The Need for Reproductive Justice in Pediatrics

Abstract

As pediatricians, we set the stage for patients' future relationships with health care professionals; nowhere are the stakes higher than sexual and reproductive health care. Listening to young people and respecting their priorities imparts a valuable lesson about self-advocacy within health care. Reproductive health is one of the most important aspects of patients' personal lives, and we should model respectful, compassionate, and evidence-based care. This means integrating reproductive justice into our clinical practice.Reproductive justice asserts that every person has "the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities." 1 Developed in 1994 by Women of African Descent for Reproductive Justice, this framework answers the call for a more expansiveunderstandingofreproductiveautonomythanthe individualistic focus of other frameworks developed in response to threats to reproductive freedom. For example, reproductive health addresses the provision of clinical services to an individual, while reproductive rights focus on the legal protection of the right to certain services, including abortion. In contrast, reproductive justice brings a societal and structural lens to "understand and root out reproductive oppression to achieve human rights and social justice." 1 This broader view recognizes that communities that historically have been marginalized bear a disproportionate burden of constraints on reproductive autonomy. These burdens include limited access to contraception and abortion care, as well as forced and coerced sterilization, carried out by medical professional and government institutions in the name of public health and reduction of poverty. 2 As pediatricians, comprehensive contraceptive counseling has become the standard of care, and many clinicians have focused on increasing access to longacting reversible contraception and promoting its use via tiered efficacy counseling. 3,4 Many pediatricians express concern about the age of patients making reproductive choices and, as such, advocate for long-acting reversible contraception in all adolescent patients. While this may be discussed flippantly, real harm is perpetuated by prioritizing public health goals over an individual patient's reproductive goals and bodily autonomy. The paternalistic belief that an adolescent's top priority should be to delay childbearing is fraught with the potential for implicit bias and further entrenchment of stratified reproduction, by which the fertility of certain patients is valued over others.While institutionalized policies of forced sterilization are no longer legal, more subtly coercive attempts to influence contraceptive decision-making still occur by providing financial incentives, pressuring patients to choose specific contraceptive methods, or refusing to remove long-acting reversible contraception until after a trial

Supporting reproductive health among birthing persons with chronic conditions in the United States: A qualitative multilevel study using systems thinking to inform action

“…Digging deeper into the problematic mental models may prompt changes that require system actors to make sacrifices that threaten their current system functioning. While seeking reproductive justice at all levels of RH/CC care is critical, a call echoed by many other groups in RH today, 27,[82][83][84][85] this requires a reworking of a system that benefits particular groups. Other aspects of the system, like profit incentives in medicine, also benefit specific groups at the expense of patients, and being realistic about system constraints that are advantageous to certain system actors may inspire action ideas that are grounded in pragmatism and possibility.…”

A qualitative study of clinicians' perspectives on a law that allows for a 12‐month supply of short‐acting contraceptives in Massachusetts: Barriers and facilitators to implementation

“…People generally desire more autonomy in their contraceptive decisions compared to decisions about other general health care issues 32 . In pediatric and adolescent health care, the tension between protection of a minor's wellbeing versus emerging patient autonomy is more evident 33 . It is imperative that those who provide contraception recognize potential bias, provide scientifically accurate information, and apply patient‐centered approaches 34…”

“…32 In pediatric and adolescent health care, the tension between protection of a minor's wellbeing versus emerging patient autonomy is more evident. 33 It is imperative that those who provide contraception recognize potential bias, provide scientifically accurate information, and apply patientcentered approaches. 34 The findings of our study should be viewed considering its…”

Development of a clinical questionnaire to support contraception decisions in an adolescent reproductive health clinic in Colorado

“…Adolescents need access to providers who offer contraception services tailored to their evolving developmental needs 8 . Contraception counseling and decision support must also be devoid of contraceptive coercion and provider bias to promote reproductive justice 9,10 …”

“…8 Contraception counseling and decision support must also be devoid of contraceptive coercion and provider bias to promote reproductive justice. 9,10 Compounding their developmental and decision-making challenges, adolescents have more contraceptive options than ever before; no single method meets all users' needs. 11 A large study in Missouri found that the majority of adolescents seeking contraception for pregnancy prevention will choose an intrauterine device (IUD) or contraceptive implant when counseling strategies present methods in order of efficacy and the barriers of cost and access are removed.…”