Changing Obstetrics and Gynecology Residency Education to Combat Reproductive Injustice

Abstract

Although reproductive injustices and reproductive health disparities are well-documented in the United States, recent studies have begun to explore the health care professional's role in their perpetuation. We hypothesized that obstetrics and gynecology residents would observe reproductive injustices during their training. Thus, using a national survey, we asked obstetrics and gynecology residents to share clinical cases in which discrimination, bias, inequity, or injustice was involved in a patient's reproductive health care and queried their preparedness to respond. Through qualitative analysis, we found that respondents shared cases involving racism, discrimination, and structural barriers to care and that they felt poorly equipped to handle injustice. We call for clinician educators to combat reproductive injustice through three key changes to obstetrics and gynecology residency training: 1) incorporate reproductive justice training into formal residency education; 2) create safe spaces for residents to collectively debrief about their experiences with injustice and collaborate on care improvement; and 3) teach community engagement and advocacy skills that identify, center, and elevate local reproductive health priorities.

Physicians and healthcare professionals as advocates for abortion care and reproductive choice

“…SisterSong, a Women of Color Reproductive Justice collective, defined reproductive justice as the right to have a child, the right not to have a child, and the right to parent the children we have in safe and sustainable environments [10 ▪ ]. Reproductive justice ‘encompasses both reproductive rights and social justice and seeks to analyze power systems, address intersecting oppressions, center the most marginalized, and unite across identities [10 ▪ ]’. An important component of our advocacy is to center these principles, ensuring that individuals who most need to be uplifted by the work are the ones most benefited [10 ▪ ].…”

“…An important component of our advocacy is to center these principles, ensuring that individuals who most need to be uplifted by the work are the ones most benefited [10 ▪ ]. In their own commentary, Finkbeiner et al [10 ▪ ] contend that to successfully accomplish this goal as advocates, we must acknowledge and combat systemic and institutional racism in health care and also reflect on our own privilege and the ways in which we have contributed to racism in medicine. This important self-reflection is essential for healthcare professionals to be effective advocates with the lens of reproductive justice [11 ▪ ].…”

“…Reproductive justice ‘encompasses both reproductive rights and social justice and seeks to analyze power systems, address intersecting oppressions, center the most marginalized, and unite across identities [10 ▪ ]’. An important component of our advocacy is to center these principles, ensuring that individuals who most need to be uplifted by the work are the ones most benefited [10 ▪ ]. In their own commentary, Finkbeiner et al [10 ▪ ] contend that to successfully accomplish this goal as advocates, we must acknowledge and combat systemic and institutional racism in health care and also reflect on our own privilege and the ways in which we have contributed to racism in medicine.…”

“…We must center our advocacy work in the mission of reproductive justice. When advocating for reproductive health, we amplify the most marginalized community voices while addressing oppression and systemic and structural racism [10 ▪ ]. As an example of incorporating this principle into practice, our team at the University of New Mexico worked with local community reproductive justice organizations on a joint initiative to create a comprehensive reproductive health clinic to provide full spectrum care in Las Cruces, New Mexico.…”

Reproductive Justice: A Case-Based, Interactive Curriculum

“…1 Recent survey data suggest that obstetrics and gynecology residents witness discrimination and injustice in patient care yet feel poorly equipped to address reproductive injustices. 6 Thus, it is critical that academic medical institutions comprehensively educate trainees on health equity and justice. 7 , 8 Metzl and Hansen proposed shifting the paradigm in medical education towards building trainees’ structural competency.…”