Reproductive Justice 101: With Alisha Liggett, MD
1. Tell us a bit about yourself and your practice? What led you to work in the field of reproductive justice?
I am a primary care physician, with a clinical practice based in New York City. I have specialized training to care for patients that live in urban, medically underserved environments, and work with patients disproportionately affected by social determinants of health (the conditions in which people are born, live, work, and age). Since our environment is such a strong indicator of our health condition, my approach to caring for people focuses on treating illness, but also prevention, education, and an understanding of the factors in that environment that promote wellness, and foster disease.
My journey to the cause of reproductive justice was born out of my personal experiences with healthcare prior to becoming a physician. I didn’t realize it then, but many of these experiences were rooted in medical trauma, and physician racism. As a patient, I also had a very scary experience with severe preeclampsia during the birth of my son. But by the grace of god, with competent doctors, my amazing husband, and doula, my son and I navigated through safely. It wasn’t until I started taking note of my patients’ tearful accounts with physician racism, disregard, and medically inflicted trauma that I started to understand fully that this issue was far bigger than my personal experience.
My mother used to tell me that my outspokenness was my very special gift, and to use that gift for good. And so I learned to use my voice to advocate and bring awareness to issues that affect our reproductive lives.
2. For readers who may not be familiar with Reproductive Justice, Can you break down the history of the term and the movement?
Historically, women have always striven for equity, and inclusion. Women’s suffrage movements, abortion rights movements, and equal pay for equal work are just a few examples of that. The term reproductive justice was founded in 1994 by a group of Black women who felt that the mainstream feminist movements could not adequately describe Black women's experience in this country. It was also a means to acknowledge the roles of racism, inequity, and environmental factors played in the provision of reproductive health services, and reproductive health outcomes for women of color.
Reproductive justice encompasses three central tenets.
Reproductive health, which encompasses the physical, mental, and social well-being of individuals across the gender spectrum.
Reproductive rights, which traditionally refers to contraception and abortion rights, but should also include legal protection to obtain and access all reproductive health services
Structural protections that allow access to care free from racism and discrimination, the right to bodily autonomy, and the right to parent in a fruitful environment.
3. How has the reproductive Justice space evolved over the decades, into this current moment? Why and how does reproductive justice matter now?
The reproductive justice movement has evolved over the last few decades in response to the injustices of the day. Today, reproductive justice is part of a larger social justice movement to dismantle racism and injustice within our societal systems. It is clear we have reached a boiling point in this country, as evidenced by the sheer size and power of the current Black Lives Matter movement, which is arguably the largest social justice movement in the history of the United States. These movements have brought together people all over the world, of all races and cultures to stand in solidarity with Black lives.
4. You’ve mentioned that racism in reproductive health can impact access, physician bias, and medical mistrust. Can you elaborate?
Access, physician bias, and medical mistrust are all interconnected and drive poorer health status for women of color. Overt and covert racism are the major drivers of these outcomes and operate in very complex ways - within our systems and within ourselves - to create the health disparities that we see today.
Access to quality care is primarily driven by insurance status. Uninsured or underinsured individuals may delay preventative care services or delay seeking treatment when care is needed. Insurance status is also intricately tied to other social determinants of health like race, educational attainment, and employment status. Access to care is also determined by proximity to a health system that can provide needed services. For example, women in rural areas, particularly Black women living in the rural south, fare far worse compared to their white counterparts, where resources are more sparse and inequities more stark.
Physician bias is more complex. It acts as a barrier to access through unequal treatment, and rendering of care because of gender, race, ethnicity and other characteristics. It is harmful to patients through the trauma it inflicts. An example of this is when providers disregard a patient’s experience in her own body, or may not suggest appropriate medical treatments based on preconceived attitudes, stereotypes, or lack of understanding of that experience. Implicit bias may play out in a conscious or an unconscious manner.
Medical mistrust is the decision that patients’ make to avoid doctors and necessary medical treatments. This deep seated fear was born out of centuries of experience with health institutions in this country, which have been historically marred by unethical experimentation on enslaved African Americans for medical science, and undue harm to individuals and their families. This generational trauma from health institutions, and avoidance of health systems has been passed down through oral history in Black communities.
5. You’ve said it’s impossible to talk about reproductive justice without acknowledging medical bias. Can you talk to us about the realities of bias without our healthcare system? How does that bias impact outcomes for Black women?
This connection between beliefs, treatment, and outcomes is critically important to understand as you dissect the role of medical bias. There are several studies that highlight how medical bias leads to poor maternal health outcomes for Black women. Studies show* that on average, providers spend less time with Black patients, are more likely to ignore symptoms or dismiss complaints, and under-treat their pain. These attitudes may lead to false assumptions and lead to life and death decisions about care. In the case of Black maternal health for example, death rates are 3-4 times higher in Black women compared to their white counterparts.
6. The stats around maternal mortality for Black women in America in 2020 are horrifying. How does the work of reproductive justice intersect with maternal mortality?
Not only are Black women more likely to die during pregnancy and postpartum but Black infants are 2 times more likely to die in their first year. Research* has asserted that racism and unequal treatment are the root causes of these disparities.
The United States healthcare system is ranked near last among all countries in the developed world and that is primarily attributed to poorer outcomes for women of color. Improving health outcomes for the most vulnerable women — through reproductive justice and other work — will improve our healthcare system for everyone.
7. How can we all work toward reproductive justice right now? What are some resources you can recommend for anyone who wants to learn more and get involved?
I recommend starting with the National Birth Equity Collaborative, which works to mitigate Black maternal and infant disparities. The Birthing Place, Bronx is a midwifery-led birthing center initiative dedicated to supporting women of color. The Tahirih Justice Center advocates for immigrant women and girls who are survivors of gender-based violence. The National Black Justice Coalition is a civil rights organization dedicated to the empowerment of LGBTQ/SGL people, including those living with HIV/AIDS. Finally, Planned Parenthood provides comprehensive reproductive health services to low income women.
The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. American Journal of Public Health, 2012.
Centers for Disease Control: www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html
Unequal Treatment: Confronting Racial and Ethnic Bias in Healthcare. Institute of Medicine, 2003.
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