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A term originally coined in the United States by organizations that promote the rights of Native women and women of color, reproductive justice is a concept that links reproductive rights with social justice. The reproductive justice movement arose in the late 1980s as an attempt by these organizations to expand the rhetoric of reproductive rights that focused primarily on choice within the abortion debate and was seen to restrict the dialogue to those groups of women they felt could make such a choice in the first place. In addition to advocating, as do traditional reproductive rights platforms, for the access of women to birth control, reproductive justice provides a framework that focuses additional attention on the social, political, and economic inequalities among different communities that contribute to infringements of reproductive justice. The paradigms that combine the empowerment of women with reproduction have since been categorized into three frameworks: reproductive health, reproductive rights, and reproductive justice. The reproductive health framework addresses inequalities in health services by advocating for the provision of services to historically under-served communities. The reproductive rights framework emphasizes the protection of an individual woman's legal right to reproductive health services, focusing on increasing access to contraception and keeping abortion legal. Finally, the reproductive justice framework utilizes an intersectional analysis of women's experiences and focuses on changing the structural inequalities that affect women's reproductive health and their ability to control their reproductive lives. As such, Asian Communities for Reproductive Justice, recently renamed Forward Together, defines the concept as follows:
"Reproductive Justice is the complete physical, mental, spiritual, political, economic, and social well-being of women and girls, and will be achieved when women and girls have the economic, social, and political power and resources to make healthy decisions about our bodies, sexuality, and reproduction for ourselves, our families, and our communities in all areas of our lives."
Reproductive justice has expanded the pro-choice movement from a focus on abortion issues that marginalizes poor women and women of color to encompass a much broader scope of women's reproductive rights. Reproductive justice attempts to move women's reproductive rights past a legal and political debate to incorporate the economic, social and health factors that impact women's reproductive choices and decision-making ability. The reproductive justice movement, in its efforts to illuminate these issues, challenges the right to privacy framework established by Roe v. Wade that was predicated on the notion of choice in reproductive decision-making, and in effect turns the focus of reproductive decision-making away from one centered on civil rights toward that of human rights. The human rights approach of reproductive justice advocates for the ability of women to make decisions about their own reproduction and emphasizes the right of reproductive decision-making as a benefit afforded to all women regardless of their circumstances as opposed to the civil rights framework of choice that is connected to the possession of resources that influences the choices one has. As Rickie Solinger notes in Reproductive Politics: What Everyone Needs to Know, "the term rights often refers to the privileges or benefits a person is entitled to and can exercise without special resources," whereas the privacy framework established by Roe, and as interpreted by the Supreme Court in Maher v. Roe, holds that "the state is not obligated to provide the means for women to realize their constitutionally protected rights, but only to refrain from putting any 'obstacles' in their 'path.'" The reproductive justice movement seeks to secure women's reproductive rights by attempting to abolish the civil rights foundation of a right to privacy created by Roe and that has restricted some women from receiving reproductive services because they lack the resources for a foundation of reproductive rights as human rights.
Origins in the United States
Roots of the reproductive justice framework can be traced to the abortion debate in the United States and the 1973 Roe v. Wade Supreme Court decision. Many new reproductive health organizations for women of color such as the National Black Women's Health Project were created in the 1980s and 1990s and objected to the rhetoric employed by the mainstream reproductive rights movement to define these along the pro-choice and anti-abortion lines that figured in the abortion disputes. The new organizations felt that the term "choice" excluded minority women and "masked the ways that laws, policies and public officials punish or reward the reproductive activity of different groups of women differently." Activists for the rights of women of color subsequently expanded their attentions from a focus on unfair sterilization practices and high rates of teen pregnancy among women of color to include the promotion of a more inclusive platform to advance the rights of all women.
The concept of reproductive justice was articulated first in 1994 at a national pro-choice conference for the Black Women's Caucus that was sponsored by the Illinois Pro-Choice Alliance in Chicago. This caucus followed the 1994 International Conference on Population and Development (ICPD) that had taken place two months prior. The ICPD produced the Cairo Programme of Action that identified reproductive health as a human right. The Black Women's Caucus sought to adapt to the United States' reproductive rights movement the human rights framework outlined by the ICPD and defined the term "reproductive justice" originally as "reproductive health integrated into social justice."
