Special Issue: Reproductive Justice – Global and Psychological Perspectives
Abstracts, Implications, and APA Citation
Documenting Reproductive Injustice, Striving for Reproductive Justice
Judith L. Gibbons, Nancy M. Sidun, and Joan C. Chrisler
Published Online: July 1, 2024
APA Style Citation:
Gibbons, J. L., Sidun, N. M., & Chrisler, J. C. (2024). Documenting reproductive injustice, striving for reproductive justice [Editorial]. International Perspectives in Psychology, 13(3), 115-118. https://doi.org/10.1027/2157-3891/a000106
Editorial:
What are the critical issues faced by women worldwide? At the 2022 meeting of the American Psychological Association (APA) Division 52’s (International Psychology) International Committee for Women (ICfW), we recognized the wide scope and severity of the challenges women face, including threats to their physical and mental health, economic well-being, social equality, education, employment opportunities, and the ability to lead a peaceful existence. Reproductive justice was identified as a critical theme that connects many of these issues. In 2010, members of the ICfW and members of APA Division 35’s (Psychology of Women) Global Issues Committee (GIC) undertook a joint project: publication of a book entitled Reproductive Justice: A Global Concern (Chrisler, 2012). Chapter authors reviewed relevant literature related to reproductive justice, pointed to gaps in knowledge, and urged psychologists to conduct research with reproductive justice in mind. Ten years after the book’s appearance, it seemed timely to revisit this pressing topic.
A special issue of International Perspectives in Psychology: Research, Practice, Consultation was the most fitting forum to showcase this important work, and we thank the Editor, Ines Meyer, for her agreement and support. The call for papers led to an enthusiastic response of 26 submissions on a variety of pertinent and interesting topics. This special issue represents the culmination of our initial selection, constructive reviews by generous expert peer reviewers, multiple revisions by engaged and persistent authors, and final publication of the five outstanding articles you find here. Those articles represent a variety of cultural and geographic settings, including diverse populations in North America, action research from South Africa, and a cross-national study of Mexico, India, the United States of America (US), and the United Kingdom (UK).
Reproductive Justice
The term reproductive justice has been in standard use in women’s studies for almost 30 years. It was introduced in 1995 by a group of US Women of Color who had attended the International Conference on Population and Development in Cairo, during which governmental representatives of 180 nations agreed that reproductive rights are human rights that must be protected (Center for Reproductive Rights, 2009). Loretta Ross (as cited in Silliman et al., 2004, p. 4) recalled that, as she and her colleagues discussed the Cairo Conference agreement, they realized that “our ability to control what happens to our bodies is constantly challenged by poverty, racism, environmental degradation, sexism, homophobia, and injustice.” In other words, reproductive rights are not sufficient if women are unable to exercise those rights. “Reproductive rights denied – whether by law, custom, ignorance, or access – is injustice” (Chrisler, 2012, p. 2). The term reproductive justice is preferred because it includes, but goes beyond, traditional concepts of reproductive rights and reproductive health.
Reproductive justice “has three primary principles: (1) the right not to have a child; (2) the right to have a child; and (3) the right to parent children in safe and healthy environments” (Ross & Solinger, 2017, p. 9). Reproductive justice intersects with other social justice movements, and it rests in a human rights framework that includes both positive rights (i.e., governments must guarantee that women can exercise their rights and live in freedom and dignity) and negative rights (i.e., governments must not interfere with women’s bodily autonomy and health-care decision-making; Ross & Solinger, 2017). A broad view of reproductive justice goes beyond the typical topics of access to contraception and abortion to include the ability to choose one’s own sexual partners, access to infertility treatments and adoption services, healthy pregnancies, safe birthing options, breastfeeding and parenting support, protection from sex trafficking and genital cutting, quality sexual and reproductive health care, and comprehensive sex education (Chrisler, 2012).
Penchansky and Thomas’ (1981) five As are important to any consideration of the health care, social resources, and legal protections that make reproductive justice possible (Chrisler & Sagrestano, 2020). For example, health care services must be available in a region in sufficient capacity to serve people’s needs. Those services must be accessible, such that they are available within reasonable distance via adequate transportation. The services must accommodate people’s diverse needs (e.g., offer evening hours and wheelchair access). The services must be affordable (e.g., universal health care or low cost). The services must be acceptable (i.e., accommodate cultural beliefs and practices) because patients are more likely to seek services from, and feel comfortable with, providers who are similar to them (e.g., in gender, race, or ethnicity); in some countries women have told researchers that they are forbidden to (or fear to) visit clinics that do not have any female physicians or staff who are members of their ethnic group (Dhaler, 2017; Yaya et al., 2018).
