Monthly Archives: May, 2021

Author: SJ Doi (MCHEPI MPH ’22)

What is Reproductive Justice? 
The Reproductive Justice framework was created in Chicago in June 1994. A group of women of color acknowledged that the mainstream reproductive rights movement – a movement which was primarily focused on a woman’s right to abortion and contraception access – did not fully represent the needs of marginalized women, children, and families. This group called for a framework that would address how intersecting oppressions (i.e. sexism, heterosexism, transphobia, racism, abelism, agesism, classism, sizeism) influence an individual’s reproductive autonomy and freedom. (SisterSong)

Reproductive Justice = Reproductive Rights + Social Justice

Reproductive Justice is a human-rights based framework which states that all individuals have the right to:

• Have children
• Not have children
• Parent children in safe and sustainable communities
• Maintain personal bodily autonomy

Trauma-Informed Care and Reproductive Justice 

The first event of our Reproductive Justice Symposium was on Tuesday 3/30, moderated by MCH Epidemiology student, Abi Bloedel. Candice Norcott, PhD, gave an insightful presentation on trauma-informed care and Reproductive Justice, urging us to consider the relationships between trauma, mental health, and reproductive health outcomes. Dr. Norcott began her presentation with an overview of how experiences of violence and relentless stress can lead to trauma. She discussed how different forms of trauma – for example adverse childhood experiences (ACEs), sexual harassment, community violence, and intimate partner violence have been linked to adverse reproductive health outcomes. She also highlighted that certain reproductive health outcomes, such as severe maternal morbidity, can act as a source of trauma, leading to PTSD.

I particularly appreciated the way Dr. Norcott framed historical reproductive oppression as a form of historical and systemic trauma.  The history of medical experimentation on Black, Latina and Indigenous women, the criminalization of Black women and girls, and the myths around Black pain, are all examples of systemic trauma against marginalized communities in the US. Dr. Norcott explained that trauma-informed care and trauma-responsive care encourages both movement-building and centering the communities that are most affected. It’s no surprise that the most vulnerable populations, in terms of MCH and reproductive health outcomes, are also the communities which experience high rates of trauma. The Reproductive Justice movement pushes against this legacy of reproductive oppression by “uplift[ing] the needs of the most marginalized women, families and communities.” (SisterSong, n.d.).

Intersex Advocacy and Reproductive Justice

The second event of our Reproductive Justice Symposium was on Wednesday, 3/31, moderated by MCH student, Kendall Lucero. Pidgeon Pagonis, MA debunked the notion that gender is binary, and presented the history of medical violence against intersex persons, highlighting the advocacy and activism to #EndIntersexSurgery. The right to maintain personal bodily autonomy is one of the key values of Reproductive Justice, yet the medical injustices against intersex people are often left out of the common Reproductive Justice narrative. Pidgeon provided a historical context of surgeries on intersex children – procedures dating back to the 1950s, when physicians performed elective, cosmetic surgeries on infants and children whose reproductive and sexual anatomy did not align with their understanding of what gender should be. It wasn’t until 2016 when the GLMA: Health Professionals Advancing LGBTQ Equality and the American Medical Association officially took a stand against medically unnecessary surgeries, and the elimination of discrimination against intersex people was incorporated into the Affordable Care Act, that the standard of care was changed. In July 2020, Pidgeon, co-founder of Intersex Justice Project, organized a high-profile protest against intersex surgeries at Lurie Children’s Hospital here in Chicago, which prompted the first public apology and pledge from a hospital in the United States to stop medically unnecessary surgeries on intersex children. In their presentation, Pidgeon highlighted 26 ways that we can show up for intersex people (see https://www.intersexjusticeproject.org/ for more information).

As public health students and professionals, we need to be more mindful and intentional about the language we use to describe bodies (i.e., not categorizing genitals as male or female but being specific about what we mean). We also need to recognize that defining gender as binary is harmful to intersex, transgender, and non-binary persons, and so we need to be inclusive of all genders in our research practices, surveys, language, and programming. (For example, we can use the term “pregnant, postpartum, and parenting persons” instead of, or in addition to, terms like “mothers”, “women”, “fathers”, etc.).

Chicago Birth Justice: Community Care in an Inequitable Health System 

The final event of our Reproductive Justice Symposium was on Thursday, 4/1, moderated by MCH Epidemiology student, SJ Doi (me!). Our three panelists, Anya Tanyavutti, MEd, Jeanine Valrie Logan, CNM, MSN, MPH, CLC, and Stephanie Tillman, APN, CNM, MSN, gave us a lot to reflect on in their discussion about birth justice, medical racism, obstetric violence, and what community care looks like in Chicago. Here in Chicago, Black women are almost six times more likely to experience a pregnancy-associated death when compared to White women, and Latina women are twice as likely. Birth justice is a movement predominantly led by communities of color, and it aims to address issues of reproductive oppression and obstetric violence against pregnant and postpartum persons.

The event began with each panelist discussing the birth justice work they are currently involved in. Jeanine, a certified nurse-midwife and birth justice activist, referenced her advocacy to get HB738 passed in IL so that she and her colleague, Karie Stewart, CNM, can open a birth center on the South Side. Anya, Executive Director of Chicago Volunteer Doulas, expressed her excitement around the attention that birth justice is currently receiving and reminded us of the importance of looking towards communities that are most affected by structural racism when working towards anti-racist solutions. Anya also discussed the role of labor support and postpartum doulas in empowering birthing people to make informed decisions regarding their care. Stephanie, also a certified nurse-midwife and writer of the blog, Feminist Midwife,  discussed her research on consent practices and the importance of providing trauma informed, anti-racist midwifery care. Other themes brought up during the panel were the impact of COVID-19 on reproductive health care delivery, the licensure of Certified Professional Midwives in IL, and the importance of solidarity over charity.

One of my favorite quotes of the evening was from Jeanine when she said, “I look at doulas and midwives as liberatory tools in preventing obstetric violence.” Given the stark racial disparities in pregnancy and birth outcomes in Chicago, improving access to doula services and midwifery care is of critical importance. This includes advocating for the opening of a Black midwife-led birth center on the South Side, allowing for Medicaid reimbursement for doulas and insurance coverage for home births, and promoting licensure of Certified Professional Midwives.

Key Takeaways

A common theme throughout this exciting series of events was the importance of challenging the status quo to advance health justice. As public health students and professionals who value health equity and Reproductive Justice, we should continue asking questions about why things are a certain way – whether it’s elective surgeries on intersex children or consent practices during labor. We should push to bring new perspectives into our conversations, with a focus on centering the voices of those who have historically been most marginalized. We should also continue building cross-sector solidarity, because only by working collectively do we have a chance at achieving true Reproductive Justice. As feminist icon (and my personal hero), Audre Lorde wrote, “there is no such thing as a single-issue struggle because we do not live single-issue lives.”

For more information on Reproductive Justice, please see this wonderful reading list compiled by one of the Reproductive Justice Symposium co-sponsors, Students for Sexual and Reproductive Health. https://drive.google.com/file/d/1NTRYHi6wids5tCl3VslLT5E2FecaSow-/view?usp=sharing