Strategy, Morality, Courage: Bioethics and Health Law after Dobbs.

Our paper examines what is required to protect and promote effective public discussion and policy development in the current climate of divisive disagreement about many public policy questions. We use abortion as a case example precisely because it is morally fraught. We first consider the changes made by Dobbs, as well as those which led up to the Dobbs decision, accompany it, and follow from it.

Beyond borders: The global impact of violating reproductive human rights.

A fundamental component of the basic right to health is the right to sexual health, encompassing an individual's right to decide freely on matters of sexual and reproductive health without discrimination. Provision of these rights is inextricably linked with a wide range of other internationally agreed upon human rights, including the right to information, participation, and equality. Evidence has shown that provision of these rights not only improves maternal and neonatal health, but also healthcare worker safety and the provision of a vast array of critical and necessary medical care. And yet, too often-and with increasing frequency-sexual and reproductive rights are being violated worldwide, with rising taboos, stigma, and discrimination, particularly within abortion, contraception, and fertility care. FIGO strongly supports comprehensive, equitable, and accessible sexual and reproductive health care for all individuals, recognizing that these rights are essential components of global health and fundamental human rights. This includes a particular emphasis on special populations, healthcare workers, and women and girls in crisis zones. FIGO encourages its member societies to deliver comprehensive sexual and reproductive health care, advocate for coverage for sexual and reproductive health care, become involved in analyzing barriers to access within health systems, and provide nonjudgemental, confidential, person-centered care.

Development, Implementation, and Formative Evaluation of a Social Needs Screening Tool.

We aim to develop and formatively evaluate a brief social needs screening tool that adheres to Massachusetts Department of Public Health (MDPH) clinical service standards for sexual and reproductive health (SRH) agencies and is acceptable and feasible for use by staff during a clinical encounter. Through a multi-stage literature and expert review process, we developed an evidence-informed, two-page social needs screening tool, scoring form, and implementation guide. We piloted this tool at three SRH agencies in Massachusetts and recruited staff to provide quantitative and qualitative feedback through post-pilot test self-reported surveys and semi-structured interviews. Participants (n = 13) felt the social needs screening tool was easy to integrate into their clinical workflow and were comfortable using it with patients. All participants reported feeling comfortable administering the tool, scoring it, and referring patients to appropriate resources, if applicable. Most reported they would like to continue using the tool after the pilot implementation period, either with or without modifications. Our multi-stage tool development and formative evaluation process involving literature review, expert review, and pilot-testing in clinical settings enabled our team to create a brief, evidence-informed social needs screening tool that is acceptable to staff and feasible for use during a short clinic visit at SRH agencies in Massachusetts. Staff felt that there is value in using this tool, are comfortable using it, and are able to integrate it into their existing clinical workflows.

One Hundred Years of Seeking Respectful Maternity Care: History and Evolution.

Growing awareness of poor maternal health outcomes and maternal health disparities in the United States has heightened urgency around the need to promote Respectful Maternity Care (RMC) as a fundamental tenet of obstetric/midwifery care and standardize efforts to improve safety, eliminate obstetric violence and racism, and optimize health outcomes for all birthing people. The historical context of prior and contemporary perspectives around childbirth influences our understanding of RMC and are shaped by varying scholarly, clinical, and community standards (e.g., religion, human rights, government, public health, midwifery, ethics, activism, and the law), which have changed significantly since the mid-19th century. In this commentary, we share results of a contextual question scoped as part of a larger systematic review of RMC to help inform consensus around a shared definition and development of a metric to standardize delivery and evaluation of RMC. Synthesis of this literature identified landmark historical influences on RMC over the past 100 years, highlighting the multidisciplinary scholarship and historical context influencing the progress toward RMC. Further understanding of this history may also inform policies and guidance for ongoing efforts to center respect and accountability in all aspects of maternity care, with particular attention to populations who are disproportionally impacted by disrespectful care.

Reflections on being a Thai transman through the lens of the reproductive justice framework.

