Black women offer lawmakers a policy guide on reproductive justice

A collaboration of more than 30 Black-led organizations has created a comprehensive guide for policymakers to apply a reproductive justice framework to formulate policy that centers and improves outcomes for Black women, girls and gender-expansive people. 

The Black Reproductive Justice Policy Agenda has been in the works since 2021, with organizations such as In Our Own Voice: National Black Women’s Reproductive Justice Agenda, Interfaith Voices for Reproductive Justice, and SisterLove Inc. at the helm. 

The guide discusses key health issues disproportionately affecting Black women and girls, including the maternal health crisis, a lack of diverse medical professionals and high rates of comorbidities — or the presence of two or more medical conditions in one patient simultaneously. The guide then offers policy recommendations to address these concerns. 

“As we assess the threats to the livelihood, safety, and joy of Black women and girls, there is one thing we’re clear on: our path forward hinges on an unwavering commitment to Reproductive Justice,” organizers for the framework said in a letter this week. “Now more than ever, we need to employ a collective framework grounded in human rights and Black Feminist theory.”

Regina Davis Moss, president and CEO of In Our Own Voice, said reproductive justice is “the right to have or not to have a child, the right to raise their child in a safe and nurturing environment and the right to bodily autonomy.”

The idea of reproductive justice was formed in 1994 by 12 Black women in Chicago. The women gathered to discuss the implications of a two-tiered health care system and what that meant for Black women, who disproportionately use the public health care system. 

At the time, the debate around choice was dominating the conversation, but the women also began highlighting other health care disparities Black women face: the higher rates of infant and maternal mortality and morbidity; breast cancer and fibroids; sexual and intimate partner violence; and the contraction of HIV, AIDS and sexually transmitted infections. 

“We’re right back to the same place where we’re saying that we’re having a conversation about the pro-choice anti-abortion binary, but we’re also saying, here’s these other things we should be talking about,” Moss told The Hill. 

Black birthing people are three to four times more likely to die from pregnancy-related causes than their white counterparts, and Black infants are twice as likely to die within their first year compared to white infants. But 84 percent of maternal deaths are preventable, according to the Centers for Disease Control and Prevention (CDC) Maternal Mortality Review Committees September report. 

The Black Maternal Health Caucus was established in 2019 to fight the racial disparities that exist for pregnant Black people. The caucus has since proposed a 12-package bill, dubbed the “Momnibus,” that includes protections for pregnant people, but most of the legislation hasn’t passed. 

Rep. Lauren Underwood (D-Ill.), a lead sponsor of the “Momnibus” and founder and co-chairwoman of the caucus, told The Hill in November that this particular package is “deeply personal” for a lot of Congressional members. 

“It really resonates with audiences and voters broadly because in 2022, we should be able to keep moms alive,” Underwood said at the time. “And that should be something where it’s consistent throughout the United States.”

“We shouldn’t have these disparities based on race or ethnicity, we shouldn’t have these disparities based on geographic location, urban or suburban or rural,” she added.

The coalition’s guide calls for the federal government to fully pass the “Momnibus,” establish an Office of Sexual and Reproductive Health and Wellbeing and increase funding for doulas and midwifery care in federal health care programs.

“The midwife allows — to the extent that you’re healthy — you can have a labor and delivery that doesn’t require a hospital,” explained Moss. “It allows you to have it in a more intimate setting and allows the connections, like bringing the baby immediately to the breast. It allows you to be surrounded more with family members.”

“And traditionally there’s a different relationship with a midwife,” she continued. “We’ve found and what the studies have shown is that the experience overall is much more patient-centered and more respectful and higher quality experience for Black women.”

But the policy guide also calls for the government to reevaluate and end certain practices for incarcerated pregnant people.

The coalition is also calling on Congress to pass a federal law — such as the Pregnant Women in Custody Act — to ban the shackling of pregnant incarcerated people. Twenty-three states do not have legislation regarding shackling pregnant incarcerated people, but the consequences of restraining them could cause falls leading to placental abruption, delayed labor because of impaired mobility and the potential for delayed emergency care. 

Shackling during pregnancy can also cause extreme pain, and many medical experts — including the American College of Obstetricians and Gynecologists, the American Medical Association, and the Association of Women’s Health, Obstetric and Neonatal Nurses — oppose the practice.

Moss said it’s a “shame” such a practice exists. 

“A lot of times when people are incarcerated, they’re forgotten. They’re left behind,” she argued. “It’s already a traumatic experience. The infants are often separated, it doesn’t allow time for the breastfeeding or the critical bonding that we know needs to happen.”

But just one day before the anniversary of the Supreme Court decision that overturned Roe v. Wade — the legislation that gave pregnant people a federal right to an abortion — the coalition is also calling for the passage of the Equal Access to Abortion Coverage in Health Insurance (EACH) Act. The bill would restore coverage for abortion care to anyone enrolled in government-managed health care programs.

“The decision to continue a pregnancy often is made in such a difficult decision based on whether or not I can afford to raise another child, or whether I have a preexisting medical condition that might increase my risk of morbidity or mortality,” Moss said. 

Moss added that the right to an abortion is only part of the process; there also has to be access to the medical procedure, she said, as well as contraceptives. 

The guide calls for the government to provide prescription contraceptives at no cost, create a mandate that all people — regardless of insurance coverage, employment or immigration status — can access comprehensive family planning counseling and services and fund health centers to provide pregnancy, sexually transmitted infections, and HIV testing and services.

Though the guidebook is the work of Black-led organizations, Moss emphasized that the movement for reproductive justice must be multicultural and multiracial. 

“[Reproductive justice] … is an organizing framework,” she said. “It calls in other communities of color, it calls in other movements like Black Lives Matter, LGBTQ environment, because we realize that this type of liberation that we’re all fighting for is a collective work.”

“The truth of the matter is, this country was never founded on just one population, one race,” she continued. “It took us all to get to where we are and it’s going to take us all to get to where we want to go.”