Abortion access and reproductive justice - Part 2

0:00:06.9 Whitney Peoples: If we think through that question of, Who should care about this? Who's issue is this? Is this only an issue for birthing people? Is this... It's an issue that impacts all of us for a range of reasons, and so I think we all have stake in the game. The legal decisions and legislative decisions that impact bodily autonomy of any kind, that impact anyone's ability to decide what they want to do with their body when and how matters for everyone, because that can then become the foundation on which other kinds of legislation gets created.

0:00:38.5 Speaker 2: In part one of abortion access and reproductive justice, we discuss the many reasons that abortion is an essential part of reproductive health care, and how lack of access to these services is a pressing public health issue. Today, we sit down with two University of Michigan School of Public Health experts to dive deeper into health disparities related to abortion access and ask, What role must public health professionals play to promote a future that embraces reproductive justice? 

0:01:08.6 S2: Hello and welcome to Population Healthy, a podcast from the University of Michigan School of Public Health. Join us as we dig into important health topics, stuff that affects the health of all of us at a population level, from the microscopic to the macroeconomic, the social, to the environmental, from cities to neighborhoods, states to countries and around the world.

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0:01:39.2 S2: Whitney Peoples, is the Director of Diversity Equity and Inclusion at the University of Michigan School of Public Health. She is a Women and Gender Studies scholar with more than 20 years of experience in feminist and Critical Race research activism and teaching. Paul Fleming, is an assistant professor of Health Behavior and Health Education at the University of Michigan School of Public Health. His research and work focuses on the root causes of racial health inequities and strategies to address them. Today we join Dr. Peoples and Dr. Fleming in a conversation about reproductive justice and ramifications of the 2022 Dobbs v. Jackson Women's Health Organization Supreme Court decision.

0:02:16.5 WP: Hi, Paul, thank you so much for making some time to talk with me today. It is always really great to talk with other folks who are deeply invested in health equity, and so to kick us off, it would be great to just think a little bit about why this topic reproductive justice is so important to you.

0:02:35.7 Paul Fleming: Yeah, great to have a conversation with you as well Whitney. When I think about reproductive justice, I really can't disentangle it from other forms of equity injustice, so for me, as somebody who tries to do work and is committed to doing work that has an impact on equity injustice in our communities, reproductive justice is a fundamental part of that, it's connected to a lot of other areas, and I think we can't really work in the area of public health, trying to improve health if we aren't considering both reproductive health but also the fundamentals of reproductive justice. How about you Whitney? 

0:03:12.0 WP: For many of the same reasons that you just named, Paul it is an important topic to me, this is also a topic that I grew up really hearing folks talk about the importance of having access to safe and legal abortion, the importance of folks who identify as women being able to make decisions about their own bodies and their own lives, I heard this from my family, which was an important foundation, and then also I was educated in Atlanta, Georgia both for undergrad and graduate school. And so Atlanta, Georgia is the home of SisterSong and the folks that founded SisterSong, women of color are the folks that coined the term Reproductive Justice, so it's because of people like Loretta Ross that we got this term in the mid-1990s, being able to see real time the work of groups like SisterSong, like GARAL the Georgia affiliate to the National Abortion and Reproductive Rights Action League. Those were really just... For me, really formative experiences that I think further cemented what I'd grown up with, but then I got to see happening real time in action, and so it has always been personally very important, but I think because of those exposures it became a really important part of my research and of my professional practice.

0:04:25.2 PF: That's really cool to hear about both your personal and professional connections, and for you to have the opportunity to work with SisterSong an amazing organization, I think that's really incredible. I'm wondering if you could share with us a little bit from this background of what exactly is reproductive justice for folks who may not be familiar with the term.

0:04:45.2 WP: Thank you, Paul, very much for that question. SisterSong and other reproductive justice advocates talk about reproductive justice through a human rights framework, so this is fundamentally... This is not just a question of gendered rights or women's rights, but this is about human rights more broadly, and they talk about reproductive justice as being connected to four main pieces, so the right to maintain personal bodily autonomy, the right to have children, to not have children, and to parent the children that we do have in safe and sustainable communities. And this is really important because in 1994, when this term is first coined and circulated, what the women of color, who coined this are trying to do is they're trying to give us an intersectional reading of reproductive rights, and they are really highlighting for us that for some birthing people, there had been a really long history around the right to not have children, so that would be the right to be able to access safe and legal abortion.

0:05:40.2 WP: But for other birthing people, there had also been a history for sterilization and of removal of children, and oftentimes that was happening to communities of color, that was happening to working class communities, and so when SisterSong coins this term in 1994, they're asking us to have this expanded understanding that access to abortion is only one piece of a broader framework that offers a robust understanding of what it is to have and not have children to be able to take care of the children that someone chooses to have, so really reproductive justice brings abortion into the conversation, but gives us a more expansive, more intersectional view and asks us to really think through and hold history as we're thinking about the contemporary moment.