Transmen are a crucial gender group within the umbrella of transgender identities, yet there remains a lack of understanding regarding their gender identities and sexualities. Transmen often face challenges related to gender discrimination and inequalities, particularly in accessing government services such as healthcare and social welfare, and in securing legal recognition of their gender identity and rights. This article explores the challenges faced by transmen in Thailand. It through a discussion of the lived experiences and gender identities of Thai transmen by examining the societal context through existing literature and qualitative interviews of transmen on their own. The aim is to examine the specific local context of Thai transmen using a reproductive justice approach to examine how transmen experience gender discrimination when challenging the dominant cis-normative gender norms in Thai society. Understanding these challenges can contribute to creating fundamental knowledge for a better understanding of transmen's identities and inform recommendations for public policies that support greater gender diversity and a more inclusive environment. Importantly, supporting legal gender recognition based on self-identified gender can promote reproductive justice for transgender people.

Ghosts in the machine: Black feminist and queer critiques of reproductive justice in Finland.

We discuss reproductive justice in the context of Finland, a Nordic welfare state often considered as having achieved exceptionally high ethical standards in reproductive health and overall justice. Every now and then, however, this reproduction is interrupted by ghosts in the machine: the problems, past and present, of marginalised, racialised, and/or otherwise non-normative people whose presences provoke specific Finnish hauntings, seething presences of reproductive injustice that suggest something is to be done. Instead of offering data analysis, this article aims to envision transformative reproductive justice futures through processual, collaborative theory development. This study uses an intersectional lens to understand how interlocking systems of oppression shape our lived experiences through an interdisciplinary, ethical analysis that suggests that what is required to resolve such hauntings is moral vigilance and care for a consistent reproductive justice orientation in global solidarity. Specifically in Finland, it requires the willingness to disavow the imperative to protect Finnish whiteness and active and meaningful solidarity across differences. Building on Black feminist and queer thought, we urge queer white people who may be tempted to become enfolded by homonationalism to take a more encompassing view of reproductive justice for a more sustainable welfare state ethic.

Transformative reproductive futures in Northern Ireland.

A foundation of rights-based solidarity has fostered an environment of cooperation between LGBTQ+ (lesbian, gay, bisexual, transgender and queer) rights and reproductive justice in Northern Ireland (NI) following the introduction of equal marriage and the decriminalization of abortion in 2019. This article provides a grounded look at this reproductive justice organizing in NI as an example of transformative organizing for reproductive futures. The case study considers a conversation with two activists who have been central to this work. Emma Campbell coconvenor of Alliance for Choice and Danielle Roberts the coconvenor of Reclaim the Agenda and former Senior Policy and Development Officer of HERe NI. Reclaim the Agenda is a coalition of feminist, youth, LGBTQ+ and community organizations that connects and mobilizes women to promote feminist activism through education, campaigning and celebration. HERe NI is a community organization and registered charity based in Belfast that supports lesbian and bisexual women and their families across NI. Alliance for Choice campaigns for free, safe legal and local abortion access for everyone who needs it in NI. Together these groups approach reproductive justice using a framework informed by lesbian feminist organizing and an intersectional approach that views access to abortion as part of a broader understanding of gender justice inspired by Black-women led SisterSong through (1) cross-movement organizing (2) centering bodily autonomy and (3) trans affirming feminist approaches to navigating shifting language about gender. The case study will be of interest to those working provide abortion services in a queer-informed way, as well as those navigating the challenges of reforming abortion policy.

Building Collective Power to Advance Maternal and Child Health Equity: Lessons from the New Orleans Maternal and Child Health Coalition.