Achievement of the United Nations Sustainable Development Goals (SDGs; United Nations, 2015) is key to supporting reproductive justice (and vice versa). The following goals are especially relevant to reproductive justice: 1 – ending poverty (e.g., to allow accessible education and health care services), 2 – zero hunger (e.g., to enhance the health and well-being of all family members, to support healthy pregnancies and menstrual cycles), 3 – good health and well-being (e.g., to support healthy families), 4 – quality education (e.g., to understand one’s reproductive processes, to provide life and employment skills), 5 – gender equity (e.g., to promote equality in health care and other decision-making), 6 – clean water and sanitation (e.g., to improve health, to ensure good menstrual hygiene), 8 – decent work and economic growth (e.g., to afford to raise children ), 10 – reducing social inequalities (e.g., to allow all members of society to live in dignity and good health), and 16 – peace, justice, and strong institutions (e.g., to support physical and mental health, to ensure human rights). The authors of the articles in this special issue have addressed how their studies are linked to the SDGs.
The first article, “Gendered Racism in Pregnancy and Stress among Women in the United States during the COVID-19 Pandemic” by Emily Rehbein, Amanda Levinson, Heidi Preis, Brittain Mahaffey, and Marci Lobel, highlights the intersectionality of women’s experiences (Rehbein et al., 2024). Prenatal stress among women in the United States was exacerbated by experiences of gendered racism during pregnancy. This study confirmed that, even during the COVID pandemic, a time of heightened stress, racism contributed significantly to women’s distress. This study underscores the need for culturally informed individual interventions and change at multiple societal levels and by multiple institutions in order to reduce the adverse reproductive outcomes that disproportionately affect Women of Color in the United States.
The second article, “Unmet Expectations, Unmet Needs, and Uncertainty – A Qualitative Survey Study of Women Who Described Giving Birth as Traumatic” by Tonya Pavlenko, Lillien Nathan, Ellen Yom, Agnes Stachnik, Allison Yarrow, and Lisa Rubin, showcases the value of listening to women’s voices (Pavlenko et al., 2024). This qualitative study analyzes the responses of 54 US women who described the experience of giving birth as traumatic. Their anguish was both emotional and physical. They suffered from loss of autonomy and conflicts with work expectations and the medical establishment. The study highlights that prior traumatic and perinatal experiences can fuel traumatic births. The authors suggest that the US cultural context of rugged individualism intensifies these women’s experiences of being discounted and ignored when they raise concerns about pain levels and what they believe is happening to their bodies. This study validates previous studies but expands them by contextualizing traumatic births in terms of the social and cultural factors that precipitate trauma. The centrality of economic and racial factors in setting the stage for birth trauma confirms the findings of the study by Rehbein et al. (2024) that racism makes achieving reproductive justice difficult.
The third article, “Abortion Attitudes Across Cultural Contexts: Exploring the Role of Gender Inequality, Abortion Policy, and Individual Values” by Lora Adair, Nicole M. Loranzo, and Nelli Ferenczi, addresses the factors associated with abortion attitudes in four countries – Mexico, India, the United States, and the United Kingdom (Adair et al., 2024). Restrictive attitudes toward abortion were associated with gender inequality and restrictive abortion policies at the country level. At the individual level, respondents with less egalitarian gender attitudes, greater belief in moralizing gods, and longer-term sexual strategies also held more restrictive abortion attitudes. The findings reinforce those of other studies in this special issue that both contextual factors and individual viewpoints are key to enacting reproductive justice.
