Justice Denied: Reproductive Injustices Facing Black Queer Birthing People in the U.S. Healthcare System

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Adams, Morgan E. Ellithorpe This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6830032/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Jan, 2026 Read the published version in Reproductive Health → Version 1 posted 20 You are reading this latest preprint version Abstract Background: This study explores the reproductive healthcare experiences of Black Queer birthing individuals in the United States, focusing on how intersecting systems of oppression, particularly anti-Black racism, heteronormativity, and medical inequity, impact their access to and quality of reproductive health services, including assisted reproductive technology (ART), pregnancy, birthing, abortion, and postpartum care. Methods: Drawing on in-depth narrative interviews with ten self-identified Black Queer individuals, we analyzed personal accounts of reproductive journeys within the healthcare system. These interviews were re-examined alongside extant health literature on medical racism, obstetric violence, and justice-oriented care to identify systemic barriers and areas where justice is routinely denied. Results: Findings revealed consistent barriers in three key domains: access (e.g., insurance discrimination, ART inaccessibility), support (e.g., racism and heteronormativity from providers, lack of recognition of bodily autonomy), and aftermath (e.g., stigmatized abortion experiences, mental health neglect). Participants often felt unheard, misgendered, or dismissed in clinical settings. Additionally, high ART costs, limited Black sperm donors, and inadequate mental health care exacerbated reproductive inequities. In contrast, community-based care models, such as those led by doulas and midwives—were cited as affirming and empowering alternatives. Conclusion: Black Queer birthing individuals experience compounding systemic harms across the reproductive healthcare continuum. Addressing these injustices requires intersectional, justice-oriented healthcare reforms and stronger integration of community-based care models to ensure dignity, autonomy, and equity for all birthing people. reproduction reproductive justice Black LGBTQIA+ Background The CDC reports a decrease in maternal mortality rates for all racial/ethnic groups except Black birthing individuals (regardless of sex assigned at birth). 1 Specifically, Black Queer (e.g., lesbian, gay, bisexual, non-binary, transgender, queer, Two-Spirit, and intersex) people face multiple forms of interconnected oppression, such as are disproportionate rates of poverty, lack of health insurance, and unemployment, 2 leading to a significantly higher risk of adverse pregnancy and abortion-related outcomes. 3 , 4 Notably, Black birthing people (regardless of sexual orientation) are losing their lives at a rate three times higher than white individuals due to inequitable healthcare rooted in anti-Black racism. 1 Furthermore, Black birthing people and Black Queer peoples’ voices often go unheard in healthcare settings when sharing their health-related concerns and needs. 3 – 5 Most maternal and abortion-related deaths among Black birthing people are preventable, underscoring the urgent need for systemic change. 6 , 7 To address these issues, calls have been made for focused research on the reproductive healthcare experiences of Black birthing individuals, especially those living with marginalized identities in sexuality and gender expression. 3 , 8 , 9 As a Black non-binary lesbian and reproductive justice activist and a White cishet woman scholar who has experienced pregnancy, childbirth, miscarriage, infertility, and assisted reproductive technology (ART), we propose recommendations for health disparities researchers and healthcare providers to better support Black Queer birthing people along their reproductive journeys and combat maternal mortality. These insights were developed based on a more extensive health study exploring Black Queer birthing peoples’ reproductive barriers in healthcare settings. Black and Black Queer Birthing People Reproductive Healthcare-related Experiences Research has shown that Black and Queer individuals face significant challenges in healthcare settings, including heightened discrimination (such as anti-Blackness and heteronormativity) and a lack of understanding from healthcare providers. 3 , 4 , 10 – 12 For instance, Black and Black Queer birthing individuals often feel that their healthcare providers are unprepared and emotionally unavailable when they seek support for LGBTQ+-centered reproductive health questions. 3 , 5 , 13 This situation puts Black and Black Queer birthing people at a greater risk of not receiving the necessary quality of care to ensure their well-being throughout their reproductive journeys. Despite expressing a desire for collaborative processes with their doctors, many Black Queer birthing individuals specifically feel unheard and dismissed when discussing their reproductive health needs, including birthing preferences, pregnancy-related care, abortion support, and fertility services. 3 These stressful interactions with medical providers are compounded by the complexities of navigating healthcare insurance systems, leading to confusion and uncertainty regarding care. Black birthing individuals—regardless of their sexual orientation or sex assigned at birth—who encounter issues with health insurance access often delay care or avoid medical expenses due to the stress involved in dealing with the insurance system. 14 Furthermore, research indicates that many gynecologists lack training in gender-affirming care and have limited education on LGBQ-specific health issues. 9 With over 1.2 million Black individuals identifying as LGBTQ + in the United States, it is essential to consider the intersections of race, sexuality, and gender when addressing the Black maternal health crisis in the country. 2 A deeper understanding of how intersectionality affects the quality of care for Black birthing individuals is necessary to identify key intervention points. This knowledge can help improve reproductive health-related research and provider-patient communication through the development of culturally sensitive health training and resources rooted in a justice-oriented approach. Justice-oriented Approaches to Reproductive Healthcare for Black Queer Birthing People We can best understand the origins and complex issues surrounding racial, sex, and gender disparities affecting Black birthing individuals by examining the theoretical work of Black women scholars who have extensively studied race, gender, and reproduction. 15 – 21 The legacy of slavery and its connection to reproduction in the U.S. continues to influence the racial and gender power dynamics that create inequities and injustices in the lives and birthing experiences of Black individuals in healthcare. 22 , 23 While concepts of obstetric violence 15 help highlight the inequities and violence faced by birthing people, the idea of medical racism, or obstetric racism, serves as the primary framework for analyzing the roots of health and reproductive disparities among Black birthing individuals (regardless of their sexual orientation or sex assigned at birth). Obstetric racism provides a lens to improve the assessment of reproductive health outcomes for Black birthing individuals. 15 Historically, reproductive health disparities among Black Queer birthing individuals have been examined through the lens of social conditions, including food and housing security, employment, education, and household responsibilities. 17 , 24 Established theories of social determinants and intersectionality, such as the Sojourner Syndrome and the weathering hypothesis, reveal how racial and gender disparities, embodied trauma, and rates of birthing morbidity and mortality are consequences of institutional and medical racism as well as structural violence. 