OBJECTIVES: The New Orleans Maternal Child Health Coalition convenes to support and amplify the work of New Orleans-based individuals and organizations working to reduce disparities and protect the health of birthing families in the New Orleans area. The objectives of this qualitative study were to identify successes, challenges, and areas of growth for the Coalition and develop broadly generalizable recommendations for similar groups seeking to mobilize and advance health equity in their own communities. METHODS: Using purposive sampling, we conducted semi-structured interviews with 12 key informants from within and outside of the Coalition. Interviews were transcribed verbatim, and data was analyzed using inductive and deductive coding approaches. RESULTS: We identified themes relating to the barriers and facilitators to the maintenance of the Coalition, as well as opportunities to advance the mission of the Coalition. Some themes included structural- and systemic-level barriers to achieving the mission, varying perspectives on the effectiveness of the Coalition, opportunities to enhance the operations of the Coalition's work, and opportunities to involve other individuals, particularly those with lived experience, and non-MCH related sectors in Coalition's work. CONCLUSIONS FOR PRACTICE: As the maternal health crisis continues, coalitions like the New Orleans MCH Coalition provide a vehicle to amplify the mission-driven work of people and organizations. Recommendations put forth by the Coalition can also be utilized by coalitions in other jurisdictions.

Surviving in the midst of 'Nowhere': Disrupting the conceptualisation of a maternity care desert.

The conceptualisation of 'care deserts' has gained increased public attention in recent years. This paper engages a reproductive justice framework to investigate the (mis)alignment of a maternity care desert within a predominantly Black rural community in the United States. I draw on a case study of Gadsden County, Florida-a community that is perceived by its members to be a maternity care desert but that is not technically defined as one-to demonstrate how Black birthing people are cultivating a reproductive liberatory consciousness. Semi-structured interviews with birthing persons and reproductive health experts reveal three overarching processes-naming barriers to health equity, resisting health inequity and cultivating health equity-that characterise a reproductive liberatory consciousness, which I identify as an analytical tool to outline how local social actors are identifying structural constraints as well as developing strategies of communal care and resistance. This work contributes to sociological research on reproductive justice and health equity by exploring the limitations of 'desert' frameworks. Pointing to the need to carefully consider the mechanisms that actively disrupt and potentially transform spatial stratifications and inequities, this paper advances a new understanding of birthing space that captures the layered movements of those living within a perceived maternity care desert.

Addressing Teenage Pregnancy and Reproductive Health Among Latinx Adolescents and Young Adults.

Despite a national decline in teenage pregnancy rates, Latinx and Black individuals continue to have higher teenage birth rates compared with White teens. In the United States, Latinx females (ages 15-19) are more than twice as likely to have a teenage birth compared with non-Latinx White teens. With an increasingly diverse nation, a shift toward culturally inclusive approaches to care is critical to achieving equitable patient outcomes. Improving access to preventive care, workforce diversity, and insurance coverage will lead to cost-savings and help restore trust in a system that has failed past generations. In this commentary, targeted recommendations tailored specifically toward Latinx women will be provided, including culturally competent birth control counseling and a focus on reproductive justice. Not speaking English, low socioeconomic status, acculturation, legal status, and being uninsured are all teenage pregnancy risk factors unique to Latinx women. Cultural preferences and attitudes toward contraception must also be considered. Further expansion of Medicaid insurance coverage is also necessary to increase reproductive access among vulnerable populations. A cultural humility framework to reproductive health counseling and services is recommended. Within this framework, family engagement is encouraged, and women are free from reproductive coercion; they have the freedom to access over-the-counter contraception and receive guidance and support from providers and community health workers who are cognizant of culture and heritage. An integrated community-based approach that is culturally sensitive and in tune with Latinx heterogenicity is necessary to lower teenage pregnancy rates and achieve reproductive justice.

Regimes of truth regarding 'sexual justice' in academic literature from 2012 to 2022: a scoping review.