In 1997, a cohort of groups that promote the rights of Native and women of color, some of which had been involved in organizing the Black Women's Caucus, organized together to form the SisterSong Women of Color Reproductive Health Collective. SisterSong spearheaded the push for a new, comprehensive reproductive justice movement as a more inclusive alternative to the "divisive" argument for women's rights that primarily emphasized access to contraception and the right to an abortion. The founders of SisterSong also felt that some of the pro-choice activists "seemed to be more interested in population restrictions than in women's empowerment."
As the collective became more organized, reproductive justice figured more prominently in the discussion of women's rights and empowerment. The 2003 SisterSong National Women of Color Reproductive Health and Sexual Rights Conference popularized the term and identified the concept as "a unifying and popular framework" among the various organizations that attended the conference. Since then, groups that promote women's rights such as the National Organization for Women and Planned Parenthood have increasingly used the language of reproductive justice for their own advocacy. The movement has become more mainstream as organizations such as the Law Students for Reproductive Justice that focus on the promotion of rights of all women have also become involved in this activism.
Reproductive justice for US prisons
Since 1980, the number of women in prison has tripled, leading to a high incidence of serious health concerns, including HIV, Hepatitis C, and reproductive diseases. The rate of HIV is higher among women prisoners than men prisoners and can be as much as one hundred times higher among prisoners than in the general population, depending on the prison group. The trend towards longer and heavier sentences have also lead to greater health concerns as many prisons offer little accessibility to adequate medical care. Also, prisons are increasingly being built on rural land, isolated from major resources for medical care. Two major areas of concern for reproductive justice in prisons lies in medical neglect in the form of little to no reproductive health care and nonconsensual prison intervention on a woman's right to reproduce.
Women in the criminal justice system tend to come from sectors of society with limited access to health care. Currently, there are few services offered to address this gender specific health disparity in the underserved communities. The time spent in prisons provides a unique opportunity to respond to health needs, particularly in reproductive health. A Rhode Island report showed that 84% had been sexually active within 3 months of their arrest while only 28% used contraception. Newly incarcerated women are at a higher risk of experiencing unintended pregnancies. Many of these pregnancies also become high risk due to lack of prenatal care services and drug use that leads to preterm deliveries, spontaneous abortions, low-birthweight infants, and preeclampsia. Also, many developing fetuses may be exposed to teratogenic medications during treatment as well as alcohol, causing fetal alcohol syndrome. Infants are twice as likely to die when mothers report that their pregnancies are unwanted in the first trimester.
While it is unknown what percentage of incarcerated women engages in unprotected sex prior to incarceration, research has shown that providing emergency contraception may decrease the risk of unintended pregnancies. In a study conducted in San Francisco with women ages 18–44 within 24 hours of arrest, 29% were eligible for emergency contraception. Of these, 48% indicated a willingness to take emergency contraception. 71% responded that they would accept advance supply of emergency contraception upon release. In a study amongst 950 prisons only 70% reported contraception counseling. Another Rhode Island study showed that 77.5% reported a desire to initiate use of birth control while 4.4% of women after four weeks of their release initiated use of contraception. Therefore, provision of contraceptive services to women during incarceration does positively affect the rates of contraception use.
Access to abortion
Although abortions were made legal in the Roe v.s. Wade Supreme Court decision of 1973, many obstacles to women's access remain. Young, low-income, and non-white women experience the greatest hurdles in their efforts to obtain an abortion in many parts of the U.S. Obstacles to obtaining an abortion in the U.S. include a lack of Medicaid coverage for abortions (except in the case of certain circumstances, such as life endangerment), restrictive state laws (such as those requiring parental consent for a minor seeking an abortion), and conscience clauses allowing medical professionals to refuse to provide women with abortions, related-information, or proper referrals. Additional obstacles to access include a lack of safety for providers and patients at abortion facilities, the conservative, anti-choice political legislators and the citizens that support them, and a lack of qualified abortion providers, especially in rural states A survey presented in Contraception found that 88% claimed there were transportation services for abortion clinics but only 54% claimed that the facility helped arrange appointments. The results from the survey also found a correlation between Republican-dominated state legislatures and severely restricted coverage for abortion. The research concludes that full access isn’t available in all settings, and correctional settings should increase the accessibility of services for women. Proponents of reproductive justice in prisons argue that withholding access to abortion can be seen as a violation of the 8th Amendment, preventing cruel and unusual punishments.
