Reproductive Healthcare Inequity 101

by Aditi Singh

art by Denisse Gonzalez-Marquez

Like many women*, I find the current political atmosphere repulsive. I rise each day to another New York Times notification that diminishes my faith in our country, another headline that convinces me America’s descent into fascism is inevitable.

As we watch aspects of global freedom and dignity corrode, it is easy to succumb to the resignation that currently plagues the democratic party. (1) We must remind ourselves that in the face of oppression, we do not lose our fight for freedom – instead, the fight has just begun, and the rage behind our struggles has only grown stronger.

The rights of women have consistently been ambushed in times of rampant misinformation. Attacks on reproductive healthcare are yet another manifestation of this. As the world experiences a regression democracy, equipping ourselves with accurate information about reproductive healthcare inequity is of utmost importance (2). I cannot pretend that a single article will be sufficient for this task, but it is a starting point. This article seeks to detangle (and unravel) the knots of this system in three larger sections: 1) access to general reproductive care, 2) forced sterilization, and 3) diminishing abortion access.

1. General Reproductive Care

Reproductive care — independent of pregnancy — is essential to identifying cervical cancer and preventing unwanted pregnancies, but accessing these tools can be incredibly difficult for low-income people of color.

Hispanic and Black women have a statistically higher likelihood of developing cervical cancer compared to white women but are less likely to participate in cervical cancer screenings. In fact, if these groups do participate in screenings and receive a result of being at risk for cancer development, they are less likely to follow up if their symptoms do not feel immediate (3). The NIH speculates that the reason Asian, Hispanic, and Pacific Islander populations are less likely to acquire initial screenings relates to a combination of culturally fueled discomfort and the notion that a lack of apparent symptoms means the diagnosis is not a time-sensitive concern (4).

The next step of the chain is even more condemning – if abnormal cells are found in a pap smear, women are directed to receive a cervical cancer biopsy, a notoriously painful procedure that typically involves a circular blade (similar to a hole puncher) removing tissue from the cervix for further analysis (5). Depending on the type of biopsy recommended, healing from this often expensive procedure can take 1-6 weeks. For women living paycheck to paycheck, missing work for an extended period of time is not a possibility; if their symptoms are temporarily ignorable, they will decide to wait. By the time they return to the doctor with symptoms, it could already be too late.

Disparities in contraceptive access are similarly concerning. Over 19 million women in the US live in contraceptive deserts, and 1.2 million live in counties that lack a single health center with birth control services. This is compounded by ideological barriers in places like Arizona, Arkansas, and Georgia, where pharmacists can legally refuse to provide birth control or emergency contraception (6). Newer birth control methods like contraceptive gels and vaginal rings are often not covered under basic insurance plans or have high copays. Considering that nearly 23% of Hispanic women and 13% of Black women of reproductive age lack health insurance, affordable contraceptives are crucial.

Even when women of color do have access to adequate healthcare and contraceptives, these resources are weaponized against them. The Guttmacher Institute writes in 2023 that healthcare professionals are more likely to encourage women of color to limit their childbearing and begin taking contraceptives earlier in life (7).

Hope Ngumezi, a 35 year old woman in Houston, had a painful miscarriage at 11 weeks. While the established procedure entailed a dilation and curettage, the physician instead prescribed a medicine that resulted in her death (8). Pregnant teenager Naveah Crain passed away in Texas after travelling to multiple emergency rooms trying to receive care and being denied. Abortion bans have made doctors fearful of following previously established care standards, resulting in devastating consequences over the past year (9).

Queer populations also face a unique set of challenges in reproductive healthcare, and these challenges are notoriously difficult to overcome for transgender populations. 19–27% of transgender people in the United States report being turned away by healthcare providers; 50% of transgender patients report having to educate a healthcare provider about how to provide care. This discrimination then prevents transgender people from seeking care at all (10).

These disparities do not each exist in a vacuum — rather, they each exist as a symptom of a broader structural failure to protect the most marginalized. Without correcting these structures, legitimate change is unlikely.

2. Forced Sterilization

Forced sterilization refers to government-sponsored programs targeting the sterilization of a particular group. It represents a blatant violation of reproductive autonomy and is a tool of genocide. 

As Mikki Kendall writes in Hood Feminism, discussions of forced sterilization are an inherently feminist, deeply intersectional issue often left behind in mainstream feminist discussions. The history of such procedures in the United States targeting people of color, incarcerated populations, and disabled people is long and disturbing.

Between 1970 and 1976, 20–25% of Indigenous women were sterilized in coerced, nonconsensual procedures. The Indian Health Service (IHS) initially evolved as a government-sponsored mechanism to address health concerns in Indigenous community, but while telling women they were receiving appendectomies, they performed irreversible tubal ligations — an invasive procedure that affects the organ — later claiming that they were “helping society” by limiting the number of births (11). Records from the Government Accountability Office suggest that they knew the IHS was skirting regulations regarding informed consent, yet they took no action for several years. After continuous legal battles and revised definitions of consent, forced sterilization has finally been minimized within the Indigenous community. This weaponization continues a long trend of white entitlement over the bodies of people of color, reducing them to dehumanizing figures to control rather than people who deserve respect and care.