25 – 27 However, these reproductive health scholars focused on race, reproduction, and birthing health caution against placing undue blame on Black birthing individuals for the consequences of social conditions and related adverse health outcomes. This study aims to address the burdens faced by Black Queer birthing individuals by exploring their lived experiences through storytelling within a larger health study and extant health research. We investigate their health and social communication, language, and relationships, as well as the socioeconomic and medical dynamics at play that influence the interactions between Black Queer birthing individuals and medical providers. By understanding their perspectives, this research contributes to creating a roadmap for enhancing justice within the healthcare system. Methods This study is based on in-depth interviews centering on 10 Black Queer people’s (i.e., “research partners”) Being/Knowing/Feeling of their gestational journey within the healthcare system (HCS) to identify the barriers that can prevent Black Queer people from receiving the reproductive care and services they desire. Aspects of the birthing journey covered in research partners’ stories include ART, pregnancy health care, birthing experiences, miscarriage, and pregnancy termination. All research partners self-identified as Queer and Black or with African diasporic-related language. Procedure The University’s Institutional Review Board approved all procedures. Informed consents were provided after the pre-screening survey. By re-examining the interviews of the previous study in conjunction with existing research on health disparities, we can see that their experiences reveal reproductive injustices that also affect others within this specific community and various identity-based groups. Moreover, by acknowledging the reproductive needs and desires of Black Queer birthing individuals through storytelling, we advocate for the reproductive healthcare needs of everyone, regardless of their social position. Results In this section, we present the lived experiences of Black Queer birthing people that can be categorized into issues of healthcare access, healthcare support, and healthcare aftermath. Areas Experienced as Justice Denied Insurance and Other Health-Related Resources Insurance. Discussing healthcare access necessitates a focus on health insurance, particularly for Black queer individuals in the U.S. Many face inadequate coverage during their family-forming journeys due to their sexual orientation and the difficulty of proving biological infertility. 28 Most insurance policies mandate a medical infertility diagnosis and require attempts to conceive with an opposite-sex partner for coverage. 28 This disregards social infertility, where individuals need ART due to circumstances like sexual and gender diversity or becoming single parents by choice. 29 The challenges are even more pronounced for Black Queer individuals, nearly half of whom may find ART inaccessible due to economic barriers; 40% live below the poverty line, 2 and ART costs can average between $ 10,000 and $ 15,000 per cycle. 30 Research indicates that over half of families struggle with the financial burden of ART long after, particularly those with low incomes. 31 These financial and coverage disparities impinge on the reproductive healthcare rights of Black Queer people. Future researchers and health providers should focus on the distinct challenges they face in accessing ART and advocate for policies that improve access to reproductive resources for Black Queer birthing individuals. Other Health-Related Resources. Despite Black Queer birthing people having similar rates of child-rearing as their non-LGBTQ counterparts, 32 they experience higher levels of food insecurity, unemployment, and limited healthcare access. 2 Many rely on Medicaid, which, while slowly improving for the Black population, does not cover essential expenses like housing. 2 Housing security is crucial for overall well-being, yet many assistance programs are underfunded, leaving 75% of eligible households without support. 33 A partner in the previous study experienced homelessness shortly after experiencing a high-risk birth and giving birth to their premature child due to their need to be away from work because of spending extensive time at the hospital healing. Navigating the complex healthcare system can cause significant stress and confusion, particularly for uninsured Black Queer individuals who may struggle to achieve the health literacy necessary for effective navigation. 34 This often leads to delayed care or avoidance of medical costs, worsening health disparities. 34 Future researchers and healthcare providers should focus on the unique challenges faced by Black Queer birthing individuals in accessing health benefits and inquire about their potential challenges outside of health-related concerns. Lack of Support Throughout the Process Encountering Racism and Heteronormativity during Reproduction. Heteronormative values influence institutional practices, leading to misunderstandings about relationships—such as assuming a partner's gender based on titles like "fiancé." These misconstructions of gender expression, reinforce barriers for Queer seeking fertility care, emphasizing the need for inclusive access via understanding of gender-affirming care to ART services beyond traditional notions of infertility for heterosexual couples. 9 Additionally, racial disparities impact access to sperm, particularly for Black individuals, with only 2% of donors in major U.S. sperm banks being Black. 35 There is minimal investment from the health community in addressing this shortage, which limits reproductive choices. 36 Outdated policies, such as excluding gay men from sperm donation, alongside genealogical requirements that disadvantage Black people (such as requiring three to five generations of family history), further exacerbate these issues. 35 , 37 The high costs of ART often lead Queer individuals to prefer at-home insemination methods. 38 Thus, these increased social and financial barriers limit Black and Queer birthing people from having the choice they deserve in their ART-based decision making, such as receiving support of the HCS. Birthing Rights Ignored by Providers. Another issue that emerged is Black Queer people feeling that medical providers do not recognize their expertise regarding their own bodies, especially during childbirth. For instance, one research partner shared that a doctor manually ruptured their membranes during labor without their consent. Research highlights a common theme of Black birthing people experiencing a lack of bodily autonomy and their preferences being overlooked by healthcare providers. 13 A California Health Report survey found that Black birthing people's preferences are less likely to be heard compared to those of other racial/ethnic groups. 13 A more recent study of pregnant Black individuals revealed a desire for collaborative care that meets their unique needs, yet many still faced inequitable treatment. 4 To address these disparities, healthcare providers must take a justice-oriented approach 21 that acknowledges that birthing people, regardless of race, sexuality, or gender, are the experts in their own health and should have the autonomy to make their own reproductive care decisions. Little Post-Experience Support. Black Queer individuals face unique challenges within the HCS, which increase their risk of severe mental illnesses. One in four Black Queer people will be diagnosed with depression, and 82% experience daily discrimination, 2 further compounding their mental health struggles, including during pregnancy, pregnancy termination, and postpartum. Research on the mental health of Black mothers, particularly those who are Queer, is insufficient, especially concerning postpartum depression and anxiety. The lack of literature on Black Queer birthing experiences makes it difficult to understand the health challenges they face during periods of heightened mental strain, such as pregnancy, abortion, or miscarriage. Many research partners reported unmet mental health care needs due to stigma and access issues. Future researchers and medical providers should focus on connecting patients with available mental health services and consider the specific needs of Black Queer birthing individuals and how providers communicate about mental health care along gestational journeys. Additionally, the aftermath of pregnancy termination and the impact it has on mental health was a major theme experienced by our research partners yet is rarely addressed even by those who champion abortion rights. Research partners described their abortion experiences as ongoing journeys that influence their emotions and sense of disconnection from their bodies. Black Queer individuals face compounded feelings of isolation and shame due to societal stigma around their sexuality and reproductive choices. Queer people in the U.S. seek abortion services at higher rates than heterosexual individuals, 39 with Black birthing people specifically seeking care more often. 