregnancies they want. They are also more likely to live in poverty because they have more children than they can easily afford to care for. Women with low incomes are more likely to rely on state social supports, which often further limit their access to birth control, reproductive health services, abortion, and high quality maternity care such as midwifery services.[101]

In 1977, the United States federal government passed the Hyde Amendment, which eliminated federal medicaid which funded abortions and reproductive services to low income women. This caused low-income women further barriers in accessing reproductive health services, and meant that they would have to “forgo other basic necessities in order to pay for their abortion, or they must carry their unplanned pregnancy to term”.[102][103] The amendment results in the discrimination of poor women who “often need abortion services the most”[104] and have “reduced access to family planning, and experience higher rates of sexual victimization”.[104] Due to systemic racism in the United States, women of color “disproportionately rely on public sources of health care”, so the Hyde amendment impacted these women substantially.[105]

Because reproductive justice is tied to community well-being, Kathleen M. de Onı's 2012 article in Environmental Communication argues that reproductive justice should be understood alongside environmental justice and climate change.[106] Reproductive justice advocates organize for environmental justice causes because issues like unhealthy drinking water and toxins in beauty products can impact physical and reproductive health and children's health.[107][108] The Flint Michigan water crisis is often cited as an example of this because a low-income community primarily composed of people of color was forced to use toxic drinking water, a situation that advocates say likely would not have been inflicted upon a wealthier, whiter community.[109] Environmental reproductive justice was built on the premise to ensure that women’s reproductive health and capabilities are not limited by environmental pollution.[110]

Environmental justice is a response to Environmental racism. “Environmental racism refers to environmental policies, practices, or directives that differentially affect or disadvantage (whether intentionally or unintentionally) individuals, groups, or communities based on race or colour”.[111] The Environmental justice movement began in 1982, in Warren County, North Carolina.[111] It was born out of protests that occurred in response to a polychlorinated biphenyls landfill, which was located in Warren County, “a rural area in northeastern North Carolina with a majority of poor, African-American residents”.[112] Due to the potential for groundwater contamination, there was immense backlash from residents and “protesters argued that Warren County was chosen, in part, because the residents were primarily poor and African-American”.[112] The protests resulted in 500 arrests, but the landfill was unable to be stopped.

An example of environmental racism that shows the enactment of environmental justice and reproductive justice is the Dakota access pipeline and protests at Standing Rock. The Standing Rock Sioux and other indigenous tribes have been protesting the construction of the Dakota access pipeline and subsequent contamination of the surrounding waters since April 2016.[113]

It is not possible to describe every reproductive justice issue on this webpage, as reproductive justice includes and encompasses many other movements. The organization Asian Communities for Reproductive Justice, one of the key groups to define and promote reproductive justice,[114] says that advocates of reproductive justice support a diversity of issues they consider necessary for women and trans people to make reproductive decisions free of constraint or coercion. These enabling conditions include access to reliable transportation, health services, education, childcare, and positions of power; adequate housing and income; elimination of health hazardous environments; and freedom from violence and discrimination.[115] Because of the broad scope of the reproductive justice framework, reproductive justice activists are involved in organizing for immigrant rights, labor rights, disability rights, LGBTQ rights, sex workers' rights, economic justice, environmental justice, an end to violence against women and human trafficking, and more.[116][117][118][119][120][121]

Under the umbrella of the United Nations, there are several entities whose objectives relate to or promote reproductive justice.[122][123] Among them, the Convention on the Elimination of All Forms of Discrimination Against Women emphasizes the rights of women to reproductive health and to choose "the number and spacing" of their children, in addition to access to the resources that would allow them to do so. The Convention Against Torture and Other Cruel, Inhuman, or Degrading Treatment "has been interpreted to include denial of family planning services to women." The United Nations Committee on the Elimination of Racial Discrimination has also been involved with the reproductive justice movement, such as when SisterSong's Executive Director presented them with a shadow report written by SisterSong, the Center for Reproductive Rights, and the National Latina Institute for Reproductive Health in 2014. It described the US crisis in maternal mortality among mothers of color as a human rights issue, and the UN committee adopted all of the report's recommendations.[124]

The United Nations also sponsors conferences and summits with the subject of the empowerment of women, and these events have historically advanced the reproductive justice movement. The International Conference on Population and Development is the primary example.

The United Nations International Conference on Population and Development (ICPD) that took place in Cairo, Egypt in 1994 marked a "paradigm shift"[125] to a set of policies on population that placed a high priority on the sexual and reproductive rights of women. Prior to the ICPD, international efforts to gauge population growth and to produce approaches that addressed its challenges focused on "strict and coercive" policy that included compulsory birth control and preferential access to health services by people who had been sterilized.[126] The Programme of Action produced at the 1994 Cairo conference has been "heralded a departure from coercive fertility strategies" by insisting on the "fundamental rights of reproductive self determination and reproductive health care"[127] and provided the ideological inspiration for grassroots organizations such as SisterSong in the United States to launch a movement for reproductive justice.[128]

The United Nations Fourth World Conference on Women in Beijing followed the ICPD a year later, taking place in 1995, and producing a Platform for Action that advocated for the complete empowerment of all women.[129] It charged states with the duty of ensuring the human rights of all women, among them the right to sexual and reproductive healthcare. The Beijing Platform for Action also promoted reproductive justice by calling on nations to reexamine laws that punished women for undergoing abortions.[128]