The notion of 'sexual justice' has gained traction in academic and policy arenas in recent years. This paper presents a scoping literature review of the regimes of truth, following Foucault, of 'sexual justice' appearing in the scientific literature from 2012 to 2022. Thirty-eight papers were coded using (1) content analysis of the studies' central problematics, the programmes referred to, and institutional location(s); and (2) thematic analysis of how the notion was deployed. Central problematics centred on (1) critiques of, or alternatives to, dominant approaches to sexual and reproductive health; and (2) highlighting injustices. As such, 'sexual justice' is fighting for legitimacy in the truth stakes. There is a distinct paucity of papers tackling the translation of 'sexual justice' into practice. South Africa dominates as the site in which papers on 'sexual justice' have been produced, but there is a lack of South-South collaboration. Two themes were apparent around which conceptions of sexual justice cohere. Firstly, sexual justice is seen as a vital, yet politically ambivalent goal, with neoliberal co-optation of progressive rights agendas being warned against. Secondly, sexual justice is viewed as a means, in which sexual justice is described as having potential to repair established frameworks' shortcomings and oppressive legacies.

Crafting the unsayable: Making meaning out of racialised maternal health-care encounters.

There are persistent and profound racialised inequalities in maternal and reproductive health in the UK. Yet in multiple settings, these disparities have been blamed on class or ethnicity, individuals and communities rather than the structures within which they live. In this study, we draw on narratives told within a 'slow-stitch' craft workshop, organised in southern England for racialised women with reproductive trauma, to show how processes of racialisation and racism shape experiences of maternal and reproductive healthcare. Experiences of reproductive trauma were multiple and cumulative. The burden of knowledge of racialised disparities was carried into health-care spaces, with plans made in advance to self-manage in risky spaces. The constant management of racialised stereotypes and subsequent strategies of bodily and emotional containment ultimately was not protective and there was little agency over levels of care received in health-care spaces. Perceptions surrounding racialised bodies shaped treatment, whilst proximities to whiteness afforded alternative realities. Taking a phenomenological approach we analyse race as a sensory, spatial and relational constellation haunted by long-standing histories of fraught inequality. Bringing together in the crafting circle a group of women racialised in different ways enabled the sharing of "unspeakable" stories surrounding racism and reproductive trauma, and allowed race to be brought into being as a form of solidarity and connection.

Freedom for some, but not for Mum: the reproductive injustice associated with pandemic 'Freedom Day' for perinatal women in the United Kingdom.

Introduction: Healthcare services for pregnant and postpartum ('perinatal') women were reconfigured significantly at the advent and for the duration of the SARS-CoV-2 pandemic, and despite the United Kingdom announcing 'Freedom Day' on 19 July 2021 (whereafter all legal lockdown-related restrictions were lifted), restrictions to maternity (antenatal, intrapartum, and postnatal) services remained. This study presents data from eight perinatal women about their experiences of psychosocial wellbeing and maternity care in the post-'Freedom Day' epoch. Methods: Semi-structured interviews were conducted virtually, with data recorded, transcribed, and analysed by hand. Grounded theory analysis was employed with the final theory assessing the reproductive injustice of the pandemic 'Freedom Day'. Results: Analysing iteratively and inductively led to four emergent themes: 'A Failing System, Failing Women'; 'Harm Caused by a State of Difference'; 'The Privileges (Not Rights) of Reproductive Autonomy, Agency, and Advocacy'; and 'Worried Women and Marginalised Mothers'. Together, these themes form the theory of 'Freedom for some, but not for Mum'. Discussion: Women experienced a lack of high-quality reliable information about the pandemic, vaccination against the virus, and the changes to, and decision-making surrounding, their perinatal care. Women recognised healthcare professionals and maternity services were stretched and that maternity services were failing but often reported hostility from staff and abandonment at times when they were unsure about how to navigate their care. The most singular injustice was the disparity between women having to accept continuing restrictions to their freedom whilst receiving maternity care and the (reckless) freedom being enacted by the general public.

"These are our children and we got to set them free": A public health approach to reading reproductive justice in black literature.