Sexually transmitted diseases
Research has shown a correlation between the 3.2% increase in women's prison population and the increase risk of incarcerated women catching an sexually transmitted diseases, such as HIV/AIDS, from another inmate. HIV/AIDS incidences are 3-4 times higher since the growth of prison populations. Many prisons also lack a pre-screening process for incarcerated women. Another survey of 188 women showed that more than half reported a history of gynecological infection, particularly yeast infections. 57.9% of STD cases were found in non-white women. The male condom (74.1%), birth control pills (66.5%), withdrawal (38.9%), and the Depo-Provera injection (24.3%) were the most common methods of contraception.
Human rights violations
Prisons have demonstrated high incidents of human rights violations. These include cases of medical neglect and forced sterilization. Often, acts of forced sterilizations have been justified as punishments for imprisoned women. These violations continue to occur due to limited public attention towards cases of prisoner dehumanization and injustice. This leads to greater helplessness as imprisoned women lose say in the treatment of their bodies. For example, prisons often perform forced hysterectomies on imprisoned women. Article 7 of the International Covenant on Civil and Political Rights established by the United Nations prohibits cruel, degrading, inhumane torture. The lifelong effects of forced sterilization as well as the unnecessary suffering due to untreated disease violates these treaties.
Broader socioeconomic issues and reproductive oppression
The organization Asian Communities for Reproductive Justice, one of the original groups to define and promote reproductive justice, defines the challenges to reproductive health, rights, and justice as the concept of reproductive oppression. They explain,
"The control and exploitation of women and girls through our bodies, sexuality, and reproduction is a strategic pathway to regulating entire populations that is implemented by families, communities, institutions, and society. Thus, the regulation of reproduction and exploitation of women's bodies and labor is both a tool and a result of systems of oppression based on race, class, gender, sexuality, ability, age and immigration status. This is reproductive oppression as we use the term."
The definition of reproductive justice established by these groups as a counter to reproductive oppression illustrates the broadening of the reproductive rights and health frameworks, expanding focus from protecting individual rights and choices to address broader socioeconomic conditions.
Advocates of reproductive justice support a diversity of issues they consider necessary for women to make reproductive decisions free of constraint or coercion. These enabling conditions include access to reliable transportation, health services, education, childcare, and positions of power; adequate housing and income; elimination of health hazardous environments; and freedom from violence and discrimination.
Reproductive justice advocates promote increased awareness of methods of contraception including IUD's, the vaginal ring, the birth control pill, condoms, and forms of emergency contraception like Plan B. By providing women with knowledge about and access to contraception, the reproductive justice movement hopes to lower unwanted pregnancies and help women take control over their bodies.
Reproductive justice also strives to make birth control more affordable for all women and petitions insurance companies to cover the costs of women's reproductive health. The National Organization for Women, for example, petitioned national legislators in 2009 to reinstate the low-cost contraception distribution by campus and community health centers, an effort that resulted in the passage of the Omnibus Appropriations Act.
Federal programs supported by reproductive justice activists date back to the Title X Family Planning program, which was enacted in the 1970s to provide low income individuals with reproductive health services. Title X gives funding for clinics to provide health services such as breast and pelvic examinations, STD and cancer testing, and HIV counseling and education. These clinics are vital to low-income and uninsured individuals. Advocates for reproductive justice also aim to increase funding for these programs and increase the number of services that are funded."Title X Family Planning Program". United States Department of Health and Human Services. Washington, D.C.: U.S. Government. Retrieved August 9, 2016.>
Prior to the passage of the Affordable Care Act, many health care plans did not offer coverage for contraception methods, especially the more expensive procedures and devices, but the new healthcare legislation now gives women access to protective reproductive health services. Such services include pap tests, STI screening and counseling, prenatal care, and the human papillomavirus vaccine. A press release by the reproductive justice organization SPARK states, "women will receive better coverage and more choices in their health care" due to this expansion of care.