40 While abortion stigma is well-documented, there's a lack of discussion on the intensified stigma Black Queer people face due to their intersecting lived identities. The foundation of abortion stigma revolves around moral objections and societal beliefs about reproduction, closely tied to heteronormativity. Consequently, Black Queer birthing people encounter heightened shame due to their race, sexuality, and health behaviors. Abortion clinics and health researchers should prioritize the experiences and storytelling of Black Queer individuals to enhance understanding of the stigma surrounding abortion as the impacts of abortion are not time-bound but result in ongoing emotional and physiological effects. Planned Parenthood addresses post-abortion changes separately, instead of interconnected and should be considered together. For example, their website states: 41 "Feelings of relief, sadness, elation, or depression are common and may be strong due to the hormonal changes that occur after an abortion. Most people find these feelings do not last very long (emphasized) " The emotional changes after abortion, as described by Planned Parenthood, 41 oversimplify the complex relationship between birthing people's emotions and their gestational bodies. A research partner reported that their emotional and physical experiences are interconnected, with them experiencing feelings of guilt and self-doubt post-procedure. This connection affects their future health decisions and challenges the mind-body split often perpetuated in healthcare, which assumes psychological health is separate from physical health. It’s crucial for health providers to address this phenomenon, especially for Black Queer birthing people, to foster more holistic health insights and improve the quality of health information provided. Moving Toward Justice in the HSC and Toward Justice: Learning from Community-based Reproductive Health Spaces While advocating for systemic change in traditional healthcare, it is important to recognize the work of advocates in alternative spaces that help mitigate issues within the HCS. Many individuals find autonomy and safe spaces with community-based doulas and midwives. 4 , 42 For instance, one research partner sought doula care services because they could not find supportive healthcare providers who understood their identity as a fat Black Queer disabled birthing person. Unfortunately, the healthcare system often dismisses the benefits of community-based reproductive health support. For example, health insurance rarely covers community-based doulas and midwives, and there is a lack of representation of community-based doulas and midwives in traditional HCS settings. 42 When exploring the storytelling of one research partner’s pregnancy journey, they detail asking their doctor in the hospital how he felt about “natural birth”, referring to their desire for unmedicated labor. They describe the response as, “Everything natural is not good. Hurricanes are natural, earthquakes are natural. Cancer can be natural. I also cried.” Unfortunately, for this partner, their desire to have an unmedicated birth was mocked by the doctor and compared to experiencing to severe deathly illnesses and weather-related. This partner's experience underscores a broader issue where one is criticized for deviating from traditional healthcare practices. In contrast, community-based doulas and midwives often utilize communication techniques that help build trust and emphasize concepts like relational autonomy, 43 , 44 free from coercion that honor patients many intersecting identities and lived experiences when guiding them in making reproductive health decisions. To the extent that the HCS and community-based spaces can coexist and coordinate, some of the practices of community health professionals could be incorporated into the HCS context. Discussion The analysis of Black birthing people’s experiences with navigating the fertility- and pregnancy-related healthcare system from a lens of places and spaces where justice is most often denied can elucidate opportunities for systemic reform that benefit all who seek healthcare access. Our research partners indicated that the points of contact with the healthcare system during their infertility, pregnancy, and/or termination journeys that were particularly challenging were in the spaces of insurance, navigating other ancillary needs such as housing, barriers in seeking care and autonomy during childbirth, and the lack of supports for mental and physical health after acute care is over. While these findings corroborate existing literatures on the ways the healthcare system contributes to worse outcomes for Black and Queer populations compared to their White heterosexual counterparts, 2 , 7 they also add nuance and individual idiosyncrasies to what it means to experience those negative outcomes directly, and what the people most affected by these broader societal patterns see as the causes and opportunities involved. Crucially, not only do barriers within the healthcare system that negatively impact the physical and mental health of this population need to be urgently addressed, but our partners also provided a new avenue for improvement by embracing community-based care systems and holistic medicine, such as that provided by doulas, midwives, and birthing centers. These resources have the potential to help fill in some of the gaps left by the traditional healthcare system that perpetuate the injustices experienced by our research partners. That said, we do not suggest that these alternative resources can counteract the negatives of the traditional system, but that their inclusion during the process of restructuring within the system can potentially help people to navigate and circumvent some of those barriers. Conclusion Black Queer birthing people experience disproportionately poor outcomes in reproductive healthcare due compounding systemic inequities and discrimination. Using a qualitative inquiry of Black Queer peoples’ storytelling of their reproductive healthcare barriers, we shed light on the how the HSC system can better support Black Queer birthing people. Additionally, we detail how more dialogue and research that partners with Black Queer people are needed to ensure equitable access, treatment, and services to improve reproductive justice for all . Declarations Ethics approval and consent to participate Michigan State University’s Institutional Review Board approved all procedures. Informed consents were provided after the pre-screening survey. Consent for publication Not Applicable. Availability of data and materials Not Applicable. Competing interests The authors declare they have no conflict of interest. Funding This project received no funding. Authors' contributions Robyn B. Adams [RA] and Morgan E. Ellithorpe [ME] conceptualized the study, developed the methodology for the study, and contributed to the original draft of the paper and subsequent edits of the paper. RA oversaw the study's distribution of materials and resources. RA led the data curation and analysis of the data. RA led the study's investigation process and study management. Acknowledgments We thank the Black queer folks who inspired this study. Your stories matter! References Hoyert DL. Maternal mortality rates in the United States, 2023. NCHS Health E Stats [Internet] 2025. Choi SK, Wilson BDM, Mallory C. Black LGBT adults in the US: LGBT well-being at the intersection of race. UCLA Williams Institute; 2021. Adams RB, Ellithorpe ME. Black Queer Being/Knowing/Feeling: Storytelling of Barriers to Reproductive Healthcare. Qual Health Res. 2024;34:1039–52. 10.1177/10497323241228190 . Adams RB. Reimagining the Future of Reproduction from a Black Queer Lens: An Art-Based Approach to the Study of Reproductive Health Care. Health Commun 2024: 1–11. Amore AD. Refocusing the conduct of maternal mortality research in Black pregnant populations: Ethical considerations. J Perinat Neonatal Nurs. 2022;36:131–7. Presser L, Surana K. A third woman has died under Texas’ abortion ban as doctors reach for riskier miscarriage treatments. Tex Tribune, 2024. Trost S, Beauregard J, Chandra G, et al. Pregnancy-related deaths: data from maternal mortality review committees in 36 US states, 2017–2019. Education. 2022;45:1–0. Agénor M, Austin SB, Kort D, et al. Sexual orientation and sexual and reproductive health among African American sexual minority women in the US South. Women's health issues. 2016;26:612–21. Gillette-Pierce Z. Black Birthing Persons Matter—All of Them. Harvard Medical School; 2022. Wingo E, Ingraham N, Roberts SC. Reproductive health care priorities and barriers to effective care for LGBTQ people assigned female at birth: a qualitative study. Women's Health Issues. 2018;28:350–7. Kyweluk MA, Reinecke J, Chen D. Fertility preservation legislation in the United States: potential implications for transgender individuals. LGBT health. 2019;6:331–4. Thomas S, Chung K, Paulson R, et al. Barriers to conception: LGBT individuals have worse fertility health literacy than their heterosexual female peers. Fertil Steril. 2018;109:e53–4. Sakala C, Declercq ER, Turon JM, et al. Listening to Mothers in California: A Population-Based Survey of Women’s Childbearing Experiences, Full Survey Report. National Partnership for Women and Families; 2018. Griese L, Berens E-M, Nowak P, et al. Challenges in navigating the health care system: development of an instrument measuring navigation health literacy. Int J Environ Res Public Health. 