The development of the concept of reproductive justice provides a significant set of intellectual and practical tools for reframing the past, present, and future of contraception. The scholar-activists Loretta Ross and Rickie Solinger state the premise of reproductive justice clearly: “The right to reproduce and the right not to—the right to bodily self-determination—is a basic human right, perhaps the most foundational human right.”1 Reproductive justice has its roots in post–World War II international human rights activity and the globalization of development aid, along with the civil and women’s rights movements of the 1960s. Reproductive justice as a specific iteration of human rights emerged in the 1990s through cooperation between reproductive rights groups organized by feminists of color. Using texts from movement organizers and historians, this chapter traces the origins and current manifestations of the American version of reproductive justice and outlines its importance in the history of contraception. The reproductive justice framework is critical to present-day thinking about contraception because it links the provision and availability of freely chosen contraception to other issues related to health and safety. The framework also provides both inspiration and concrete guidance to individuals, NGOs, international and national nonprofit agencies, and for-profit medical device and pharmaceutical companies that produce and sell reproductive technology.
Reproductive justice is not just a set of ideas to study from an academic distance. Rather, it is designed to connect diverse reproductive health issues in an easily understandable way; to provide guidelines for developing and executing policy for public agencies and NGOs at local, national, and international levels; and to give activists guidelines and talking points for advocating the importance of their work to the public and to public officials. In short, reproductive justice is “a theory, a practice, and a strategy that can provide a common language and broader unity in movements for women’s health and rights.”2 Reproductive justice has three primary organizing principles: “(1) the right not to have a child; (2) the right to have a child; and (3) the right to parent children in safe and healthy environments.” Furthermore, “reproductive justice clarifies the need for protection from coerced sex and reproduction and also from coerced suppression or termination of fertility.”3 Thus, a society oriented around reproductive justice supports interconnected policies and principles, including sex education appropriately designed for children, teenagers, and adults; the freedom to choose when or if to have children; access to information about contraception and the technology itself; freedom from child marriage and forced pregnancy; quality prenatal care and birth support; nutritious and affordable food; and the enforcement of health and safety measures for all children brought into the world. These basic principles of reproductive justice are simple enough to state but challenging (not to mention time-consuming and expensive) for governments at any level to enact, even if there was strong political will to do so. However, linking these elements under the broad banner of “reproductive” provides both specific foci for individuals and groups to address and an ideal, inspirational vision of a healthy human society to work toward.
Reproductive justice does not operate independently of or aside from the organizational principles that structured the movements related to making sex and reproduction healthier and safer earlier in the twentieth century. It both criticizes and builds on concepts of reproductive health and rights that were articulated in the early and mid-twentieth century. These concepts, as outlined in previous chapters, identify the importance of protecting the health of people of reproductive age and providing them access to information and technologies that help them manage their sexual and reproductive lives healthily and safely. Nonetheless, as is abundantly clear, some motivations—population control, the limiting of the reproduction of people deemed “unfit,” and the development of new contraceptives—were often stronger for those involved in developing contraceptive technologies historically than ensuring safety, sexual health and fulfillment, or the absence of pain and discomfort. As Loretta Ross writes, “Reproductive justice is a real and present embodied activism by women of pushing against a conservative, racist, and misogynist antisex society that devalues our lives, our partners, and our children.”4 Reproductive justice builds on the most positive legacies of reproductive health and rights, demonstrates the inadequacies and failures of these concepts, and offers a holistic perspective on how to move thought, advocacy, and practice forward in the twenty-first century.
The working group Asian Communities for Reproductive Justice (now Forward Together) clarified the differences and similarities between these three concepts in a 2005 document:
These three conceptual structures together provide a complementary and comprehensive response to reproductive oppression as well as a proactive vision. ...
Reproductive Health is a framework that looks at service delivery and addresses the reproductive health needs of individual women. ...
Reproductive Rights is a legal and advocacy-based model that is concerned with protecting individual women’s legal rights to reproductive health care services, particularly abortion. ...
Reproductive Justice is a movement-building and organizing framework that identifies how reproductive oppression is the result of the intersection of multiple oppressions and is inherently connected to the struggle for social justice and human rights.5
Thus, reproductive justice is an intellectual and practical means for identifying the ways that historical and political forces have deprived those capable of reproduction of their abilities to control their reproductive futures. More specifically, it does not just point out past and current inadequacies in reproductive care but points to connections with other human rights movements and provides a vision for enacting just and inclusive reproductive health for all.
