Is What the Moment Requires.
Giving birth while Black in America is as dangerous if not more dangerous as it is in parts of the developing world. When we talk about whether to birth children, we cannot ignore that maternal deaths have been steadily rising in the United States, in stark contrast to the world’s other affluent countries. Beyond the maternal death rate, birthing people experience life-threatening postpartum complications. More than half of these deaths and near deaths are from preventable causes, and a disproportionate number of those suffering are Black. Black women are three to four times more likely to die during or after delivery than are white women. When we talk about not birthing children, we must recognize that the right to safe and voluntary sex, birth control, and motherhood has always been restricted, controlled, and criminalized for Black women.
In this defining moment in history, there is a scramble to recodify the framework that has failed us. Roe v Wade was the floor, not the ceiling. We can build something better. While mainstream feminist groups continued to focus on choice, groups like the National Black Feminist Organization, the Third World Women’s Alliance, and the Committee for Abortion Rights and Against Sterilization Abuse were focusing on wider issues. The term reproductive justice was coined in 1994 by a group of American Black women in Chicago who founded Women of African Descent for Reproductive Justice. Four main tenets of reproductive justice include: 1) the right to bodily autonomy, 2) the right to have children, 3) the right to not have children, and 4) the right to parent children in safe and sustainable communities. These women shined a light on how the lives of Black birthing people could be re-envisioned within the framework of a value-led society. It was an urgent call to directly link human rights and reproductive rights. Reproductive Justice analyzes how our ability to determine our own reproductive destiny is linked directly to the conditions of our community. Reproductive Justice addresses the social reality of inequality, specifically the inequality of opportunities that we have to control our reproduction when we are oppressed.
Reproductive justice is an intersectional theory that calls for us to move beyond a demand for privacy and respect for individual decision making to include the social support necessary for our individual decisions to be optimized. This framework includes the obligations of our government to provide the conditions for our choices to be safe, affordable, and accessible. Our government and our society are ignoring the inherent and systemic racism and bias that is killing birthing people, especially Black birthing people, in numbers that are not just disproportionately high but growing. Forcing pregnancy and childbirth due to policies that harm Black people more than white people, continues historical patterns of violence against Black bodies.
During slavery, enslaved Black people were subjected to sustained, legalized sexual and reproductive violence. The US chattel slavery system treated Black women as breeding machines to meet the demands of the economic system built from their labor. Through arranged marriages, forced sexual encounters with other enslaved people, and rape by slave owners, enslaved Black women were subject to frequent sexual exploitation. They were not given a choice about who they had sexual relationships with, when, and the outcomes of those sexual relations.
In resistance to slavery and specifically sexual oppression, Black enslaved women often resorted to their own forms of abortion and contraception. They drew upon African folk remedies and Native American knowledge concerning local plant life to concoct medicines that would be shared and spread throughout the plantations.
We must understand this history, because the end of slavery did not mean the end of racist stereotypes, attitudes, institutional racism, or the generational economic and emotional harm done to Black people in America. As researchers on Black reproductive health point out, “If past influences that have potentially shaped current outcomes are not taken into consideration, then public health efforts may neglect the impact of larger, contextual factors that affect health and contribute to inequities.”
In 1865, the Emancipation Proclamation granted freedom to enslaved Black people. However, Black codes and Jim Crow laws arose to continue to oppress and suppress the Black community. Sexual and reproductive abuses continued, such as rape laws only being enforced for white women, which were a direct threat to both Black women and men. Black people were victims of public lynching, many of which involved gang rape and genital mutilation.
It’s crucial to remind ourselves that Jim Crow laws and Black codes did not formally end until President Lyndon Johnson signed the Civil Rights Act in 1964, that is, within the lifetime of many Black people alive today, their parents, and grandparents. This is not ancient history. And like slavery, the discrimination that these laws codified and the damaging results including stereotypes embedded in our culture from them did not end with the laws’ demise. Racism persists, including attitudes about Black women and their reproduction. Proof of this is that even with Jim Crow laws gone, the American government kept up systemic racism in the form of forced sterilization and contraception in which the American medical system was fully complicit.
Beginning in the early 1900s, eugenics programs spread across the nation to control Black population growth by way of coerced sterilizations. By 1970, Black women were sterilized at over twice the rate of white women: 9 per 1,000 for Black women as compared to 4.1 per 1,000 for white women. One Princeton University study found that in 1970, 21 percent of married Black women had been sterilized.
State-sponsored eugenics were often forced on women of color either without their knowledge or with the threat that they’d lose their benefits or their children or they’d be subject to criminal prosecutions if they didn’t comply. While state-sponsored eugenics programs were halted in 1977, by then 100,000 to 150,000 poor, mostly Black women had been sterilized each year in the United States under federally funded programs.
Coerced use of long-term contraceptives was rampant through the 1970s. Like sterilization, many of these devices including IUDs and birth control implants were inserted without the understanding or consent of the recipients. They were also forced on women as conditions of receiving government benefits, keeping custody of existing children, or avoiding criminal prosecutions. While federal funds could often be used to implant the devices, these funds couldn’t be used to remove them, leaving women unable to become pregnant if their minds or their circumstances changed. The weaponization of contraceptives against women of color created lingering harm that to this day complicates individuals’ relationship with the medical system and their own pursuit of better lives for themselves and their children.
Oppressive and discriminatory policies must be examined and dismantled. Strategic policy change requires us to step outside of frameworks that only look at health care and consider the full scope of factors and policies that influence Black American lives. Reproductive justice shows us the way.
Dr. DeShawn Taylor, MD is a Gynecologist and Family Planning Specialist, Gender Affirming Care Provider, and Reproductive Justice Activist, and Author whose work advances reproductive health care access through direct services, education and training, advocacy, and leadership. As founder and CEO of Health Justice MD, Dr. Taylor helps organizations incorporate a justice lens into new and emerging commitments to support reproductive rights.
Amy Roeder, “America Is Failing Its Black Mothers,” Harvard Magazine, Winter 2019, https://www. hsph.harvard.edu/magazine/magazine_article/america-is-failing-its-black-mothers/.
Cynthia Prather et al., “Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity,” Health Equity 2, no. 1 (September 24, 2018), 249–259, doi:10.1089/heq.2017.0045, https://www. ncbi.nlm.nih.gov/pmc/articles/PMC6167003/.
Jennifer Nelson, Women of Color and the Reproductive Rights Movement (New York: NYU Press, 2003), 67.
Keeanga-Yamahtta Taylor, “How Black Feminists Defined Abortion Rights,” The New Yorker, February 22, 2022, https://www.newyorker.com/news/essay/ how-black-feminists-defined-abortion-rights.
See Villarosa, Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation, page 38