Justice denied: reproductive injustices facing Black Queer birthing people in the U.S. healthcare system

TL;DR

This paper explores how Black Queer individuals in the U.S. face multiple barriers and injustices in reproductive healthcare due to racism, queerphobia, and systemic inequities.

Contribution

The study uniquely applies an intersectional lens to analyze how anti-Black racism and anti-queerness compound in reproductive healthcare settings.

Findings

Participants reported systemic barriers like insurance discrimination, lack of bodily autonomy, and post-abortion mental health neglect.

High ART costs, limited Black sperm donors, and inadequate mental health care worsen reproductive inequities for Black Queer individuals.

Community-based care models, such as doula- or midwife-led care, were seen as empowering and affirming alternatives.

Abstract

This paper offers a critical review of reproductive injustices informed by secondary analysis of Black Queer birthing individuals’ narratives in the United States, focusing on how intersecting systems of oppression, particularly anti-Black racism, anti-queerness, and medical inequity, impact their access to and quality of reproductive health services, including assisted reproductive technology (ART), pregnancy, birthing, abortion, and postpartum care.

Drawing on in-depth interviews with ten self-identified Black Queer birthing individuals from a prior published study (Qual Health Res 34:1039–52, 2024), we conducted secondary thematic analysis re-examining their narratives through the framework of obstetric racism, alongside extant health literature on medical racism, obstetric violence, and justice-oriented care to identify systemic barriers and areas where justice is routinely denied.

Findings revealed systemic barriers across access, support, and aftermath, with interview excerpts highlighting experiences of insurance discrimination, lack of bodily autonomy, and post-abortion mental health neglect. Participants often felt unheard, misgendered, or dismissed in clinical settings. Additionally, high ART costs, limited Black sperm donors, and inadequate mental health care exacerbated reproductive inequities. In contrast, community-based care models, such as those led by doulas and midwives, were mentioned by participants as affirming and empowering alternatives.

Black Queer birthing individuals experience compounding systemic harms across the reproductive healthcare continuum. Addressing these injustices requires intersectional, justice-oriented healthcare reforms and stronger integration of community-based care models to ensure dignity, autonomy, and equity for all birthing people.