Reproductive Justice Overview

Last Updated Mar 1, 2024

This guide is intended to help donors gain a deeper understanding of reproductive justice and outlines opportunities to address the root causes of inequitable outcomes. See the entire series. By Kelly Macías, Ph.D.

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What Is Reproductive Justice?

Every person deserves the right to make decisions about their own body, to choose to have children or not, and to raise the children they have in safe and healthy communities. Unfortunately, this is not the case everywhere. Access to safe, legal abortion, contraception, sexual education, and reproductive healthcare (annual exams, pap smears, and cervical cancer treatment) are barriers for many people around the world. Reproductive justice is a term coined by Black women in 1994, who recognized that the right to plan a family, or choose not to have one, is a central part of discussions on economic and social empowerment. Reproductive justice seeks to ensure that women, transgender, and gender nonbinary people are healthy, able to reproduce if and when they choose to, and have the economic resources to plan and care for their families.

"Without adequate income and healthcare, many women find it almost impossible to protect their health and provide for their families. In addition, an unplanned or forced pregnancy can push a [poor] woman even further into economic peril." -National Organization for Women Foundation

Lack of access to quality sexual and reproductive healthcare disproportionately impacts people who are low-income, women (particularly women of color), immigrants, and LGBTQIA+ people. This is why reproductive justice is connected to other issues like income inequality, racial and gender discrimination, criminal justice, unemployment, environmental justice, adequate housing, and transportation.

Women living in U.S. states with better reproductive healthcare access (including insurance coverage of contraceptive drugs and services, expanded Medicaid eligibility for family planning, and availability of state-supported public funding for medically necessary abortions) have higher earnings, are more likely to transition between jobs and from unemployment to employment than women in states with limited reproductive healthcare access.

Nearly 150 female inmates in California prisons were sterilized, many without giving consent, between 2006 and 2010. This practice was not officially banned until 2014.

In 2020, 19 women, the majority of whom were Black and Latina, held at a Georgia immigration detention facility reported being forced to take birth control and subjected to unwarranted and unwanted gynecological surgeries to remove their reproductive organs.

Women of color are more likely to be low-wage workers, and therefore are disproportionately exposed to hazardous chemicals that cause infertility, reproductive cancers, higher rates of low-birth weight, stillbirths, and miscarriages.

Reproductive justice goes beyond the legal right to obtain abortion and birth control services. They are a necessary step, but they are not enough. To advance reproductive health, rights, and justice means ensuring that the following services are widely available: Comprehensive sex education, STI prevention and treatment, alternative birth options, prenatal and pregnancy care, and domestic violence assistance.

Why Donors Should Care About Reproductive Justice

The right to sexual and reproductive health is a basic human right along with the right to privacy, education, and freedom from violence and discrimination. Yet, violations of this right are everywhere. Family planning, access to abortion, and sex education remain extremely controversial issues, subject to political decisions that can negatively impact people’s lives. Governments around the world have often banned access to or cut funding for contraception and failed to provide reproductive health information, services, and supplies. However, philanthropists have stepped in to support access to services and programs which has helped dramatically reduce unintended pregnancies, teen pregnancies, and made abortion more widely available. Without donors, hundreds of millions of people would not benefit from the billions of dollars which go to reproductive healthcare services worldwide.

Donor Investment in Reproductive Justice

Ensuring that reproductive healthcare services are widely available and easily accessible is not only good for individuals and their families, but also has an added benefit of improving society as a whole. Offering contraceptive counseling as a part of postpartum and post-abortion care could reduce unintended pregnancies by 75% in developing regions.

Negative Consequences from Unintended Pregnancies

Unintended PregnanciesWhen we take action to reduce teen pregnancy, we improve education and employment opportunities and reduce vulnerability to crime, violence, and social exclusion.

Teen Pregnancy

Teen Pregnancy

Access to quality sexual and reproductive healthcare is especially difficult for transgender, nonbinary, and gender nonconforming individuals. Transgender individuals face higher rates of discrimination in healthcare facilities and laws prohibiting discrimination based on gender identity in health programs have been challenged in court, making it hard for transgender patients to access sexual and reproductive healthcare. It is impossible to reach true equity if vulnerable and marginalized people are prevented from accessing the care and services they need to be healthy and have bodily autonomy.

