Black girls and women face disproportionately adverse sexual and reproductive health outcomes resulting from a history of systemic racism and reproductive oppression that has denied them bodily autonomy, access to high-quality health care, and social and economic equality. Black girls and women are more likely to experience unintended pregnancies, die of pregnancy-related complications, face higher rates of infant mortality, and endure heightened levels of parenting stress as their children grow older amid concerns about their well-being and survival. However, solutions that incorporate principles of the reproductive justice framework—which asserts that human rights include the right to have a child (or not have a child) and the right to parent one’s child in safe, sustainable communities—can mitigate the influence of reproductive oppression and promote Black girls’ and women’s sexual and reproductive health and the well-being of their families.

Below, we offer five strategies for policymakers and practitioners, based on the principles of the reproductive justice framework. Elements of these five strategies and other efforts to apply the framework are underway across the country, especially in communities of color. Collectively, they hold promise for improving the sexual and reproductive health of Black girls and women, and for all birthing people.[1]

1. Expand pharmacists’ authority to provide contraceptive services.

Black girls and women are more likely to experience contraceptive deserts, or locations lacking reasonable access to health care providers that offer a full range of contraceptive methods. Barriers to contraceptive access limit Black girls’ and women’s ability to choose when and how to have children. Although not a panacea, giving pharmacists the authority to prescribe contraceptives and provide family planning services is a promising strategy to address this inequity. The Food and Drug Administration’s recent decision to allow retail pharmacies to offer abortion pills in the United States for the first time is an important step in this direction. Another strategy for targeting contraceptive deserts is to increase the number of months covered by a contraceptive prescription. The benefits of a 12-month prescription include reduced costs to patients, an increased likelihood of continued contraceptive use, and reductions in unintended pregnancies and abortion rates. Currently, only a limited number of states provide these services: 21 states, including the District of Columbia, allow pharmacists to provide contraceptive and family planning services and 23 states allow for a 12-month contraceptive prescription.

2. Enact new state and federal policies that protect access to safe abortions.

Black girls and women are more likely to live in states with stricter abortion policies and are systematically denied access to information and resources needed to make critical reproductive health decisions. Barriers to safe abortions are linked to an increase in unintended births among teens and adults, which are, in turn, associated with negative health outcomes for mothers (e.g., postpartum depression) and infants (e.g., pre-term births and low birth weight) and adverse economic outcomes for families. This is especially the case for Black girls and women, who experience disproportionate rates of unintended pregnancies. Several states and the District of Columbia have laws to protect or expand access to safe abortions in the face of the Supreme Court’s recent decision to overturn Roe v. Wade. For example, Maryland passed a bill to expand its definition of abortion providers to include nurse practitioners, physician’s assistants, and midwives; a new California law prohibits cost-sharing requirements such as copayments for abortions; and Oregon has allocated funds to cover costs of abortion care services, including patient travel and lodging. Such state actions, along with federal legislation that would explicitly protect the right to a safe abortion, are key to safeguarding this reproductive right.

3. Extend Medicaid coverage for postpartum mothers for a minimum of one year.

Postpartum care is especially essential for Black mothers and infants given that they experience over twice the mortality rate of White mothers and infants. Moreover, Black mothers experience a disproportionately higher rate of mortality between the first six weeks and first year postpartum, relative to their White counterparts. Additionally, Black girls and women are more likely to lose coverage services during this critical period due to the 60-day postpartum cut-off. The Medicaid Postpartum Coverage Extension—which extends coverage for one year postpartum and is being implemented in some states—is one way to reduce maternal and infant health inequities. If the one-year extension had been implemented in all states in 2018, an estimated 610,000 Medicaid enrollees with a live birth would have been able to retain continuous health care coverage and experience its associated benefits. To date, 27 states (including Washington, DC) have approved the extension, and federal legislators have explored options to broaden the extension to additional states.

4. Increase access to doulas to support birthing experiences and postpartum wellness.

Many Black girls and women lack access to high-quality sexual and reproductive health care and report instances of medical racism that include being ignored, misdiagnosed, and neglected through the birthing process. As care providers who serve pregnant people from pre- to postpartum, doulas and midwives have been shown to mitigate the negative experiences and adverse outcomes linked to medical racism while increasing positive outcomes such as postpartum service access and breastfeeding. While many desire doula services, Black women and women who are publicly insured are less likely than White and privately insured women to have access to doulas. Expanding doula access to these populations is a critical strategy to advance racial equity in reproductive and maternal health outcomes. Currently, six states (Oregon, Minnesota, New Jersey, Florida, Maryland, and Virginia) have expanded doula access to Medicaid users through Medicaid reimbursement and coverage for doula services, while another six are preparing to implement Medicaid doula reimbursements.

5. Increase public funding for high-quality, affordable child care.

Unlike other relevant frameworks, the reproductive justice framework includes a focus on the community conditions that affect birthing people’s sexual and reproductive autonomy and decision making. Communities that offer access to affordable, high-quality child care provide parents with greater freedom to make reproductive decisions because parents know their children will have safe and nurturing environments while they are occupied at work or school. Many Black families lack access to high-quality child care services due to the high costs of available programs in their neighborhoods. Federal and state efforts to improve access to high-quality child care services can help Black girls and women—often the primary earners for their families—raise their children in safe and sustainable environments. For example, the federal Child Care and Development Fund includes several provisions to expand access to high-quality care and ensure continuity of care for families with low incomes, and to strengthen child care quality and safety monitoring. As currently implemented, however, only a small percentage of families eligible for CCDF child care receive it. Variations in state CCDF policies affect the rates at which eligible Black families receive subsidies, ranging from 5 percent of eligible Black children in South Carolina to 33 percent in Pennsylvania. Federal and state policymakers can bolster Black children’s enrollment in high-quality child care by appropriating funds to serve more eligible families. Many states are leading the way by supplementing federal child care funds to reduce or temporarily eliminate copayment fees, raise eligibility income thresholds, or increase reimbursement rates.

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Footnote

[1] The authors recognize that reproductive justice is a human rights issue that extends to all birthing people. However, this piece focuses on the needs of Black girls and women in the American health context to emphasize their unique experiences and outcomes.