2020;17:5731. Davis D-A. Reproductive injustice: Racism, pregnancy, and premature birth. Oxford University Press; 2020. Owens DC. Medical bondage: Race, gender, and the origins of American gynecology. University of Georgia; 2017. Bridges K. Reproducing race: An ethnography of pregnancy as a site of racialization. Univ of California; 2011. Morgan J. Laboring women: Reproduction and gender in new world slavery. University of Pennsylvania; 2004. Roberts D. Killing the black body: Race, reproduction, and the meaning of liberty. Vintage, 2014. Washington HA. Medical apartheid: The dark history of medical experimentation on Black Americans from colonial times to the present. Doubleday Books; 2006. Ross L, Derkas E, Peoples W, et al. Radical reproductive justice: Foundation, theory, practice, critique. Feminist Press at CUNY; 2017. Spillers HJ. Mama's baby, papa's maybe: An American grammar book. diacritics 1987; 17: 65–81. Jackson ZI. Becoming human: Matter and meaning in an antiblack world. Becoming human. New York University; 2020. Moore M. Invisible families: Gay identities, relationships, and motherhood among Black women. Univ of California; 2011. Jones CP. Levels of racism: a theoretic framework and a gardener's tale. Am J Public Health. 2000;90:1212. Geronimus AT. The weathering hypothesis and the health of African-American women and infants: evidence and speculations. Ethn Dis 1992: 207–21. Crenshaw KW. Mapping the margins: Intersectionality, identity politics, and violence against women of color. The public nature of private violence. Routledge; 2013. pp. 93–118. Centers for Disease Control and Prevention. Infertility. 2023. Lo W, Campo-Engelstein L. Expanding the clinical definition of infertility to include socially infertile individuals and couples. In: Reproductive ethics II: New ideas and innovations 2018, pp.71–83. Springer. Chambers GM, Keller E, Choi S, et al. Funding and public reporting strategies for reducing multiple pregnancy from fertility treatments. Fertil Steril. 2020;114:715–21. Dyer SJ, Vinoos L, Ataguba JE. Poor recovery of households from out-of-pocket payment for assisted reproductive technology. Hum Reprod. 2017;32:2431–6. Goldberg SK, Conron KJ. How many same-sex couples in the US are raising children? 2018. Bailey P. Housing and health partners can work together to close the housing affordability gap. JSTOR; 2020. Tipirneni R, Politi MC, Kullgren JT, et al. Association between health insurance literacy and avoidance of health care services owing to cost. JAMA Netw open. 2018;1:e184796–184796. Ferguson A. Why gay men and other groups are banned from donating sperm. Wash Post, 2022. Mamo L. Queering the fertility clinic. J Med Humanit. 2013;34:227–39. Medicine PCotASfR and Technology PCftSfAR. Guidance regarding gamete and embryo donation. Fertil Steril. 2021;115:1395–410. Fertility E. LGBTQ Fertility . 2025. Charlton BM, Everett BG, Light A, et al. Sexual orientation differences in pregnancy and abortion across the lifecourse. Women's Health Issues. 2020;30:65–72. Kaiser Family Foundation. Reported legal abortions by race of women who obtained abortion by the state of occurrence . 2022. Planned Parenthood. Caring for yourself after an abortion, https://www.plannedparenthood.org/planned-parenthood-michigan/healthcare/abortion-services/caring-for-yourself-after-an-abortion (2023). Sobczak A, Taylor L, Solomon S et al. The effect of doulas on maternal and birth outcomes: A scoping review. Cureus 2023; 15. Meadow SL. Defining the doula's role: fostering relational autonomy. Health Expect. 2015;18:3057–68. DONA. What is a doula? https://www.dona.org/what-is-a-doula/ (2025). Additional Declarations No competing interests reported. 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Adams","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAs0lEQVRIiWNgGAWjYFACHhDBzMAP4TGToEWyjZlULQbHiNVi3t57TLqgxlre+H7/MQmGCuvEBkJaZM6cS5OecSzdcNsxZjYJhjPphLVISOSYSfOwHWYEa2FsO0ysln+H7Te3gbT8I1YLL9DwDWwgLQ3EaOE5l2zN25eePONYsrFFwrF0Y8Ja2HsP3ub5Zm3b33zw4Y0PNdayBLUAAYsEnJlAhHIQYP5ApMJRMApGwSgYqQAAHDg1xyPHS/kAAAAASUVORK5CYII=","orcid":"","institution":"Texas Tech University","correspondingAuthor":true,"prefix":"","firstName":"Robyn","middleName":"B.","lastName":"Adams","suffix":""},{"id":468857592,"identity":"675c84ee-62cd-4807-b308-027bc92ed800","order_by":1,"name":"Morgan E. Ellithorpe","email":"","orcid":"","institution":"University of Delaware","correspondingAuthor":false,"prefix":"","firstName":"Morgan","middleName":"E.","lastName":"Ellithorpe","suffix":""}],"badges":[],"createdAt":"2025-06-05 14:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6830032/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6830032/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12978-025-02258-w","type":"published","date":"2026-01-24T15:58:15+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":101151933,"identity":"eb6babf4-f39f-4d02-b8c0-b868bc75b3b4","added_by":"auto","created_at":"2026-01-26 16:08:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":722507,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6830032/v1/c17b17b3-532e-4cbe-89a7-ba1d07c9b9c7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Justice Denied: Reproductive Injustices Facing Black Queer Birthing People in the U.S. Healthcare System","fulltext":[{"header":"Background","content":"\u003cp\u003eThe CDC reports a decrease in maternal mortality rates for all racial/ethnic groups except Black birthing individuals (regardless of sex assigned at birth).\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Specifically, Black Queer (e.g., lesbian, gay, bisexual, non-binary, transgender, queer, Two-Spirit, and intersex) people face multiple forms of interconnected oppression, such as are disproportionate rates of poverty, lack of health insurance, and unemployment,\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e leading to a significantly higher risk of adverse pregnancy and abortion-related outcomes.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Notably, Black birthing people (regardless of sexual orientation) are losing their lives at a rate three times higher than white individuals due to inequitable healthcare rooted in anti-Black racism.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Furthermore, Black birthing people and Black Queer peoples\u0026rsquo; voices often go unheard in healthcare settings when sharing their health-related concerns and needs.\u003csup\u003e\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Most maternal and abortion-related deaths among Black birthing people are preventable, underscoring the urgent need for systemic change.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e To address these issues, calls have been made for focused research on the reproductive healthcare experiences of Black birthing individuals, especially those living with marginalized identities in sexuality and gender expression.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e As a Black non-binary lesbian and reproductive justice activist and a White cishet woman scholar who has experienced pregnancy, childbirth, miscarriage, infertility, and assisted reproductive technology (ART), we propose recommendations for health disparities researchers and healthcare providers to better support Black Queer birthing people along their reproductive journeys and combat maternal mortality. These insights were developed based on a more extensive health study exploring Black Queer birthing peoples\u0026rsquo; reproductive barriers in healthcare settings.\u003c/p\u003e\n\u003ch3\u003eBlack and Black Queer Birthing People Reproductive Healthcare-related Experiences\u003c/h3\u003e\n\u003cp\u003eResearch has shown that Black and Queer individuals face significant challenges in healthcare settings, including heightened discrimination (such as anti-Blackness and heteronormativity) and a lack of understanding from healthcare providers.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e For instance, Black and Black Queer birthing individuals often feel that their healthcare providers are unprepared and emotionally unavailable when they seek support for LGBTQ+-centered reproductive health questions.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e This situation puts Black and Black Queer birthing people at a greater risk of not receiving the necessary quality of care to ensure their well-being throughout their reproductive journeys. Despite expressing a desire for collaborative processes with their doctors, many Black Queer birthing individuals specifically feel unheard and dismissed when discussing their reproductive health needs, including birthing preferences, pregnancy-related care, abortion support, and fertility services.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e These stressful interactions with medical providers are compounded by the complexities of navigating healthcare insurance systems, leading to confusion and uncertainty regarding care. Black birthing individuals\u0026mdash;regardless of their sexual orientation or sex assigned at birth\u0026mdash;who encounter issues with health insurance access often delay care or avoid medical expenses due to the stress involved in dealing with the insurance system.