How Ignoring the Fundamental Causes of Maternal Morbidity/Mortality Impedes Progress Toward a Reproductive Justice Model of Contraceptive Counseling

Abstract

The American College of Obstetricians and Gynecologists recently published guidance promoting a reproductive justice model of contraceptive counseling that prioritizes patient preferences rather than centering effectiveness (American College of Obstetricians and Gynecologists, 2022c). However, practitioners may be hesitant to follow these new guidelines if they do not understand how maternal morbidity and mortality are rooted in fundamental causes like racism. If practitioners believe that pregnancy is innately dangerous, they may prioritize effectiveness in the name of patient safety. Taking a reproductive justice perspective, we assess how contraceptive counseling guidance portrays maternal morbidity/mortality by qualitatively examining 25 authoritative gynecology publications. Our abductive analysis shows that these documents describe maternal morbidity/mortality as rooted in biology and position highly effective contraception as the antidote. Ignoring fundamental causes of maternal morbidity/mortality impedes progress toward patient-centered contraceptive counseling and shifts the burden of addressing maternal morbidity/mortality away from public policy and toward individual contraceptive use.