The history of reproductive justice has three strands: global human rights standards, women’s and civil rights movements, and intersectional theories used for analyzing human behavior and sociopolitical systems. Together, these three strands of thought and action have shaped its present-day form.
First, “many feminists around the world prefer to use international human rights standards to make claims for full reproductive freedom,” instead of an individual rights–based or privacy-based set of standards.6 In that way, they can unite reproductive justice to the most fundamental global standards for human rights: the Universal Declaration of Human Rights (UDHR), proclaimed by the United Nations General Assembly on December 10, 1948. The UDHR was drafted in the aftermath of World War II and serves as a centralizing, unifying document around which all nations could unite and declare that the atrocities of that war would never happen again. The articles of particular importance to reproductive justice include article 1 (“All human beings are born free and equal in dignity and rights”), article 16(1) (“Men and women of full age, without any limitation due to race, nationality, or religion, have the right to marry and to found a family”), and article 25(2) (“Motherhood and childhood are entitled to special care and assistance”).7
By basing reproductive justice on a globally accepted text—the foundation of human rights law worldwide—reproductive justice advocates expand on the rights enumerated in the UDHR specifically for reproductive concerns and claim the universal importance of their beliefs. As Ross and Solinger write in Reproductive Justice: An Introduction, “Reproductive human rights start with the acknowledgement that a person has an inherent human right to control her own body and then seeks to use the political process to express this right and the judicial process to protect this right.”8 Reproductive justice necessitates that both public and private entities respect individual rights to bodily autonomy and highlights the need to respect and support each person’s ability to act on those rights. That reproductive justice is needed in the first place illuminates how far the world community still has to go in establishing and enforcing human rights specific to sexuality and reproduction. This is particularly necessary for people lacking power in their societies because reproductive justice “draws attention to the lack of physical, reproductive, and cultural safety for vulnerable people.”9 Human rights theory provides a solid legal and political foundation for reproductive justice.
Second, in addition to human rights, the history of reproductive justice is also intertwined with the African American and Latina/o civil rights movements in the 1960s, some of whose members noted that civil rights include the right to have control over one’s own body and the right to choose when and with whom to have children. In those contexts, the ability to have children and to avoid unwanted sterilization spurred activism regarding reproductive justice along the lines of both race and class. The civil rights activist Fannie Lou Hamer, for example, stated famously that “a black woman’s body was never hers alone.”10 She also called forced sterilizations of African American women in the Jim Crow South “Mississippi appendectomies,” noting that the persistent state violation of women’s rights to have children was so common that many considered it a standard medical procedure.11 Although an end to forced sterilization (especially for incarcerated people) was one issue among many in the African American civil rights movement, the sexism endemic to the movement limited women’s ability to gain positions of power and to influence its overall direction. Some civil rights and later black power leaders argued that contraception was a form of black genocide: in other words, any kind of birth control, including abortion, was white supremacists’ way of using technology to limit the number of African Americans being born.12 Unsurprisingly, African American women objected to this characterization of contraception—not because they were unconcerned that many contraceptive advocates had eugenic or population-control aims but because a focus on limiting their reproductive autonomy narrowed analysis of racist oppressions to one when multiple factors were at play.
African American women shaped the US women’s rights and women’s health movements of the 1970s and 1980s on their own terms, even though their arguments for what would later be called intersectional feminism (feminism that included different axes of oppression, such as race, class, and disability status) would often not be clearly heard, much less acted on, by the white feminist leadership of mainstream organizations like the National Organization for Women (NOW). They supported contraception and safe and legal abortion and at the same time identified forced sterilization of women of color as a central feminist issue. “In so doing,” scholars of reproductive activism write, “they negotiated a space that at once distanced them from white feminists who prioritized legal abortion and birth control to the exclusion of other reproductive rights issues and those black Nationalists who declared all contraception and abortion genocidal.”13 As white women tended to face the reverse problem regarding desired sterilization—doctors would often not sterilize them if they had not had three or more children and reached a certain age—they usually did not perceive forced sterilization as a major issue.14 This lack of attention to sterilization led some African American women to create their own organizations based on a growing interest in intersectional reproductive justice–oriented feminism.