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Furthermore, research indicates that many gynecologists lack training in gender-affirming care and have limited education on LGBQ-specific health issues.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e With over 1.2\u0026nbsp;million Black individuals identifying as LGBTQ\u0026thinsp;+\u0026thinsp;in the United States, it is essential to consider the intersections of race, sexuality, and gender when addressing the Black maternal health crisis in the country.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e A deeper understanding of how intersectionality affects the quality of care for Black birthing individuals is necessary to identify key intervention points. This knowledge can help improve reproductive health-related research and provider-patient communication through the development of culturally sensitive health training and resources rooted in a justice-oriented approach.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eJustice-oriented Approaches to Reproductive Healthcare for Black Queer Birthing People\u003c/h2\u003e \u003cp\u003eWe can best understand the origins and complex issues surrounding racial, sex, and gender disparities affecting Black birthing individuals by examining the theoretical work of Black women scholars who have extensively studied race, gender, and reproduction.\u003csup\u003e\u003cspan additionalcitationids=\"CR16 CR17 CR18 CR19 CR20\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e The legacy of slavery and its connection to reproduction in the U.S. continues to influence the racial and gender power dynamics that create inequities and injustices in the lives and birthing experiences of Black individuals in healthcare.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e While concepts of obstetric violence\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e help highlight the inequities and violence faced by birthing people, the idea of medical racism, or obstetric racism, serves as the primary framework for analyzing the roots of health and reproductive disparities among Black birthing individuals (regardless of their sexual orientation or sex assigned at birth). Obstetric racism provides a lens to improve the assessment of reproductive health outcomes for Black birthing individuals.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHistorically, reproductive health disparities among Black Queer birthing individuals have been examined through the lens of social conditions, including food and housing security, employment, education, and household responsibilities.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Established theories of social determinants and intersectionality, such as the Sojourner Syndrome and the weathering hypothesis, reveal how racial and gender disparities, embodied trauma, and rates of birthing morbidity and mortality are consequences of institutional and medical racism as well as structural violence.\u003csup\u003e\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e However, these reproductive health scholars focused on race, reproduction, and birthing health caution against placing undue blame on Black birthing individuals for the consequences of social conditions and related adverse health outcomes. This study aims to address the burdens faced by Black Queer birthing individuals by exploring their lived experiences through storytelling within a larger health study and extant health research. We investigate their health and social communication, language, and relationships, as well as the socioeconomic and medical dynamics at play that influence the interactions between Black Queer birthing individuals and medical providers. By understanding their perspectives, this research contributes to creating a roadmap for enhancing justice within the healthcare system.\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThis study is based on in-depth interviews centering on 10 Black Queer people\u0026rsquo;s (i.e., \u0026ldquo;research partners\u0026rdquo;) Being/Knowing/Feeling of their gestational journey within the healthcare system (HCS) to identify the barriers that can prevent Black Queer people from receiving the reproductive care and services they desire. Aspects of the birthing journey covered in research partners\u0026rsquo; stories include ART, pregnancy health care, birthing experiences, miscarriage, and pregnancy termination. All research partners self-identified as Queer and Black or with African diasporic-related language.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eThe University\u0026rsquo;s Institutional Review Board approved all procedures. Informed consents were provided after the pre-screening survey. By re-examining the interviews of the previous study in conjunction with existing research on health disparities, we can see that their experiences reveal reproductive injustices that also affect others within this specific community and various identity-based groups. Moreover, by acknowledging the reproductive needs and desires of Black Queer birthing individuals through storytelling, we advocate for the reproductive healthcare needs of everyone, regardless of their social position.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn this section, we present the lived experiences of Black Queer birthing people that can be categorized into issues of healthcare access, healthcare support, and healthcare aftermath.\u003c/p\u003e\n\u003ch3\u003eAreas Experienced as Justice Denied\u003c/h3\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eInsurance and Other Health-Related Resources\u003c/h2\u003e \u003cp\u003e \u003cb\u003eInsurance.\u003c/b\u003e Discussing healthcare access necessitates a focus on health insurance, particularly for Black queer individuals in the U.S. Many face inadequate coverage during their family-forming journeys due to their sexual orientation and the difficulty of proving biological infertility.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e Most insurance policies mandate a medical infertility diagnosis and require attempts to conceive with an opposite-sex partner for coverage.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e This disregards social infertility, where individuals need ART due to circumstances like sexual and gender diversity or becoming single parents by choice.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe challenges are even more pronounced for Black Queer individuals, nearly half of whom may find ART inaccessible due to economic barriers; 40% live below the poverty line,\u003csup\u003e \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e \u003c/sup\u003e and ART costs can average between \u003cspan\u003e$\u003c/span\u003e10,000 and \u003cspan\u003e$\u003c/span\u003e15,000 per cycle.\u003csup\u003e \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e \u003c/sup\u003e Research indicates that over half of families struggle with the financial burden of ART long after, particularly those with low incomes.\u003csup\u003e \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e \u003c/sup\u003e These financial and coverage disparities impinge on the reproductive healthcare rights of Black Queer people. Future researchers and health providers should focus on the distinct challenges they face in accessing ART and advocate for policies that improve access to reproductive resources for Black Queer birthing individuals.\u003c/p\u003e \u003cp\u003e \u003cb\u003eOther Health-Related Resources.\u003c/b\u003e Despite Black Queer birthing people having similar rates of child-rearing as their non-LGBTQ counterparts,\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e they experience higher levels of food insecurity, unemployment, and limited healthcare access.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Many rely on Medicaid, which, while slowly improving for the Black population, does not cover essential expenses like housing.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Housing security is crucial for overall well-being, yet many assistance programs are underfunded, leaving 75% of eligible households without support.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e A partner in the previous study experienced homelessness shortly after experiencing a high-risk birth and giving birth to their premature child due to their need to be away from work because of spending extensive time at the hospital healing.\u003c/p\u003e \u003cp\u003eNavigating the complex healthcare system can cause significant stress and confusion, particularly for uninsured Black Queer individuals who may struggle to achieve the health literacy necessary for effective navigation.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e This often leads to delayed care or avoidance of medical costs, worsening health disparities.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e Future researchers and healthcare providers should focus on the unique challenges faced by Black Queer birthing individuals in accessing health benefits and inquire about their potential challenges outside of health-related concerns.