0:06:26.5 PF: I really appreciate that more expansive framing, 'cause obviously with the recent Supreme Court decision that's restricted abortion access, a lot of the attention has really focused on access to abortion, but especially within the field of public health we need to really be thinking more expansively about all those different domains of reproductive justice that you named, so really appreciate that. And speaking of health and public health, when you think about the issue of restricting access to abortion, like we saw with the Dobbs decision by the Supreme Court and different efforts across states to restrict abortion access, What are some of the health implications and especially the health inequities that you see that might stem from that.

0:07:08.9 WP: When we see access to abortion or when abortion access is restricted, I think we see an amplification of existing disparities and existing inequities. And we may even see the emergence of some new ones, what the Dobbs decision did is that it gave the decision back to states, and so you could be living in one state where abortion is illegal, but you could have a neighboring state where abortion is legal, and so we might just say, Well, you can just travel to a place where abortion is legal, and you can access a safe and legal abortion, and that's it, but if you were someone that's already experiencing economic insecurity, if you're experiencing job insecurity, then the the ability to travel, even one state away, even a few hours away to have the money to get there and back to be able to get a hotel room to be able to pay for the health services that you need, it could be severely negatively impacted if you're already experiencing economic insecurity, job insecurity, and so I think we will see existing disparities like that are amplified in this moment when people's options are restricted, when their safe legal options are restricted.

0:08:14.9 PF: Yeah, I think this is an area that public health researchers will be looking at really closely, because like you said, there's some that we can very much predict, but there may even be some additional consequences that we're not even imagining right now. So I think the research will bear that out in the future, the one that comes to mind for me right away is just that abortion care is part of reproductive health services, and whenever we're really denying folks access to a type of health service, we are gonna see some spillover impacts. So just as an example, somebody may be seeking abortion care, but the health care provider also identifies that they have high blood pressure, or they also identify that they're at risk for depression or other mental health issues, and that can be a gateway into other health services. So if somebody is able to effectively get abortion care, it may also connect them to these other health services, and what the abortion restrictions, these policies are really doing is preventing people from connecting with healthcare services in this way. So that's something that comes to mind for me, that's a big concern, and we already know that marginalized folks already have a lot of barriers to accessing health care in general, and this sort of adds another barrier.

0:09:30.8 WP: That's really helpful and really important point. We're talking a lot about the contemporary impact and fall out of the Dobbs decision. I would really be interested in thinking a little more about history and how we got to this moment, and so it would be great if you might share what are some of the historical factors and legislative decisions that have contributed to some of the health disparities and some of the inequities that we've already named and how we got to this moment with the current abortion restrictions that we have in this country.

0:10:01.4 PF: Yeah, Whitney that's a great question. I think when we're looking at any health issue or even any policy, it's so important to examine the historical roots because those historical roots really shaped the contemporary moment, and in this country, we have seen efforts and policies to curtail reproductive autonomy for women, and especially women of color over centuries. So we have seen again and again, examples where people have not been able to exercise their bodily autonomy. There have been issues of forced sterilization of women, and in particularly poor women, women who are marginalized, women who are either Black or other people of color, and this has been allowed through our policies. The Supreme Court has made decisions allowing for sterilization in our past, and so that's really some of the foundation that we're working on in this country, and as we get closer to present day, we see that there's a kind of a push and pull of, there have been policy efforts to curtail access to things like contraception and other ways, and it even connects in present day to trans rights and the ways in which folks who identify as transgender are able to exercise their bodily autonomy. So there's a really long history in this country that maintains till present day, and when we think about abortion access, it's really within this long stream of our history. Whitney, what are you thinking about when you think about its connections to history? 

0:11:31.2 WP: I think one of the things is, if you talk to abortion rights advocates, if you talk to reproductive justice advocates, they might say to you in the US, we've been undermining abortion rights since the very moment that they were guaranteed. So it's not long after Roe v. Wade that the Hyde Amendment, which restricts the use of federal funds for abortion comes into play, so immediately abortion is legal in the country, or almost immediately abortion is illegal throughout the country, but it's not accessible if you are someone who relies on government funds, federal funds, public funds to be able to access healthcare. This isn't something where all of a sudden the rug was just ripped out from under us, this is something that, to your point, Paul, has been happening over time from almost the moment that Roe v. Wade was decided. And so that's I think, an important part of the historical piece. And I think just again, what you highlighted that even before Roe v. Wade, we were talking about a really long history of controlling women's bodies, controlling the bodies of birthing people. If we think about chattel slavery in the US, and we think about enslaved African women and the way that their reproduction would have been controlled and used in support of the slave economy, we get a little bit of an understanding of how deep that history of controlling bodies and controlling reproduction goes.