In the mid-1980s, African American groups began to organize in order to manifest their own literature and networks regarding black women’s health care. The National Black Women’s Health Project (NBWHP) was founded by Byllye Y. Avery in 1983 after a conference at Spelman College, and it published Body & Soul: The Black Women’s Guide to Physical Health and Emotional Well-Being in 1994. In 1987, Loretta Ross organized the first National Conference on Women of Color and Reproductive Rights at Howard University.15 In the 1990s, the Committee on Women, Population, and the Environment (CWPE) initiated a campaign to raise awareness about and to challenge Children Requiring a Caring Kommunity (CRACK), later renamed Project Prevention, a privately funded organization founded in 1989 that paid women addicted to drugs $200 to be sterilized or to use long-acting contraceptives.16 In 1998, the NBWHP (renamed the Black Women’s Health Imperative four years later) published another book called Our Bodies, Our Voices, Our Choices—echoing the title of the well-known grassroots feminist sexual and reproductive health guide first published in 1970, Our Bodies, Ourselves.17
Despite the advances of (largely cisgender- and white-led) second-wave feminism, the African American women’s health movement, and the civil rights movement in the United States, state-sponsored sterilization of poor women, women of color, imprisoned women, and women with disabilities continued to occur across the US throughout the 1970s. As the law professor Dorothy E. Roberts notes, in 1970, 200,000 sterilization operations were performed in the US, and in 1980, more than 700,000 were performed, a disproportionate number of them on women of color.18 Women’s health activism in the Latina/o community organized around ending state sterilization abuse began in the mid-1970s.
Hundreds of women were sterilized without their knowledge from 1969 to 1973 at the University of Southern California–Los Angeles County Medical Center. In addition to Puerto Rican and Mexican-origin women, other Latinas, poor women, and women of color were sterilized in teaching hospitals across the nation.19 Ten Latina women filed a federal class action lawsuit against the Los Angeles County Hospital, arguing that they had been sterilized against their will because they did not understand English well enough to agree to the procedures. Although the women lost the case, California hospitals changed their obstetric and gynecological practices to accommodate non-native English speakers, such as printing information sheets in different languages and giving patients under twenty-one years old seventy-two hours to consider their decision so that involuntary sterilizations would not happen again.20
In 1970, 200,000 sterilization operations were performed in the US, and in 1980, more than 700,000 were performed, a disproportionate number of them on women of color.
Additionally, a group of women including Helen Rodríguez-Trías founded the Committee to End Sterilization Abuse (CESA) in 1974, which in turn created a coalition of women’s health activist groups that developed regulations to protect women patients at public hospitals in New York City.21 The related Committee for Abortion Rights and against Sterilization Abuse (CARASA) was established in 1977 and published Women under Attack: Abortion, Sterilization Abuse, and Reproductive Freedom on their findings in 1979. Both committees were instrumental in establishing US federal guidelines to limit forced sterilization through the Department of Health, Education, and Welfare in 1979, even though the practice continued in some areas of the United States, including California and Tennessee, through the 2010s.22 As Ross points out, “Women of color, who continuously face strategies of population control through eugenics-based ideologies, must fight equally as hard for the right to have children.”23
Along with human, civil, and women’s right activism, intersectional theories are also critical to understanding reproductive justice. Ross and Solinger state that “reproductive justice is the application of the concept of intersectionality to reproductive politics in order to achieve human rights.”24 The theoretical roots of reproductive justice include black feminist theory, self-help theory, critical race and critical feminist theory, human rights theory, standpoint theory, and womanist ethics and religion theory.25 Standpoint theory—the idea that knowledge is situated along different axes of power and marginalization—is particularly important, Ross writes, because “as black women, we occupy both an insider and outside position within the feminist movement, the African American community, and in gender-nonconforming spaces.”26 It is no accident that reproductive justice emerged not from academic circles but from activists of color, many of whom suffered from injuries to their reproductive health and human dignity. It is undeniable that “women of color are ideologically leading the movement.”27
In sum, the experiences of reproductive justice advocates as members of marginalized groups shaped their abilities to identify with systematic injustice and to analyze the mechanisms necessary to manifest political and social change. As the authors of Radical Reproductive Justice note, “intersecting forces produce differing reproductive experiences that shape each individual’s life. While every human being has the same human rights, our intersectional identities require different considerations to achieve reproductive justice.”28 A foundation in human, civil, and women’s rights and also sensitivity to the specific needs of individuals and groups provide reproductive justice activists the intellectual and practical grounding that they need to facilitate the changes that would make the reproductive lives of all healthier and safer.
