I would like to be able to say that I felt supported by feminists. But it wasn’t my experience. Although mainstream feminists paid lip service to the idea that I deserved support, they mostly made demands. They wanted me to speak at rallies, to testify, to give them copies of my medical records. My article had gone viral, you see, and there was no shortage of attention, though the negative reactions far outweighed the positive. Amid the lawyers and activists reaching out, no one seemed to care that I was scared, that my family was being threatened, or that I couldn’t expect the same support from the police that they took for granted. I was supported by the hood. By the people who put my safety and sanity above whether I was a candidate to testify before Congress. The fact that the right to have an abortion is seen as innately feminist is accurate. But what gets obscured is that consistent access to quality health care is something everyone needs at every stage of their life. And that for many, when things go awry, the first step isn’t a lawsuit; it is survival.
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RECENTLY, THE FACT that the United States has a higher-than-average maternal mortality rate has brought more attention to the way racism impacts health care. We know that Black mothers in the United States die at three to four times the rate of white mothers, one of the widest racial disparities in women’s health, and that personal wealth does not protect Black mothers from that higher risk. Serena Williams’s story of having to demand necessary health care to prevent a pulmonary embolism or worse is a prime example. She’s wealthy and highly visible; the same is true of her husband. She’s well versed in her own health-care needs, and she still had to argue with the staff to get the necessary treatment.
However, while abortion is seen as a feminist issue, access to health care is not necessarily framed that way. Reproductive justice needs to be reframed to include the entire spectrum of choices surrounding every stage of women’s health, reproductive and otherwise. The United States is constantly facing a health-care crisis, and only some people seem to understand that the issues are related and reflect a systemic failure.
Some forty-five thousand people were dying each year from a lack of insurance before the Affordable Care Act. And that’s just from a lack of insurance. Add to that the people who die as a result of reaching lifetime maximums for care, or from unapproved treatments, and the number climbs. Now, as we talk about the disparity in maternal mortality rates by race, there has to be a shift in how we approach health-care access. It has to be seen as a right, not as a commodity or an option. And health- care providers have to interrogate what biases they have brought into the ways they approach patient care.
Persistent racist beliefs in medicine and otherwise are at the root of ongoing racial disparities in treatment and patient outcomes; this represents a challenge not only for twenty-first-century medical providers, but for those who fight for the access of marginalized communities to quality health care. Problems are amplified by unconscious biases that are embedded in the medical system, affecting quality of care in stark and subtle ways ranging from experiences like mine, where the pregnancy was not viable but there was plenty of judgment about what I should have done, to situations where motherhood is a death sentence because no one gets it together in time.
This is an issue that spans communities with Black, Latina, and Indigenous women facing similar complications as a result of bigotry. Alongside “Mississippi appendectomies” (which was another name for unnecessary hysterectomies performed at teaching hospitals in the South on Black women), there was the forced sterilization of Indigenous Americans, which persisted into the 1970s and ’80s, with young women receiving tubal ligations when they were ostensibly getting appendectomies. Ultimately an estimated 25 to 50 percent of Indigenous women were sterilized between 1970 and 1976. Forced sterilization programs are also a part of history in Puerto Rico, where sterilization rates are said to be among the highest in the world. Most recently, California prisons were alleged to have authorized coerced sterilization of nearly 150 female inmates between 2006 and 2010.
In countries where eugenics by way of coerced sterilization is not just a shameful history but sometimes still a current issue, we have to interrogate the lack of quality care available to the populations most impacted by eugenics. Driven by prejudiced notions, these programs informed policies on immigration and segregation, and now seem to be impacting maternal health care.
In a climate where society doesn’t value families of color, is it any wonder that the right to have children at all is still contested? Reproductive justice rightfully focuses on preserving the right to choose, but too often advocates center on access to contraception at the expense of communities that are still facing other obstacles. True reproductive justice involves not only access to affordable birth control, abortion, and health care but also providing access to those who are imprisoned, who are in immigration detention centers, who are seen as unworthy of controlling their own lives for a variety of reasons. And that’s before we get into the ways that trans, nonbinary, and intersex people are impacted by a framework that largely prioritizes the needs of cis white middle-class women.
Reproductive health care is about bodily autonomy, which is something trans people are often denied because of transphobia. Aside from being assigned a gender at birth that may not match their identity, they face obstacles in accessing medical care in general. Trans people can face ignorance or outright prejudice from medical professionals, who then become yet another barrier to quality care. Everything from accessing basic health care to safe hormone regimens can be difficult or even impossible depending on location and finances. Sadly, when some care providers discovered that their patients were trans people, their discriminatory attitudes increased to the point of refusing to write prescriptions or sometimes even see trans patients again. Others claimed they didn’t understand the needs of the transgender community, but also refused to seek out the education they lacked. That leaves trans patients in the awkward position of paying out of pocket for appointments they’ll spend providing free education to health-care providers.
A dear friend who transitioned outside the United States got breast cancer some years ago. Her care should have been fairly straightforward; she makes a good living, has excellent insurance, and lives in a state that has long had protections for LGBTQIA people codified in the law. But her excellent insurance routed her to a specialist who, while not outright discriminatory, had very little information about the transition process. So for a part of almost every appointment with her oncologist, my friend had to answer invasive questions that had nothing to do with her medical care. She wanted to be healed, needed this doctor’s help, and felt pressured into maintaining a cordial relationship while her doctor processed his feelings about gender in the midst of her treatment. It was incredibly unprofessional, and anytime she attempted to redirect the conversation he was quick to assert that he just wanted to be a better doctor. His prurient curiosity about how her wife had handled her transition mattered more to him than professional ethics. And yet, she was able to get the treatment she needed; she had to count that as a win.