Our fourth article, “Enacting Reproductive Justice: The Development and Refinement of Person-Centred Abortion Counselling Training” by Catrionia Ida Macleod, Yamini Kalyanaraman, and Laurah Mogonong, reports innovative action research (Macleod et al., 2024). Pre-abortion counseling sessions by 28 abortion healthcare workers from the Eastern Cape province of South Africa and interviews with 30 Black cisgender women and four healthcare providers regarding their experiences of pre-abortion counseling were analyzed. Numerous problematic directive and anti-abortion interactions were identified; they centered around actively trying to discourage women from having an abortion. This led to the development of a policy brief and the creation of an in-service person-centered abortion counseling training course. This step-by-step guide for providers addressed the content and process of abortion counseling, including what should be avoided. Significant shifts in the healthcare providers’ actions were recognized when the baseline findings were compared to the action research. The changes noted included, but were not limited to, respecting bodily integrity and enabling autonomous decision-making. Advocacy that promotes ongoing structural and social barriers to abortion access is needed to support and sustain the positive changes noted by abortion counseling healthcare providers.
In the fifth article, “Uncovering Reproductive Injustice Towards Women with Disabilities: A Scoping Review,” the authors Laura Pacheco, Coralie Mercerat, Marjorie Aunos, Marie-Marthe Cousineau, Ami Goulden, Michelle Swab, Bethany Michelle Brenton, and Sibusio Moyo review literature about reproductive violence suffered by women with disabilities (Pacheco et al., 2024). Most of the 28 articles in English and French included in the scoping review focused on the perspectives of women with disabilities rather than those of medical professionals or caregivers. The themes included experiences of not receiving adequate information or having contraception imposed. Women were sometimes sterilized with consent from caregivers, but not from the women themselves. Women with disabilities also faced physical barriers to reproductive healthcare and were not afforded agency in making their own healthcare decisions. This article is critical to the special issue, not only because of its focus on women with disabilities, but because the scope is wider than abortion, pregnancy, and childbirth. It encompasses other reproductive injustices such as lack of information and access to appropriate and respectful care.
Conclusion
Most of the work done within a reproductive justice framework, whether by scholarly researchers, women’s rights activists, or women’s health advocates, has focused on contraception and abortion, with reduction of maternal mortality a close second. Psychologists have produced a large literature on sexual assault, but it has rarely been studied in connection with reproductive justice. There is also a considerable literature on the stresses associated with infertility and its treatment, but, again, rarely within a reproductive justice framework. Most psychological research on the menstrual cycle in minority world countries concerns attitudes and symptom management, although menstrual rights activists have been focused in recent years on period poverty (i.e., inaccessibility of menstrual hygiene products) in both majority and minority world countries. Recently psychologists have begun to pay closer attention to reproductive health needs of women from particular subgroups, sometimes with reference to reproductive justice, such as women with disabilities (e.g., Miles-Cohen & Signore, 2016), homeless women (e.g., ElBanna et al., 2023), heavy weight women (e.g., Ward & McPhail, 2019), immigrant and refugee women (e.g., Hawkey et al., 2018), incarcerated and formerly incarcerated women (e.g., Ramaswamy et al., 2018), injection drug users ( e.g., Mburu et al., 2018), and transgender and non-binary people (e.g., Salden et al., 2023).
Despite the progress that has been made in the last 12 years, much more work remains to be done. We would like to see the scope of research within the reproductive framework broadened to cover topics beyond contraception, abortion, prenatal care, and childbirth. We need more (and more sophisticated) studies of women in the majority world, and we need larger and more diverse samples of participants from the minority world. Studies that address multiple factors and more than one related topic could be useful. Researchers should be aware of biases that may account for, for example, the scarce studies of infertility in the majority world and period poverty in minority world countries. As Ross et al. (2004) noted, women’s reproductive rights and health are challenged almost everywhere.
Psychologists have long known the importance of a sense of control to people’s mental health. When women lack the ability to control their own bodies and to make their own health care decisions, we can expect psychological distress and mental health concerns to emerge (e.g., Chrisler & Johnston-Robledo, 2018). Reproductive justice is important for women’s mental, physical, social, and economic health. Furthermore, work toward reproductive justice can help nations to reach their Sustainable Development Goals and thus improve the quality of life of their entire populations.
