Following the Dobbs decision in 2022, reproductive health has come to the forefront of conversations in public health. Professionals in public health have spent decades promoting access to reproductive health services. However, increasing politicization has created new barriers across the U.S. to accessing reproductive care. How can we better address inequities in reproductive health care, especially in states with restrictive laws?
Whitney S. Rice is a Rollins Assistant Professor at the Emory University Rollins School of Public Health and the director of the Center for Reproductive Health Research in the Southeast (RISE). Rice recently spoke with Public Health Post about her work to advance reproductive health and the importance of using a lived experience-centered approach to scientific research.
Public Health Post: What social and structural circumstances do individuals in the U.S. experience regarding sexual and reproductive health? Are there circumstances unique to the Southeast? Are there different challenges for males and females?
Whitney S. Rice: The policies in the U.S. contribute to sexual and reproductive inequities and are especially relevant in the Southeast. Specifically, the patchwork of state-level policies constrains our ability to realize our reproductive autonomy, limits the opportunity for comprehensive sexual and reproductive health care, and exacerbates interrelated health professional shortages, resulting in stark geographic disparities in access to care, income inequality, and structural racism.
Structural racism is a critical challenge to sexual and reproductive health and is a fundamental cause of health inequity. A long history of systemic racial discrimination and biases continues to affect the health and well-being of pregnant and postpartum people and families. Black people, specifically, face persistently higher rates of maternal morbidity and mortality in the U.S. compared to other groups. Research by our team and others in the field have also found racialized impacts of restrictive reproductive health policies on health service access and outcome inequity, across states and time.
Gender discrimination intersects with structural racism. People whose lived experiences of marginalization related to their race and gender face unique and compounded stigma and discrimination, and distinct opportunities for resistance and liberation.
What are the most promising interventions to address sexual and reproductive health challenges in the Southeast?
Solutions rooted in and driven by communities most affected by sexual and reproductive health inequity and injustice. For example, full-spectrum care by community-based doulas, midwives, and other perinatal care workers, plus policies and programs that enable them, such as insurance coverage, can help.
Are there any myths regarding reproductive health that you are working on debunking?
Many. One of the first that comes to mind is the myth that people living in states with restrictive reproductive health policies agree with decisions to ban or severely restrict abortion access. Polling data has shown otherwise, including finding that most people in my state of Georgia support legal abortion, for example.
Our team at RISE has collaborated on a study led by Amplify GA Collaborative – a convener, connector, and capacity-builder in state and local reproductive justice advocacy – to understand attitudes and policy views of abortion-moderate Georgians (i.e., those who support legal abortion but also some abortion access restrictions) living in more rural metropolitan areas. We heard in focus groups among this cohort that the vast majority supported legislative action to protect and expand abortion access in Georgia.
Your bio discusses your commitment to lived experience-centered production and translation of scientific evidence. Can you define this phrase and its importance?
This phrase refers to efforts to ensure better representation and leadership in research and in sharing research findings with people from communities that bear inordinate harm of health inequities yet are often historically and systemically marginalized in research funding and priorities.
In my work at RISE, we have been intentional about our processes for developing research, considering external collaboration opportunities, and building our team, regularly reflecting on, and evaluating who the recipients of resources are, who the knowledge producers are, and particularly whether individuals and institutions from historically marginalized social groups lead in this work.
How would you like to see the field of sexual and reproductive health evolve in the next decade? Do you have any suggestions for what we can do as a society to get there?
I would love to see evolution in the direction of equity and justice, in health and well-being and how we do the work to improve those outcomes. As a researcher and director of a research center, I am often thinking: Is the research responsive to the needs and values of communities most affected by inequities? Are the same communities leading this work? What are the metrics of success according to the communities involved? How are resources distributed to these communities? How will results reach key communities? Reflections like these should be prioritized within the broader field and across society.
Dr. Rice spoke more about her work at Boston University School of Public Health’s Public Health Conversation, The Future of Reproductive Care in the U.S., on March 6. Revisit the conversation here. Photo provided.
