The Reproductive Justice framework was developed over the course of a decade by SisterSong, Forward Together, and other organizations representing women of color. The framework connects reproductive health and rights to broader power structures that have a disproportionate impact on communities of color and other marginalized groups. The Reproductive Justice framework acknowledges that a narrow focus on the legal right to abortion too often fails to address historical and contemporary patterns of reproductive coercion and oppression experienced by these communities. Reproductive Justice calls our attention to policies and practices that actively undermine and devalue childbearing by some women, as well as those that effectively force childbearing on others. It also questions the value of “pro-choice” rhetoric for women whose life choices are severely limited by a lack of social, political, and economic power.
The Reproductive Justice framework developed by SisterSong and others is grounded in a set of basic human rights. These include:
- The right to maintain personal bodily integrity
- The right to have children
- The right not to have children
- The right to parent children in safe and sustainable communities
Together, these rights advance a broad vision of reproductive health and well-being. They also highlight the intersectional impact of gender, race, class, sexuality, age, disability, and immigration status in a society where genuine reproductive autonomy is often reserved for a privileged few.
RHEDI’S RJ APPROACH
RHEDI is committed to integrating a Reproductive Justice approach into all aspects of our work, including training, research, and programming. We believe our work must be grounded in an understanding of the pivotal role that American health care professionals and institutions have often played in reproductive coercion and racist injustice—particularly with regard to forced sterilizationForced sterilization has a long history in the United States and has frequently targeted nonwhite, poor, incarcerated, disabled, or LGBTI people, among other marginalized and stigmatized groups. Forced and coerced sterilizations still occur in the U.S., most frequently in the criminal justice system. and coerced contraceptionCoerced contraception use in the United States includes both overt and subtle efforts to force or “incentivize” contraceptive use by individuals and groups whose reproduction or parenting has been deemed undesirable by government and/or medical authorities. The practice targets many of the same groups forced to accept sterilization, including, for example, Puerto Rican women (on whom the first birth control pills were tested), women on welfare, and the incarcerated. use. It also requires ongoing analysis of how contemporary practices and systems perpetuate social injustice, barriers to care and services, and outcome disparities. By helping physicians both examine and challenge the social, racial, and economic structures that profoundly impact their patients’ lives, we seek to expand and advance the practice of family medicine.
As an organization focused on full-spectrum reproductive health care, RHEDI incorporates the Reproductive Justice framework in the following ways:
• Transforming Resident Education. RHEDI’s educational programs help residents see reproductive health care as intertwined with broader structures of power and privilege. We expect residents to understand the long history of reproductive coercion and oppression in the U.S. and its profound impact on patients and their families. Our clinical and didactic training places particular emphasis on power dynamics between providers and patients, and the subtle ways that language and tone may undermine patient autonomy and self-determination. We teach residents to take account of the vulnerability and legitimate mistrust that many patients experience in reproductive health care settings and to develop innovative clinical practices that treat each patient with respect and empathy. We believe that family medicine providers have unique opportunities to expand access and mitigate the disparities that shape our contemporary health care system. At the same time, we recognize that access will remain limited without progress toward a more equitable, just, and sustainable society. To this end, RHEDI encourages physicians to engage with local organizations and social justice movements in the communities where their patients live, work, and raise families. We also support RHEDI graduates’ work within medical institutions and professional organizations to advance policies that promote patient autonomy and the reproductive justice movement.
• Promoting Patient-Centered Care. Underlying our work is a patient-centered approach, which honors each patient’s preferences, values, and choices. Our programs challenge providers to identify and change practices that, however well-intentioned, may have a coercive or stigmatizing impact on patients, undermining autonomy and compounding disparities. Our resident education and train-the-trainer curricula are designed to prompt reflection on the personal and historical factors that shape patients’ experiences with reproductive health care and the structural barriers that may prevent patients from reaching their desired health outcomes. Through a process of clinical training, interactive learning, listening, and self-reflection, we encourage both trainers and residents, as well as other learners, to examine their own biases and judgments—conscious or unconscious—that may impact their ability to offer compassionate, patient-centered care.
• Increasing Access. RHEDI’s funding and technical assistance programs are designed to help family medicine residencies and clinics reduce barriers that prevent patients from accessing full-spectrum reproductive health services. Integrating abortion, contraception, and miscarriage care into family medicine training increases the number of physicians who can provide these services in a wide range of settings, including community health centers, rural clinics, and dedicated reproductive health clinics. This ensures that patients in underserved and low-access areas can access reproductive services at the family medicine practices that are frequently their first (or only) means of access to the health care system. Conversely, reproductive health care provides a point of entry for many patients and families who might not otherwise access the full range of family medicine services. We believe that increased access to comprehensive reproductive health care can be an essential part of addressing the disparate health outcomes that continue to impact underserved and marginalized communities. Offering such care in a local setting helps providers understand and serve the needs of each community and to the combat the structural barriers and biases that too often limit access and reinforce inequity.
• Reducing Stigma in Reproductive Health Care. RHEDI was founded with the premise that full-spectrum reproductive health care is primary care. We believe such care should be available without barriers and should be a standard component in the training and practice of family medicine. A central objective of our work is to reduce the stigma associated with abortion and contraception care by offering it to patients in settings where they and their families receive the rest of their basic health care services. At the same time, RHEDI remains committed to challenging the bias and stigma encountered by many patients who wish to bear children, especially those with low incomes, teens, immigrants, and people of color. Together, these objectives help us work toward a world in which all people can exercise self-determination in their reproductive lives, free from judgment, discrimination, and coercion. In addition to our educational materials on non-judgmental, patient-centered care, RHEDI counters reproductive coercion and stigma through advocacy and reform work within professional organizations and medical institutions.
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