The creation and maintenance of the United States is littered with violence towards Black and Indigenous communities. At its core, the United States is an empire founded on the pillars of patriarchy, white supremacy, and settler colonialism. Indigenous elimination and the enslavement of Black people was the start of a legacy we have yet to unlive. As I reflect on the current state of the world and the United States’ active role in many issues—immigration rights, abortion rights, trans rights, access to healthcare, police brutality, incarceration, censorship, fascism, imperialism, to name a few—I remind myself that these issues are all coming from the same systems of oppression. The lens of reproductive justice helps us see how these systems are operationalized and connected; when we know how they operate, we are better equipped to disrupt, or at the very least, not perpetuate them.
Reproductive justice was born out of a necessity to address the racism and exclusion that Black women experience in their daily lives. Twelve Black women in Chicago developed three tenets that lay the foundation of the modern reproductive justice framework: the right to have a child, the right to not have a child, and the right to parent one’s child in a safe environment. Bodily autonomy was later incorporated in the framework, expanding our understanding of justice to include autonomy over one’s gender, sexuality, and overall life. A fifth tenet is currently in the works by Dr. Crystal M. Hayes: “the right to heal, rest, and experience joy in our bodies.” These tenets encompass a human rights perspective that examines the interconnectedness of social, cultural, political, and economic factors that affect us all.
“Well, reproductive justice is a human rights based framework. And so we demand the achievement of full human rights, not only to protect the right to have a child, or not to have a child, and to raise your children, and to express your gender identity, and all of that, but we’re up against a real—I don’t even want to call it a resurgence—of neo-fascism and authoritarianism across the globe. And I believe human rights is the best antidote to fascism.” –Loretta J. Ross
From ICE raids to inequitable healthcare, climate crisis to food insecurity, anti-abortion laws to long-COVID, genocides to militarism and policing, there is an ever-flow of state sanctioned violence that we are subjected to, both domestically and abroad. In order to move towards a society where human rights are guaranteed, we can use a reproductive justice framework to understand the interconnections between white supremacy, patriarchy, and settler colonialism, and their impacts on health justice. In particular, we must understand the function of anti-Blackness and how it is weaved throughout.
Slavery is one of the foundations of the United States. In order to justify slavery and its capitalist utility, Black people were dehumanized socially, politically, and culturally. Black women who were enslaved experienced gender-specific torture through rape, separation from their children, and medical experimentation. For instance, J. Marion Sims, known as the “father of gynecology,” experimented on Black women without anesthesia for his own understanding on how to surgically fix fistulas. Though we do not know the names of all the Black women he experimented on, we do know Anarcha, Lucy, and Betsey. The violence Sims subjected onto them and many others is a prime example of the long history of the United States exploiting Black people’s bodies, particularly Black women. With this foundation, alongside the genocide and occupation of Indigenous communities, the United States normalized inhumane conditions for a group of people deemed “unworthy,” solidifying violence as a mechanism for oppression.
The exploitation of Black women also appeared in the treatment of Black midwives. Black midwives were a cornerstone of birthing, as they provided emotional care, hygienic practices, and prenatal and maternal care for both Black women and non-enslaved people up until the 1900s. This is in addition to being forced to birth children for white men through rape. As medicine began gaining prestige and becoming institutionalized, white male physicians saw Black midwives as a threat to owning, practicing, and evolving reproductive medicine. By the 1920s and 1930s, physicians led racist propaganda about Black midwives, created systemic barriers to midwifery education, and helped create racist laws leading to the medicalization of birth and reproductive care, drastically reducing the number of Black midwives that could practice. Black midwives were branded as unprofessional, untrustworthy, and incompetent which helped delegitimize midwifery as a field and changed the landscape of birthing practice with only 15% of births attended by midwives by 1945 and an increase in maternal mortality in the same time period. By 2021, about 77.5% of midwives in the United States were white and about 4.7% were Black. The combination of midwifery practices being pushed out of reproductive care, the ushering of medicalizing reproductive care, and the whitewashing of midwifery itself was a way of institutionalizing white supremacy in medicine. By using the labor and bodies of Black women for white society and then abruptly discarding them, Black women were not just exploited, they were fully dehumanized.
White supremacy explains the position of ‘white’ as the dominant race in a racial hierarchy that adheres to a system of ensuring that white people maintain power through the means of exploitation and dehumanization. The cycle of white supremacy includes white rage, white fragility, white pleasure, and white guilt, all of which sustain structural racism in all parts of the United States including reproductive health care. The medical system is founded on white supremacy and in its wake, has left non-white communities with enormous medical trauma and public health inequities. The ongoing existence of medical racism and sexism is a consequence of the dehumanization of enslaved Black women in reproductive care. For instance, Henrietta Lacks was a Black woman diagnosed with cervical cancer at John Hopkins Hospital in 1951. Lacks died about eight months after the diagnosis and her cells, eventually called the HeLa immortal cell line, were used for experiments without her permission in life and even after her death, including for the development of the polio vaccine, in vitro fertilization, cloning, and gene mapping. Lacks’ body was used for advancing medicine—and profits—with no concern for her bodily autonomy. This disregard is not happenstance. It is a clear example of how white supremacy functions in medicine and medical research to this day.