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eLack of Support Throughout the Process\u003c/h3\u003e\n\u003cp\u003e \u003cb\u003eEncountering Racism and Heteronormativity during Reproduction.\u003c/b\u003e Heteronormative values influence institutional practices, leading to misunderstandings about relationships\u0026mdash;such as assuming a partner's gender based on titles like \"fianc\u0026eacute;.\" These misconstructions of gender expression, reinforce barriers for Queer seeking fertility care, emphasizing the need for inclusive access via understanding of gender-affirming care to ART services beyond traditional notions of infertility for heterosexual couples.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAdditionally, racial disparities impact access to sperm, particularly for Black individuals, with only 2% of donors in major U.S. sperm banks being Black.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e There is minimal investment from the health community in addressing this shortage, which limits reproductive choices.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e Outdated policies, such as excluding gay men from sperm donation, alongside genealogical requirements that disadvantage Black people (such as requiring three to five generations of family history), further exacerbate these issues.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e The high costs of ART often lead Queer individuals to prefer at-home insemination methods.\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e Thus, these increased social and financial barriers limit Black and Queer birthing people from having the \u003cem\u003echoice\u003c/em\u003e they deserve in their ART-based decision making, such as receiving support of the HCS.\u003c/p\u003e \u003cp\u003e \u003cb\u003eBirthing Rights Ignored by Providers.\u003c/b\u003e Another issue that emerged is Black Queer people feeling that medical providers do not recognize their expertise regarding their own bodies, especially during childbirth. For instance, one research partner shared that a doctor manually ruptured their membranes during labor without their consent. Research highlights a common theme of Black birthing people experiencing a lack of bodily autonomy and their preferences being overlooked by healthcare providers.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e A California Health Report survey found that Black birthing people's preferences are less likely to be heard compared to those of other racial/ethnic groups.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e A more recent study of pregnant Black individuals revealed a desire for collaborative care that meets their unique needs, yet many still faced inequitable treatment.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e To address these disparities, healthcare providers must take a justice-oriented approach\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e that acknowledges that birthing people, regardless of race, sexuality, or gender, are the experts in their own health and should have the autonomy to make their own reproductive care decisions.\u003c/p\u003e \u003cp\u003e \u003cb\u003eLittle Post-Experience Support.\u003c/b\u003e Black Queer individuals face unique challenges within the HCS, which increase their risk of severe mental illnesses. One in four Black Queer people will be diagnosed with depression, and 82% experience daily discrimination,\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e further compounding their mental health struggles, including during pregnancy, pregnancy termination, and postpartum. Research on the mental health of Black mothers, particularly those who are Queer, is insufficient, especially concerning postpartum depression and anxiety. The lack of literature on Black Queer birthing experiences makes it difficult to understand the health challenges they face during periods of heightened mental strain, such as pregnancy, abortion, or miscarriage. Many research partners reported unmet mental health care needs due to stigma and access issues. Future researchers and medical providers should focus on connecting patients with available mental health services and consider the specific needs of Black Queer birthing individuals and how providers communicate about mental health care along gestational journeys.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAdditionally, the aftermath of pregnancy termination and the impact it has on mental health was a major theme experienced by our research partners yet is rarely addressed even by those who champion abortion rights. Research partners described their abortion experiences as ongoing journeys that influence their emotions and sense of disconnection from their bodies. Black Queer individuals face compounded feelings of isolation and shame due to societal stigma around their sexuality and reproductive choices. Queer people in the U.S. seek abortion services at higher rates than heterosexual individuals,\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e with Black birthing people specifically seeking care more often.\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e While abortion stigma is well-documented, there's a lack of discussion on the intensified stigma Black Queer people face due to their intersecting lived identities. The foundation of abortion stigma revolves around moral objections and societal beliefs about reproduction, closely tied to heteronormativity. Consequently, Black Queer birthing people encounter heightened shame due to their race, sexuality, and health behaviors.\u003c/p\u003e\u003cp\u003eAbortion clinics and health researchers should prioritize the experiences and storytelling of Black Queer individuals to enhance understanding of the stigma surrounding abortion as the impacts of abortion are not time-bound but result in ongoing emotional and physiological effects. Planned Parenthood addresses post-abortion changes separately, instead of interconnected and should be considered together. For example, their website states:\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e\"Feelings of relief, sadness, elation, or depression are common and may be strong \u003cb\u003edue to the hormonal changes that occur after an abortion. Most people find these feelings do not last very long (emphasized)\u003c/b\u003e \"\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe emotional changes after abortion, as described by Planned Parenthood,\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e oversimplify the complex relationship between birthing people's emotions and their gestational bodies. A research partner reported that their emotional and physical experiences are interconnected, with them experiencing feelings of guilt and self-doubt post-procedure. This connection affects their future health decisions and challenges the mind-body split often perpetuated in healthcare, which assumes psychological health is separate from physical health. It\u0026rsquo;s crucial for health providers to address this phenomenon, especially for Black Queer birthing people, to foster more holistic health insights and improve the quality of health information provided.\u003c/p\u003e\n\u003ch3\u003eMoving Toward Justice in the HSC and Toward Justice: Learning from Community-based Reproductive Health Spaces\u003c/h3\u003e\n\u003cp\u003eWhile advocating for systemic change in traditional healthcare, it is important to recognize the work of advocates in alternative spaces that help mitigate issues within the HCS. Many individuals find autonomy and safe spaces with community-based doulas and midwives.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e For instance, one research partner sought doula care services because they could not find supportive healthcare providers who understood their identity as a fat Black Queer disabled birthing person. Unfortunately, the healthcare system often dismisses the benefits of community-based reproductive health support. For example, health insurance rarely covers community-based doulas and midwives, and there is a lack of representation of community-based doulas and midwives in traditional HCS settings.\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWhen exploring the storytelling of one research partner\u0026rsquo;s pregnancy journey, they detail asking their doctor in the hospital how he felt about \u0026ldquo;natural birth\u0026rdquo;, referring to their desire for unmedicated labor. They describe the response as, \u0026ldquo;Everything natural is not good. Hurricanes are natural, earthquakes are natural. Cancer can be natural. I also cried.