Access to abortion
Advocates for reproductive justice such as SisterSong and Planned Parenthood believe that all women should be able to obtain a safe and affordable abortion if they desire one. Having safe, local, and affordable access to abortion services is a crucial part of ensuring high quality healthcare for women. Access to abortion services without restrictive barriers is a vital part of women's healthcare because "…induced abortion is among the most common medical procedures in the U.S…Nearly half of American women will have one or more in their lifetimes." Furthermore, these organizations point to studies that show that when access to abortion is prohibitive or difficult, abortions will inevitably be delayed, which increases risks to women's health and raises the cost of procedures. Increasing access to abortion in the U.S. will undoubtedly result in more women being able to obtain abortions in the first trimester of pregnancy. Procedures performed after 12 weeks of pregnancy may be costlier for women (and states) financially and medically, as waiting longer results in greater risks of medical complications and mortality than abortions performed earlier in pregnancy. The American Medical Association also echoes the importance of removing barriers to obtaining an early abortion, concluding that these barriers increase the gestational age at which the induced pregnancy termination occurs, thereby also increasing the risk associated with the procedure.
Minority groups experience poverty and high rates of pregnancy due to lack of available contraception. In addition, poor women are more likely to turn to unsafe abortion providers, and as a result, be hospitalized for complications related to the procedure than higher-income women. Organizations that promote reproductive justice such as NOW and Planned Parenthood aim to provide increased access to safe abortions at a low cost and without external pressure. They advocate increasing insurance coverage for abortions, decreasing the stigma and danger attached to receiving an abortion, eliminating parental notification for teens, training more physicians and clinics to provide safe abortions, and creating awareness about abortion.
According to the website, The Pro-Choice Public Education Project, the U.S provides more funding towards Abstinence-only programs rather than Comprehensive sex education. From 1996 through 2007, Congress committed over $1.5 billion to abstinence-only programs. If funding is not provided towards sex education, students will not get the opportunity to learn about how to prevent pregnancy and STDs from occurring.
The website, Advocates for Youth, discusses abstinence-only education programs and how they are not effective at delaying the initiation of sexual activity or in reducing teen pregnancy. It attempts to prevent teens from engaging in sexual activities but this is ineffective and it makes teens more prone to engage in these activities with little to zero knowledge.
HIV Positive Women
HIV positive women are excluded from the reproductive justice framework. There is a difference in access to resources that directly impacts HIV-positive women's daily lives. Inequality of services affects women's overall physical, mental, spiritual,emotional, and sexual health. Health is greatly affected by stress with high stress levels resulting in increased susceptibility to illnesses. Positive women continually have to maintain good health, and eliminating stressors such as those that are due to reproductive rights can help improve overall health. A change in many sexual and reproductive health programs is vital. These programs operate with a pragmatic approach that is detrimental to women's rights. Addressing positive women's needs pragmatically is done so in a structured, emotionless manner that is not sensitive to women's desires. This ignores that humans are naturally sexual beings. A diagnosis of HIV does not eliminate the desire for sex. Women must be given proper information to discuss sexual rights and ways to safely be sexually active. Sexual rights are a justice that all women should have in order to enjoy sex regardless of a positive diagnosis. HIV positive women do not share the same options as other women and in many instances, positive women often feel their only option is abstinence. Access to medication such as ARVs is crucial for sexual and reproductive freedom yet lacking. ARVS have been restricted and only given to women who agree to be on some form of contraception such as hormonal injections or IUDS. Emma Bell and Luisa Orza's article ‘Understanding Positive Women's Realities’ explains,
"Many HIV-positive women have sexual desires and sexual relationships, and services need to recognize this by providing them with contraceptive advice and services, sexual health check-ups, and comprehensive advice on pre- and post-natal care for mother and child."
Services targeted towards HIV-positive women do not have appropriate support services that prepare and enable women to manage their complex lives after testing positive. Services rendered to them often attempt to restrict their reproductive rights by denying ARV doses unless they are on a doctor-controlled method of contraceptive. The violation of their reproductive right puts a greater risk of re-infection and STI's since safe sex is often negotiated around contraceptive use. Health care workers tend to have harsh judgment concerning HIV-positive women who do become pregnant. The mother's health is neglected and saving the life of the child becomes priority. Neglecting the mother's health impacts the chances of mother to child transmission of HIV.