This paper explores reproductive justice themes in different works of Black literature and juxtaposes that literature with modern scholarship to consider a reproductive justice agenda for public health researchers. Incorporating multiple disciplines including public health, critical geography, and anthropology, this paper goes on to suggest that public health researchers would benefit from engagement with works from beyond academia. Specifically looking into Black fiction, nonfiction, and autobiographical writing, this paper traces reproductive justice themes and suggests that attention to these themes will bolster academic public health scholarship aligned with the reproductive justice movement.

Sexual and Reproductive Justice and Health Equity for LGBTQ+ Women.

LGBTQ+ women have long been overlooked in sexual and reproductive health research. However, recent research has established that LGBTQ+ women have unique and specific needs that need to be addressed in order to improve effectiveness of sexual health education and practice with this historically and presently underserved population. Informed by a reproductive justice framework coupled with liberation psychology theory, this review discusses the current state of sexual and reproductive health and technologies among LGBTQ+ women. In particular, we focus on a range of HIV prevention and reproductive technologies and their use and promotion, including the internal condom, abortion, oral contraceptives, dapivirine ring, HIV pre-exposure prophylaxis, intrauterine device, and other less studied options, such as the contraceptive sponge. Grounded in an intersectional framing, this review acknowledges the intersecting systems of oppression that affect multiply marginalized women inequitably and disproportionately. A sociohistorical, critical lens is applied to acknowledge the well-documented racist origins of reproductive health technologies and ongoing coercive practices that have led to medical mistrust among marginalized and stigmatized communities, particularly racialized LGBTQ+ women, women with disabilities, and women who are poor or incarcerated. Moreover, we discuss the urgent need to center LGBTQ+ women in research and clinical care, community-engaged health promotion efforts, affirming non-heteronormative sexual health education, and health policies that prioritize autonomy and dismantle structural barriers for this population. We conclude with recommendations and future directions in this area to remedy entrenched disparities in health.

Treating Mycoplasma genitalium (in pregnancy): a social and reproductive justice concern.

Antimicrobial Resistance is a threat to individual and to population health and to future generations, requiring "collective sacrifices" in order to preserve antibiotic efficacy. 'Who should make the sacrifices?' and 'Who will most likely make them?' are ethical concerns posited as potentially manageable through Antimicrobial Stewardship. Antimicrobial stewardship almost inevitably involves a form of clinical cost-benefit analysis that assesses the possible effects of antibiotics to treat a diagnosed infection in a particular patient. However, this process rarely accounts properly for patients - above and beyond assessments of potential (non)compliance or adherence to care regimes. Drawing on a vignette of a pregnant woman of colour and migrant diagnosed with Mycoplasma genitalium, a sexually transmissible bacterium, this article draws out some of the ethical, speculative, and practical tensions and complexities involved in Antimicrobial Stewardship. We argue that patients also engage in a form of cost-benefit analysis influenced by experiences of reproductive and social (in)justice and comprising speculative variables - to anticipate future possibilities. These processes have the potential to have effects above and beyond the specific infection antimicrobial stewardship was activated to address. We contend that efforts to practice and research antimicrobial stewardship should accommodate and incorporate these variables and acknowledge the structures they emerge with(in), even if their components remain unknown. This would involve recognising that antimicrobial stewardship is intricately connected to other social justice issues such as immigration policy, economic justice, access to appropriate medical care, racism, etc.

LBTQ parents' needs for support postpartum following a complicated birth: A matter of reproductive justice.

LBTQ people have increased risks of complications during birth, risks potentially driven by minority stress and increased levels of mental illness and fear of childbirth. With the aim of exploring reproductive injustices in postpartum care for LBTQ people, we analyzed qualitative interviews where 22 LBTQ birth and non-birth parents shared their experiences of support needs during the postpartum period after births where complications had arisen. Results point to the importance of providing an LBTQ safe space, which includes the need to feel safe regarding one's gender or sexual identity, by avoiding cisheteronormative assumptions and using inclusive language. In the context of recently experiencing birth complications, parents needed a space where they were able to focus on physical and mental healing. The results further show the need for validation of the non-birth parent and inclusive breast/chest-feeding support. Results emphasize the need for more psychosocial support around the birth experience, including better medical support and information during the whole process of childbirth.