\u0026rdquo; Unfortunately, for this partner, their desire to have an unmedicated birth was mocked by the doctor and compared to experiencing to severe deathly illnesses and weather-related. This partner's experience underscores a broader issue where one is criticized for deviating from traditional healthcare practices. In contrast, community-based doulas and midwives often utilize communication techniques that help build trust and emphasize concepts like relational autonomy,\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e free from coercion that honor patients many intersecting identities and lived experiences when guiding them in making reproductive health decisions. To the extent that the HCS and community-based spaces can coexist and coordinate, some of the practices of community health professionals could be incorporated into the HCS context.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe analysis of Black birthing people\u0026rsquo;s experiences with navigating the fertility- and pregnancy-related healthcare system from a lens of places and spaces where justice is most often denied can elucidate opportunities for systemic reform that benefit all who seek healthcare access. Our research partners indicated that the points of contact with the healthcare system during their infertility, pregnancy, and/or termination journeys that were particularly challenging were in the spaces of insurance, navigating other ancillary needs such as housing, barriers in seeking care and autonomy during childbirth, and the lack of supports for mental and physical health after acute care is over. While these findings corroborate existing literatures on the ways the healthcare system contributes to worse outcomes for Black and Queer populations compared to their White heterosexual counterparts,\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e they also add nuance and individual idiosyncrasies to what it means to experience those negative outcomes directly, and what the people most affected by these broader societal patterns see as the causes and opportunities involved.\u003c/p\u003e \u003cp\u003eCrucially, not only do barriers within the healthcare system that negatively impact the physical and mental health of this population need to be urgently addressed, but our partners also provided a new avenue for improvement by embracing community-based care systems and holistic medicine, such as that provided by doulas, midwives, and birthing centers. These resources have the potential to help fill in some of the gaps left by the traditional healthcare system that perpetuate the injustices experienced by our research partners. That said, we do not suggest that these alternative resources can counteract the negatives of the traditional system, but that their inclusion during the process of restructuring within the system can potentially help people to navigate and circumvent some of those barriers.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBlack Queer birthing people experience disproportionately poor outcomes in reproductive healthcare due compounding systemic inequities and discrimination. Using a qualitative inquiry of Black Queer peoples\u0026rsquo; storytelling of their reproductive healthcare barriers, we shed light on the how the HSC system can better support Black Queer birthing people. Additionally, we detail how more dialogue and research that partners with Black Queer people are needed to ensure equitable access, treatment, and services to improve reproductive justice for \u003cb\u003eall\u003c/b\u003e.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMichigan State University\u0026rsquo;s Institutional Review Board approved all procedures. Informed consents were provided after the pre-screening survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project received no funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRobyn B. Adams [RA] and Morgan E. Ellithorpe [ME] conceptualized the study, developed the methodology for the study, and contributed to the original draft of the paper and subsequent edits of the paper. RA oversaw the study\u0026apos;s distribution of materials and resources. RA led the data curation and analysis of the data. RA led the study\u0026apos;s investigation process and study management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the Black queer folks who inspired this study. Your stories matter!\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHoyert DL. Maternal mortality rates in the United States, 2023. \u003cem\u003eNCHS Health E Stats [Internet]\u003c/em\u003e 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChoi SK, Wilson BDM, Mallory C. Black LGBT adults in the US: LGBT well-being at the intersection of race. UCLA Williams Institute; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdams RB, Ellithorpe ME. Black Queer Being/Knowing/Feeling: Storytelling of Barriers to Reproductive Healthcare. Qual Health Res. 2024;34:1039\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/10497323241228190\u003c/span\u003e\u003cspan address=\"10.1177/10497323241228190\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdams RB. Reimagining the Future of Reproduction from a Black Queer Lens: An Art-Based Approach to the Study of Reproductive Health Care. Health Commun 2024: 1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmore AD. Refocusing the conduct of maternal mortality research in Black pregnant populations: Ethical considerations. J Perinat Neonatal Nurs. 2022;36:131\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePresser L, Surana K. A third woman has died under Texas\u0026rsquo; abortion ban as doctors reach for riskier miscarriage treatments. Tex Tribune, 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrost S, Beauregard J, Chandra G, et al. Pregnancy-related deaths: data from maternal mortality review committees in 36 US states, 2017\u0026ndash;2019. Education. 2022;45:1\u0026ndash;0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAg\u0026eacute;nor M, Austin SB, Kort D, et al. Sexual orientation and sexual and reproductive health among African American sexual minority women in the US South. Women's health issues. 2016;26:612\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGillette-Pierce Z. Black Birthing Persons Matter\u0026mdash;All of Them. Harvard Medical School; 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWingo E, Ingraham N, Roberts SC. Reproductive health care priorities and barriers to effective care for LGBTQ people assigned female at birth: a qualitative study. Women's Health Issues. 2018;28:350\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKyweluk MA, Reinecke J, Chen D. Fertility preservation legislation in the United States: potential implications for transgender individuals. LGBT health. 2019;6:331\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThomas S, Chung K, Paulson R, et al. Barriers to conception: LGBT individuals have worse fertility health literacy than their heterosexual female peers. Fertil Steril. 2018;109:e53\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSakala C, Declercq ER, Turon JM, et al. Listening to Mothers in California: A Population-Based Survey of Women\u0026rsquo;s Childbearing Experiences, Full Survey Report. National Partnership for Women and Families; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGriese L, Berens E-M, Nowak P, et al. Challenges in navigating the health care system: development of an instrument measuring navigation health literacy. Int J Environ Res Public Health. 2020;17:5731.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavis D-A. Reproductive injustice: Racism, pregnancy, and premature birth. Oxford University Press; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOwens DC. Medical bondage: Race, gender, and the origins of American gynecology. University of Georgia; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBridges K. Reproducing race: An ethnography of pregnancy as a site of racialization. Univ of California; 2011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorgan J. Laboring women: Reproduction and gender in new world slavery. University of Pennsylvania; 2004.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoberts D. Killing the black body: Race, reproduction, and the meaning of liberty. Vintage, 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWashington HA. Medical apartheid: The dark history of medical experimentation on Black Americans from colonial times to the present. Doubleday Books; 2006.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoss L, Derkas E, Peoples W, et al. Radical reproductive justice: Foundation, theory, practice, critique. Feminist Press at CUNY; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpillers HJ. Mama's baby, papa's maybe: An American grammar book. \u003cem\u003ediacritics\u003c/em\u003e 1987; 17: 65\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJackson ZI. Becoming human: Matter and meaning in an antiblack world. Becoming human. New York University; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoore M. Invisible families: Gay identities, relationships, and motherhood among Black women. Univ of California; 2011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones CP. Levels of racism: a theoretic framework and a gardener's tale. Am J Public Health. 