Gendered Racism in Pregnancy and Stress Among Women in the United States During the COVID-19 Pandemic
Emily Rehbein, Amanda Levinson, Heidi Preis, Brittain Mahaffey, and Marci Lobel
Published Online: July 1, 2024
APA Style Citation:
Rehbein, E., Levinson, A., Preis, H., Mahaffey, B., and Lobel, M. (2024). Gendered racism in pegnancy and stress among women in the United States during the COVID-19 pandemic. International Perspectives in Psychology, 13(3), 119-127. https://doi.org/10.1027/2157-3891/a000104
Abstract: High stress experienced during pregnancy increases risk for adverse birth outcomes such as low birthweight and preterm birth that occur disproportionately among women of color in the United States. Prior research has identified a distinct form of discrimination, gendered racism in pregnancy (GRiP), that likely elevates stress and is suspected to contribute to racial disparities in birth outcomes among American women. We investigated associations of GRiP experiences and distress with two types of stress, pregnancy related and pandemic related, among 2,995 pregnant women in the United States at the height of the COVID-19 pandemic, a time when health care restrictions, social contact limitations, and concerns about COVID-19 infection created added stress for pregnant women. Using data collected online during the second US pandemic surge (December 2020), we found that pregnant self-identified Hispanic/Latina (n = 233), Non-Hispanic/Latina Black/African American (n = 182), and Multiracial/Other (n = 201) women experienced greater GRiP and greater stress of both types than Non-Hispanic/Latina White women. Structural equation modeling indicated a strong association of racial/ethnic identity with prenatal stress that was mediated by GRiP, independent of other contributors to prenatal stress. Focusing on the harmful impact of gendered racism coupled with culturally informed individual interventions and change at multiple societal levels and institutions may help reduce the poorer reproductive outcomes that are disproportionately common among communities of color in the United States. Addressing and alleviating discrimination can improve reproductive justice for all who choose to give birth throughout the world, regardless of their race, ethnicity, nationality, or other identities.
Impact and Implications: Reproductive justice for pregnant women requires recognition of the harms imposed by structural and societal systems that elevate stress and resulting health risks, especially for marginalized groups. Study results confirm that gendered racism experienced during pregnancy by American women of color is associated with greater stress and highlights the likely impact of discrimination on reproductive health disparities in this country and among marginalized communities across the world. This study addresses United Nations Sustainable Development Goals (SDGs) #3 good health and well-being; #5 gender equality; #10 reduced inequalities; and #16 peace, justice, and strong institutions.
Unmet Expectations, Unmet Needs, and Uncertainty–A Qualitative Survey Study of Women Who Described Giving Birth as Traumatic
Tonya Pavlenko, Lillien Nathan, Ellen Yom, Agnes Stachnik, Allison Yarrow, and Lisa Rubin
Published Online: July 1, 2024
APA Style Citation:
Pavlenko, T., Nathan, L., Yom, E., Stachnik A., Yarrow, A., & Rubin, L. (2024). Unmet expectations, unmet needs, and uncertainty – A qualitative survey study of women who eescribed giving birth as traumatic. International Perspectives in Psychology, 13(3), 128-137. https://doi.org/10.1027/2157-3891/a000102
Abstract: Traumatic childbirth can have wide-ranging consequences for birthing individuals. Data were obtained from a large-scale (N = 1,210) online survey of perinatal experiences in the United States. Utilizing a Reproductive Justice framework, we analyzed open-ended responses regarding the most difficult aspects of pregnancy and childbirth from 54 participants who solely identified their births as traumatic. We identified the following themes: Mental and Emotional Toll; The Toll of Relentless Work Expectations; The Embodied Toll; Complications and Interventions; Loss of Control: Bodily Autonomy; and Loss of Control: Interactions with Medical Systems and Professionals. Results underscore the inadequacy of perinatal support in the United States, highlighting the imperative to address policy and research to advance the UN Sustainable Development Goals of Good Health and Wellbeing and Gender Equality.
Impact and Implications: In the present study, participants who self-described their births solely as traumatic highlighted key challenges throughout the perinatal period: lack of paid family leave, inadequate access to holistic perinatal care, dismissal of pain and embodied cues, and constraining cultural norms surrounding birth and motherhood. Findings underscore the systemic lack of support for birthing people in the United States, emphasizing the need to address policy and research gaps to achieve UN SDGs of Good Health and Wellbeing and Gender Equality.
