Conversations around reproductive rights often focus exclusively on topics like abortion and pregnancy, without considering the full spectrum of women’s health. But what about the decades of reproductive healthcare needs before, between, and after pregnancies?
A comprehensive reproductive justice framework includes the right to bodily autonomy, to bear children or not bear children, and to parent children in safe and sustainable communities. When we neglect core reproductive rights and ignore the full spectrum of women’s needs (including menstrual health, perimenopausal symptoms, access to contraception, and fertility preservation), we are neglecting women’s health.
This neglect results in a lack of policy attention, creating gaps that actively harm women, especially women of color and those from low-income communities. Unfortunately, this is a pattern that has been in place for decades, and the consequences are already evident. Only 55.4% of Black women and 49.9% of Indigenous women have continuous health insurance during and after pregnancy, for example, compared to 75.3% of white women.
If we are going to change statistics like these, embracing the reproductive justice framework is a way to address the full spectrum of reproductive healthcare. This is especially true among the most marginalized women, who face compounding barriers of poverty, racism, and systemic abuse and neglect.
The Trust Gap: Acknowledging a History of Reproductive Violence
The United States has a long history of not only neglecting but also actively harming the health of women, especially those from marginalized communities. Consider the legacy of reproductive control in the country, for example. By 1970, Black women were sterilized at twice the rate of white women. And prior to 1977, an estimated 100,000 to 150,000 poor, mostly Black women were sterilized annually under federal programs.
Coerced contraception is another longstanding issue. In some cases, IUDs or implants were inserted without a patient’s complete understanding or consent. In others, contraception was cited as a prerequisite for women to keep getting government benefits or even retain custody of their children.
Such issues continue to shape present-day healthcare disparities and influence how women, particularly women of color, experience reproductive healthcare today. Historical violence has mutated and now appears in different forms, like undertreated pain, denied access, and policies that prioritize control over care.
Take something like IUD insertion, for example. This can be an excruciating procedure, but pain management is rarely prioritized, especially for Black women. Pain during IUD insertion is routinely undertreated in Black women due to persistent racist beliefs that Black bodies experience less pain.
Systemic hurdles further complicate the situation. Transportation barriers, lack of paid sick leave, inadequate insurance coverage, and rigid clinic policies that penalize lateness all work to limit healthcare access, especially for women from marginalized communities. The result: Rightful mistrust in a system that often hurts more than it helps.
The Conversation Gaps: What’s Missing in Reproductive Healthcare Policy
Mistrust in the system is compounded by the fact that the current reproductive rights framework blatantly ignores key components of women’s lived experiences. Menstrual health topics are conspicuously absent from policy conversations, for example, including perimenopause and menopause.
Neglecting these topics in policy conversations has very real repercussions for women’s health. Take perimenopause and menopause as an example. While symptoms like hot flashes, mood changes, irregular bleeding, and sleep disturbances can significantly impact quality of life and work, there is generally limited insurance coverage for treatments to address these symptoms.
It’s a similar story for menstrual health complications, such as painful or irregular periods. Managing these symptoms requires regular access to healthcare. However, the same insurance disparities, transportation barriers, and lack of workplace flexibility that limit abortion access also prevent women from getting routine gynecological care needed to address painful menstruation and related disorders, like endometriosis (a condition that is underdiagnosed in Black women).
What Reproductive Justice Across the Lifespan Looks Like
We cannot claim to support reproductive health while ignoring the decades of care people need outside of pregnancy. Policy attention must also expand to encompass these areas. This could include steps like full contraception coverage without copays, expanded coverage for doula and midwife care, fertility treatment access regardless of marital status or sexual orientation, and menopause symptom management.
It’s also critical to address social determinants that impact access to reproductive healthcare services. Affordable childcare, paid family leave protections, and transportation assistance to healthcare appointments are just a few ways that barriers to access can be addressed.
Such steps align with my principle that when we center care around equitable access for the most marginalized, we improve healthcare for all. By demanding policies that support the full spectrum of reproductive justice, especially in historically underserved communities, we create a healthcare system that works for all women, across the entire lifespan, not just the privileged few, in a select few moments of their lives.