Definitions


Reproductive Justice

Reproductive Justice is a term coined in 1994 by Black women activists as a way to address the ongoing struggles for reproductive rights and social justice through a human rights lens. (1) Two decades after its birth, the term is often mistakenly tossed around in connection solely with abortion rights, however it was created to bring together multiple social justice issues left out of the pro-choice movement and to centre the voices of those experiencing the most marginalization. It is a framework with which to examine a spectrum of issues including those related to pregnancy, parenting, abortion, and birthing options. (2)

“Reproductive Justice as the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” (SisterSong)

The Birth Justice movement, led once again by Black and Indigenous women and activists of colour, exists under the umbrella of Reproductive Justice, and “is part of a wider movement against reproductive oppression” (3)

In their 2010 working paper “Birth Justice as Reproductive Justice”, The National Advocates for Pregnant Women discussed the inextricable links between Birth Justice and Reproductive Justice. The complete integration of these two, they explain, “occurs when the goals of reproductive justice fully address and incorporate not only women’s ability to make decisions about whether and when to have children, but also about how they are treated during the critical times of labor and childbirth.” They further note that “[Birth Justice] is, at minimum, having access to evidence-based maternity care, accurate information about pregnancy, the risks and benefits of medical procedures, and the agency to choose whether or not to undergo those medical procedures. It is having the power to make those choices and give birth free from fear of intimidation or interference from the state due to “noncompliance” with medical advice, or because of poverty, race or ethnicity, or immigrant status. It is also having access to competent and culturally respectful labor support.”(4)

Though interactions with the healthcare system are just one small sliver of the issues that Reproductive Justice is meant to address, it is one worth looking at to imagine a future in which the reproductive healthcare available in Canada is truly accessible, equitable, and focused on the unique needs of each patient.

The Reproductive Justice Story Project came from the idea that issues of patient mistreatment and abuse in reproductive healthcare are part of this same family of social justice and human rights issues, and can therefore be framed as reproductive justice issues. As a website with white founders, the choice to borrow this bold term was not taken lightly and continues to be a consideration to wrestle with, critique, and explore.

The absence of access to respectful and inclusive reproductive healthcare disproportionately affects patients from marginalized communities and those with vulnerable life circumstances. Indigenous, Black, and people of colour, young people, Two-Spirit and LGBTQIA+ folks, incarcerated and criminalized folks, those living on low incomes, with different (dis)abilities, whose first language is not that of their care providers, folks with diverse gender expression or presentation, less conventional family structures, mental health or trauma histories, and many others feel the gaps much harder than those of more privileged identities and experiences.

One central goal of this project is to work towards bringing together many voices to highlight the work that must be done before justice can exist for all in the healthcare system here in Canada. This is truly a work in-progress.



Obstetric Violence

Parts of the following definition were first published in our survey report of Patient Experiences at St. Joseph’s Health Centre, Toronto in June 2018.

Obstetric Violence is defined as “the act of disregarding the authority and autonomy that [pregnant and birthing individuals] have over their own sexuality, their bodies, their babies, and in their birth experiences.”(
1) Though it exists at the intersection of structural/institutional violence and gender-based violence (2), obstetric violence can be perpetrated by care providers regardless of title or gender and can have a disproportionate effect on marginalized populations.(3) Much like other forms of gender-based violence, obstetric violence can be subtle and underhanded, rooted in the stark imbalance of power between patient and care provider throughout the childbearing process.

Healthcare providers may be committing acts of obstetric violence, regardless of intent, when they reinforce this power imbalance, by prioritizing their own needs or plans, communicating disrespectfully, or removing opportunities for patients to exercise informed, autonomous decision-making and have agency over their own bodies. It is important to note that “labour and birth can be framed as sexual events, with obstetric violence being frequently experienced and interpreted as rape.”(
4)

Obstetric violence is absolutely a human rights issue and therefore, a reproductive justice issue. It’s so normalized in our healthcare system that some healthcare providers and healthcare administrators have a difficult time understanding or even acknowledging the problem.

The harm of obstetric violence can even be difficult to pin down and put into words by those who experience it, as it can occur even when no physical violence is present, even if the birthing person and baby are physically healthy and safe.

[O]bstetric violence portrays a violation of human rights and a serious public health problem and is revealed in the form of negligent, reckless, omissive, discriminatory and disrespectful acts practiced by health professionals and legitimized by the symbolic relations of power that naturalize and trivialize their occurrence.” (5)



Birth Trauma

Parts of the following definition were first published in our survey report of Patient Experiences at St. Joseph’s Health Centre, Toronto in June 2018.

Birth Trauma refers to symptoms of post-traumatic stress disorder (PTSD) experienced by some individuals after giving birth. Although birth trauma can be caused in many ways (i.e. a frightening emergency situation during labour, unexpected complications, etc.) for some patients it can be a direct result of obstetric violence, for “it is not always the sensational or dramatic events that trigger childbirth trauma but other factors such as loss of control, loss of dignity, the hostile or difficult attitudes of the people around them, feelings of not being heard or the absence of informed consent to medical procedures.” (1) It is estimated that 33-45% of individuals who have given birth perceive their experiences to be traumatic, while as many as 9% experience postpartum post-traumatic stress disorder following the birth. (2)

Although Postpartum PTSD is not particularly uncommon, there are still few accessible supports, even in city centres with otherwise decent mental health infrastructure. There also seems to be a profound lack of awareness of P-PTSD even amongst mental health professionals who are supposed to be the "experts".

For example, birth trauma is frequently omitted from conversations around perinatal mental health, the focus being narrowly highlighting only perinatal depression and anxiety - both incredibly important to address, of course, and these diagnoses often overlap with PTSD - but it means that folks struggling with other conditions like trauma that don’t quite fit into the “depression” or “anxiety” boxes often have trouble getting an accurate diagnosis, validation from care providers, and effective treatment for their symptoms. (3)

Here in Toronto, there are incredibly limited resources for individuals struggling with the aftermath of a traumatic birth experience. Even the well-respected perinatal mental health programs at major downtown hospitals do not comprehensively address Postpartum PTSD. If birth trauma is mentioned at all, it’s in connection with near-death complications and emergency interventions, not care provider abuse/obstetric violence. It’s unclear why mental healthcare providers continue to ignore the evidence. Private therapists and counsellors who bill themselves as birth trauma experts fill in the gaps, but most operate on a fee-for-service structure which is out of reach for many families.

While Birth Trauma is rarely given the spotlight it deserves, even rarer still are public conversations about the mental health impacts of other reproductive health matters like pregnancy & infant loss, abortion, complications, sterilization, and chronic reproductive health concerns, to name a few.




The Reproductive Justice Story Project © 2018