The individuals and groups involved in the US reproductive justice movement started to work together in the early 1990s. They took inspiration first from global women’s health movement events in 1994 (Cairo) and 1995 (Beijing) and second from each other regarding domestic federal health initiatives. Some of the SisterSong Collective for Reproductive Justice “founding mothers” were connected with the Campaign for Women’s Health, a national coalition of organizations formed in 1990.29 In 1992, six of those organizations in turn founded the Women of Color Coalition for Reproductive Health Rights (WOCCRHR), including Asian and Pacific Islanders for Choice, NBWHP, and the Native American Women’s Health and Education Resource Center. On the international scale, members of the WOCCRHR participated in the International Conference on Population and Development in Cairo in September 1994, establishing global intellectual and advocacy connections between reproductive health activists and poverty and sexual abuse.30 Also, the Platform for Action of the fourth United Nations Commission on the Status of Women conference in Beijing in 1995 featured a section on women and health that emphasized sexual and reproductive rights. It suggested specific actions, including woman-centered clinical trials; the regularized provision of safe, effective, and affordable contraceptives; and guaranteed self-determination, equality, and sexual and reproductive security.31 The Platform for Action provided yet another source of motivation and focused planning for the emerging US reproductive justice community, expanding on the original UDHR.
American reproductive activists found encouragement and direction from each other as well. In June 1994, twelve African American women working in the reproductive health and rights movement established the specific concept of reproductive justice. Gathered for a conference in Chicago sponsored by the Illinois Pro-Choice Alliance and the Ms. Foundation for Women, a group of reproductive justice activists decided to draft a unified response to the Clinton administration’s ultimately failed Health Security Act (the universal health-care reform act), first proposed in 1993. Over eight hundred African American women signed an advertisement published in the Washington Post and Roll Call newspapers in August 1994, decrying the act’s lack of attention to preventative health care for women of color, including contraception and abortion.32
Writing and publishing that group response energized participants in that conference, and some of its signatories decided to name their new coalition Women of African Descent for Reproductive Justice (WADRJ), renamed SisterSong Collective for Reproductive Justice in 1997 under the leadership of Luz Rodriguez. The coalition included participants from sixteen women-of-color groups active in promoting reproductive health.33 In fostering collaborative scholarship and action, SisterSong “provided a much-needed space and analysis for these women, allowing them to see connections between themselves as well as the similarities between the past and present reproductive oppressions they faced as a direct result of their identities.”34 They organized to respond to governmental initiatives on women’s reproductive health care and to chart and advocate for their own vision of a healthy human society grounded in reproductive justice. That vision reframes the analysis of the history of contraception moving forward.
As noted above, women-of-color activists first created their own health-oriented organizations based around problems within their specific ethnic groups and also joined forces in SisterSong to advocate for solutions to problems common across communities. They made these decisions when mainstream, largely white-led organizations did not take seriously reproductive health problems that included both structural racism and sexism. Organizations like Planned Parenthood and the Feminist Women’s Health Network based much of their thought and action on the concept of choice alone: women needed a full range of choices for fertility-related purposes, including contraception, pregnancy, birth, and infant care. Their leaders were already fighting multifront battles for legalizing new nonhormonal contraceptives like cervical caps; opposing harmful hormonal contraceptives like Depo-Provera; protecting patients and clinic staff from antiabortion protesters; and securing ongoing adequate funding to provide services to poor women. They did not take on systemic racism in reproductive care as well.35 In sum, “women of color were frustrated with the limitations of the privacy-based pro-choice movement that did not fully incorporate the experiences of women of color, and the failure of the pro-choice movement to understand the impact of white supremacist thinking on the lives of communities of color.”36
The absence of white feminist leadership for tackling the combined effects of racism and sexism created a gap that women of color would fill with their own intersectional thinking and writing. They criticized the notion that the right to contraception was based in the constitutional right to privacy. This right is not expressed specifically in the original text but put forward in majority US Supreme Court decisions like Griswold v. Connecticut (1965), which established the right of married people to possess contraception for their personal use.37 Women of color saw the limitations in basing arguments for health care in privacy and thus “created a radical shift from ‘choice’ to ‘justice’ to locate women’s autonomy and self-determination in international human rights standards and laws, rather than in the constitutionally limited concepts of individual rights and privacy.”38 In establishing reproductive justice theory, women of color drew attention to the conceptual and practical inadequacies of deriving a vision for reproductive health and safety from choice alone: “The concept of choice masks the different economic, political, and environmental contexts in which women live their reproductive lives. ... individual choices have only been as capacious and empowering as the resources any woman can turn to in her community.”39 It is critical to acknowledge that “choice” takes on different casts depending on local resources and individual, local, and community reproductive histories.