The Millennium Declaration of September, 2000 and the eight Millennium Development Goals (MDGs) that emerged as a result of the declaration built on the framework for sexual and reproductive health rights the ICPD had put forth five years earlier.[127] The third and fifth MDGs, to promote gender equality and empower women and to improve maternal health, respectively, embody the principles of reproductive justice through "the promotion of healthy, voluntary, and safe sexual and reproductive choices for individuals and couples, including such decisions as those on family size and timing of marriage." Indeed, the Outcome Document of the 2005 World Summit reiterates the connection between the Millennium Development Goals and their support of the many social factors that promote reproductive justice by committing the participating countries to reproductive health as related to the fulfillment of all eight Millennium Development Goals. Advocates of reproductive justice have noted that by extension, reproductive justice is critical to include in strategies to meet the MDGs.[130]

Organizations that promote reproductive justice have criticized several United States policies that aim to remedy international issues of reproductive health. Below are just a few examples:

Groups such as Georgetown's Law Students for Reproductive Justice have objected for example to the Mexico City Policy, also known by some critics as the Global Gag Rule.[131] Although repealed by the Obama administration, this policy requires that non-governmental organizations that receive federal funding from the United States avoid promoting family planning and abortion services in reproductive health settings.

The President's Emergency Plan for AIDS Relief (PEPFAR) is another contentious American program related to funding initiatives for global reproductive health. The purpose of the program is to combat the global HIV/AIDS pandemic, but agencies such as the Center for Health and Gender Equity (CHANGE) have called its methods and effectiveness into question.[116] Critics say that it gives higher priority in funding distribution to faith-based organizations, including some "with little or no relevant international development experience" and some which promote abstinence instead of utilizing effective prevention methods.[131] This policy approach, which has been nicknamed the ABC—Abstinence, Be faithful, Condom-use— poses a challenge to reproductive justice. Advocates hold that such policies marginalize groups of people such as LGBTQ persons who may be discriminated against, as well as women who have been raped, for whom "abstention is not an option."[132] Although these organizations recognize the gains made by US aid as a whole, they argue that the rigid structure of the PEPFAR funding hinders a holistic, community-appropriate strategy to reduce HIV/AIDS infections, and they contend that the program is "laden with earmarks and restrictions from Washington that eliminate discretion for making funding decisions based on local realities and restrict alignment with European counterparts."

Another policy that has been condemned by reproductive justice advocates is the Anti-Prostitution Loyalty Oath (APLO) produced in 2003.[123] Required by the United States to grant funding to non-governmental organizations that work to reduce the burden of HIV/AIDS internationally, this oath pledges to oppose sex trafficking and prostitution. Organizations that promote the empowerment of women, such as the International Women's Health Coalition, maintain that the oath is "stigmatizing and discriminatory" and that the groups of people opposed by the policy are precisely those who need help combating HIV/AIDS.

In the early 20th century, it was legal in Alberta (1928-1972) and British Columbia (1933-1973) to perform reproductive sterilizations under the Sexual Sterilizations Act.[133] It was not until the 1970s that this legislation was repealed.[134] However, the damage done towards Indigenous women is irreversible and has continued in the decades after the 1970s.[134] The start of coerced sterilization began with the eugenics movement in the early 20th century and many Canadians, at the time, were in favour of this act.[133] In Canada, it began with the idea of population control, however, it was disproportionally targeting Indigenous people, specifically Indigenous women and their right to reproduction.[135] Many Indigenous women were not clearly informed of the tubal ligation procedure and believed it was a reversible form of birth control, when in fact, it was permanent.[136]

A report was released in 2017 which highlighted the coerced tubal ligations which were done to Indigenous women at the Saskatoon Health Region.[137] In the report, interviews were conducted with Indigenous women who underwent tubal ligation surgery and spoke of their experience. They said they felt, “invisible, profiled, and powerless.”[137] Many Indigenous women stated that they felt pressured into signing consent forms for the procedure while they were still in labour or in operating rooms.[137] This report has suggested that a nationwide study is done to accurately understand how many Indigenous women were affected by this.[137] The class, region, and race of the individual did come into play when there was coerced sterilization.[135] In 2017, a formal apology was given by the Saskatoon Health Region for being involved with the coerced sterilization of Indigenous women and recognizing that racism was a factor.[138] Coerced sterilizations are still occurring in Canada, as recently as 2018.[139] There is currently lawsuits against certain provincial governments by Indigenous women who underwent coerced sterilizations.[139][140]

Thousands of temporary farm workers, many being women, migrate to Canada through the “Seasonal Agricultural Workers Program” (SAWP), which is part of Canada’s Temporary Foreign Worker Program (TFWP).[141] Researchers who have studied migrant women who enter into British Columbia, Canada through this program found that they face unique barriers that inhibit their bodily autonomy and freedom to make choices surrounding their sexual health through “state-level policies and practices, employer coercion and control, and circumstances related to the structure of the SAWP”.[142] These women are impacted by many factors that contribute to their marginalization, including precarious legal status, lack of access to health care services, poverty, knowledge and language barriers, and job insecurity.[141]

Utilizing a reproductive justice framework to analyze this issue, researchers shift the focus from “abortion rights and sexual freedom” to governmental processes that inhibit access for women to be able to make choices that are “safe, affordable, and accessible.”[143] Women in SAWP are highly vulnerable due to the program’s legal restrictions, which results in a limited access to social programs or services, labour rights and health care services.[141]

Migrant women in SAWP take part in “everyday” forms of resistance to injustices and oppression. Rather than large scale forms of protest or objection, tactics to resist these forms of oppression are more subtle. Forms of resistance for these women often involve private disobedience of restrictive regulations, informing the media anonymously of injustices, finding and accessing forms of birth control or reproductive health services even when discouraged not to do so, forging relationships and building a community as well as seeking the aid of advocacy groups.[141]