Who Is Missing Out?

In the U.S., long travel distances, lack of transportation, economic inequality, and the lack of available services are all barriers to accessing sexual and reproductive healthcare. But there are also interrelated issues, such as historical and systemic discrimination based on race and ethnicity, gender, sexual orientation, and socio-economic status that impact the ability to attain sexual and reproductive health and well-being.

The rates of unintended pregnancy for Black women and Latinas are nearly 2.5 and 2 times higher than white women. Black women are 3.5 times more likely to die in pregnancy and childbirth than white women due to lack of access and poorer quality of care.

Most private insurance covers reproductive health services and abortion care but Black women, who are disproportionately lower-wage workers, are 55% more likely to be uninsured compared to their white counterparts. Approximately 53% of abortion patients paid out of pocket for their procedure in 2014.

Average Cost of Birth Control (Uninsured Women)Birth Control Costs

Women (Reproductive Age) Living in States Considered Hostile to Abortion Rights (2019)

Abortion Rights

Access to safe abortions is increasingly becoming difficult in certain states. In a single week during April 2021, states enacted 28 abortion restrictions. While New York, Vermont, Connecticut, Oregon, Washington, and Hawaii have all expanded access to abortion, many states have passed bans to prohibit abortion if Roe v. Wade is overturned. Alabama has the most restrictive abortion law in the United States, which bans abortion under any circumstances. The Guttmacher Institute named 2021, “the worst legislative year ever for U.S. abortion rights.”Distance to Nearest Abortion Facility (if Roe v. Wade were overturned or weakened)

Pregnancy Statistics (Global)

Pregnancy Stats - Global

While 970 million women (59% of women of reproductive age) live in countries where they can exercise their right to abortion, 41% of women live under restrictive laws.

Approximately 218 million women of reproductive age in low- and middle-income countries have an unmet need for modern contraception.

The chances for unintended pregnancies are often highest for older, poor and less educated women, and is linked to increased maternal death, malnutrition, mental illness, and increased transmission of HIV to children.

What Is Causing These Disparities?

Lack of Access to Contraceptives

Unintended pregnancy mainly occurs because of factors such as contraceptive failure, lack of access to contraception, or non-contraceptive use. People who were not planning to get pregnant may delay getting care which can endanger their lives as well as the lives of their children. Unplanned pregnancies can have devastating physical, emotional, and economic consequences for everyone. It is estimated that unplanned pregnancies cost federal tax payers between $9.6 and $12.6 billion annually for prenatal, labor and delivery, postpartum, and infant care.

Studies show that publicly funded family planning programs play a direct role in making contraceptives more affordable and can prevent unintended pregnancy and abortion. In 2010, 9 million women (47% of all women in need of publicly subsidized care) received publicly funded contraceptive services, which prevented 2.2 million unplanned pregnancies and 760,000 abortions. Providing comprehensive sexual and reproductive health education to young people as well is important for their health and well-being.

Reproductive and Sexual Health Education (2011-2013)

Sex Education (Teens)

And only 29 states and the District of Columbia have laws that mandate sex education in schools. Fewer than half of high schools and one-fifth of middle schools teach all 16 topics that the Centers for Disease Control and Prevention recommend as essential components of sexual health education.

By providing access to contraceptive services and sexual health education, it is possible to prevent unintended pregnancies, save money, and improve the quality of life for millions of people.

Lack of Access to Safe, Legal Abortions

Research shows that the rate of abortions in the United States reached a historic low in 2017.

Abortion Rates, 1973-2017

Abortion Rates, 1973-2017

Despite the many differing opinions about it, abortion is a safe and legal alternative, especially for poor people and those who have already had at least one child. In 2014, around 75% of abortion patients had an income below the federal poverty level. And 59% of abortions in 2014 were obtained by patients who previously had at least one birth.

Nonbinary and transgender people require access to abortions and reproductive care as well. Unintended pregnancies can be experienced by transgender men, nonbinary, and gender nonconforming people who have been assigned female at birth. In a study of almost 200 transgender men, 17% became pregnant and 12% of those who were pregnant had abortions.