It is no surprise, then, that another group of victims came from another system that disproportionately targets women of color: United States prisons. Between 2006 and 2010, California prisons were accused of authorizing coerced sterilization of nearly 150 female inmates (12). Because America’s sympathy for the incarcerated population is troublingly lacking, media coverage of this transgression was incredibly low. Despite the accusations surfacing just a few years ago with substantial evidence, the American public was largely unaware.

A doctor from Valley State prison — one of the prisons exposed by ABC News — justified conducting such procedures, saying that the amount of money they spent performing those sterilizations was a small price “compared to what you save in welfare paying for these unwanted children as they procreated more. (13)”  By playing into narratives about desirable and undesirable children, particularly along racial boundaries, these sterilizations effectively contribute to a modern-day eugenics-based healthcare system in prisons. This is an incredibly dangerous precedent to set.

The Immigrant and Customs Enforcement (ICE), an agency of the US government, has long been condemned for its violence against immigrants, but this issue has always been a feminist one as well. As the ACLU writes, officers in detention centers have a long history of sterilizing people assigned female at birth coercively under the guise of signed documents “proving consent.” In the early 1970s, the Madrigal case was particularly horrifying. As women were in the midst of labor and heavily medicated, hospital staff reportedly pressured the women into signing consent forms in a language they could not understand. Isolated and in pain, these women signed the documents and were devastated when they learned the reality of what had happened to them: they were forcibly sterilized (14). Unfortunately, these allegations are far from the past — just last year, there were allegations of almost identical conditions in Irwin County Detention Center (ICDC) in Georgia (15). Internal government accountability structures are poorly managed at best and nonexistent at worst. While the abuses in detention centers are recognized, they are rarely responded to, leaving America’s most vulnerable populations at the whims of cruel medical professionals. In trying so hard to ensure that immigrants enter the country legally, the American government is perfectly willing to ignore its own crimes and atrocities.

Disabled women are endangered by these narratives as well. The National Women’s Law Center explains that as of 2022, 31 states and Washington, D.C. have laws under which judges can decide whether to sterilize someone without their consent (16). These laws stem from the assumption that disabled people are incapable of making decisions for themselves, infantilizing people as part of a larger pattern that seeks to build control of disabled peoples’ bodies.

3. Diminishing Abortion Access

While abortion has long been considered a feminist issue, the level of disparity among women is not homogeneous. Women of lower socioeconomic class and women of color are more likely to have an abortion due to limit contraceptive access and financial limitations, and these people are also more likely to be raped and subjected to unwanted pregnancies (17).

People in rural areas — particularly conservative areas — already lack access to abortion centers, but this problem is compounded by new “trafficking” laws such as that in Idaho, which outlaws assisting a minor get an abortion in another state (18). For minors who experience unwanted or non-consensual pregnancies, this legal framework is devastating. Ultimately, it dictates that while a minor and their parents are not capable of deciding whether a child should deliver a baby, they somehow should be capable of raising that baby.

As Jessica Valenti explains in her book, Abortion, even women who do not have abortions are targeted under current legislation. In a world where reproductive care of all kinds is being criminalized, traumatic miscarriages become weaponized against women as well. People who have partial miscarriages and need medical assistance to finish evacuating their uterus are denied care because vague legal definitions of abortion leave doctors fearing license suspension and criminal charges. Ohioan Brittany Watts’ story is particularly harrowing — a woman who had a miscarriage and flushed it was subsequently charged with “abuse of a corpse.” While she was eventually released and sued the hospital that reported her to police, the additional pain she endured while recounting the traumatic event of her miscarriage to politically biased law enforcement members is impossible for her to erase. 

Under the new administration — one which seeks to criminalize people assigned female at birth and politicize medical care — there is no doubt that issues like this will continue to surface. Because these issues often involve the legal system and law enforcement, vulnerable populations and communities of color will have fewer resources to fight back, and as such, end up more vulnerable to these unsolicited attacks.

Final Thoughts

My intention is not to diminish your hope for the women of America. Instead, it is to breathe consciousness and intentionality into your advocacy. It is to remind you of the rage you must harness for the people you love — for your siblings, mothers, friends, and daughters — and to help you recognize that feminist struggles are not experienced uniformly by all women. 

*Note: This article interchangeably uses the words “women,” “people,” and “assigned female at birth” to refer to people impacted by these damages to reproductive rights, recognizing that many people who need access to such care do not identify as women. However, most of the available data on state-sponsored reproductive violence centers around people who identify as women, which is why these terms are used interchangeably.