People make sexual and reproductive health decisions not just with private, individual motives but also in the contexts of their relationships, families, and communities. In developing reproductive justice, women of color turned attention to contextualizing the ability to make informed contraceptive and reproductive decisions as part of advocating for the rights of disadvantaged groups. “Another problem with ‘choice,’” Ross and Solinger argue, “is that this market concept strongly refers to the preferences of the individual and suggests that each woman makes her own reproductive choices freely, unimpeded by considerations of family and community. ... Reproduction is a biological event and also a social (family and community-based) event, and ... the concept of individual choice cannot capture the context in which persons do or do not become parents.”40 Rights advocacy can be particularly effective in a group that demands attention to racism as well as sexism in pursuit of justice: “Shifting from a focus on individual rights based on privacy, the [reproductive justice] framework invokes collective rights and collective responsibility for organizing our power and acting. ... The [SisterSong] collective’s motto [is] ‘Doing collectively what we cannot do individually.’”41
It is critical to acknowledge that “choice” takes on different casts depending on local resources and individual, local, and community reproductive histories.
Among the collective actions of SisterSong and its affiliate organizations, and an example of the need for reproductive justice, is advocacy for safe contraception in underserved communities because “access to effective contraceptive services is crucial to the dignity of women of all races.”42 Reproductive justice advocates are mindful that contraception is just one of the health technologies necessary for people who can become or can make someone else pregnant and who may or may not want to have a child at a given time. They also know the histories of forced sterilization; the use of contraception as a means of population control by governments, NGOs, and private actors; and the ways that government policy, technological and health-care provider availability, and cost may limit contraceptive options in poor and underserved communities. In short, “many women are constrained to make a choice among dangerous or potentially dangerous contraception.”43
One form of contraception often promoted to poor and undereducated people are long-acting reversible contraceptives (LARCs), usually hormonal-based, which serve as “an effective, if double-edged, solution for persons trying to avoid unintended pregnancy.”44 LARCs may provide protection from pregnancy with limited follow-up, but they also come with health risks, as outlined in chapter 4—and those who take them may not have their full fertility restored for months after their potency ends. Poor people may also be wary of taking part in state-sponsored contraception, given the global history of elites testing new contraceptives on them without full knowledge of the risks and side effects. Moreover, it is clear that “low-income people know that neither LARCs nor any kind of contraceptives can, all by themselves, fix the inequalities—economic, racial, educational, gender, and other—that they face and that may weaken their commitment to contraceptive use, anyway.”45 Thus, contraception is only part of a synthetic approach to reproductive justice based on human rights.
The example of contraception illustrates the intellectual and practical potential of basing advocacy and policymaking on the three main principles of reproductive justice. Where looking at reproductive rights alone would have advocates focused on providing a range of contraceptive options in an underserved community, reproductive justice instead encourages advocates to focus on real-world matters of contraceptive access and at the same time call for changes to public policy that underfunds the program providing that access in the first place. Reproductive justice will be achieved when all people have equal access to safe reproductive health technologies and care and also can raise children in homes and communities that provide related support for healthy development, such as proper nutrition, adequate education, and overall public safety. In the end, “no right can achieve the status of a right if it doesn’t apply to all people—and to its corollary: that no right is secure if it is not secure for everybody.”46
Finally, reproductive justice does not imply “that only biologically defined women experience reproductive oppression.”47 In 2006, SisterSong launched its Queer People of Color Caucus (QPOCC) to incorporate into its work the intersection between LGBTQ rights and reproductive justice.48 Ross and Solinger make this connection explicit: “transgender issues are reproductive justice issues because both domains recognize that the definitions of womanhood, birthing, and mothering (among other concepts involving reproduction) do not fit neatly into the male-female binary.”49 Trans individuals need targeted medical advice when choosing contraceptives, and the reproductive health community in turn requires more education on how best to serve their needs (chapter 6).
In conclusion, inclusivity across multiple identity categories—class, age, income level, ethnic differences within identity categories (multiple possibilities within Asian Pacific Islander communities, for example), and sexual and gender identity—is essential for reproductive justice to come to fruition. These groups face the challenges of balancing similarities of woman-of-color oppressions with differences between and within communities of color. Reproductive justice can be a means of understanding the intersectionality of an individual’s or group’s sexual and reproductive experiences and also axes of oppression across time and place. It provides a comprehensive vision of what a reproductively just world would look like and tools for evaluating new contraceptives that come on the market. Learning the past and present of reproductive, sexual, and contraceptive history provides a firm foundation for promoting reproductive justice in the future. Some techniques and technologies now in development may indeed forward reproductive justice goals.