Reproductive Justice: Voices Not Just Choices

What Is Reproductive Justice?

Indigenous women, women of color, and trans people have long fought for the right to make decisions about their bodies. Coined in 1994, the term reproductive justice is defined 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.”

One way to differentiate reproductive justice from reproductive rights is that the latter is the “legal right to access health care services such as abortion and birth control”. Initially, spokespeople of this women’s rights movement often included educated wealthy, middle class White women. This left marginalized communities and minority women who did not have easy access to their rights with minimized opportunities to voice their problems and experiences. This begs the question of what good are these rights, if they aren’t accessible. Built upon the United Nations human rights framework, reproductive justice is an intersectionality issue where reproductive rights and social justice are combined so the voices of LGBTQ+ people, marginalized women, and minority communities are uplifted.

Abortion as a Voice, Not a Choice

Choice comes from a place of privilege. The chance of deciding reproductive options is more easily accessible to middle class White women, while these same options are typically unavailable or restricted for poor, low-income women of color. These are the same marginalized women who historically bore the burden of unethical research in reproductive medicine from issues regarding the study of gynecology, to sterilization, and everything in between. For example, James Marion Sims, the father of modern gynecology, conducted medical procedures on enslaved Black women, which is unethical in more ways than one. No consent was given. A patient that has no knowledge of what is going on or what is being done to them cannot give consent. As an enslaved person, the patient was not seen as a human being, but rather as property, and therefore no consent was necessary. The medical procedure was purely experimental, and Sims’ likely had poor knowledge of what he was doing which made his actions torturous. Women like the patients Sims practiced on, women of color, women who were and are oppressed and marginalized, women with disabilities, and people of the LGBTQ+ community continue to be exploited, and it is important that their voices are heard now more than ever.

Source: Robert Thom, circa 1952. From the collection of Michigan Medicine, University of Michigan. Sims’ not only purchased Black women to conduct his inhumane experiments on, but he did so on the belief that Black women could not feel pain.

Often there are misguided notions that reproductive justice is just about abortion, and while access to abortions is a major component of the movement, the movement does not end there. Reproductive justice also goes on to include access to proper sex education, inclusive to all genders and sexualities, affordable contraception, and access to safe and healthy abortions. It’s not enough for abortion to be legalized. “Access is key,” meaning that the cost of the medical procedure is bearable. Medical expenses include travel to a medical provider, paid time off from work, prescription costs, dietary expenses, relocation, etc. all of which can cause difficulty in accessing care. As something that women of color, women with low incomes, and the LGBTQ+ community have brought to attention, reproductive justice is an umbrella that goes beyond the pro-choice versus pro-life debates. It calls into light that factors such as race and class in society affect each woman and LGBTQ+ persons differently. This means not every person has the choice to choose or not choose a pregnancy due to lack of access to services, stigma, or historic oppression, which is where the pro-voice movement intercedes.

The pro-voice movement is meant to “replace judgement with conversation” from both pro-choice and pro-life advocates. Abortion is an incredible emotionally and morally draining topic to converse on, and it’s a decision that should be void of politics and instead filled with empathy and compassion so an individual can make the healthiest choice and live their healthiest life. It is important to validate a person’s lived experiences and to acknowledge that they made the best decision they felt like they could with the resources available to them at the time.

Stigma Around Reproductive Health

There is lack of access to the topic of reproductive health due to incomprehensive sexual education in school systems. Access to this information, access to proper medical care, access to contraception and abortion “is a political, human rights and reproductive justice issue.” Some educational systems fail to mention how to obtain contraceptive methods, how to use them, and which methods are more suited for an individual. This lack of information and stigma around sexual education does not reduce the incidence of unsafe and “unprotected sex or rates of abortion.” In fact, lack of education around contraception and restrictive abortion practices leads to more unsafe abortions globally due to financial burdens as well as social and cultural stigma.

Source: Maria Nunes. An LGBTQ+ Pride event takes place in the Caribbean.

Another issue is heteronormativity which is the trend in sex education focusing “on straight, cisgender young people, but ignores LGBTQ+ youth.” These conservative views that do not cater to a whole population of young adults exacerbates this stigma around sexual and reproductive health. This leads to people feeling like they cannot ask questions due to fear of social repercussions or that their sexuality is abnormal. Not being provided with “information to address their health needs, leaves the LGBTQ+ youth at risk for sexual violence and unprotected sex,” making them more vulnerable to various sexually transmitted diseases, teen pregnancy, and mental health disorders. As important as it is it to address reproductive justice and reproductive health as a women’s issue, it’s even more important to know that LGBTQ+ people “can get pregnant, use birth control, have abortions, carry pregnancies, and become parents.” Part of fighting for and providing reproductive justice involves activism against controlling reproductive voices, and often controlling sexualities and gender expressions are synonymous with gatekeeping those voices.

Providing access to sexual and reproductive healthcare to LGBTQ+ people is one way to ensure that all communities are able to have information, resources, and the power to make their own decisions about their bodies, genders, sexualities, families, and lives. Access to reproductive healthcare can come in the form of gender affirming care and treatment for transgender, nonbinary, and gender nonconforming individuals. Having free access to reproductive education is a foundational piece within the reproductive justice movement. Talking about the framework around sex and reproductive justice is so much more than sex. It involves intersectionality and considerations of reproductive health regarding pregnancy, abortions, racial and class division and discriminations, maternal mortality rates, and environmental conditions. It’s about the dichotomies between oppression and liberation, individuality and collectivity, and most importantly choices and voices.

Source: Terry Moon for News and Letters. An individual in Chicago attends a protest in support for Planned Parenthood.

