This blog is a guest submission by Hannah Liu! Hannah is a health content writer and ER nurse in Los Angeles. She is no stranger to the chaos and beauty of life. With a humanistic approach, she advocates for both mental and physical health for herself, her patients, and her readers.
Reproductive Justice for Marginalized Communities: The Fight for Equity in Healthcare
Centering the experiences of marginalized communities is essential to providing unbiased care for patients. Healthcare workers must understand the scope of disparities in reproductive care while working consistently to dismantle their own underlying prejudices. Within the realm of reproductive justice, nurses have the unique opportunity to either empower or further disenfranchise vulnerable communities seeking care.
What is Reproductive Justice?
Reproductive justice became a center of the human rights discussion in 1994 when 12 Black women at apro-choice conference in Chicagodecided that the focus on reproductive rights should be expanded to include the liberation of Black, Indigenous, and other marginalized communities seeking bodily autonomy. The key tenets of reproductive justice can be simplified as:
- The right to have children
- The right to not have children
- The right to birth and care for children in safety
- The right to access healthcare, social equity, education, and other resources uninhibited by discrimination based on race, gender, or socioeconomic status
Once the effects of marginalization in reproductive healthcare are understood, nurses and healthcare providers can learn how to be agents of change in systems of oppression.
Barriers to Reproductive Justice
Before positive change can take place, it is important to understand the systemic issues involving reproductive health in marginalized populations. The following are statistics presented by the CDC:
- The maternal mortality rate for Black and Indigenous women is 2-3 times higher than for White women.
- In 2019, Black infants were more than twice as likely to die than White infants.
- Teenagers in foster care are more than twice as likely to become pregnant than teenagers not in foster care.
- The incidence of teen birth is 2.5 times higher in rural areas than in large urban areas.
- Teen mothers are 40% less likely to receive a high school diploma by age 22 than their peers without children.
- Children born to teen mothers are more likely to have health complications, drop out of high school, become pregnant as a teenager, and experience incarceration and unemployment.
Barriers to receiving quality reproductive care include the high cost of medical bills (especially for uninsured patients), lack of access to educational and clinical services in rural areas, and the fear of racism or discrimination from healthcare corporations and staff. The Affordable Care Act, enacted in 2010, helped to alleviate high cost and provide access to medical care for women in poverty and/or in rural areas. However, recent changes in policy threaten the availability of affordable and available healthcare for these patients. Many people in marginalized communities lack access to reproductive care including education, STD treatment, cancer screenings, and contraception.
Systems of oppression are not established overnight. In order for nurses to provide unbiased care to patients of all backgrounds, they must first understand the extensive history of discrimination in the American healthcare system.
A History of Oppression in Reproductive Healthcare
Many marginalized women find it difficult to trust medical professionals – and for good reason. The American healthcare system has a historical record of treating minority and low-income women with cruelty instead of compassion. To provide these individuals with quality care, nurses and other healthcare providers must take the time to understand the source of the distrust that is present in many marginalized communities.
One example of the serious consequences of discrimination in reproductive care involves the unethical and inhumane treatment of Indigenous women. Until the late 1970s, an estimated25% of Native American women were sterilizedin federal clinics and hospitals, often without their full knowledge or consent. This led to a sharp drop in the birth rate of Native infants and an increased distrust of medical professionals among Indigenous populations.
The American healthcare system has a history marked by structural racism and discrimination. The worst of these cases include experimentation without consent, withholding treatment for curable diseases, withholding pain medication, eugenics (which is considered by some to be a form of modern genocide), and forced sterilization based on gender, race, or income level.
It is no wonder that many people in marginalized communities find it difficult to trust medical professionals. Can this understandable lack of faith in the American healthcare system be repaired? I believe that nurses who know how to combat structural and internal biases are the answer.
How Can You – A Nurse – Be an Advocate for Change?
The first actionable step in achieving reproductive justice in nursing takes place on the individual level. Many nurses assume that their standard of care is always fair and free from bias, especially when the nurse has never personally experienced discrimination based on gender, race, or socioeconomic status. It is important to keep an open mind to the probability that your internal bias is influencing the way you treat your patients.
For this self-exploratory exercise, ask yourself the following questions:
- What internalized stereotypes do I have about patients from marginalized communities? (ex: “X race/socioeconomic status people always behave like Y because they want Z.”)
- What is one example of a person I encountered who did not match my stereotype?
- How can I begin to see this person as an individual instead of a member of a group?
- What would it feel like to put myself in the shoes of a marginalized person? How would my perspective and behavior change if I were to share their experience?
Racism and discrimination in healthcare often go unnoticed and unchecked by those in privileged positions but can have devastating effects on those harmed by them. Taking a few moments each day for self-examination will go a long way.
Looking for ways to get educated on reproductive justice within the nursing profession? Check out NSRH'sResource Library, Online Institute, and Professional Programsfor more tools for becoming an effective, informed advocate for marginalized communities.
There is hope for the advancement of reproductive justice in American healthcare. With a conscious effort to listen to and learn from the stories of marginalized people, nurses, and other healthcare workers will lead the way to achieving reproductive justice.