Transgender and nonbinary people face significant barriers to obtaining necessary reproductive health services because of discrimination. Additionally, many doctors and nurses have little experience in treating transgender and nonbinary patients, resulting in a lack of competent and compassionate care.

There are many laws around the country which seek to restrict abortion with the belief that if they aren’t available, people will not have them. But experts say this is inaccurate. According to the Guttmacher Institute, the decline in the national abortion rate is likely due to the decline in pregnancy and birth rates overall. More importantly, experts say that preventing access to abortion by closing clinics and creating barriers for patients is in direct conflict with sound public health policy.

“Rather, it is critical to remember that timely and affordable access to abortion should be available to anyone who wants and needs it. And it is equally important to recognize that obstructing or denying care in the name of reducing abortion is a violation of individuals’ dignity, bodily autonomy and reproductive freedom.”

Limited Funding for Reproductive Health

Despite the tremendous need for programs that support sexual and reproductive health, funding for these issues is on the decline internationally. Out of the total amount of donor funding spent on health, the amount given for reproductive health went from 52% in 2011 to 42% in 2016 and 2017.

Donor Funding for Reproductive Health

Donor Funding - Reproductive RIghts

Most of the funding given for sexual and reproductive health goes to HIV prevention, while services like prenatal and postnatal care, access to safe abortion, and family planning are extremely limited. Critical reproductive healthcare services and family planning accounted for less than one-sixth of all sexual and reproductive health donor funding in 2017.

In the United States alone, 1 in 3 low-income women relies on a clinic (either a health center, Planned Parenthood, or publicly-funded clinic) in order to obtain contraception. These clinics also provide preventative care, STI (sexually transmitted infections) treatment and are sometimes the sole source of a woman’s medical care. Likewise, Medicaid provides coverage for more than 4 in 10 (44%) women of reproductive age, ensuring that they have affordable coverage for their healthcare and eliminating out-of-pocket costs for family planning services and pregnancy-related care. Advocates for sexual and reproductive health and rights state that the way to strengthen reproductive justice is to make these issues a priority in spending, both domestically and abroad.

Increased funding for global family planning and health programs, research and development for contraceptives, investing in teen pregnancy prevention, and improving mother and infant health will go a long way in preventing unplanned pregnancies and STIs (sexually transmitted infections).

Social Stigma and Beliefs About Sexual and Reproductive Healthcare and Access

In order to achieve reproductive healthcare for all, we need to consider all the societal factors that impact a person’s health and ability to choose, or not choose, to have children and secure the resources necessary to provide for their families. Talking about sex, reproduction, and reproductive rights remains taboo in many parts of the world and certain political, religious, and social ideologies frame these issues as shameful. Inequality persists when people are miseducated and uninformed.

At the same time, certain commonly used medical language and assumptions about gender lead to the exclusion of the experiences of transgender, nonbinary, and gender nonconforming people and poorer health outcomes. The use of gender inclusive language like “pregnant people” rather than defaulting to “pregnant women,” can increase the accuracy of data and quality of reproductive health research and clinical care. Recent research shows that transgender, nonbinary, and gender nonconforming people have unique needs and priorities for contraception and abortion care which can be met when providers use more inclusive language and take into account their specific needs and preferences.

One way to reduce stigma, shame, and exclusion around sexual and reproductive health is to share stories and invest in storytelling for social impact. Narratives build solidarity among people with shared experiences, help to amplify systemic issues that pose barriers to access, and can be a catalyst for social action. Donors can fund organizations which utilize storytelling, amplify marginalized voices, and support leaders of the reproductive justice movement. Renee Bracey Sherman, the executive director of We Testify, urges donors to listen to and invest in abortion storytellers as the next generation of leaders. “Abortion storytellers have been breaking the silence for decades and are leading the way to envision what the future of justice we seek to create will be.”

Get Involved

  • SisterSong strengthens and amplifies the voices of Indigenous women and women of color to achieve reproductive justice by eradicating reproductive oppression and securing human rights.
  • URGE (Unite for Reproductive and Gender Equity) builds power and sustains a young people’s movement for reproductive justice by centering the leadership of young people of color who are women, queer, trans, nonbinary and people of low-income.
  • National Latina Institute for Reproductive Justice builds Latina/x power to fight for the fundamental human right to reproductive health, dignity, and justice.
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