0:12:57.2 WP: And so when we get to the Dobbs decision, we come to understand that it rests on that very long history, and so as we are trying to work back and think about how do we get ourselves out of this, how do we create new and better futures, we're not just thinking, how do we reverse Dobbs, we really have to be thinking in the way that reproductive justice asks us, How do we think more expansively and really think about the histories that have gotten us here.

0:13:23.8 PF: Yeah, that's really fantastic. Additions, and I'm someone that always thinks that we always strengthen our advocacy and actions when we put it into a historical perspective. One of the things I'm thinking about as we're having this conversation is we are talking out loud about abortion access, but in so many sectors of our society, abortion is a taboo word. In professional spaces, people can't even name it. So I'm wondering, that connection to the fact that abortion is so stigmatized in our culture and in our country, What do you think of as some of the ways forward to reduce some of that stigma, and really think more about it as just a standard healthcare procedure or healthcare access.

0:14:09.4 WP: I think one of the ways that we do that, Paul, is we start by thinking about why abortion matters to everyone. If we think through that question of, Well, who should care about this? Who's issue is this? Is this only an issue for birthing people? Is this... It's an issue that impacts all of us for a range of reasons, and so I think we all have stake in the game. The legal decisions and legislative decisions that impact bodily autonomy of any kind that impact anyone's ability to decide what they want to do with their body when and how matters for everyone, because that can then become the foundation on which other kinds of legislation gets created. The National Network of Abortion Funds had a great t-shirt when they were doing a fund-raiser years ago, and it simply said, "Everybody loves somebody who's had an abortion." And I really love that sentiment because it highlights for us whether you know or not, you know someone who's had an abortion, you know someone who's considered having abortion, even if they didn't choose to move forward with it. And so it really highlights that this isn't just for some people, for women, for birthing people.

0:15:15.9 WP: It's an issue that impacts all of us. And that we all have a vested interest in making sure that we respect and ensure bodily integrity and autonomy, and I think that is one of the first ways that we start to challenge stigma, because now it's not just something that some of us are holding and we're trying to figure out where we can share it, but rather we all hold a little bit of the weight of that, of the importance of this service in our world, and in our individual lives. What about you, Paul, when you think about stigma, and reducing stigma and even just the impact of stigma on health and on access to healthcare, What do you think are some of the ways that we can work to reduce stigma? 

0:16:00.5 PF: Yeah. Well, I love a lot of the things that you suggested, and I agree with you that sort of rethinking how we consider this, drawing the focus away from perhaps an individual who may be seeking abortion care to really more think about community health and what's gonna be best for the community is one way. I also really resonated with what you're saying is that everybody is connected in some way to the issue of abortion access. And I can say from my own perspective, I think as a man who does not have the ability to become pregnant or seek an abortion, I have asked myself the question, Well, how am I connected to this issue? Or should I be speaking up about this issue? Or should I leave that to folks who are more closely connected? But in some of that critical reflection, I came to some of the same conclusions that you named that I am very connected to this... There are people in my life that I love who have had abortions. I believe fundamentally that it is connected to human rights, and as somebody who cares about human rights of my community, this is an issue I have to care about.

0:17:04.6 PF: And further it's an issue that I need to speak up about. I'm not an expert in abortion care, I'm not an expert in Reproductive Health necessarily, but I do do work in Community Health, I do do work on issues of health equity. I am a member of the community, and so these are issues I care about, and I think every single one of us really needs to open up and talk about the issue, rather than just kind of leaving it behind closed doors or leaving only activists to talk about it, but it's really an issue that we all care about, and especially in public health, we can see from our research, we can see all the different ways that abortion access is connected to health, and so if we are being silent, if we as a field are being silent about abortion access. Then we are only contributing to the stigma and we are only contributing to some of these policies that are restricting abortion access.

0:17:58.5 WP: I really appreciate you naming that last piece, because when we talk about stigma and abortion stigma, I think we're often talking about for folks that have chosen to have abortions, or for folks that may be considering having an abortion, and we don't actually talk about... For folks who have not had to make that decision for themselves, the ways that fear might shape, or might impact whether we talk about this in our own work, whether we see this as fundamentally relevant or central to our professional practice. And so it is a stigma for folks that access the services or that may access it, but it's also stigma that other folks may feel around, This is political. Can I say this? Is this relevant? So I just really appreciate you naming those two different pieces of the way stigma and fear play out to keep folks silent and to keep people separated around this really important issue.