Social Determinants of Health and Patient-Reported Difficult Discontinuation of Long-Acting Reversible Contraception.

Background: Some individuals who receive long-acting reversible contraception (LARC) face barriers to discontinuation. The inability to discontinue a contraceptive method when desired negatively impacts a person's reproductive autonomy. Persons impacted by social determinants of health (SDH) may be disproportionately affected. The objective of this study is to evaluate the association of SDH with patient-reported difficult LARC discontinuation. Methods: A retrospective cross-sectional analysis of data from the 2017-2019 cycle of the National Survey of Family Growth was conducted. The main outcome was patient-reported difficulty discontinuing a LARC method (intrauterine device or implant) in the last 10 years. Descriptive statistics were used to identify demographic characteristics and SDH domains. Multivariable logistic regression models were used to estimate associations across SDH domains with difficult LARC removal. Results: A total of 754 respondents reported wanting to have their LARC removed, and 105 (11%) reported difficulty discontinuing LARC methods. One-third of respondents experienced one or more SDH, notably food insecurity (26%) or transportation barriers (30%). After adjusting for age, race, education, geographic location, parity, and body mass index (BMI), persons with one or more SDH had an increased adjusted odds ratio (aOR) for difficultly discontinuing LARCs compared with respondents without any SDH (2.11; 95% confidence interval [CI]: 1.21, 3.69). Transportation barriers demonstrated the largest aOR of 2.90 (95% CI: 1.07, 7.87). Conclusions: SDH are associated with challenges to LARC discontinuation. SDH are unique risk factors that can impact one's entire contraceptive experience. A nuanced discussion of SDH at the time of contraceptive counseling may be a critical step in addressing the intersectionality of method selection and reproductive agency.

The Making of Clandestinity: Strategic Ignorance in Abortion Practices in Latin America.

Abortion is a public secret in Latin America. It is highly restricted across the majority of the continent and yet millions of abortions take place every year. We use the sociological framework of 'strategic ignorance' to argue that convenient not knowing, erasure and concealment allow for the simultaneous negation and allowance of abortions in Latin America. By drawing on interviews with people involved in abortion activism and access across the continent we examine three sets of actors: the state, abortion providers and individuals. When wielded by the state, strategic ignorance reproduces the status quo of the criminalization of abortion but when wielded by abortion providers and individuals it creates the conditions for 'clandestine' abortions to be procured without prosecution. Strategic ignorance is therefore mobilized by the powerful as well as the powerless who are resisting state control of their fertility and reproductive lives.

Developing an interactive reproductive health equity session for pre-clerkship medical students.

In the United States, sexual, reproductive, and perinatal health inequities are well documented and known to be caused by a history of systemic oppression along many axes, including but not limited to race, ethnicity, gender, socioeconomic position, sexual orientation, and disability. Medical schools are responsible for educating students on systems of oppression and their impact on health. Reproductive justice advocates, including lay persons, medical students, and teaching faculty, have urged for integrating the reproductive justice framework into medical education and clinical practice. In response to medical student advocacy, we developed introductory didactic sessions on social and reproductive justice for preclinical medical students. These were created in a team-based learning format and include pre-course primer materials on reproductive justice. During the sessions, students engaged with hypothetical clinical vignettes in small groups to identify oppressive structures that may have contributed to the health outcomes described and potential avenues for contextually relevant and level-appropriate advocacy. The sessions took place in November 2019 (in-person) and 2020 (virtually) and were well attended by students. We highlight our experience, student feedback, and next steps, including further integration of reproductive health equity into medical school curricula in concert with department-wide education for faculty, residents, nursing, and allied health professionals. This introduction to social and reproductive justice can be adapted and scaled across different medical school curricula, enhancing the training of a new generation of physicians to become critically aware of how oppressive structures create health inequities and able to mitigate their impact through their roles as clinicians, researchers, and advocates.