The Challenges of Reproductive Health Equity in the 2020s
December 1, 2022 4 minutes read
The reversal of Roe v. Wade and the COVID-19 pandemic — both of which have had a disproportionate impact on Black, indigenous, and people of color (BIPOC) — have added to a reproductive health crisis in the United States. Contraceptive Technology Update asked Cherisse Scott, chief executive officer and founder of SisterReach, based in Memphis, TN, and Chicago, to discuss the challenges and possible solutions, such as a patient-led model or framework. (This transcript has been lightly edited for length and clarity.)
CTU: What are the most common types of contraceptive and health equity issues? How can these be resolved?
Scott: What we are seeing in Tennessee and across the South is a growing need to control the births of drug-using mothers by the public health community (NICU and maternal health, county hospitals, incarcerated mothers), the drug court/criminal justice community, the anti-abortion and crisis pregnancy community, and conservative legislatures.
LARC is the most commonly chosen method among these groups to control births and prevent newborn babies from being born exposed to opiates. Leading up to the overturn of Roe, we have seen an uptick in white women unable to access their birth control in Tennessee, and a constant driving of BIPOC pregnant people continuously being targeted for LARCs. We have no clear data to support white women’s birth control disparities, but this is more on-the-ground and social media testimonials knowledge.
As far as a resolution, our reproductive justice strategy has been to educate these groups, as much as they will allow us access, and lift the dangers and history of coercion, implicit, and explicit bias against low-income communities, communities of color, and young people. We have also launched a natural family planning campaign (1-8-19-28 Campaign) that will not serve every person but will support those with a regular cycle (every 24-32 days) understand their fertility and be empowered to control if or when they will become pregnant. Also, due to Roe’s overturn, it is imperative that we highlight other issues that exacerbate the needs for abortion and for contraception as these two access points are inextricably linked until Roe is codified.
CTU: What do you hope the framework for contraceptive access initiatives might do to improve family planning health equity?
Scott: I can’t confidently say that there is a “framework” for contraceptive access. But I hope that the entire public health community shifts from a patient-centered to a patient-led model of working with the people they serve and, with that, prioritize the oaths they have taken separate from their personal religious practice or faith-based medical institutional mandate. One of the things that I continue to promote among medical providers is to regard their patients as the expert of their own lives and needs, and they are to work as the advocate for those experts. Contraceptive equity and access works the same way for me. It is in the shifting of this dynamic that relationships are built with patients and where trust is established or re-established. One of the questions I always ask medical providers is, “Do they trust their patients?” More than not, I hear no. My follow-up is, “Whose fault is that?” Surely, not the patient’s.
CTU: Can you give an example of how a family planning provider might contribute to contraceptive access barriers through unrecognized prejudice or other equity issues?
Scott: One of the most disheartening parts of my work training providers about their biases is that I find myself calling in providers on our side of this fight. These are providers who often believe they are doing no harm. They have good intentions and don’t recognize that their own religious compass — around single mothers, teens having multiple babies, undocumented people needing more than a translator to feel comfortable in a medical setting, or drug-using women having unlimited and unmonitored rights and autonomy to have sex and have children — is a problem.
About three years ago, I worked with two major medical provider stakeholders in Tennessee where one of the doctors in my cohort was on the board of a LARC provider and believed the work she was doing was righteous until I introduced her to the reproductive justice framework. She was able to see how complicit she had been in harming vulnerable women accepting services from the organization whose board she sat on. She eventually stepped down from the board after realizing their harm and their unwillingness to shift their approach.
CTU: As you contributed to the framework, what was your most important finding or understanding of where we are today with family planning and access/equity issues?
Scott: More than not, we’re all trying to help people who give birth, help babies, and help communities. But where we are not aligned is trusting patients to be self-determining about their sex, their pregnancies, natural family planning tools, or self-informed sterilization. We cannot shift this dynamic to a reproductive frame or person-centered frame without trust, investment, and ongoing support. Our path to that outcome is where there is a need for self-reflection, a need to dismantle systems and structure of oppression, and check our religious — or even classist — compasses at the door.
CTU: How has the issue of reproductive justice changed since the COVID-19 pandemic and the overturn of Roe v. Wade?
Scott: Reproductive justice has not changed. It still operates with those most impacted at the center of the need and in the lead of their own liberation. But trusting women and people who can become pregnant to be self-determining is fading fast. We must ask ourselves why we do not and did not trust Black women, who crafted a winning strategy — the reproductive justice framework — as our guide to help us all be and stay free. We must ask ourselves why we do not and did not trust women overall to control our own bodies and inform our futures. It is there where we need to shift, transform, and be renewed.
The reversal of Roe v. Wade and the COVID-19 pandemic — both of which have had a disproportionate impact on Black, indigenous, and people of color — have added to a reproductive health crisis in the United States. Contraceptive Technology Update asked Cherisse Scott, chief executive officer and founder of SisterReach, to discuss the challenges and possible solutions, such as a patient-led model or framework.
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