What Are Three Things I Can Do?

  1. Understand that it’s not about being pro-choice or pro-life. Understanding abortion is about validating people’s stories and experiences. If you haven’t experienced abortion or don’t know of someone who has, the first step is to come from a place of compassion and empathy.
  2. Know that reproductive justice goes beyond being a women’s issue. The same resources and information given to women need to be disseminated throughout the LGBTQ+ community.
  3. Research organizations such as SisterSong, Planned Parenthood, and URGE to start your activism and make your impact.

COVID-19’s Impact on Gender Equality

women wearing patterned hijab and mask looking directly into the camera
COVID-19 emergency response activities. Source: UN Women Asia and the Pacific, Creative Commons

COVID-19 has had a significant impact on the health and social structure of the world. Over one million lives have been lost, and over 35 million people have been infected with the virus. While infectious diseases don’t discriminate by age, race, social class, or gender, these factors do influence how COVID-19 and the related social ramifications will affect the illness experience for different people. For instance, when looking at gender, women have been more severely impacted than men. Men are more likely to die as a result of contracting COVID-19, but women experience the brunt of the long-term social effects, partially due to preexisting gender inequalities.

Looking at the healthcare sector alone, women were affected tremendously for many reasons. First of all, about 70% of healthcare workers are female. This means that a disproportionate number of females are putting their health and lives at risk to improve the lives of others. They were more heavily affected by PPE shortages at the beginning of the pandemic, and when PPE did become available, the “one-size fits all” design, which defaulted to the typical cisgender male body, was often ill-fitting and not conducive to managing menstrual cycles. Additionally, women who work in healthcare delivery have been historically overworked and underpaid. In normal circumstances, many healthcare professions, like nursing, have high burnout rates. However, studies have shown that the pandemic has increased the negative mental health effects of the job, primarily in females and in nurses.

Additionally, women live longer than men, and women are the vast majority of the population in nursing homes. During the pandemic, nursing homes have had to take drastic action to ensure the safety of their residents through restricting visitation and group events. This has led to significant social isolation in nursing homes, and loneliness follows closely behind. Further, many elderly people that live alone are women who rely on the care from their family. With the social distancing and their increased risk for severe disease, this has left many women almost entirely isolated—with the exception of family and friends dropping off groceries. This has led many women over 65 to meet up with friends. This makes them more likely to contract COVID-19, but for many, the increased risk is worth it to not be lonely.

Another health effect of the pandemic for women has been reduced access to healthcare, especially sexual and reproductive health. Across the globe, procedures considered elective were postponed due to concerns of restricting nonessential personnel from being in hospitals.  However, many elective procedures can play an important role in a woman’s health. For example, endometriosis is a disease in which the uterine lining grows in areas where it shouldn’t, such as in the fallopian tubes and on the bladder, and it can cause immense pain in women who have it. One of the treatments is surgery to remove the excess growth. This not only may relieve pain but also increase fertility, so women who want to have children are more likely to be able to do so. While this surgery undoubtably improves the lives of women with endometriosis, it is considered an elective surgery, and in many places, women had their surgeries postponed. For women with immense pain, finally seeing the light at the end of the tunnel, this was devastating.

This is one of many experiences that women have faced. Many treatments and prevention methods for women’s sexual and reproductive health are considered nonessential, so many women have had to postpone their HPV vaccines, and STI and cervical cancer screenings. Additionally, some states have tried to roll back abortion services. India had a very strict lockdown, which prevented many women from access to contraceptives. This led to “over 800,000 unsafe abortions,” which is the third most common cause of death among pregnant women in India.

Outside of the healthcare sector, women have experienced many social repercussions due to the pandemic. Even before the pandemic, women were largely responsible for the unpaid care work, such as taking care of children or older family members. Now, with children home from school, and older people less able to do their own errands because of the risk of contracting COVID-19, the burden is falling on women and girls. Because of this, many women have to give up their job, or at least cut back hours, and many girls have to put their education on pause.

mom reading a book and son holding a baby while doing homework
Homeschooling. Source: Iowapolitics.com, Creative Commons

Before the pandemic, there were indications that great strides were being made towards gender equality in society and in work. However, a lot of the progress was lost with the onset of the pandemic and with lockdowns. While female-dominated jobs are typically the most protected during economic downturns, lockdowns affected female-dominated jobs at a higher rate than male-dominated jobs: it is estimated that female job loss was 1.8 times higher than male job loss. This is mainly because women are more likely to work jobs that are part-time or temporary, which makes their job security decrease significantly. As mentioned before, women are more likely to take care of family due to closures in school and older family needing assistance, making them less able to work, even from home. All of these factors mean women will be making less money because of the pandemic.

Finally, because of lockdowns, women are staying home more. While this is frustrating for many people, it can be dangerous for women in abusive relationships. Abusive relationships are dangerous to begin with, but with the added stress of the pandemic and being stuck in the same house for days, weeks, or even months, the severity rises. Additionally, a lockdown places women experiencing domestic abuse in a dangerous situation because it’s harder for them to escape the abuse through women’s shelters. Another way some women would typically be able to escape a domestic violence situation would be through a community, but even in normal circumstances those can be hard to come by as it’s typical for abusers to isolate their victims, and with the added isolation of the pandemic, it’s even harder.

Everyone has been significantly impacted by the pandemic. However, some people have been affected more than others, especially when indirect health effects and social effects are taken into account. Because of the disparity between the effects on men and women, we must aim interventions at women and girls. Not doing so could negatively affect years of progress made toward gender equality, and negatively impact the mental and physical health of women in the future.