During the fervor of 2020’s massive uprisings against systemic racism in America and in the midst of the COVID-19 pandemic that has proven to be far deadlier and devastating to Black and Brown communities, activists and health leaders unleashed a powerful rallying cry: “Racism is a public health crisis!” This has always been true; and, today, society is beginning to reckon with the reality that Black women and Black LGBTQ people sit at the intersection of these dual public health crises.
No type of health care is more subject to the political whims of the elected class than what has been branded “women’s health.” But sexual and reproductive health is also a vital part of Black LGBTQ people’s health. Black LGBTQ people are affected by all repressive reproductive health policies and biased treatment of Black pregnant people.
In America, Black bodies are also inherently political. The history of this country was built on our bodies as vehicles for economic production and as a continuing labor force. To exercise control over our own bodies is to defy that history and the systems of economic and social oppression perpetuated over centuries. To be a Black woman or a Black LGBTQ person and do the same is to resist multiple currents of oppression.
When the COVID-19 pandemic hit the United States, governors in several states exploited the urgency of the situation to ban abortion — both surgical and medication-induced. No other medical procedure was so singled out. Over the course of their lifetime, one in four women in the U.S. has an abortion; and, for each woman, an abortion is time-sensitive and essential heath care. It cannot wait for politics or the end of a pandemic.
While many Black communities were bearing the brunt of COVID-19, politicians used this moment of panic to—again—limit control of our bodies. Whenever hurdles to health care are built, systemic racism and structural barriers ensure Black and Brown people are the first to lose access.
Health Depends on Much More Than Access
Access to medical care is just one factor in people’s health — and not even the most important factor. The social determinants of health — the conditions people live in and the forces and systems that create those conditions — can account for up to 90% of a person’s health status. That means how healthy you are depends more on whether or not you experience stressors like low wages or unemployment, food insecurity, unclean air or water, or unstable housing than on your access to a health care provider.
In the U.S., Black people are much more likely to experience these kinds of stressors. The country’s long history of anti-Black racism has created inequities in economic, educational, and health resources and led to discriminatory targeting of Black communities by law enforcement and the criminal justice system.
Last year, Planned Parenthood conducted research on the social determinants of health among women of reproductive age in an effort to better understand how we can serve our patients’ needs. Unsurprisingly, Black respondents report experiencing stressors that negatively affect their health more than white respondents. The Black Women’s Health Imperative, in partnership with the Black Women’s Health Study, published a report that showed a causal relationship between experiences of racial discrimination and uterine fibroid tumors, low birth weight babies, and maternal deaths.
The state of sexual and reproductive health for Black women and Black LGBTQ people cannot be separated from the way systemic racism manifests in their lives because their bodies bear the brunt.
The Statistics Tell the Story
The evidence is plain in the disparities we have long seen in sexual and reproductive health outcomes for Black women and Black LGBTQ people. In recent years, thanks to the leadership of reproductive justice movement leaders, and celebrities like Serena Williams and Beyoncé sharing their stories, the public has begun to hear how Black women’s experiences during childbirth differ greatly from those of white women, regardless of fame, income, or education levels. Black women suffer higher complication rates and are more than three times as likely to die of pregnancy- and childbirth-related causes.
But the chasm between Black women’s sexual and reproductive health and white women’s goes far beyond maternal mortality.
Many, including Madonna and New York Gov. Andrew Cuomo, have dubbed COVID-19 “the great equalizer.” This is, of course, far from the truth. Recent data from the Centers for Disease Control and Prevention shows that Black and Latinx people are three times as likely to be infected and nearly twice as likely to die of COVID-19 than white people.
Because reproductive health care is not immune to racism and its stark disparities, we can expect Black women and Black LGBTQ people’s sexual and reproductive health to be deprioritized through the inequitable allocation of health care resources and the blatant and relentless political attacks on reproductive rights. As we suffer these deprivations, we must also endure the loss of family members, perform essential jobs, and try to make ends meet through an economic crisis that has hit Black communities the hardest.
Attacks on Reproductive Health
Black people in the U.S. are more likely than white people to have low incomes, be uninsured, or rely on federally funded programs to access reproductive health care. So when the Trump administration dismantled the nation’s only program dedicated to affordable family planning — including birth control and STI testing and treatment — it was an attack on Black women and Black LGBTQ people. The administration enacted a gag rule which blocks providers in the Title X family planning program from telling their patients how to access safe and legal abortion. As a result, providers that serve half of the 4 million people who rely on the program dropped out. This means even less care for communities already underserved by the health care system.
Abortion is an essential part of sexual and reproductive health care. In the last decade, attacks on abortion have resulted in less access, especially in the South and Midwest. State laws are written specifically to shame women for controlling their own bodies and subject them to paternalistic rules like waiting periods and mandatory, medically unnecessary ultrasounds. And the federal Hyde Amendment prohibits federal Medicaid funding from covering abortion, meaning those who have the least are forced to pay the most for their care.
The constitutional right to abortion is under constant threat. In June, the Supreme Court blocked a restrictive Louisiana law that would have made abortion all but inaccessible in the state. While this decision was widely—and rightly—praised as a victory for reproductive rights, with only three clinics providing abortion in the entire state, access will feel unavailable to many. Five states still have just one clinic providing this service. Just because abortion remains legal does not mean it remains accessible—especially for Black people in the South. But the promise of Roe v. Wade has never been real in many Black communities; factors like geography, poverty, discrimination, and shame have made our “choices” moot.
Progress to Protect
When the Affordable Care Act passed, it included a requirement that all health insurance plans cover birth control with no copay. In the first year alone, women saved $1.4 billion on birth control pills.
As states expanded Medicaid and the federal health insurance marketplace opened, uninsured rates among Black people dropped dramatically — from nearly 20% to 10.7% in 2016. Under the Trump administration, uninsured rates have ticked upward to 11.5%. Protecting the progress made under President Obama must continue to be a priority.
However, there is progress in the public’s understanding of inequity. Better data on maternal mortality put the threat to Black women’s lives in stark relief. The epidemic of violence against Black trans and gender nonconforming people is making its way into public consciousness. Black women and Black LGBTQ people are telling their own stories about abortion, pregnancy, and their treatment by the health care system.
We cannot fix what we cannot see. Bringing visibility to the ways sexual and reproductive autonomy is denied to Black women and Black LGBTQ people by our economic, social, and medical systems is the first step in rebuilding those systems equitably.
Reproductive Rebellion
Any progress we have made in the last decade has come only because Black women and Black LGBTQ people organized. The reproductive justice movement rewrote the rules in the fight for autonomy, demanding more than “choice” but the economic, political, and social power to be able to raise families—should we choose—in safe and sustainable communities.
The fight for sexual and reproductive health for Black communities is not only waged at the Supreme Court. It is not only waged through civic participation. It is waged every time we must be on our guard and advocate for ourselves at the doctor’s office, state capitols, town halls, and in our own communities. This year, we took our fights to streets all across America, demanding that this country recognize, once and for all, that our lives matter.
For centuries, Black women and Black LGBTQ people have waged a reproductive rebellion, taking on all the forces that attempt to take ownership of our bodies from us. We have rebelled in small ways, making the decisions we know are right for ourselves and our families. We have also rebelled on a massive scale, demanding change in the halls of power to which we were not invited.
Now is the time to stand with and trust Black women and Black LGBTQ people. Now is the time to join the rebellion.
