Racism persists in contraceptive care

By Bixby Center on

Racism is pervasive in the US health care system. The history and legacy of medical racism deeply impact racialized communities—those that are marginalized based on a socially constructed race. Today, racism continues to manifest as stereotyping, microaggressions, invalidation, dismissal by healthcare professionals, lack of shared decision-making, coercive reproductive practices, and a lack of political will to diversify the healthcare workforce. 

Racism in contraceptive care is intertwined with contraception coercion, when providers exert control over patients’ reproductive choices. While racialized patients must be centered in solving this problem, providers’ perspectives can help identify racist practices in contraceptive care and identify ways to do less harm to these communities in clinical settings. 

In a study led by Yasaman Zia, PhD, researchers interviewed contraceptive providers around the country and identified 3 main themes of contemporary racism among contraceptive care providers. 

  • Racism awareness and consciousness, but no action. Some providers recognized how the medical field perpetuated racism, whether through direct or indirect observations of their coworkers mistreating racialized patients. While providers were conscious of how their colleagues perpetuated racism and discrimination, they failed to recognize how their own action or inaction influenced these circumstances. 
‘But yeah, we have some doctors that don’t feel like there is racial inequity in birth. And I work with them, and I am also sending my patients who I know are worried about that. But we don’t have any other options for them to go deliver with’. 
White, Nurse Practitioner, #3
 

  • Intersection of historic and modern-day reproductive harms. Some providers saw the link between historical harms inflicted on Black and Latinx communities in the US and patients’ current contraceptive choices. The modern-day obstetric harms that the providers described gave rise to questions about their lack of cultural humility and unethical practices around informed consent as drivers for forced sterilizations.

Was this forced upon her because she is a young Black woman who is dependent on public assistance and has had three babies before she’s you know 24 years old? Or did she truly choose this and does she truly understand the long-term consequences. Um, one could argue that her brain is not fully developed and she had a lot of trauma, and maybe she could never understand the long-term consequences of a tubal ligation at that age. I definitely think the paternalistic in putting on well you must not want any more babies. We don’t want you to have any more babies as a society. Um, and getting to kind of battle against that like we don’t get to pick who has babies’ 
White, Physician #5
 

  • Race and power dynamics affecting care for patients of color. Some health providers in the study exhibited negative racial stereotyping by attributing patients’ beliefs and behavior to race and ethnicity without reference to context. Providers’ comments focused on assumptions about people’s sexual behavior, fear of birth control, and fertility preference, including around family size and whether to have kids. Some attributed the fear that patients had of contraception to their race, with little to no attention to systemic and institutional racism or how historic obstetric harms might have shaped patients’ beliefs, fears, and preferences.
‘I feel like their grandparents didn’t use it and then their parents didn’t use it and then they didn’t use it. And it just carries forward in this way that they almost have to break through the system of normalcy in order for them to even consider thinking about being on contraceptive management, because they’re really not getting taught that through the filters of family experience in a way that I think is unique to that population’ 
White, Registered Nurse,  #7
 

Contemporary racism in contraceptive care is perpetuated by both healthcare providers and the systems they work within, in terms of policies and practices. Historic and modern injustices described by providers in contraceptive care continue to foster distrust and fear and cause racialized people to delay seeking care. To disrupt these injustices, empowered providers must become active change agents within the care system. These findings amplify the urgent need to develop evidence-based, anti-racist interventions for structural and policy change that involve providers and other stakeholders. 

The researchers’ primary recommendation is to develop community accountability and review boards at hospitals and healthcare practices to collaborate on anti-racist practices and equitable protocols in reproductive health care delivery, counseling, and education. This solution holds the potential to create accountability and transparency in addressing systemic racism while centering communities of color with autonomy, mutuality, and respect.