Because of the broad scope of the reproductive justice framework, reproductive justice activists are involved in organizing for a wide array of causes. These causes include movements for immigrant rights, labor rights, disability rights, LGBTQ rights, economic justice, and environmental justice. Other causes include organizing for comprehensive sex education, safe and affordable contraceptives, the repeal of the Hyde Amendment, and an end to violence against women and human trafficking.
United Nations involvement
Under the umbrella of the United Nations, there are several entities whose objectives relate to or promote reproductive justice. Among them, the Convention on the Elimination of All Forms of Discrimination Against Women emphasizes the rights of women to reproductive health and to choose "the number and spacing" of their children, in addition to access of the resources that would allow them to do so. The Convention Against Torture and Other Cruel, Inhuman, or Degrading Treatment "has been interpreted to include denial of family planning services to women."
The United Nations also sponsors conferences and summits with the subject of the empowerment of women that have historically advanced the reproductive justice movement, such as the International Conference on Population and Development.
Conferences in Cairo and Beijing
The United Nations International Conference on Population and Development (ICPD) that took place in Cairo, Egypt in 1994 marked a "paradigm shift" to a set of policies on population that placed a high priority on the sexual and reproductive rights of women. Prior to the ICPD, international efforts to gauge population growth and to produce approaches that addressed its challenges focused on "strict and coercive" policy that included compulsory birth control and preferential access to health services by people who had been sterilized. The Programme of Action produced at the 1994 Cairo conference has been "heralded a departure from coercive fertility strategies" by insisting on the "fundamental rights of reproductive self determination and reproductive health care" and provided the ideological inspiration for grassroots organizations such as SisterSong in the United States to launch a movement for reproductive justice.
The United Nations Fourth World Conference on Women in Beijing followed the ICPD a year later, taking place in 1995, and producing a Platform for Action that advocated for the complete empowerment of all women. It charged states with the duty of ensuring the human rights of all women, among them sexual and reproductive health. The Beijing Platform for Action also promoted reproductive justice by calling on nations to reexamine laws that punished women for undergoing abortions.
Millennium Development Goals
The Millennium Declaration of September, 2000 and the eight Millennium Development Goals (MDGs) that emerged as a result of the declaration built on the framework for sexual and reproductive health rights the ICPD had put forth five years earlier. The third and fifth MDGs, to promote gender equality and empower women and to improve maternal health, respectively, embody the principles of reproductive justice through "the promotion of healthy, voluntary, and safe sexual and reproductive choices for individuals and couples, including such decisions as those on family size and timing of marriage." Indeed, the Outcome Document of the 2005 World Summit reiterates the connection between the Millennium Development Goals and their support of the many social factors that promote reproductive justice by committing the participating countries to:
"Achieving universal access to reproductive health by 2015, as set out at the International Conference on Population and Development, integrating this goal in strategies to attain the internationally agreed development goals, including those contained in the Millennium Declaration, aimed at reducing maternal mortality, improving maternal health, reducing child mortality, promoting gender equality, combating HIV/AIDS and eradicating poverty."
Reproductive health has been related to the fulfillment of all eight Millennium Development Goals, and advocates of reproductive justice have noted that by extension, this last issue is also critical to include in strategies to meet the MDGs.
Reproductive justice and U.S. foreign policy
Organizations that promote reproductive justice have criticized several United States policies that aim to remedy international issues of reproductive health. Groups such as Georgetown's Law Students for Reproductive Justice have objected for example to the Mexico City Policy, also known by some critics as the Global Gag Rule. Although repealed by the Obama administration, this policy requires that non-governmental organizations that receive federal funding from the United States avoid promoting family planning and abortion services in reproductive health settings.