White supremacy is not limited to prenatal and maternal care, but also pervades the choice around children. Control over Black women’s bodies in the United States extended into having children and not having children during slavery and thereafter. Since Black women were “owned” as “property” by white people during slavery, they had to secretly have an abortion if they wanted one. In response, white male doctors banned abortions nationwide (but the ban did not apply to wealthy white women). It was not until 1973 that Roe v. Wade offered legal protections for receiving abortions across the country, which has since been overturned. And, despite 49 years of legal protection for receiving an abortion, Roe v. Wade did not actually address the systemic barriers Black and Brown women face around accessing abortion services, reproductive healthcare, and maintaining bodily autonomy. The “ownership” and control on Black women through slavery, restrictions to abortion, medical racism and sexism, and exploitation of labor elucidates how misogynoir—the unique form of violence against Black women—underpins gender oppression and human right violations as a whole, in healthcare and beyond.
Forced sterilization is yet another example of how control over Black women’s bodies extends to control any group of people deemed “undesirable,” such as disabled people, poor people, incarcerated people, and people of color. The term “Mississippi appendectomy,” for instance, refers to when Black women in the South were forcibly sterilized from the 1920s-1980s. California had eugenics programs that targeted Asian, Mexican, and incarcerated communities and Virginia’s Buck v. Bell led to the forced sterilization of 65,000 Americans with mental illness and other disabilities. Between 1970 and 1976, 25-50% of Native American women were sterilized and between the 1930s and 1970s, about one third of Puerto Rico women were sterilized. Recent examples include a nurse at an ICE detention in 2020 who sounded the alarm on a physician performing sterilizations on immigrant women that were detained. Forced sterilization is a deliberate means to further the settler colonial agenda through control and erasure, and “purify” the United States to uphold white supremacy, all through medical practice.
Consider also the case of Adriana Smith, a Black woman in Georgia whose dead body was used to continue a pregnancy she could not consent to. Smith first experienced medical racism by being dismissed at an ER when she presented with headaches. Her boyfriend rushed her to a different hospital the next day due to difficulty breathing. After being examined, Smith’s mother was told by doctors that Smith had multiple clots in her brain; the doctors were unable to successfully do a necessary procedure and pronounced Smith brain dead on February 19, 2025. Without any consent from the family, Smith was put on life support. At the time of Smith’s death, she was nine weeks pregnant and the hospital kept Smith’s body on machines until a fetus was extracted from her dead body.
Georgia’s “personhood law” or the LIFE Act outlines that abortion is illegal after an ultrasound detects cardiac activity in an embryo and that “unborn children are a class of living, distinct persons.” The implications of such legislation go beyond abortion services, touching on fertility treatment, child support, and the criminalization of pregnant people for miscarriages. There is ongoing debate on the “personhood law,” with an attorney general voicing that the Georgia law did not prohibit Smith to be taken off the ventilator and a Senator stating that doctors acted appropriately to save the fetus. In this case, “consent” is being manufactured by the government and the media to normalize anti-Black violence by creating language, narratives, and laws that control and dehumanize Black women, while situating an embryo’s personhood as greater than the pregnant person, making it even easier to justify medical violence.
It is important to note that Smith experienced medical racism from the very system she worked in. As a nurse, Smith provided care for patients at Emory University hospital. It is not unique for Black women who work as healthcare providers to die from the system that should theoretically care for them. In 2020, Dr. Susan Moore had COVID-19 and was admitted to the hospital where she experienced dismissal and neglect; she died. That same year, Dr. Chaniece Wallace developed complications from giving birth, and existing preeclampsia that doctors had not identified, and died two days later.
Smith joins a lineage of Black women where racism was a causative factor of their deaths and whose labor was used in the medical system that had no care for them. Black women’s labor is historically essentialized and then demonized at the whim of white supremacy (e.g., Black midwives), and their lives are systematically neglected and violated. Additional recent examples of the treatment of Black women in reproductive care include Karrie Jones who was in active labor in Mesquite, Texas and ignored by a nurse for thirty minutes, and Mercedes Wells who was discharged in Crown Point, Indiana while in active labor and delivered her baby on the side of the road, eight minutes after leaving.
By investigating the control of Black women’s reproductive health we can see how white supremacy and the patriarchy attempt to both homogenize a nation and utilize an oppressed group for labor and white society through dehumanization and exploitation. And, through the dehumanization and exploitation of Black women it lays the foundation to expand white supremacy and target more groups of people. It is imperative that public health understands the historical context of Black women’s experiences and how reproductive justice can frame the context of these issues. Reproductive justice was created by Black women as a means to understand and address misogynoir in healthcare. The framework is integral to public health addressing the vast consequences of oppression. As public health professionals and practitioners we must equip ourselves with the knowledge of history to better address public health issues and center humanity in our practices.
Authored by Lidia Aragai
Lidia Aragai is a public health professional based in the United States. She is an advocate for reproductive justice and in her free time volunteers with grassroots organizations for mutual aid in the local community.