2000;90:1212.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeronimus AT. The weathering hypothesis and the health of African-American women and infants: evidence and speculations. Ethn Dis 1992: 207\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrenshaw KW. Mapping the margins: Intersectionality, identity politics, and violence against women of color. The public nature of private violence. Routledge; 2013. pp. 93\u0026ndash;118.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCenters for Disease Control and Prevention. Infertility. 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLo W, Campo-Engelstein L. Expanding the clinical definition of infertility to include socially infertile individuals and couples. In: \u003cem\u003eReproductive ethics II: New ideas and innovations\u003c/em\u003e 2018, pp.71\u0026ndash;83. Springer.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChambers GM, Keller E, Choi S, et al. Funding and public reporting strategies for reducing multiple pregnancy from fertility treatments. Fertil Steril. 2020;114:715\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDyer SJ, Vinoos L, Ataguba JE. Poor recovery of households from out-of-pocket payment for assisted reproductive technology. Hum Reprod. 2017;32:2431\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoldberg SK, Conron KJ. How many same-sex couples in the US are raising children? 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBailey P. Housing and health partners can work together to close the housing affordability gap. JSTOR; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTipirneni R, Politi MC, Kullgren JT, et al. Association between health insurance literacy and avoidance of health care services owing to cost. JAMA Netw open. 2018;1:e184796\u0026ndash;184796.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerguson A. Why gay men and other groups are banned from donating sperm. Wash Post, 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMamo L. Queering the fertility clinic. J Med Humanit. 2013;34:227\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMedicine PCotASfR and Technology PCftSfAR. Guidance regarding gamete and embryo donation. Fertil Steril. 2021;115:1395\u0026ndash;410.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFertility E. \u003cem\u003eLGBTQ Fertility\u003c/em\u003e. 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCharlton BM, Everett BG, Light A, et al. Sexual orientation differences in pregnancy and abortion across the lifecourse. Women's Health Issues. 2020;30:65\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaiser Family Foundation. \u003cem\u003eReported legal abortions by race of women who obtained abortion by the state of occurrence\u003c/em\u003e. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePlanned Parenthood. Caring for yourself after an abortion, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.plannedparenthood.org/planned-parenthood-michigan/healthcare/abortion-services/caring-for-yourself-after-an-abortion\u003c/span\u003e\u003cspan address=\"https://www.plannedparenthood.org/planned-parenthood-michigan/healthcare/abortion-services/caring-for-yourself-after-an-abortion\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSobczak A, Taylor L, Solomon S et al. The effect of doulas on maternal and birth outcomes: A scoping review. Cureus 2023; 15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeadow SL. Defining the doula's role: fostering relational autonomy. Health Expect. 2015;18:3057\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDONA. What is a doula? \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.dona.org/what-is-a-doula/\u003c/span\u003e\u003cspan address=\"https://www.dona.org/what-is-a-doula/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2025).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"reproduction, reproductive justice, Black, LGBTQIA+","lastPublishedDoi":"10.21203/rs.3.rs-6830032/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6830032/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e This study explores the reproductive healthcare experiences of Black Queer birthing individuals in the United States, focusing on how intersecting systems of oppression, particularly anti-Black racism, heteronormativity, and medical inequity, impact their access to and quality of reproductive health services, including assisted reproductive technology (ART), pregnancy, birthing, abortion, and postpartum care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Drawing on in-depth narrative interviews with ten self-identified Black Queer individuals, we analyzed personal accounts of reproductive journeys within the healthcare system. These interviews were re-examined alongside extant health literature on medical racism, obstetric violence, and justice-oriented care to identify systemic barriers and areas where justice is routinely denied.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Findings revealed consistent barriers in three key domains: access (e.g., insurance discrimination, ART inaccessibility), support (e.g., racism and heteronormativity from providers, lack of recognition of bodily autonomy), and aftermath (e.g., stigmatized abortion experiences, mental health neglect). Participants often felt unheard, misgendered, or dismissed in clinical settings. Additionally, high ART costs, limited Black sperm donors, and inadequate mental health care exacerbated reproductive inequities. In contrast, community-based care models, such as those led by doulas and midwives—were cited as affirming and empowering alternatives.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Black Queer birthing individuals experience compounding systemic harms across the reproductive healthcare continuum. Addressing these injustices requires intersectional, justice-oriented healthcare reforms and stronger integration of community-based care models to ensure dignity, autonomy, and equity for all birthing people.\u003c/p\u003e","manuscriptTitle":"Justice Denied: Reproductive Injustices Facing Black Queer Birthing People in the U.S. Healthcare System","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-10 10:08:54","doi":"10.21203/rs.3.rs-6830032/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-20T04:34:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-20T02:45:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-20T00:58:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-18T14:46:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-18T11:45:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-15T04:50:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"283130965315305251652382954578307007798","date":"2025-06-13T00:52:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"91038302044853027525525606033503578191","date":"2025-06-11T12:47:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"207663438739625484667428101689612863888","date":"2025-06-10T16:17:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"144984093783534386939808099300002252153","date":"2025-06-10T08:25:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250059520589588776520893879920423262125","date":"2025-06-09T23:25:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155627271609011861448043748307754795696","date":"2025-06-09T22:36:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"59515400932058395972720029529082236172","date":"2025-06-09T14:38:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"123302905296235834998798639061160412481","date":"2025-06-08T14:08:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"82095961490126454739449577059648229259","date":"2025-06-06T17:05:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"82092781198008960465071768195475861054","date":"2025-06-06T12:15:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-06T12:09:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-06T09:22:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-06T06:35:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"Reproductive Health","date":"2025-06-05T14:11:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2126cee1-63a7-4fa1-8acd-7be83c09a0aa","owner":[],"postedDate":"June 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-26T16:04:52+00:00","versionOfRecord":{"articleIdentity":"rs-6830032","link":"https://doi.org/10.1186/s12978-025-02258-w","journal":{"identity":"reproductive-health","isVorOnly":false,"title":"Reproductive Health"},"publishedOn":"2026-01-24 15:58:15","publishedOnDateReadable":"January 24th, 2026"},"versionCreatedAt":"2025-06-10 10:08:54","video":"","vorDoi":"10.1186/s12978-025-02258-w","vorDoiUrl":"https://doi.org/10.1186/s12978-025-02258-w","workflowStages":[]},"version":"v1","identity":"rs-6830032","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6830032","identity":"rs-6830032","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}