With the recent proposal from the Trump administration to roll back protections that prevent doctors from legally discriminating based on gender identity, the American government stands ready to not only allow doctors to refuse to treat trans patients, but to actively encourage this discrimination. That can mean someone who is gender nonconforming could go to the doctor for a persistent cough, and instead of their lung function being evaluated they could be turned away with no legal recourse. It won’t matter if the cough is bronchitis, tuberculosis, or lung cancer, because unless they can find a series of good doctors, their health is going to be compromised.
While being educated about your own health can lead to better care outcomes, this goes beyond advocacy and into an exploitation of a marginalized community as a walking unpaid resource. Because of bigotry, providers who refuse to see trans patients contribute to a medical culture where people who already have difficulty obtaining providers can’t easily seek out those who are better versed in their care. That means trans patients can be forced to repeatedly engage with situations that can trigger dysphoria in order to access any level of care.
And gender dysphoria can be fatal if untreated: a staggering 41 percent of the trans community has attempted suicide. Trauma in reproductive health services can drive trans people into fearing the health-care system as a whole. Between discrimination and the fear that keeps marginalized people out of doctors’ offices, trans people are less likely to get preventive care and more likely to develop complications from delayed care. This can include care during an abortion or during pregnancy. For nonbinary and trans people, access to reproductive care is already fraught because of limited access due to the economic and social barriers. Add in any health-care trauma, and the very place you should be able to get help becomes yet another emotional minefield.
It’s also critical to discuss the fact that a common reason given for a need to keep abortion accessible is fetal disability. On the one hand, no one should be forced to have a child they do not want; on the other, even though feminism as a movement is committed to eliminating discrimination, a central tenet of the right to choose should not hinge on discriminatory logic. Arguments that disability is a reason abortion needs to be legal frame being disabled as a condition incompatible with a healthy, fulfilling life. You can argue for the right to choose without arguing against the right of people with disabilities to exist.
Disability should not be a death sentence. Does that mean the right to choose should be abrogated? No. I firmly believe that abortion should be the decision of the pregnant person. But much of the concern around abortion rates has centered on the idea that abortion on demand is eugenics in action. Reproductive justice advocates should never parrot the rhetoric of eugenicists, especially around the idea that only some people are fit to exist.
Reproductive justice is fundamentally about agency and autonomy. Abortion rights should never be a fight over the value of disabled lives, because disabled people absolutely deserve to exist. Fetuses, who are potential life with no capability of surviving on their own, and are not the same as humans living on their own outside the womb, should be framed in conversations as exactly that.
Higher abortion rates in low-income communities are sometimes connected by anti-choice groups to eugenics as well. Because of environmental racism, limited access to prenatal care, and subpar nutrition and housing for many in marginalized communities, the risk factors for having a child with a serious disability are higher than average. Add in the fact that resources are limited not only for children with disabilities but also for adults with disabilities, and those higher rates of pregnancy termination make sense.
That lack of resources is what we should be addressing when we talk about reproductive justice. The mainstream reproductive rights movement does not talk about disability enough to even know how to address these concerns. Instead the pro-life movement has successfully centered itself as the movement concerned with the right of disabled children to be born. As that movement has seized control of this conversation, pro-choice activists have largely absolved themselves of the responsibility of advocating for reproductive options for disabled adults, and of getting into a discussion of what it means to screen for disability as standard medical care. In a reproductive rights framework that centers on autonomy and self-determination, there should be a clear connection with disability rights activism.
Instead, a coalition of misogynists, racists, and violent terrorists masquerading as people concerned with the right to life have made more visible attempts to include people with disabilities. And they are supported by people who assert that they truly believe in the right to life, and who may indeed mean the words they say with no consideration for the very real consequences of supporting anti-choice rhetoric for people who are not them. Anyone can be a hypocrite, including those who claim to rescue children via adoption. Does that mean that everyone who adopts a child with a disability is doing so from a cynical place? Absolutely not.
But there are some very real problems with the way that anti-choice groups will use children as props in their campaigns. They bolster their arguments by adopting children with disabilities, tell purple prose–laden stories about the miraculous love they have found by “saving” those children, and then vote for the candidates who will remove services for disabled people from their communities. More concerned with their public messaging than any real change, they undermine the health-care access that might provide the best chance at an independent, fulfilling life for people with disabilities. While fetal disability narratives are central to pro-life rhetoric, and pro-life feminists are quick to point to abortions of fetuses with disabilities as a form of eugenics, they falter at follow-up care and concern.
True reproductive justice advocates have done a better job of including a disability rights framework in the broader movement, but they too have faltered at being truly inclusive of people with disabilities and their concerns. It’s hard to have a conversation across these communities when an accessibility framework is lacking in choosing locations for meetings, meetings lack services to make them accessible for those who are hard of hearing or deaf, or other obstacles arise because activists are too used to speaking for communities instead of listening to them.
It’s uncomfortable and sometimes enraging to consider a dialogue with the pro-life movement, but without it, they will be able to continue the wholesale appropriation of a disability rights framework for a movement that ultimately betrays everyone. No one in reproductive justice should want to identify as a eugenicist, not just because it is a fake label the pro-life movement uses on people who advocate for abortion rights. They should want to avoid eugenicist rhetoric because it can ultimately only serve to undermine the work of reproductive justice.
When the pro-life movement brings up the women who abort fetuses with Down syndrome diagnoses, reproductive justice advocates need a better response than ignoring it. The conversation needs to be centered on resources, on support, and on countering ableist narratives. When they frame these statistics as proof of eugenics, as proof that the abortion rights movement doesn’t care about people with disabilities, reproductive justice feminists must be ready to frame disability not just in terms of children and fetuses but also in terms of adults with disabilities. The conversation about the right to choose should explicitly include that right for people with disabilities. It has to talk about the infrastructure and the access that they might need. It has to talk about the rights of people with disabilities to control their own fertility and sexuality.