Advancing diversity, equity, inclusion, and anti-racism in Contraception: A statement of commitment from the Editorial Board

Abstract

In the United States (US) marginalized and minoritized individuals experience a disproportionate burden of adverse health outcomes [ 1 Woolf S.H. Schoomaker H. Life expectancy and mortality rates in the United States, 1959-2017. JAMA. 2019; 322: 1996-2016https://doi.org/10.1001/jama.2019.16932 Crossref PubMed Scopus (434) Google Scholar , 2 Petersen E.E. Davis N.L. Goodman D. Cox S. Syverson C. Seed K. et al. Racial/ethnic disparities in pregnancy-related deaths: United States, 2007–2016. MMWR Morb Mortal Wkly Rep. 2019; 68 (http://dx.doi.org.proxy.bib.uottawa.ca/10.15585/mmwr.mm6835a3): 762-765 Crossref PubMed Scopus (0) Google Scholar ]. Although scholars from a range of disciplines have long highlighted the role of structural, political, and social factors in producing health inequities, the fields of medicine and public health have been slower to shift attention away from individual-level factors to structural and systemic determinants [ 3 Yearby R. Clark B. Figueroa J.F. Structural racism in historical and modern US health care policy. Health Aff (Millwood). 2022 Feb; 41: 187-194https://doi.org/10.1377/hlthaff.2021.01466 Crossref PubMed Scopus (41) Google Scholar , 4 Krieger N. Boyd R.W. De Maio F. Maybank A. Medicine’s privileged gatekeepers: producing harmful ignorance about racism and health. Health Affairs Blog. 2021; https://doi.org/10.1377/hblog20210415.305480 Crossref Google Scholar ]. Identities of oppression versus privilege fall across a number of axes [ [5] Crenshaw K. Demarginalizing the intersection of race and sex: a Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal. Forum. 1989; 1: 139-167 Google Scholar ], including race, ethnicity, gender, sexuality, ability, neurodiversity, religion, language, nativity, and citizenship. However, the history of slavery and settler colonialism [ 6 Roberts D.E. Killing the Black body: race, reproduction, and the meaning of liberty. Pantheon Books, New York, NY1997 Google Scholar , 7 Owens D.C. Medical bondage: race, gender, and the origins of American gynecology. University of Georgia Press, Athens, GA2017 Crossref Google Scholar , 8 Theobald B. Reproduction on the reservation: pregnancy, childbirth, and colonialism in the long twentieth century. The University of North Carolina Press, Chapel Hill, NC2019 Crossref Google Scholar ], the continuous promulgation of policies that reinforce structural racism in the US [ 3 Yearby R. Clark B. Figueroa J.F. Structural racism in historical and modern US health care policy. Health Aff (Millwood). 2022 Feb; 41: 187-194https://doi.org/10.1377/hlthaff.2021.01466 Crossref PubMed Scopus (41) Google Scholar , 9 Chambers B.D. Arabia S.E. Arega H.A. Altman M.R. Berkowitz R. Feuer S.K. et al. Exposures to structural racism and racial discrimination among pregnant and early post-partum Black women living in Oakland, California. Stress Health. 2020; 36: 213-219 Crossref Scopus (44) Google Scholar ], false biological concepts of race [ [10] Roberts D.E. Fatal invention: how science, politics, and big business re-create rate in the twenty-first century. The New Press, New York, NY2012 Google Scholar ], and conscious and unconscious bias [ [11] Hall W.J. Chapman M.V. Lee K.M. Merino Y.M. Thomas T.W. Payne B.K. et al. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health. 2015; 105: e60-76https://doi.org/10.2105/AJPH.2015.302903 Crossref PubMed Scopus (1057) Google Scholar ] lead to patterns of inequity that commonly and severely fall along the axis of race and ethnicity.