Reproductive justice advocacy requires more than being “pro-choice”

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By Jallicia Jolly

Amidst the spate of restrictive legislation limiting the right of access to abortion, much of the national conversation has focused on women’s rights to choose whether or not to have a child. This ignores the unique reproductive justice concerns of Black women—who face risks during pregnancy and childbirth, have historically experienced abuse at the hands of medical practitioners, and are disproportionately impacted by HIV—which have been largely absent from pro-choice-versus-pro-life debates.

HIV/AIDS continues to be a devastating epidemic within Black communities, particularly among Black women, gay men, and transgender folks who carry the brunt of the impact. Black people account for 43% of the 1.2 million individuals living with HIV and AIDS in the United States. Though less frequently discussed, Black women account for the largest share of new HIV diagnoses (4,397, or 59% in 2017), and the rate of new diagnoses among Black women (24.9%) is nearly 15 times the rate among white women and nearly 5 times the rate among Latinas.

These systematic disparities mean that Black women continue to shoulder the racial and gender disparities of HIV prevention and care, as well as coercive reproductive policies.

RELATED: Why intersectional feminism needs reproductive justice approaches to HIV

This is heightened in the South where states have the most restrictive abortion and Medicaid eligibility policies, as Medicaid is the largest source of public insurance for people with HIV that provides medical treatment for and covers more than 40% of people with HIV in care. As the epidemic extends from the urban epicenter to the South, African American women in the region accounted for 69% of all HIV diagnoses among women in 2016.

Black youth are especially hit hard. In 2017, Black teens and young adults (ages 13-24) represented 52% of new HIV diagnoses in that age group, the majority of whom were young gay and bisexual men. Despite the decline in both the number and rate of annual new diagnoses among Black people in general in recent years, HIV was the 6th leading cause of death for Black men ages 25-34 and 5th for Black women ages 35-44 in 2016, ranking higher than for their respective counterparts in any other racial/ethnic group.  

The disparities in HIV diagnoses, mortality and care that Black youth in general—and Black women in particular—continue to disrupt the recent celebrations of “The End of AIDS” following the eradication of HIV from a white gay male London patient’s body.

The cycle of structural inequality and interpersonal biases in reproductive medicine intersects with HIV in ways that create uneven advancements in HIV antiretroval treatment and health care delivery. The lack of a safety net for poor women, court-mandated birth control, forced contraception without comprehensive sex education, sterilization, and the termination of parental rights are all consistently linked to both HIV/AIDS and reproductive justice. The ongoing stigmatization and policing of the sexual and reproductive autonomy of Black girls and women, coupled with their historically poor access to quality health care, heightens the challenges they face in getting their sexual and reproductive health needs met.

HIV-positive Black girls and women face unique embodied terrors given the racist, sexist and classist restrictions of recent abortion laws.

As their bodies are framed as public health risks and as sources of infection to sexual partners and their children, HIV-positive women are denied safe abortion care or have been “asked” to agree to sterilization in order to access abortion services in a legal landscape that makes it increasingly difficult to access quality and safe contraceptives and abortion services. Even as women living with HIV/AIDS are at an increased risk of miscarriage and stillbirths, many lack access to safe post abortion-care services.

RELATED: Black youth need more than public health strategies that read sexuality as diseased and immoral

HIV affects all dimensions of women’s sexual and reproductive health, as well as their emotional and mental well-being. A positive status may also cause women to reject pregnancy. Some women may decide to delay childbearing and childrearing until they have addressed past or ongoing trauma and/or until they have achieved an undetectable viral load, which means having low levels of HIV in the blood.

Yet, racial disparities in viral suppression, a goal of HIV medications, suggest that HIV control goals will continue to fail Black women if our broader reproductive justice concerns and needs are not addressed. Rather than bear and rear a child, HIV positive women would often prefer to use their restricted incomes to access basic resources such as food and shelter, as well as their own medications and treatments. As low-income Black women living with HIV/AIDS often have lower levels of employment and annual income, they are prone to unstable housing, poverty, and hunger—all of which reduces their chances of survival.

These holistic concerns require that pro-choice advocates, feminists, and organizers consider the unique intersectional needs and interests of HIV-positive Black women in order to develop more strategic action.

Where local and national policy and interventions fall short, reproductive justice actors have worked vigorously around HIV. Organizations such as the Black Women’s Health Imperative and Sistersong understand that racialized gendered violence alongside systematic regulation—legal, institutional and interpersonal—often undermine Black girls and women’s ability to make informed decisions about their lives and bodies.

Even as the productive and reproductive capacities of all bodies are restricted, reproductive justice should recognize the unique violence subjected to Black girls and women in general, and those living with HIV in particular. In a world where they are viewed as undeserving of holistic care and unworthy of life, reproductive justice still gives us the tools to persist with tenacity greater than both the disease and domination.

Jallicia is a writer, poet, and reproductive justice practitioner. As a PhD candidate, she studies the political mobilization of HIV-positive Black women and is currently a doctoral fellow at Amherst College and Yale University.