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0:18:55.5 PF: So I think to close out this conversation, Whitney, I'd love to talk... Both of us are located here in Michigan. I'd love to talk a little bit about what has happened in the policy arena in Michigan, in particular, in November, there was a ballot initiative called Prop 3 that ended up guaranteeing some access to abortion rights in the state. I wonder if you can just share a little bit more about that initiative and what you think it means in Michigan and nationwide.

0:19:22.6 WP: Proposition 3 was really about trying to protect abortion rights in the state constitution, and really make sure that we could count on having access to safe and legal abortion in the state of Michigan for years to come, so to really make it harder to undermine that fundamental human right to safe and legal abortion. So that's just the basis of what Prop 3 was, but I think what it really shows us is it highlights some of what we were just talking about around broad ownership and broad support for reproductive justice in general, and abortion access in particular.

0:19:57.5 WP: Lots of folks showed up with their vote to say, This matters to me, I think this is important, and I think it galvanized people, and I think that's really important. I grew up and Paul don't know, maybe you heard this too, I certainly heard people express the sentiment, Oh, abortion is safe, we will never not have abortion in this country. We will always... And I think the Dobbs decision was really jarring for people. This thing, particularly as someone who was born after Roe v Wade, there was a term that folks used to use the daughters of feminist privilege, that I was born into a world where as a woman I would have access as a potentially a birthing person, I would have access to safe and legal abortion, and just thinking that that would always be the case, and then all of a sudden it wasn't the case.

0:20:46.4 WP: The mid-term elections really showed us that there is broad ownership, there is broad support for and understanding of the importance of access to abortion and of reproductive justice. For you, when you think about the way that abortion rights legislation really won in the mid-terms and that folks really showed up for that across the country, where those things were on the ballot, What do you think about that in terms of our future work around protecting reproductive justice.

0:21:16.0 PF: It is really telling that in places where abortion access has been on the ballot, it's driven voter turnout, and again and again, the voters are really saying, We want abortion access, we think this is an important thing for our community, for our state. And I think what's been really heartening for me to see is not only just everyday citizens or every day residents getting out and mobilizing around this issue, so the Prop 3 campaign, there was door-knocking, there was calling and average folks were getting out there on behalf of this issue, but we also saw public health folks mobilizing around this issue, so the group Public Health Awakened really put some energy into pushing for this, and I think, again, public health as a field, stepping up and really saying what our values are within public health, we have values around human rights, around equity, and this issue of access to abortion falls directly within that, and so it's really encouraging to see public health folks really... Not that they were necessarily leading this, but really playing a part alongside other activists, alongside other residents to help guarantee abortion access.

0:22:25.9 PF: And so in Michigan, this has passed and there is access to abortion moving forward, but I think I wanna remind us of the tenets of reproductive justice, even though the state of Michigan may have access to abortion, it doesn't necessarily mean that all the tenets of reproductive justice are being addressed, so there's still much more work to be done to guarantee reproductive justice for all in our state. And I look forward to doing that work alongside you, Whitney, as well as other folks at our School of Public Health and beyond. I think this has been a really meaningful conversation to have with you around this topic, I just wanna thank you for engaging with me.

0:23:05.4 WP: Same here, Paul. I've really enjoyed our time together today and thank you.

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0:23:16.1 S2: Thanks for joining us for part two of abortion access and reproductive justice. If you missed part one, feel free to go back and listen at any time. In part one, we're joined by two experts who discuss more around the history of abortion access in the US, the impact of the landmark Roe versus Wade decision and the public health consequences of piecemeal legislation around abortion. On the next edition of Population Healthy.

0:23:43.3 S4: In order to build a safe school environment, I can't help but to bring in my public health training and public health perspective, and not just focusing on students, but also those that surround a school community that would include parents, that could also include folks in neighborhoods and businesses. All of these stakeholders have a role to play in order to improve safety within school environments.

0:24:15.8 S2: Thanks for listening to this episode of Population Healthy from the University of Michigan School of Public Health. We're glad you decided to join us and hope you learned something that'll help you improve your own health and make the world a healthier place. If you enjoyed the show, please subscribe or follow this podcast on iTunes, Apple Podcast, Google Play, Stitcher, Spotify, or wherever you listen to podcast, be sure to follow us @umichsph on Twitter, Instagram and Facebook, so you can share your perspectives on the issues we discuss. Learn more from Michigan public health experts and share episodes of the podcast with your friends on social media. You're invited to subscribe to our weekly newsletter to get the latest research news and analysis from the University of Michigan School of Public Health. Visit publichealth.umich.edu/news/newsletter to sign up. You can also check out the show notes on our website, population-healthy.com for more resources on the topics discussed in this episode. We hope you can join us for our next edition where we'll dig in further to public health topics that affect all of us at a population level.

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