ACOG is asking clinicians to 'acknowledg[e] historical and ongoing reproductive mistreatment of people of color and other marginalized individuals whose reproductive desires have been devalued.'
Late last month, the American College of Obstetricians and Gynecologists issued guidance to its members to help them center patients and their needs when providing contraceptive counseling. That guidance asks practitioners to keep a reproductive justice framework in mind when talking with patients about contraception and could help address entrenched health care inequities for people of color.
The reproductive justice framework, ACOG explains, was first developed in the 1990s by people of color. It asks clinicians and others to acknowledge that patients have the right to have a child, not to have a child, and to control birthing options such as using a midwife.
With this in mind, the new guidelines ask OB-GYNs to "prioritiz[e] patients' values, preferences, and lived experiences in the selection or discontinuation of a contraceptive method." Additionally, they recommend that clinicians "acknowledg[e] historical and ongoing reproductive mistreatment of people of color and other marginalized individuals whose reproductive desires have been devalued."
This may seem small, but health care experts are hoping it will be a positive move forward. Disparities in treatment for people of color, particularly Black people, are often reflected in conversations between providers and patients about contraception. The 2020 KFF Women's Health Survey, which tracks sexual and reproductive health, found that Black patients do not receive client-centered care nearly as much as white patients do when seeking information on contraception. This is also true for Hispanic patients, as well as low-income, underinsured and uninsured patients. Sixty percent of Black people seeking health care report discussing contraception with their provider, compared to 70% of white people.
While disparities between Black patients and white patients exist in many areas of health care, including in cancer care and the management of chronic conditions, these disparities are especially malignant when it comes to reproductive health care.
In 2021, a March of Dimes study found, "The threat of maternal mortality and morbidity is especially acute for women of color. Black mothers of all ages are three times more likely to die from pregnancy-related complications than their White peers." ProPublica found that these disparities exist even when you control for economic and social factors: "Nothing protects Black women from dying in pregnancy and childbirth."
One way to start rectifying these disparities, reproductive justice groups say, is to afford Black people a better, safer experience when seeking contraceptive advice. ACOG's new guidelines note that clinicians should approach conversations about contraception by acknowledging that, while the provider is an expert on the medical aspects of contraception, the patient is "the expert in their own experience, values, and preferences." In doing so, clinicians can better learn the reproductive health goals of the patient while providing individualized information about what contraceptive methods, if any, best fit with those goals and health concerns.
Published with permission of The American Independent Foundation.