References

[1] Charles Blow, “Temporarily Disconnected From Politics? Feel No Guilt About It,” The New York Times, last modified December 18, 2024, https://www.nytimes.com/2024/12/18/opinion/trump-liberals-resistance.html

[2] James Dean, “Democratic decline a global phenomenon, even in wealthy nations,” Cornell Chronicle, last modified January 17, 2024, https://news.cornell.edu/stories/2024/01/democratic-decline-global-phenomenon-even-wealthy-nations

[3] Teresa Boitano, “Increased disparities associated with black women and abnormal cervical cancer screening follow-up,” National Institutes of Health, last modified July 16, 2022, https://pmc.ncbi.nlm.nih.gov/articles/PMC9309676/#:~:text=While%2085%20%25%20of%20Black%20women,Society%2C%202019%E2%80%932021).

[4] Carolyn Fang, “Overcoming Barriers to Cervical Cancer Screening Among Asian American Women,” National Institutes of Health, last modified June 15, 2011, https://pmc.ncbi.nlm.nih.gov/articles/PMC3115728/#:~:text=Studies%20indicate%20that%20various%20psychosocial,screening%20among%20Asian%20American%20women.&text=For%20example%2C%20Asian%20American%20women,not%20having%20a%20Pap%20test.

[5] “Cervical Biopsy,” Johns Hopkins Medicine, https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/cervical-biopsy

[6] Shishira Sreenivas, “Health Disparities and Bias in Contraception Access and Care,” WebMD, last modified May 27, 2024, https://www.webmd.com/sex/birth-control/contraception-access-care-disparities-bias

[7] Liza Fuentes, “Inequity in US Abortion Rights and Access: The End of Roe Is Deepening Existing Divides,” Guttmacher Institute, last modified January 2023, https://www.guttmacher.org/2023/01/inequity-us-abortion-rights-and-access-end-roe-deepening-existing-divides

[8] Lizzie Presser and Kavitha Surana, “A third woman has died under Texas’ abortion ban as doctors reach for riskier miscarriage treatments,” The Texas Tribute, last modified November 27, 2024, https://www.texastribune.org/2024/11/27/texas-abortion-death-porsha-ngumezi/

[9] Lizzie Presser and Kavitha Surana, “A Pregnant Teenager Died After Trying to Get Care in Three Visits to Texas Emergency Rooms,” ProPublica, last modified November 1, 2024, https://www.propublica.org/article/nevaeh-crain-death-texas-abortion-ban-emtala

[10] “Transgender Sexual and Reproductive Health: Unmet Needs and Barriers to Care,” Advocates for Trans Equality, https://transequality.org/resources/transgender-sexual-and-reproductive-health-unmet-needs-and-barriers-care#:~:text=Many%20providers%20still%20turn%20transgender,sexual%20and%20reproductive%20health%20care.

[11] Jane Lawerence, “The Indian Health Service and the Sterilization of Native American Women,” American Indian Quarterly, last modified 2000, https://www.jstor.org/stable/1185911?mag=the-little-known-history-of-the-forced-sterilization-of-native-american-women&seq=1

[12] “California Prisons Caught Sterilizing Female Inmates Without Approval,” ABC News, last modified July 2018, https://abcnews.go.com/ABC_Univision/doctors-california-prisons-sterilized-female-inmates-authorizations/story?id=19610110

[13] “California Prisons Caught Sterilizing Female Inmates Without Approval,” ABC News

[14] Maya Manian, “Immigration Detention and Coerced Sterilization: History Tragically Repeats Itself,” American Civil Liberties Union, last modified September 29, 2020, https://www.aclu.org/news/immigrants-rights/immigration-detention-and-coerced-sterilization-history-tragically-repeats-itself

[15] Elizabeth Ghadakly and Rachel Fabi, “Sterilization in US Immigration and Customs Enforcement’s (ICE’s) Detention: Ethical Failures and Systemic Injustice,” National Institutes of Health, last modified May 2021, https://pmc.ncbi.nlm.nih.gov/articles/PMC8034024/

[16] “Forced Sterilization of Disabled People in the United States,” National Women’s Law Center, last modified January 23, 2022, https://nwlc.org/resource/forced-sterilization-of-disabled-people-in-the-united-states/?gad_source=1&gclid=Cj0KCQiAqL28BhCrARIsACYJvke-kFEtPKrXL2-_dauktRWsqxC6rQ2wZnqRXphHbWy0_029jB6mUPIaAoFkEALw_wcB

[17] Latoya Hill and Samantha Artiga, “What are the Implications of the Dobbs Ruling for Racial Disparities,” KFF, last modified April 24, 2024, https://www.kff.org/womens-health-policy/issue-brief/what-are-the-implications-of-the-dobbs-ruling-for-racial-disparities/

[18] Aria Bendix, “Idaho becomes one of the most extreme anti-abortion states with law restricting travel for abortions,” NBC News, last modified April 6, 2023, https://www.nbcnews.com/health/womens-health/idaho-most-extreme-anti-abortion-state-law-restricts-travel-rcna78225