The President's Emergency Plan for AIDS Relief (PEPFAR) is another contentious American program related to funding initiatives related to global reproductive health. The purpose of the program is to combat the global HIV/AIDS pandemic, but agencies such as the Center for Health and Gender Equity (CHANGE) have called into question its effectiveness. Although these organizations recognize the gains made by US aid as a whole, they argue that the rigid structure of the PEPFAR funding hinders a holistic, community-appropriate strategy to reduce HIV/AIDS infections, and contend that the program is "laden with earmarks and restrictions from Washington that eliminate discretion for making funding decisions based on local realities and restrict alignment with European counterparts."
In particular, PEPFAR has been criticized for its partnerships in the past. Its critics feel it gives higher priority in funding distribution to faith-based organizations, including some "with little or no relevant international development experience" and some which promote abstinence instead of utilizing effective prevention methods. Critics argue that this policy approach, which has been nicknamed the ABC—Abstinence, Be faithful, Condom-use—approach poses a challenge to reproductive justice. Reproductive justice activists hold that such policies marginalize groups of people such as LGBTQ persons who may be discriminated against, as well as women who have been raped for whom "abstention is not an option."
Another policy that has been condemned by activists for reproductive justice is the Anti-Prostitution Loyalty Oath (APLO) produced in 2003. Required by the United States to grant funding to non-governmental organizations that work to reduce the burden of HIV/AIDS internationally, this oath pledges to oppose sex trafficking and prostitution. Organizations that promote the empowerment of women such as the International Women's Health Coalition maintain that the oath is "stigmatizing and discriminatory" and that the groups of people opposed by the policy are precisely those who need help combating HIV/AIDS.
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- Boyd-Judson, Lyn (2013). Women's Global Health: Norms and State Policies. Lanham, Maryland: Lexington Books. p. 73. ISBN 978-0739188880.
- Swinski, June Samuel (2007). Adapting to Norms at the United Nations: The Abortion-rights and Anti-abortion Networks. Ann Arbor, Michigan: ProQuest. p. 254. ISBN 978-0549451051.
- Drey, MD, Eleanor; Foster, Diana; Jackson, MD, Rebecca; Lee, S.J.; Cardenas, L.H.; Darney, MD, Philip (2006). "Risk factors associated with presenting for abortion in the second trimester". Obstetrics & Gynecology. 107 (1): 128–134. PMID 16394050.
- Crane, Barbara B.; Smith, C.E.H. (2006). "Access to Safe Abortion: An essential strategy for achieving the millennium development goals to improve maternal health, promote gender equality, and reduce poverty." (PDF). Public Choices, Private Decisions: Sexual and Reproductive Health and the Millennium Development Goals: 95.
- Ross, Loretta (2007). "WHAT IS REPRODUCTIVE JUSTICE?". Reproductive Justice Briefing Book: A Primer on Reproductive Justice and Social Change. Berkeley, California: UC Berkeley School of Law: 4–5, 11–12, 14, 21.
- Rossi, Alice S. (1988). The Feminist Papers: From Adams to de Beauvoir. Lebanon, New Hampshire: Northeastern University Press. pp. 138–139, 533. ISBN 978-1555530280.
- Kirk, Gwyn; Okazawa-Rey, Margo (2012). Women's Lives: Multicultural Perspective (6th ed.). New York City: McGraw-Hill Education. pp. 247–250. ISBN 978-0073512341.
- Sanger, Margaret (2010). Woman and the New Race. Whitefish, Montana: Kessinger Publishing. pp. 93–100. ISBN 978-1162717623. Archived book from 1920 New York City: McGraw-Hill Education
- Silliman, Jael; Gerber Fried, Marlene; Ross, Loretta; Gutierrez, Elena R. (2004). Undivided Rights: Women of Color Organize for Reproductive Justice. Brooklyn: South End Press. p. 40. ISBN 978-0896087293.
- "SisterSong Women of Color Reproductive Health Collective" (PDF). SisterSong. Atlanta. p. 4. Retrieved April 16, 2008.
- Forward Together (formerly Asian Communities for Reproductive Justice)
- California Latinas for Reproductive Justice
- SPARK! Reproductive Justice NOW
- Black Women for Reproductive Justice
- Colorado Organization for Latina Opportunity and Reproductive Rights
- National Asian Women's Health Organization
- National Latina Institute for Reproductive Health