Abortion Attitudes Across Cultural Contexts: Exploring the Role of Gender Inequality, Abortion Policy, and Individual Values
Lora Adair, Nicole Lozano, and Nelli Ferenczi
Published Online: July 1, 2024
APA Style Citation:
Adair, L., Lozano, N., & Ferenczi, N. (2024). Abortion attitudes across cultural contexts: Exploring the role of gender inequality, abortion policy, and individual values. International Perspectives in Psychology, 13(3), 138-152. https://doi.org/10.1027/2157-3891/a000101
Abstract: We explored between-country and within-country variability in abortion attitudes, using country-level factors (e.g., gender equality) and individual-level factors (e.g., gender role attitudes) as predictors. Participants from Mexico (N = 215), India (N = 215), the United States (N = 215), and the United Kingdom (N = 206) were recruited via Qualtrics Panels. Regression models and ANOVAs were used to assess whether estimates of gender inequality, gender role attitudes, motherhood norms, belief in big/moralizing gods, and sexual strategy were associated with abortion attitudes. As predicted, individuals living in countries with greater gender inequality, and more restrictive abortion policy, reported more restrictive abortion attitudes and stronger support for banning abortion. Furthermore, individuals who endorsed more traditional gender role ideologies, who reported belief in big/moralizing gods and who used long-term sexual strategies also reported more restrictive abortion attitudes and stronger support for banning abortion. Exploratory analyses highlight how these relationships vary as a function of cultural context. We can conclude that both contextual factors (e.g., local abortion legislation and gender inequality) as well as individual factors (e.g., gender role attitudes and religious/spiritual belief) shape people’s attitudes toward abortion. Implications regarding the bidirectional relationship between attitudes and policy in reproductive health are discussed.
Impact and Implications: Abortion attitudes matter—disapproving and judgmental attitudes toward abortion may create barriers to accessing needed abortion care as well as ostracism and stigma toward those receiving abortion care. Our findings, across the United States, the United Kingdom, India, and Mexico, demonstrate that achievement of gender equality (United Nations’ SDG #5) and promoting well-being and healthy lives for all at all ages (SDG #3) will depend on addressing both individual beliefs (i.e., beliefs about supernatural punishment, attitudes about people’s roles in society as a function of their gender, and attitudes about casual sex) and institutional structures (i.e., gender inequality and abortion legislation) that stand against safe and accessible abortion care for all.
Enacting Reproductive Justice: The Development and Refinement of Person-Centered Abortion Counseling Training
Catriona Ida Macleod, Yamini Kalyanaraman, Laurah Mogonong
Published Online: July 1, 2024
APA Style Citation:
Macleod, C. I., Kalyanaraman, Y., Mogonong, L. (2024). Enacting reproductive justice: The development and refinement of person-centered abortion counseling training. International Perspectives in Psychology, 13(3), 153-163. https://doi.org/10.1027/2157-3891/a000105
Abstract: How may reproductive justice be enacted in services and provider training to further the sustainable development goals of healthy lives and universal access to sexual and reproductive health and rights? We argue for careful baseline qualitative research infused with feminist and reproductive justice theory and, based on the findings of this research, the development and refinement of healthcare provider training through action research. We report on our implementation of this process in developing an in-service person-centered abortion counseling training course aimed at South African abortion healthcare providers. The baseline research consisted of recordings of abortion counseling sessions and interviews with healthcare providers and users. Several problematic directive and anti-abortion interactions were surfaced, which led to the development of a policy brief and step-by-step guidelines for providers. Subsequently, action research was employed to operationalize these guidelines into an in-service person-centered abortion counseling training course, and an iterative process enabled course improvement. Data collected for the course refinement included recordings of various sessions during the course, participants’ reflective journals, case presentations, and feedback forms, as well as interviews conducted two months post the first course. Comparing baseline findings with data collected as part of the action research shows some shifts in healthcare providers’ actions. We report on a shift in respecting bodily autonomy and encouraging autonomous decision-making. Structural and normative barriers continue, however. The enactment of reproductive justice through in-service training shows promise but must be supplemented with advocacy around other barriers.
Impact and Implications:
• Careful qualitative health research can surface healthcare practices that undermine reproductive justice and the realization of SDG5.
• Using our development of an in-service abortion counseling training course, we show how such research can be used to inform training and how action research can be used to refine training.
• Shifts in the healthcare provider practices illustrate how such processes can bear fruit in enacting reproductive justice.