True Choice in Reproductive Care: Using Cultural Humility and Explanatory Models to Support Reproductive Justice in Primary Care

Abstract

Reproductive justice is the human right to maintain personal bodily autonomy, have children, not have children, and to parent children in safe and sustainable communities. Historically, marginalized individuals have experienced reproductive oppression in multiple forms. This oppression continues in modern times through health policy and patient-clinician communication. To combat this, the framework of reproductive justice outlines four key actions: analyzing power systems, addressing intersecting oppressions, centering the most marginalized, and joining together across issues and identities. Primary care clinicians have a unique role and responsibility to carry out these four key actions in order to provide patient centered reproductive care. To translate reproductive justice into clinical practice, clinicians care can use reflective practice, the framework of cultural humility, and the concepts from the explanatory model of illness.

Teaching reproductive justice

“…Humble and curious inquiry is essential for understanding patients' answers and how they align with patients' reproductive values and the subsequent care to be provided. 14 In our context, we supported the 'planning a course of action' 2). Learners can practice using the elements of the cultural humility and RJ frameworks to co-produce patient-centred, culturally informed, and RJoriented reproductive counselling.…”

“…In the setting of reproductive care, clinicians can use these same principles (common language, expectations, beliefs and goals) to develop an open‐ended approach to discussion and ensure that a safe environment is created for patients to ask questions. Humble and curious inquiry is essential for understanding patients' answers and how they align with patients' reproductive values and the subsequent care to be provided 14 …”

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.…”

Contraceptive Use and Missed Opportunities for Family Planning Discussions in Women Living with Human Immunodeficiency Virus at an HIV Clinic

“…It has been demonstrated previously that minority and marginalized populations may have concerns about contraceptive coercion. 18 This is an important consideration for providing contraceptive care within the framework of reproductive justice, which includes the right to bodily autonomy and individual decision-making about contraception choice and childbearing.…”