What is reproductive justice?

Reproductive justice is “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities” as defined by SisterSong Women of Color Reproductive Justice Collective [1]. Reproductive justice exists in a trinity of frameworks also consisting of reproductive health and rights.

 

How does it apply to pharmacy practice?

All health care providers, including pharmacists, take oaths to serve their patients as ethically and professionally as possible. The concept of reproductive justice falls within the scope of this promise, especially as it pertains to women of color and other marginalized people.

Legislators, healthcare providers and communities can address the intersectionality of oppressive forces (e.g. racism, sexism, classism, and ageism) that influence care given and received [2]. Barriers to the realization of reproductive freedoms and choices have stood in the way of family planning and personal health for ages. If we value reproductive justice and recognize the injustices of the past and present, we can prepare providers to shape a revolutionized future for reproductive care.

 

What historical injustices should we be aware of?

In contrast to reproductive justice, reproductive oppression is the control and manipulation of people through their bodies, sexuality, labor, and reproduction, according to Forward Together [3]. The goals of reproductive justice become clear when the injustices of the past are studied and acknowledged as reproductive oppression. They are stark by today’s standards, but they also remind us of a time when such acts were considered appropriate.

Just a few examples of historical injustices:

• Rape and forced breeding of black slaves (1700s-1800s) [4]
• Sterilization of the “hereditarily diseased” in Nazi Germany (1934-1945) [5]
• Experimentation on low-income, imprisoned, and/or women of color for birth control research without informed consent (mid-1900s) [6]
• Sterilization of Native Americans (1960s-1970s) [7]
• China’s one-child policy (1979-2015) [8]

 

Are reproductive injustices still occurring now?

Although not as extreme, reproductive injustices still exist and hide in plain sight, including [9]:

• Promotion of abstinence
• Propagation of social “taboos” like teen and premarital pregnancies
• Refusal of service (denying OTC emergency contraception sales or prescription medications)
• Low access and availability of services to immigrants
• Providing access to reproductive and contraceptive resources but limiting their feasible attainability through scarcity, geographical distance, and cost (lack of insurance)
• Long-acting reversible contraception (e.g. implants and IUDs) as first-line birth control methods

• The Hyde Amendment, which restricts the use of federal funds for abortions

• Targeted Regulation of Abortion Providers (“TRAP”) laws, which shut down abortion clinics and effectively reduce access to abortion services

 

What can pharmacy professionals do?

The changes needed to achieve reproductive justice are easier said than done but not impossible. Widespread change depends on political decisions made at state and federal levels, but each health care provider can do their part in enacting progress in their workplaces. Putting aside personal beliefs in favor of patients’ best interests is key. Pharmacists in one-quarter of U.S. states are prescribing birth control with other states following suit [10].

Pharmacists can adopt practices that align with reproductive justice like the following:

1. Be aware of personal biases. It is normal to have them, but recognition is key to avoid acting on them. Imagine serving a patient who has a different racial or socioeconomic background from you. How would your care and demeanor differ (if at all)?
2. Do your research. Don’t fall prey to industry claims and monetary influences. For instance, with contraception consider all methods equally initially and narrow down the choices throughout the course of the patient interview and assessment.
3. Share decision-making. Do not assume that your patient has the same values as you when making healthcare decisions. For instance, with contraception we cannot assume that effectiveness is the most important factor for patients. There are many other values and preferences that influence their choices, such as side effects, frequency of use, return to fertility, invasiveness/discomfort, and confidentiality. In one study, 28% of black women reported feeling pressured to use a method that was not their preferred [11]. Pharmacists should educate patients on all the various options available to them and give people the freedom to make their own decisions; this will improve patient satisfaction and outcomes. Always be mindful of their values, goals, and lifestyles.

Remember that what we now view as outrageous was once normal, and always try to think years ahead of the present to lead and be better prepared for inevitable change.

References

1. “Reproductive Justice.” Sister Song, www.sistersong.net/reproductive-justice. 
2. McIntosh, J. “Reproductive Justice: A Practice Framework.” ACSAP 2018 Book 2: Women’s and Men’s Care, ACCP, May 2018, 171–89.
3. Forward Together, forwardtogether.org/. Accessed on 29 August 2020.
4. Foster, Thomas A. “The Sexual Abuse of Black Men under American Slavery.” Journal of the History of Sexuality 2011;20(3):445–64.
5. “German Law Authorizes Sterilization for Prevention of Hereditary Diseases.” United States Holocaust Memorial Museum, newspapers.ushmm.org/events/german-law-authori- zes-sterilization-for-prevention-of-hereditary-diseases. 
6. Blakemore, Erin. “The First Birth Control Pill Used Puerto Rican Women as Guinea Pigs.” History.com, A&E Television Networks, 9 May 2018, www.history.com/news/ birth-control-pill- history-puerto-rico-enovid.
7. Blakemore, Erin. “The Little-Known History of the Forced Sterilization of Native American Women.” JSTOR Daily, 25 August 2016, daily.jstor.org/the-little-known- history-of-the-forced-sterilization-of-native-american-women/. 
8. Connett, Wendy. “Understanding China’s Former One-Child Policy.” Investopedia, 28 August 2020, www.investopedia.com/articles/investing/120114/understanding-chinas-one -child-policy.asp. 
9. McDonald-Mosley, Raegan, MD, MPH, FACOG. “Reproductive Justice and Patient- Centered Care.” Maryland Department of Health Reproductive Health Roundtable Virtual Series. 2 July 2020.
10. “Pharmacist Prescribing of Hormonal Contraception.” Birth Control Pharmacist, https://birthcontrolpharmacist.com/policies/. 
11. Thorburn S, Bogart LM. African American women and family planning services: perceptions of discrimination. Women Health. 2005;42(1):23-39. 

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About the Author

Gayane Kechechyan, PharmD Candidate is a pharmacy student in the Class of 2023 at University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences. Gayane completed a summer internship with Birth Control Pharmacist.